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Han SF, Gao JP, Cao Y, Zhu RF, Wang YP. Dermatology nurse prescribing in China: a Delphi method. FRONTIERS OF NURSING 2023. [DOI: 10.2478/fon-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Abstract
Objectives: To identify the dermatological system drugs that may be prescribed by Chinese dermatological nurses through expert consensus.
Methods: A 2-round study, consisting of 32 medical and nursing experts, was conducted using the Delphi method from September 2019 to June 2020. Microsoft Excel 2019 and IBM SPSS Ver. 22 were used to analyze the results of the consultations.
Results: A total of 63 drugs across 13 categories were identified as relevant to Chinese nurses working in dermatological departments. Among these drugs, 1 drug was generally prescribed independently, 17 drugs tended to be prescribed collaboratively, and 45 were prescribed either independently or in collaboration with others.
Conclusions: This expert consensus determines the prescription drugs that may be prescribed by dermatology nurses in China, which can be used as the key content of prescription drug training for dermatology nurses in future. The results of the study could provide a basis for the implementation of nurses’ prescription rights in China in future and provide a reference for the formulation of relevant legislation on nurses’ prescription rights.
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Affiliation(s)
- Shi-Fan Han
- School of Nursing, Shanxi Medical University , Taiyuan, Shanxi , China
| | - Jin-Ping Gao
- School of Nursing, Shanxi Medical University , Taiyuan, Shanxi , China
| | - Yan Cao
- School of Nursing, Shanxi Medical University , Taiyuan, Shanxi , China
| | - Rui-Fang Zhu
- School of Nursing, Shanxi Medical University , Taiyuan, Shanxi , China
| | - Ya-Ping Wang
- School of Nursing, Shanxi Medical University , Taiyuan, Shanxi , China
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Edwards J, Coward M, Carey N. Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review. BMJ Open 2022; 12:e052227. [PMID: 35676011 PMCID: PMC9185484 DOI: 10.1136/bmjopen-2021-052227] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders' views on IP in primary care and identify barriers and facilitators influencing implementation. SETTING UK primary/community care. PARTICIPANTS Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. PRIMARY AND SECONDARY OUTCOME MEASURES N/A. RESULTS Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) 'Preparation', (2) 'Training', (3) 'Transition' and 4) 'Sustainment'. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care. CONCLUSIONS In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO REGISTRATION NUMBER CRD42019124400.
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Affiliation(s)
- Judith Edwards
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Melaine Coward
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
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Carey N, Edwards J, Otter S, Gage H, Williams P, Courtenay M, Moore A, Stenner K. A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists. BMC Health Serv Res 2020; 20:1074. [PMID: 33234141 PMCID: PMC7687831 DOI: 10.1186/s12913-020-05918-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. AIM to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications. DESIGN a mixed method comparative case study. METHODS Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). RESULTS 489 patients were recruited: n = 243 IP sites, and n = 246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p > 0.05) and patient satisfaction (p ≤ 0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 min). CONCLUSION This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.
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Affiliation(s)
- Nicola Carey
- School of Health Sciences, University of Surrey, Kate Granger Building, Guildford, GU2 7YH UK
| | - Judith Edwards
- School of Health Sciences, University of Surrey, Kate Granger Building, Guildford, GU2 7YH UK
| | - Simon Otter
- School of Health Science, University of Brighton, Brighton, UK
| | - Heather Gage
- Department of Clinical and Experimental Medicine, Surrey Health Economics, University of Surrey, Guildford, UK
| | - Peter Williams
- Department of Mathematics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Moore
- School of Health Science, University of Brighton, Brighton, UK
| | - Karen Stenner
- School of Health Sciences, University of Surrey, Kate Granger Building, Guildford, GU2 7YH UK
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Pearson M, Papps E, Walker RC. Experiences of registered nurse prescribers; a qualitative study. Contemp Nurse 2020; 56:388-399. [PMID: 32814514 DOI: 10.1080/10376178.2020.1813044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aims: This study aimed to investigate the experiences of registered prescribers and their perceptions of the enablers and barriers to registered prescribing and the value of this fledgling role. Background: The role of prescribing has been extended to registered nurses in New Zealand. By adding the designated prescribing role to a nurse's role, their scope of practice expands and nurses are able to provide patients with holistic care while achieving greater independence and role satisfaction. Yet new nurse prescribers can experience anxiety and fear when confronted with the reality of the responsibility of prescribing. Methods: Sixteen semi-structured interviews were conducted with registered nurse prescribers across New Zealand. Data were analysed using a general inductive approach and thematic analysis utilised to identify themes and sub-themes. Results: Sixteen registered nurse prescribers participated in the study. Three main themes emerged with sub-themes: ability to expand practice, improving access to care, and importance of working in a collaborative team. Participants explained how they enjoyed the challenge and responsibility of the new prescribing role yet were frustrated with the realities of the restrictions of what they could actually prescribe and in some cases lack of role recognition. Registered nurse prescribing also improved access to care as nurses felt they provided more comprehensive care, resulting in reduced wait times, better continuity of care and a reduction in patient costs. The participants highlighted the importance of working in a collaborative team and believed their ability to prescribe maximised clinician time, however cautioned the need for on-going clinical mentorship and a prepared and supportive work environment. Conclusions: The addition of registered nurse prescribing provides a number of advantages to individual nurses in terms of career development and job satisfaction, and to patients and the health care system. The benefits to health care consumers and the health care system align directly to health care priorities of improving equity and access to care. Impact statement: Registered nurse prescribers perceive a number of advantages to the addition of prescribing to their own practice and benefits to patients and the health care system by enabling more accessible and cost-effective care.
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Affiliation(s)
- Maria Pearson
- Eastern Institute of Technology, Napier, New Zealand
| | - Elaine Papps
- Eastern Institute of Technology, Napier, New Zealand
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Wilson DM, Fahy A, Nam MA, Murphy J. The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation. Int J Nurs Pract 2020; 27:e12877. [PMID: 33155742 DOI: 10.1111/ijn.12877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/31/2020] [Accepted: 06/21/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to determine the need for and value of nurse and midwife prescribing in Ireland as identified by these prescribers-the people most able to provide relevant insights and information. BACKGROUND Since 2007, nurses and midwives in Ireland who have passed an additional educational program can prescribe medicinal products relative to their clinical practice areas. Research evidence of efficacy is needed now for prescribing sustainability in Ireland and to encourage, if successful, the adoption or expansion of frontline nurse/midwife prescribing rights in other countries. DESIGN A qualitative study was undertaken. METHODS Interviews with registered nurse and midwife prescribers were conducted in 2017 until data saturation. Constant-comparative coding and categorization of data revealed themes and categories, with explanatory quotes for research trustworthiness and credibility purposes. RESULTS Six data themes emerged: (a) more than just writing prescriptions; (b) highly individualized evidence-based specialist care; (c) assured, timely and rapid accessibility to needed care; (d) health system and healthcare efficiency gains; (e) satisfaction with nurse/midwife prescriber services and (f) quality care improvements. CONCLUSION Nurse/midwife prescribing in Ireland was identified as needed, safe, effective and cost-effective. Prescribing permitted accessible, thorough and proactive holistic health promotive care to be provided in nurse- or midwife-led outpatient clinics.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Department of Nursing and Midwifery, University of Limerick, Limerick, Republic of Ireland
| | - Anne Fahy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Republic of Ireland
| | - Mavis A Nam
- Nursing and Midwifery Training College, Mampong, Ghana
| | - Jill Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Republic of Ireland
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Courtenay M, Deslandes R, Harries-Huntley G, Hodson K, Morris G. Classic e-Delphi survey to provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services in Wales. BMJ Open 2018; 8:e024161. [PMID: 30232116 PMCID: PMC6150146 DOI: 10.1136/bmjopen-2018-024161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 08/18/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services. DESIGN Classic e-Delphi survey. SETTING National study in Wales. PARTICIPANTS Pharmacists, nurses and allied health professionals with the independent/supplementary prescribing qualification. RESULTS A total of 55 non-medical prescribers agreed to become members of the expert panel of whom 42 (76%) completed the round 1 questionnaire, 40/42 (95%) completed round 2 and 34/40 (85%) responded to round 3. Twenty-one statements were developed, and consensus was achieved on nine factors representing those necessary for the successful implementation of non-medical prescribing and five representing actions required for its continued development. Strategic fit between non-medical prescribing and existing service provision, organisation preparedness, visible benefits, good managerial and team support, and a clear differentiation of roles were each important influences. CONCLUSION Given the high degree of consensus, this list of factors and actions should provide guidance to managers and commissioners of services wishing to initiate or extend non-medical prescribing. This information should be considered internationally by other countries outside of the UK wishing to implement prescribing by non-medical healthcare professionals.
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Affiliation(s)
- Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhian Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Gail Harries-Huntley
- Workforce Education and Development Service, NHS Wales Shared Services Partnership, Cardiff, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Gary Morris
- School of Healthcare Sciences, Cardiff University & HywelDda University Health Board, Carmarthen, SA31, Cardiff University, Cardiff, UK
- Advanced Physiotherapy Practitioner, Hywel Dda University Health Board, Carmarthen, UK
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Graham-Clarke E, Rushton A, Noblet T, Marriott J. Facilitators and barriers to non-medical prescribing - A systematic review and thematic synthesis. PLoS One 2018; 13:e0196471. [PMID: 29709006 PMCID: PMC5927440 DOI: 10.1371/journal.pone.0196471] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom. Methods The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786). Results Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007–2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were ‘medical professionals’, ‘area of competence’, ‘impact on time’ and ‘service’. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances. Discussion Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists.
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Affiliation(s)
- Emma Graham-Clarke
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Timothy Noblet
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Marriott
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Clinical and cost-effectiveness of non-medical prescribing: A systematic review of randomised controlled trials. PLoS One 2018; 13:e0193286. [PMID: 29509763 PMCID: PMC5839564 DOI: 10.1371/journal.pone.0193286] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the clinical and cost-effectiveness of non-medical prescribing (NMP). Design Systematic review. Two reviewers independently completed searches, eligibility assessment and assessment of risk of bias. Data sources Pre-defined search terms/combinations were utilised to search electronic databases. In addition, hand searches of reference lists, key journals and grey literature were employed alongside consultation with authors/experts. Eligibility criteria for included studies Randomised controlled trials (RCTs) evaluating clinical or cost-effectiveness of NMP. Measurements reported on one or more outcome(s) of: pain, function, disability, health, social impact, patient-safety, costs-analysis, quality adjusted life years (QALYs), patient satisfaction, clinician perception of clinical and functional outcomes. Results Three RCTs from two countries were included (n = 932 participants) across primary and tertiary care settings. One RCT was assessed as low risk of bias, one as high risk of bias and one as unclear risk of bias. All RCTs evaluated clinical effectiveness with one also evaluating cost-effectiveness. Clinical effectiveness was evaluated using a range of safety and patient-reported outcome measures. Participants demonstrated significant improvement in outcomes when receiving NMP compared to treatment as usual (TAU) in all RCTs. An associated cost analysis showed NMP to be more expensive than TAU (regression coefficient p = 0.0000), however experimental groups generated increased QALYs compared to TAU. Conclusion Limited evidence with overall unclear risk of bias exists evaluating clinical and cost-effectiveness of NMP across all professions and clinical settings. GRADE assessment revealed moderate quality evidence. Evidence suggests that NMP is safe and can provide beneficial clinical outcomes. Benefits to the health economy remain unclear, with the cost-effectiveness of NMP assessed by a single pilot RCT of low risk of bias. Adequately powered low risk of bias RCTs evaluating clinical and cost effectiveness are required to evaluate NMP across clinical specialities, professions and settings. Registration PROSPERO (CRD42015017212).
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Noblet T, Marriott J, Graham-Clarke E, Rushton A. Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. J Physiother 2017; 63:221-234. [PMID: 28986140 DOI: 10.1016/j.jphys.2017.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 01/06/2023] Open
Abstract
QUESTION What are the factors that affect the implementation or utilisation of independent non-medical prescribing (iNMP)? DESIGN Mixed-methods systematic review. Two reviewers independently completed searches, eligibility and quality assessments. DATA SOURCES Pre-defined search terms were utilised to search electronic databases. Reference lists, key journals and grey literature were searched alongside consultation with authors/experts. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Qualitative and quantitative studies investigating independent prescribing by any non-medical professional group. Study participants included any stakeholders involved in actual or proposed iNMP. Measurements reported on data describing stakeholders' perceptions and experiences of the barriers to/facilitators of iNMP. RESULTS A total of 43 qualitative and seven quantitative studies from three countries (n=12, 117 participants) were included. Quality scores varied from 9 to 35 (Quality Assessment Tool for Studies with Diverse Designs, 0 to 48). Qualitative data were synthesised into four themes (and subthemes): systems (government and political, organisational, formulary); education and support (non-medical prescribing (NMP) courses/continuous professional development (CPD)); personal and professional (medical profession, NMP professions, service users); and financial factors. Quantitative data corroborated the qualitative themes. Integration of the qualitative themes and quantitative data enabled the development of a NMP implementation framework. CONCLUSION Barriers to and facilitators of the implementation and utilisation of iNMP are evident, demonstrating multifactorial and context-specific variables within four explicit themes. Professional bodies, politicians, policy and healthcare managers and clinicians could use the resulting NMP implementation framework to ensure the safe and successful implementation and utilisation of NMP. Clinical physiotherapists and other clinicians should consider whether these variables have been adequately addressed prior to adopting NMP into their clinical practice. REGISTRATION PROSPERO CRD42015017212. [Noblet T, Marriott J, Graham-Clarke E, Rushton A (2017) Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. Journal of Physiotherapy 63: 221-234].
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Affiliation(s)
- Timothy Noblet
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Department of Health Professions, Macquarie University, Sydney, Australia
| | - John Marriott
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Emma Graham-Clarke
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Courtenay M, Khanfer R, Harries-Huntly G, Deslandes R, Gillespie D, Hodson K, Morris G, Pritchard A, Williams E. Overview of the uptake and implementation of non-medical prescribing in Wales: a national survey. BMJ Open 2017; 7:e015313. [PMID: 28947441 PMCID: PMC5623514 DOI: 10.1136/bmjopen-2016-015313] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify (1) the non-medical healthcare professionals in Wales qualified to prescribe medicines (including job title, employer, where the prescribing qualification is used, care setting and service provided); (2) the mode of prescribing used by these healthcare professionals, the frequency with which medicines are prescribed and the different ways in which the prescribing qualification is used; and (3) the safety and clinical governance systems within which these healthcare professionals practise. DESIGN National questionnaire survey. SETTING All three National Health Service (NHS) Trusts and seven Health Boards (HB) in Wales. PARTICIPANTS Non-medical prescribers. RESULTS 379 (63%) participants responded to the survey. Most of these prescribers (41.1%) were specialist nurses who work in a variety of healthcare settings (primarily in secondary care) within each HB/NHS Trust, and regularly use independent prescribing to prescribe for a broad range of conditions. Nearly a quarter of the sample (22%) reported that prior to undertaking the prescribing programme, they had completed master's level specialist training and 65.5% had 5 years qualified experience. Over half (55.8%) reported that there were plans to increase non-medical prescriber numbers within the team in which they worked. Only 7.1% reported they did not prescribe and the median number of items prescribed per week was between 21 and 30. Nearly all (87.8%) of the sample reported that they perceived prescribing to have ensured better use of their skills and 91.5% indicated that they believed it had improved the quality of care they were able to provide. CONCLUSION Non-medical prescribing has been implemented across the whole of Wales; however, its uptake within HBs and NHS Trusts has been inconsistent, and it has not been considered across all services, particularly those in primary care. Opportunities therefore exist to share learning across organisations.
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Affiliation(s)
- Molly Courtenay
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Riyad Khanfer
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Gail Harries-Huntly
- Department of Workforce Education and Department Service, NHS Wales Shared Services Partnership, Cardiff, UK
| | - Rhain Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - David Gillespie
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Karen Hodson
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Gary Morris
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- Hywel Dda University Health Board, Carmarthen, UK
| | - Anthony Pritchard
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Elizabeth Williams
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Kooienga S, Wilkinson J. RN Prescribing: An Expanded Role for Nursing. Nurs Forum 2016; 52:3-11. [PMID: 27102376 DOI: 10.1111/nuf.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/23/2015] [Accepted: 12/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE With the implementation of the Affordable Care Act, recommendations of the Future of Nursing Report, and recent regulatory changes by state boards of nursing, registered nurse (RN) roles are expanding. In this article, we advocate for RN prescribing as an expanded role in the United States. METHODS We reviewed the literature on RN prescribing, the background in both high- and low-resource countries, levels of prescribing, specialized settings for RN prescribing, both RN and patients views/perceptions of prescribing, and evaluation research. From this review, we developed a proposal for RN prescribing. FINDINGS Due to expansion of RNs into prescribing worldwide to meet unmet healthcare needs in both primary and specialty settings, we propose a role for RN prescribing within both primary care and outpatient specialty settings. The differences between RN and advanced practice RN prescribing are defined, and U.S.-based regulatory challenges are examined. CONCLUSION Considering unmet healthcare needs and patients' need for medication and medication education, we advocate for RN prescribing as expanded scope and role change for experienced RNs to practice to the highest level of their education.
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Affiliation(s)
- Sarah Kooienga
- Assistant Professor, Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY, and
| | - Jill Wilkinson
- Senior Lecturer, School of Nursing, Massey University, Wellington, NZ
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Creedon R, Byrne S, Kennedy J, McCarthy S. The impact of nurse prescribing on the clinical setting. ACTA ACUST UNITED AC 2015; 24:878-85. [DOI: 10.12968/bjon.2015.24.17.878] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rena Creedon
- Nurse Lecturer and Programme Coordinator, Nurse Prescribing, School of Nursing and Midwifery, University College Cork, Ireland
| | - Stephen Byrne
- Head of School of Pharmacy, University College Cork, Ireland
| | - Julia Kennedy
- Head of School Pharmacy, University of Auckland, New Zealand
| | - Suzanne McCarthy
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Ireland and Research Pharmacist, Cork University Hospital, Ireland
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Affiliation(s)
- Sandra Lawton
- Nurse Consultant Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH
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Carey N, Stenner K, Courtenay M. An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England. BMC Health Serv Res 2014; 14:27. [PMID: 24443796 PMCID: PMC3903435 DOI: 10.1186/1472-6963-14-27] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a need to reduce symptoms, exacerbations and improve quality of life for patients with respiratory diseases. Across the world, increasing numbers of nurses are adopting the prescribing role and can potentially enhance service provision. Evidence suggests improved quality of care and efficiencies occur when nurses adopt the prescribing role. No evidence is available on the views of nurse prescribers who care for respiratory patients. The aim was to explore how nurse prescribing is being used for patients with respiratory conditions in different care settings across one strategic health authority, and whether this has benefited patients, healthcare professionals and the National Health Service. METHODS A qualitative study involving semi-structured interviews with a purposive sample of 40 nurses who prescribed for respiratory patients across the six counties in the East of England Strategic Health Authority. Data were collected in 2011 and subject to thematic analysis. RESULTS Disease management, including treatment and prevention of exacerbations, emergency episodes and minor illness, optimising and co-ordinating care were key aspects of care provided. Findings are reported under three themes: access, adherence and risk management and impact on nurses. Prescribing enabled nurses overcome existing problems in service provision to improve access, efficiency and patient convenience, reducing hospital admissions and length of stay. It also enabled patient centered consultations, which encouraged self-management, improved adherence, helped manage expectations, and reduced inappropriate service use. While participants experienced increased job satisfaction, knowledge and confidence, concerns were raised about increased responsibility, support, governance and future commissioning of services in line with planned major changes to the National Health Service. CONCLUSIONS This study provides new knowledge about how nurse prescribers provide care to patients with respiratory diseases. Despite a lack of consensus over the most effective model of respiratory care, prescribing was reported to have improved and extended points of access to treatment, and supported management of complex patients, particularly vulnerable groups. Given the high burden of chronic respiratory disease to patients and families this has important implications that need to be considered by those responsible for commissioning services in the United Kingdom and other countries.
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Affiliation(s)
- Nicola Carey
- School of Health and Social Care, University of Surrey, Surrey, England
| | - Karen Stenner
- School of Health and Social Care, University of Surrey, Surrey, England
| | - Molly Courtenay
- School of Health and Social Care, University of Surrey, Surrey, England
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Carey N, Courtenay M, Stenner K. The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey. J Clin Nurs 2013; 22:2064-76. [DOI: 10.1111/jocn.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Nicola Carey
- School of Health and Social Care; University of Surrey; Guilford UK
| | - Molly Courtenay
- Prescribing and Medicines Management; School of Health and Social Care; University of Surrey; Guilford UK
| | - Karen Stenner
- School of Health and Social Care; University of Surrey; Guilford UK
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Bowskill D, Timmons S, James V. How do nurse prescribers integrate prescribing in practice: case studies in primary and secondary care. J Clin Nurs 2012. [DOI: 10.1111/j.1365-2702.2012.04338.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dianne Bowskill
- School of Nursing Midwifery and Physiotherapy; Queens Medical Centre; University of Nottingham; Nottingham; UK
| | - Stephen Timmons
- Faculty of Medicine & Health Sciences; Queens Medical Centre; University of Nottingham; Nottingham; UK
| | - Veronica James
- School of Health and Life Sciences; Glasgow Caledonian University; Glasgow; UK
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17
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Stenner K, Carey N, Courtenay M. Prescribing for pain - how do nurses contribute? A national questionnaire survey. J Clin Nurs 2012; 21:3335-45. [DOI: 10.1111/j.1365-2702.2012.04136.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diagnostic decision making: The last refuge for general practitioners? Soc Sci Med 2011; 73:375-82. [DOI: 10.1016/j.socscimed.2011.05.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 05/13/2011] [Accepted: 05/24/2011] [Indexed: 11/19/2022]
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Stenner KL, Courtenay M, Cannons K. Nurse prescribing for inpatient pain in the United Kingdom: A national questionnaire survey. Int J Nurs Stud 2011; 48:847-55. [DOI: 10.1016/j.ijnurstu.2011.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/14/2011] [Accepted: 01/16/2011] [Indexed: 11/29/2022]
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Courtenay M, Carey N, Stenner K. Non medical prescribing leads views on their role and the implementation of non medical prescribing from a multi-organisational perspective. BMC Health Serv Res 2011; 11:142. [PMID: 21635744 PMCID: PMC3120647 DOI: 10.1186/1472-6963-11-142] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 06/02/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In the United Kingdom, non-medical prescribing (NMP) has been identified as one way to improve healthcare quality and efficiency. Healthcare organisations are charged with overseeing the clinical governance of NMP and guidance recommends the identification of a lead director to be responsible for its implementation. While over twelve million items are prescribed each year by the 50,000 qualified NMPs its uptake is inconsistent. Several studies have explored the barriers to NMP at a practice level, however little is known about the role the NMP lead and the implementation of NMP from an organisational perspective. The aim of this research was to explore the role of the organisational NMP lead across a range of practice settings within one Strategic Health Authority (SHA) and consider the development of NMP from a multi-organisational perspective. METHODS Semi-structured telephone interviews with 28 NMP leads across one SHA were undertaken by a trained qualitative researcher. Interviews addressed the purpose of the role and difficulties encountered; audiotapes were transcribed, coded and themes were identified. RESULTS The NMP lead role comprised of four main functions; communication, coordinating, clinical governance and support. Factors hampering progress in overseeing the safe development of NMP included lack of clarity about the NMP lead role and responsibilities, strategic support and a lack of protected time. The extent to which clinical governance systems were in place across organisations was inconsistent. Where a strategic approach to its development was adopted, fewer barriers were encountered and NMP was more likely to become embedded within organisations. CONCLUSIONS The significant contribution that NMP leads play in embedding NMP within organisations should be acknowledged by clearer national guidance for this role and its responsibilities. Greater standardisation and consistency is required of clinical governance systems if quality and safety is to be ensured given the expanding development of NMP. The extent to which NMP is in place worldwide differs. However, our findings will be of interest to policymakers in other countries involved in the development and implementation of this role.
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Affiliation(s)
- Molly Courtenay
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Nicola Carey
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Karen Stenner
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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Abstract
AIMS To explore the views of patients with diabetes about nurse prescribing and the perceived advantages and disadvantages. METHODS Patients were recruited from the case-loads of seven nurse prescribers in six National Health Service sites in England. Sites reflected the key settings in which nurses typically prescribe for patients with diabetes within primary care. Forty-one interviews were undertaken by trained qualitative researchers. Interviews addressed opinions and experiences of nurse prescribing; audiotapes were transcribed, coded, and themes identified. RESULTS Patients were confident in nurse prescribing. Distinctions were made between the role of the nurse and that of the doctor, and views varied with regard to the extent patients felt nurses should work autonomously. Confidence in nurse prescribing was inspired by nurses' specialist knowledge and experience, a mutual trusting relationship, a thorough consultation, and experience of the benefits of nurse prescribing. Communication between nurses and doctors about patient care, awareness by nurses of their area of competence, training and experience, specialist diabetes knowledge and access to training updates were considered important for safe prescribing. Patterns of attendance had changed in some cases, with patients tending to see doctors less often. Access to medicines was improved for patients during non-routine/emergency situations. CONCLUSIONS Nurse prescribing is acceptable to patients and can increase the efficiency of diabetes service in primary care. Workforce planners need to include the services of nurse prescribers alongside those of doctors.
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Affiliation(s)
- M Courtenay
- Division of Health and Social Care, University of Surrey, Guildford, UK.
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