Prescribing Competencies Framework

We recognise the need for, and value of, a consistent and standard approach to prescribing for all health professionals with prescribing rights. In a bid to promote quality use of medicines across all prescribing professions, we developed the Prescribing Competencies Framework.

The Prescribing Competencies Framework describes the competencies that health professionals require to prescribe medicines judiciously, appropriately, safely and effectively in the Australian healthcare system.  Download the complete framework  

 

Click in the diagram below to learn more about each competency area.

Horizontal competency area H1: Practices professionally

This area encompasses the professional competencies that health professionals require to prescribe medicines. It covers:

  • practising in accordance with the relevant legislative, regulatory, professional, and organisational frameworks
  • applying quality use of medicines principles
  • effectively managing influences on prescribing behaviour
  • working to continually improve prescribing practice.

This competency area entails the following elements:

  • Element H1.1 - Practices within the applicable legislative and regulatory frameworks.
  • Element H1.2 - Practices according to professional standards, codes of conduct, and within the health professional's own scope of practice.
  • Element H1.3 - Practices within the applicable frameworks of the healthcare setting and system.
  • Element H1.4 - Practices quality use of medicines principles.
  • Element H1.5 - Demonstrates a commitment to continual quality improvement of the health professional's own prescribing.
  • Element H1.6 - Addresses the potential for bias in prescribing decisions.

Horizontal competency area H2: Communicates and collaborates effectively with the person and other health professionals

This area focuses on the communication and collaboration competencies required for safe and effective prescribing. It covers communicating effectively with the person, their family, or carers (where appropriate), and with other health professionals, particularly their main healthcare provider (usually their general practitioner).

This competency area entails the following elements:

  • Element H2.1 - Obtains consent to provide clinical services to the person.
  • Element H2.2 - Acknowledges the person, their family, and carers as integral to care and collaborates to achieve optimal health outcomes.
  • Element H2.3 - Respects the person.
  • Element H2.4 - Communicates effectively with the person using appropriate communication skills to enable the safe use of medicines.
  • Element H2.5 - Collaborates with other health professionals to achieve optimal health outcomes for the person.

Competency area 1: Understands the person and their clinical needs

This area focuses on the competencies required to obtain information to understand a person's clinical needs. It covers the competencies required to:

  • establish a therapeutic partnership
  • perform a comprehensive medicines assessment
  • generate and explore possible diagnoses.

This competency area entails the following elements:

  • Element 1.1 - Establishes a therapeutic partnership with the person and a collaborative relationship with other health professionals.
  • Element 1.2 - Performs a comprehensive medicines assessment to obtain information to understand the person's clinical needs and context.
  • Element 1.3 - Generates and explores possible diagnoses

Competency area 2: Understands the person and their clinical needs

This area focuses on the competencies required to identify and discuss appropriate, safe, effective, and evidence-based treatments for the person. This framework acknowledges that the most appropriate treatment may not be a medicine and describes the competencies required to assess non-pharmacological treatments in broad terms only. It describes in detail the competencies required to identify the medicines suitable for treating the person's condition that can be incorporated into a treatment plan.

This competency area entails the following elements:

  • Element 2.1 - Considers non-pharmacological treatment options suitable for treating the person and their condition.
  • Element 2.2 - Identifies appropriate medicines options that can be incorporated into the person's treatment plan.

Competency area 3: Works in partnership with the person to develop and implement a treatment plan

This competency area focuses on the competencies required to negotiate therapeutic goals, reach agreement about medicines to be used to treat the person's condition, and tailor the treatment plan to meet the needs of the person.

This area entails the following elements:

  • Element 3.1 - Negotiates therapeutic goals with the person
  • Element 3.2 - Works in partnership with the person and other health professionals to select medicines and to tailor and implement a treatment plan
  • Element 3.3 - Develops a review plan tailored to the person's needs

Competency area 4: Communicates the treatment plan clearly to other health professionals

This area focuses on the competencies required to provide information to other health professionals to ensure that the treatment plan is implemented safely and effectively. It covers the competencies required to provide:

  • clear instructions to other health professionals who dispense, supply, or administer prescribed medicines
  • information about the treatment plan to other health professionals who provide care for the person.

Effective communication is particularly important for ensuring coordinated care in collaborative care settings.

This competency area entails the following elements:

  • Element 4.1 - Provides clear instructions to other health professionals who dispense, supply, or administer medicines prescribed for the person.
  • Element 4.2 - Provides information about medicines and the treatment plan with the person's consent to other health professionals who provide care to the person.

Competency area 5: Monitors and reviews the person's response to treatment

This area focuses on the competencies required to monitor and review the person's response to treatment. It covers:

  • obtaining and interpreting information to decide whether the therapeutic goals have been achieved
  • whether to continue treatment, stop treatment, or to refer the person to another health professional for further assessment and/or treatment
  • discussing these decisions with the person and other health professionals.

This competency area entails the following elements:

  • Element 5.1 - Obtains information to assess the person's response to treatment.
  • Element 5.2 - Works in partnership with the person and other health professionals to address issues arising from the review.

Prescribing Competencies Framework structure

The seven competency areas in the Prescribing Competencies Framework each describe an activity essential for prescribing. The order in which they are presented does not imply a hierarchical order of importance; all are equally important for ensuring that prescribing is judicious, appropriate safe, and effective.

The competency areas

  • Competency area 1: Understands the person and their clinical needs.
  • Competency area 2: Understands the treatment options and how they support the person's clinical needs.
  • Competency area 3: Works in partnership with the person to develop and implement a treatment plan.
  • Competency area 4: Communicates the treatment plan clearly to other health professionals.
  • Competency area 5: Monitors and reviews the person's response to treatment.
  • Horizontal competency area H1: Practices professionally.
  • Horizontal competency area H2: Communicates and collaborates effectively with the person and other health professionals.

The horizontal competencies (H1 and H2) are integrated with the other competency areas during the prescribing cycle.

The framework at a glance

Prescribing competencies framework structure explained

  1. The competency area titledescribes an activity essential for prescribing.
  2. Each competency area begins with an introductory section that summarises the focus for each competency.
  3. As each of the competency areas is too large to be practicably demonstrated or assessed, the competency areas are broken down into elements that describe the specific processes, actions, and tasks that health professionals carry out when prescribing.
  4. The performance criteria for each competency area describe the performance required in practice and break the elements into the observable behaviours or results that are expected of competent prescribers.
  5. Evidence examples provide cues for assessing prescribing performance. They are examples only, and should be customised for the scope of practice and role the prescriber performs in the workplace.
  6. Each competency area also ends with knowledge, skills, and behaviours subsections describing the level of underpinning knowledge, skills and behaviours that prescribers require, and integrate, when performing the competency.

Development of the framework

The development of the Prescribing Competencies Framework commenced in February 2011 and concluded in May 2012 with the launch of the framework at the 2012 National Medicines Symposium (NMS).

Literature review, initial consultations and draft framework

A literature review was conducted at the beginning of this project. Based on its findings, we decided to:

  • work with practicing health professionals to develop a competency framework for prescribing medicines from first principles
  • include evidence examples/indicators in this framework
  • align the framework to the World Health Organization’s Guide to good prescribing
  • involve a wide range of health professionals, people who prescribe medicines, and stakeholder organisations in the development and review of the framework.

We worked with 10 nationally-regulated health professions to develop the initial draft of the framework, including:

  • chiropractors
  • dentists
  • medical practitioners
  • nurses (including nurse practitioners) and midwives
  • optometrists
  • osteopaths
  • pharmacists
  • physiotherapists
  • podiatrists
  • psychologists.

We invited more than 70 organisations that work with these professions to take part. Many organisations informed their members about the 18 focus groups that gathered data about the competencies to be included in the initial draft. More than 130 health professionals attended these focus groups held in urban and regional areas across Australia in August/September 2011 and provided input. Both the expert reference group and the advisory group involved in the project reviewed this initial draft.

Feedback from stakeholders

In addition to the 10 health professions involved in the initial draft, representatives of four additional health professions were invited to be involved in consultations to obtain feedback:

  • Aboriginal and Torres Strait Islander health practitioners
  • Chinese medicine practitioners
  • medical radiation practitioners
  • occupational therapists.

Other stakeholders, including state governments, accreditation councils, and councils of university deans, were also invited to participate. In December 2011, representatives from 46 stakeholder organisations attended consultation meetings held in four states to provide feedback on the draft framework. Between then and February 2012, 33 organisations provided written feedback on the framework. The feedback provided at the consultations and in writing was collated and used to refine the framework.

Individuals also had the opportunity to provide feedback on the draft framework. Two surveys were available on the NPS website during February 2012 to obtain feedback from health professionals and consumers respectively. The data obtained were analysed and used to refine the framework.

Final framework development

The expert reference group and subsequently the project advisory group reviewed the final draft of the framework in April 2012. Both groups’ recommendations were considered and the final framework was signed off in May 2012.

For in-depth information download and read the complete framework document: Competencies required to prescribe medicines: putting quality use of medicines into practice.

Project leaders for the Prescribing Competencies Framework

The project included representatives from over 70 organisation across Australia. Input from focus groups held across the country was included as part of the framework development.

We received advice from an advisory and an expert reference group. The advisory group provided strategic advice while the expert reference group reviewed and provided feedback on drafts of the framework.

The groups were made up of the following members.

Advisory group

Prof Chris Baggoley (Chair) Department of Health and Ageing
Ms Carol Bennett Consumers Health Forum
Dr Rosemary Bryant Department of Health and Ageing
Dr Eleanor Chew Royal Australian College of General Practitioners
Prof Trish Dunning National Medicines Policy Committee
Dr Andrew Knight NPS Board
Mr Pat Maher Health Workforce Australia
Mr Steve Marty Forum of National Board Chairs (Registration Boards)
Dr John Primrose Department of Health and Ageing
Mr Chris Robertson Australian Health Practitioner Regulatory Agency
Dr Michael Smith Australian Commission on Safety and Quality in Health Care
Dr Lynn Weekes NPS: Better choices, Better health

Expert reference group

Ms Amanda Adrian Prof Michael McCullough
Emeritus Prof Felix Bochner A/Prof Lisa Nissen
Dr Rosa Canalese A/Prof Jan Radford
Dr Ian Coombes A/Prof Mark Roth
Mrs Margaret Duguid Mr David Stokes
Prof Sandra Dunn Mr Greg Weeks
Prof Albert Frauman Dr Sue Whicker
Prof Alastair Goss Dr Guan Yeo
Mr Darryn Marks

To fully explain the performance required in this competency area, the elements are further broken down into:

  • performance criteria
  • evidence examples.

You can read more about these, along with the knowledge, skills and behaviours that prescribers integrate when performing this competency in the complete framework document: Competencies required to prescribe medicines: putting quality use of medicines into practice.

Note: This framework acknowledges that the person, their family, and carers are integral to care, and refers to 'the person' on the understanding that the health professional will involve the person's family and/or carers in consultations, discussions, and decisions about the person's care where appropriate.

Want more information?

If you have any questions, need more information, or would like to comment on the Prescribing Competencies Framework, contact us or call:

  • Anne Hallard, Product Manager, Online Learning, 02 8217 8742.

  Download the complete framework  

 

This information is intended for health professionals and health organisations. This information is intended as a guide only and health organisations should exercise their own independent skill and judgement when determining a prescribing competency framework to describe the knowledge, skills and behaviours required of their practitioners with autonomous prescribing rights.