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Bayot i Escardívol R, Mateo-Viladomat E, Galbany-Estragués P, Vilar-Pont M, Calderó i Solé MA, Mora-López G, Flores-Montoya R, Vicente-Belis M, Escoda-Geli N, Molina-Nadal A, Canet-Vélez O, Jodar-Solà G. Implementation of Nurse Prescriptions throughout the Public Health System in Catalonia (2021-2022). Healthcare (Basel) 2024; 12:1232. [PMID: 38921348 PMCID: PMC11204069 DOI: 10.3390/healthcare12121232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Nurses in Catalonia have always prescribed health advice, health products, and medication in line with the professional competency of the discipline. Legislation about nurse prescriptions and the implementation of nurse prescribing varies widely among different countries. This article reports data regarding nurse prescribing in Catalonia in 2021 and 2022. METHODS This retrospective longitudinal study analyzed data from all care-providing units in Catalonia's integrated public health system. RESULTS The number of nurse prescriptions increased from 139,435 in 2021 to 573,822 in 2022, and the number of nurses issuing prescriptions increased from 3604 in 2021 to 5563 in 2022. The proportion of prescriptions for different products was similar in the two years analyzed. Prescriptions for medication increased by 7.5% in 2022. CONCLUSIONS Nurse prescribing is a recent advance in Catalonia. Despite some difficulties in rollout, the data indicate that this practice is becoming consolidated, as in other European countries.
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Affiliation(s)
- Rosa Bayot i Escardívol
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
| | - Enric Mateo-Viladomat
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
| | - Paola Galbany-Estragués
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, 08907 L’Hospitalet de Llobregat, Spain
| | | | | | | | - Raquel Flores-Montoya
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Montse Vicente-Belis
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Núria Escoda-Geli
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Andrea Molina-Nadal
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Olga Canet-Vélez
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain
| | - Glòria Jodar-Solà
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
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Mokhtari-Nouri J, Hashemi S, Karimi L, Moradian S, Ebadi A, Vahedian-Azimi A. Identifying structure, process and outcome factors of the clinical specialist nurse: A scoping review study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:1-9. [DOI: 10.4103/ijnmr.ijnmr_297_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/27/2021] [Accepted: 04/17/2022] [Indexed: 01/26/2023]
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Low C, Namasivayam P, Barnett T. Co-designing Community Out-of-hours Palliative Care Services: A systematic literature search and review. Palliat Med 2023; 37:40-60. [PMID: 36349547 PMCID: PMC9843546 DOI: 10.1177/02692163221132089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In order to provide responsive, individualised and personalised care, there is now greater engagement with patients, families and carers in designing health services. Out-of-hours care is an essential component of community palliative care. However, little is known about how patients, families and carers have been involved in the planning and design of these services. AIM To systematically search and review the research literature that reports on how out-of-hours palliative care services are provided in the community and to identify the extent to which the principles of co-design have been used to inform the planning and design of these services. DESIGN Systematic literature search and review. DATA SOURCES A systematic search for published research papers from seven databases was conducted in MEDLINE, PsycINFO, Embase, Emcare, PubMed, CINAHL and Web of Science, from January 2010 and December 2021. Reference list searches of included papers were undertaken to source additional relevant literature. A manifest content analysis was used to analyse the data. RESULTS A total of 77 papers were included. The majority of out-of-hours services in the community were provided by primary care services. The review found little evidence that patients, families or carers were involved in the planning or development of out-of-hours services. CONCLUSION Incorporating patients, families and carers priorities and preferences in the planning and designing of out-of-hours palliative care service is needed for service providers to deliver care that is more patient-centred. Adopting the principles of co-design may improve how out-of-hours care scan be delivered.
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Affiliation(s)
- Christine Low
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | | | - Tony Barnett
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
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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] [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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Santos-Willshere J, Pizarro N. Introducing nurse prescribing in Gibraltar: the impact on palliative care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:162-168. [PMID: 35152752 DOI: 10.12968/bjon.2022.31.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article critically explores the impact of the introduction of nurse prescribing on palliative care in Gibraltar. A preliminary audit review of the prescriptions issued by the two palliative independent nurse prescribers over their first full calendar year of prescribing (2020) revealed two primary areas of impact: facilitating end-of-life care at home and improving anticipatory prescribing for end-of-life symptom management. These initial findings will be discussed in the context of the challenges and facilitators encountered during the first year of prescribing practice. Challenges were primarily related to the introduction of an advanced nursing role into an existing medical paradigm. Identified facilitators included comprehensive record keeping, collaborative working and the development of local guidelines, as well as the support of management and peers. The article concludes with a recommendation for further audits of prescribing data as a way to measure the impact of the new role and to inform future palliative service development.
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Affiliation(s)
| | - Nicole Pizarro
- Specialist Palliative Nurse, Gibraltar Health Authority, Gibraltar
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Saunders MM. Informing and Supporting the New Clinical Nurse Specialist Prescriber. AACN Adv Crit Care 2021; 32:404-412. [PMID: 34879132 DOI: 10.4037/aacnacc2021869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.
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Affiliation(s)
- Mitzi M Saunders
- Mitzi M. Saunders is Professor and AG-CNS Program Coordinator, University of Detroit Mercy, 4001 W McNichols, Detroit, MI 48221-3038
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Osborne J, Kerr H. Role of the clinical nurse specialist as a non-medical prescriber in managing the palliative care needs of individuals with advanced lung cancer. Int J Palliat Nurs 2021; 27:205-212. [PMID: 34169745 DOI: 10.12968/ijpn.2021.27.4.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Rapid identification of the palliative care needs of individuals with a diagnosis of advanced lung cancer is crucial to maximise the patient's quality of life by upholding exemplary standards of patient-centred holistic care. The clinical nurse specialist is in an ideal position to contribute to the identification and management of the palliative care needs of individuals with advanced lung cancer through the assessment and timely prescribing of medications to manage distressing symptoms. AIM This paper reviews and critiques the role of the clinical nurse specialist as an independent non-medical prescriber in the management of palliative symptoms in end-of-life care for patients with advanced lung cancer. RESULTS Published literature highlights the positive impact the clinical nurse specialist has as a non-medical prescriber in addressing the palliative needs of individuals with lung cancer. However, there are barriers and challenges, and to overcome these, maximising resources and the availability of support is required to ensure the delivery of timely, person-centred care. CONCLUSION The clinical nurse specialist as a non-medical prescriber is an evolving role. There are a range of factors that may influence the clinical nurse specialist to confidently and competently undertake this role. These include the perception that there will be an escalation in the workload, concerns about increased accountability and inadequate mentoring for this new role. To incentivise this role, multidisciplinary support is essential in promoting the clinical nurse specialist's confidence for developing this service to individuals with advanced lung cancer.
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Affiliation(s)
- Jenny Osborne
- Macmillan Lung Cancer Clinical Nurse Specialist, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Helen Kerr
- Senior Lecturer, School of Nursing and Midwifery, Queen's University, Belfast
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Ogi M, Campling N, Birtwistle J, Richardson A, Bennett MI, Santer M, Latter S. Community access to palliative care medicines-patient and professional experience: systematic review and narrative synthesis. BMJ Support Palliat Care 2021:bmjspcare-2020-002761. [PMID: 33775932 DOI: 10.1136/bmjspcare-2020-002761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Providing palliative care patients living at home with timely access to medicines is critical to enable effective symptom management, minimise burden and reduce unplanned use of healthcare services. Little is known about how diverse community-based palliative care models influence medicine access. OBJECTIVE To produce a critical overview of research on experiences and outcomes of medicine access in community-based palliative care models of service delivery through a systematic review and narrative synthesis. METHODS MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library databases and grey literature were systematically searched for all types of studies. Study quality was assessed using the Mixed Methods Appraisal Tool; a narrative synthesis was used to integrate and summarise findings. RESULTS 3331 articles were screened; 10 studies were included in the final sample. Studies included a focus on community pharmacy (n=4), hospice emergency medication kits (HEMKs) in the home (n=3), specialist community nurse prescribers (n=1), general practice (n=1) and one study included multiple service delivery components. Community pharmacy was characterised by access delays due to lack of availability of medicine stock and communication difficulties between the pharmacy and other healthcare professionals. HEMKs were perceived to reduce medicine access time out of hours and speed symptom control. However, the majority of studies comprised small, local samples, largely limited to self-reports of health professionals. There was a lack of data on outcomes, and no comparisons between service delivery models. CONCLUSIONS Further research is required to understand which models facilitate rapid and efficient access to medicines for community-based palliative care patients.
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Affiliation(s)
- Mizue Ogi
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Natasha Campling
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jakki Birtwistle
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael I Bennett
- Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Miriam Santer
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Susan Latter
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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