A model for professional decisions
The provision of healthcare is tightly regulated. You (probably) want it that way—certainly society wants it that way. The principle purpose of regulation (healthcare or otherwise) is to keep the public safe.
Being a health professional well means practicing in accordance with the law.
Practising outside of the law puts the public at risk.
If that is not a good enough reason; practising outside the law puts you at risk.
Risk of civil litigation
Risk of professional censure: unprofessional conduct/professional misconduct (perhaps leading to removal of registration).
Risk of prosecution in the courts for breaches of the HDPR
Quite a lot of legislation is relevant to nursing and midwifery practice.
Download and save a copy of each of these pieces of legislation (you will be working closely with them). These documents are also available via Blackboard.
The Medicines and Poisons Bill 2019 provides a framework for replacing the Health (Drugs and Poisons) Regulation 1996 and updating the approach to regulation.
The new regulations will be the Medicines and Poisons Regulation (Medicines Regulation). As at August 2019, this regulation is yet to be in force and the time frame for its implementation is unclear.
While there will be changes, there will still be much that is similar to the HDPR. See here for discussion of the new regulation.
We’ll focus on the first objective
Understand the purpose and contents of the HDPR in the context of nursing and midwifery practice
We will start with the broader context.
These are the key concepts you should take away from this section of the module:
The HDPR provides (among other things) the regulations for prescribing, dispensing and administering medicines in Queensland.
Here’s a schematic of some of the things that are important before a medicines is administered to supplied to a patient:
| SUSMP | HDPR | Alternatives | Examples |
|---|---|---|---|
| S2,S3 | Poisons | Over-the-counter drugs | Paracetamol |
| S4 | Restricted drug | Prescription drug | Antibiotics |
| S8 | Controlled drug | Dangerous drug | Opioids |
The HDPR provides the regulations for judging whether the prescription is legal and has been dispensed appropriately. It also legislates which professions are permitted to prescribe, dispense and administer medicines. This is referred to in the HDPR as an endorsement.
We will work through the key sections of the HDPR shortly.
First we discuss some of the additional guidance available for (and influences on) practice: key reference texts, professional standards and the Pharmaceutical Benefit Scheme.
It is important to keep in mind that the HDPR is state-based; it provides the regulations for Queensland. There are different regulations for the other states and territories of Australia.
Judging whether a prescription is therapeutically appropriate for an individual can be the most difficult (and important) step. Responsibilities for assessing therapeutic appropriateness differs among the healthcare team and the roles that different professions are playing. Prescribers (medical and non-medical prescribers such as nurse practitioners), dispensers (usually pharmacists) and those administering the medicine (often nurses and midwives) each have a role to play in ensuring quality use of medicines.
A number of medicines-specific resources can help inform this judgement:
“Professional standards” are standards of practice that have been developed by your profession. The standards provide guidance for most aspects of professional practice.
Examples can be found on the Nursing and Midwifery Board of Australia website:
Professional standards describe how nurses and midwives should practice.
The competency standards describe the knowledge and skills required to practice nursing and midwifery
The professional practice standards describe how nurses and midwives should provide good care; e.g. the systems and procedures they should put in place to ensure safe and effective care, including safe and effective use of medicines.
A model for professional decisions
The Pharmaceutical Benefits Scheme is the mechanism by which the Australian Government subsidises the costs of necessary medicines for the Australian public.
Many of the drugs dispensed in community pharmacies are subsidised through the Pharmaceutical Benefits Scheme (otherwise known as the “PBS”).
The PBS places requirements on prescriptions—if the prescription does not meet these requirements the prescription can’t be subsidised under the PBS.
State governments are responsible for the medicines supplied in hospital, the federal government through the PBS is responsible for medicines supplied privately (or on discharge from hospital).
This section of the module has introduced the Health (Drugs and Poisons) Regulation and Schedule for the Uniform Scheduling of Medicines and Poisons (SUSMP) and put these into a broader context of professional standards for practice.
Do the quiz! Then start the next section of the module.