A survey of nurses prescribing in diabetes care: Practices, barriers and facilitators in New Zealand and the United Kingdom.

AIMS AND OBJECTIVES: To compare diabetes-related prescribing practices, barriers and facilitators amongst nurse prescribers in New Zealand and the United Kingdom. BACKGROUND: Nurses have been prescribing in the United Kingdom for many years but nurse prescribing in New Zealand is relatively recent. It is unknown whether similar system factors act to facilitate or limit prescribing. DESIGN: A survey of 250 nurses prescribing in diabetes care in New Zealand (n = 111) and the United Kingdom (n = 139). METHODS: A SurveyMonkey questionnaire was used to survey nurses about the extent of their prescribing practices, and barriers and facilitators experienced. Quantitative data were explored descriptively, and qualitative responses were grouped according to content, with quotes provided to exemplify thematic content. This study is reported following STROBE guidelines. RESULTS: Insulin, metformin and sulphonylureas are the drugs most frequently prescribed in both countries. Considerably more New Zealand than United Kingdom nurses reported prescribing for cardiovascular and renal disease. In both countries, direct prescribing to the patient was most common, followed by remote prescribing in New Zealand and via recommendation to other prescribers in the United Kingdom. Most common barriers were lack of time and inadequate mentoring. Most common facilitators were as follows: good supervision; collegial relationships with specialists, pharmacists and peers; and ongoing education. CONCLUSIONS: These New Zealand and United Kingdom nurses are prescribing a broad range of diabetes-related medications. Similar barriers and facilitators were identified in both countries. Adequate supervision, support from multidisciplinary team colleagues and prescribing education and guidelines are paramount. RELEVANCE TO CLINICAL PRACTICE: Important insights on barriers and facilitators to implementation of nurse prescribing in two countries are highlighted and, despite a considerable difference in the longevity of prescribing practice, similar issues were identified.

Independent nurse medication provision: A mixed method study assessing impact on patients' experience, processes, and costs in sexual health clinics.

BACKGROUND: Local services in the United Kingdom National Health Service enable autonomous provision of medication by nurses, supporting individual nurses to gain prescribing qualifications or by introducing local patient group directions. AIM: To compare nurse prescribing and patient group directions about clinic processes, patients' experiences, and costs from the perspectives of providers, nurses, and patients. DESIGN: Mixed methods, comparative case study in five urban sexual health services in the United Kingdom. METHODS: Data were collected from nurse prescribers, patient group direction users and their patients July 2015 to December 2016. Nurse questionnaires explored training (funding and methods). Nurses recorded consultation durations and support from other professionals in clinical diaries. Patient notes were reviewed to explore medication provision, appropriateness and safety; errors were judged by an expert panel. Patients completed satisfaction questionnaires about consultations and information about medications. RESULTS: Twenty-eight nurse prescribers and 67 patient group directions users took part; records of 1682 consultations were reviewed, with 1357 medications prescribed and 98.5% therapeutically appropriate. Most medication decisions were deemed safe (96.0% nurse prescribers, 98.7% patient group directions, Fisher's Exact Test p = .55). Errors were predominantly minor (55.6% nurse prescribers, 62.4% patient group directions) and related to documentation omissions (78.0%); no patients were harmed. Consultation durations and unplanned re-consultations were similar for both groups. Nurse prescribers sought assistance from colleagues less frequently (chi-squared = 46.748, df = 1, p < .001) but spent longer discussing cases. Nurse prescribing training required more resources from providers and nurses, compared with patient group directions. Nurse prescribers were on higher salary bands. Patient satisfaction was high in both groups (>96%). CONCLUSIONS: Nurse medication provision by both nurse prescribers and patient group direction users is safe and associated with high patient satisfaction; effects on clinic processes and costs are similar. Undertaking the prescribing qualification involves independent study but may bring longer-term career progression to nurses.

Patient satisfaction with medication consultations and medicines information provided by nurses working autonomously in sexual health services: A questionnaire study.

AIM: To compare the satisfaction of patients managed by independent nurse prescribers with that of patients managed by nurses using PGDs with respect to experience of the consultation and information received about the medication. DESIGN: Survey. METHODS: Patients receiving medications from nurses in five urban sexual health services in the United Kingdom completed validated questionnaires immediately after the consultation, September 2015-August 2016. Scores of independent nurse prescribers and nurses using patient group directions were compared about consultation experience (5 items) Satisfaction with Information about Medicines (SIMS 16 items scale). RESULTS: Of 808 patients receiving medications, 393 (48.6%) received questionnaires and 380 were returned (independent nurse prescribers 180 of 198, 90.9%; patient group directions 173 of 195, 88.7%). Patients in both groups reported high levels of satisfaction. About the consultation experience, patients found nurses friendly/ approachable (>99%), instilling confidence and trust (>99%) and explaining reasons for medications clearly (97%). Satisfaction with medication information: Of 348 (92%) respondents completing SIMS, the overall mean score was 13.4 of maximum 16 (no difference between groups, t-test, p = .63). CONCLUSIONS: Patients were highly satisfied with nurse consultations and information around medications regardless of whether they were managed by independent nurse prescribers or nurses using patient group directions. IMPACT: Findings provide evidence in support of autonomous provision of medications by nurses in sexual health clinics.

A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists.

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.

A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: A mixed methods study.

BACKGROUND: United Kingdom legislation allows nurses to autonomously provide medications as independent nurse prescribers or using patient group directions. Evidence of medication safety and appropriateness is limited. We compared nurse prescribers and patient group direction users in terms of prevalence, types and severity of medication provision errors. METHODS: Objectives: Compare safety and appropriateness of medication provision between nurse prescribers and patient group direction users. DESIGN: MIXED METHODS: clinical notes review and nurse-patient consultation observations. SETTING: Five United Kingdom sexual health services. SELECTION CRITERIA: 'Clinical notes review' included a random selection of nurse-patient consultations July-December 2015, 743 consultations managed by nurse prescribers and 939 consultations by patient group direction users. 'Observation study' involved 15 nurse prescriber and 15 patient group direction user nurse-patient medication consultations. Patients aged under 16 or non-English speaking were excluded. MEASUREMENTS: Medication safety/appropriateness was compared between nurse prescribers and patient group direction users. Medication provision errors were categorised and assigned severity ratings. The Medication Appropriateness Index and the Prescribing Framework were used to assess medication provision. RESULTS: Of 1682 clinical notes (nurse prescribers=743, 44%; patient group directions=939, 56%), 879 involved the provision of 1357 medications (nurse prescribers=399, 54%; patient group directions=480, 51%). The overall error rate was 8.5% (1844 errors from a potential 21,738 errors), predominantly related to documentation omissions. Nurse prescribers were more likely to make an error compared to patient group directions users (error rates 9% versus 8%, respectively; p=0.001); most were 'minor' (nurse prescribers=489, 56%; patient group directions=602, 62%). Both nurse prescribers and patient group direction users made safe medication decisions (n=1640 of 1682 patient care episodes, 98%); however, patient group directions users worked outside patient group directions restrictions in 39 (8%) of consultations. In 101 consultations, medication was indicated but not documented as offered/provided. From 30 observed consultations assessed against the Prescribing Framework, nurse prescribers' and patient group directions users' clinical practice were comparable (maximum score 46: nurse prescribers=44.7; patient group direction=45.4, p=0.41). CONCLUSION: Sexual health nurse prescribers and patient group direction users provided safe and therapeutically appropriate medication. Improvements in clinical documentation are recommended. Moreover, patient group directions users should be encouraged to adhere to patient group directions' governance restrictions, such as through regular training, audits and staff updates.

The prescribing needs of community practitioner nurse prescribers: A qualitative investigation using the theoretical domains framework and COM-B.

AIM: With a number of qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. DESIGN: A qualitative research design. METHODS: Semi-structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March-July 2018 and continued until data saturation was reached. RESULTS: Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion-led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient-centred care'. Themes were then deductively mapped to the TDF and COM-B. CONCLUSION: There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non-adherence. IMPACT: Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient-centred care and the best outcome should be supported, this may mean increasing time allocated to consultations.

Medicines management activity with physiotherapy and podiatry: A systematic mixed studies review.

OBJECTIVE: Making best use of existing skills to increase service capacity is a global challenge. The aim was to systematically review physiotherapy and podiatrist prescribing and medicines management activity, including evidence of impact on patient care, levels of knowledge and attitudes towards extended medicines role. METHODS: A search of MEDLINE, CINAHL, and Cochrane databases, using terms to identify prescribing and medicines management across a range of roles, was conducted from January 1985 to May 2016 for physiotherapy, and January 1968 to May 2016 for podiatry. Hand searching of citations and databases from professional organisations was undertaken. Data were extracted and analysed descriptively, and quality appraised by 2 reviewers using the mixed methods appraisal tool. RESULTS: 1316 papers were identified, and 21 included in the review. No studies were identified that reported prescribing and no studies specific to podiatry met the inclusion criteria. Physiotherapists were highly involved in administering medicines, providing medicines advice, and recommending new medicines. Patient satisfaction, cost and outcomes were equivalent when comparing physiotherapist-led injection therapy to traditional care. Pharmacology knowledge was variable and unmet training needs identified. CONCLUSION: Medicines management practices were identified in physiotherapy and positive outcomes of extended scope physiotherapy. There was a lack of evidence regarding podiatric practice. Review of educational preparation for medicines management is recommended along with evaluation of medicines management practice.

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.

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.

Patterns of dispensed non-medical prescriber prescriptions for antibiotics in primary care across England: a retrospective analysis.

Objectives: To describe the patterns of dispensed non-medical prescriber (NMP) prescriptions for antibiotics in primary care across England between 2011 and 2015. Methods: A retrospective analysis of dispensed antibiotic prescriptions, written by NMPs and medical prescribers between 2011 and 2015 in primary care in England, obtained from the National Health Service Business Services Authority. Results: Between 2011 and 2015, the number of NMPs (mainly nurses but also pharmacists and small numbers of allied health professionals) in England, who have independent prescribing capability, has risen by over one-third to nearly 30000. Most of these prescribers provide a broad range of services in primary care. The rate of dispensed NMP prescriptions for antibiotics over this period has increased, as has the percentage of all primary care antibiotics dispensed that were prescribed by NMPs, which is currently nearly 8%. The most commonly dispensed NMP antibiotic prescriptions were penicillin, sulphonamides, trimethoprim, macrolides, tetracyclines and nitrofurantoin. Conclusions: Increasing numbers of NMPs are working in primary care in England and managing infections. Antibiotics prescribed by this group align with surveillance reports of antibiotic use in primary care. With the numbers of NMPs being set to rise further, they form an important group to involve in antimicrobial stewardship efforts.

Overview of the uptake and implementation of non-medical prescribing in Wales: a national survey.

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.

Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management.

OBJECTIVE: To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations. DESIGN: Mixed methods. SETTING: Primary care. PARTICIPANTS: Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs). RESULTS: Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by NMPs. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. 'Patient-centred' management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients' expectations or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions and lack of time restrictions were each reported to contribute to patient satisfaction. CONCLUSIONS: NMPs demonstrate an understanding of patient expectations of RTI consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients' expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by NMPs were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.

A comparison of prescribing and non-prescribing nurses in the management of people with diabetes.

AIM: The aim of this study were to compare nurse prescribers and non-prescribers managing people with diabetes in general practice regarding: (a) patient characteristics; (b) activities and processes of care; (c) patient outcomes (self-management, clinical indicators, satisfaction) and (d) resource implications and costs. BACKGROUND: Over 28,000 nurses in the UK can prescribe the same medicines as doctors provided that it is in their level of experience and competence. Over 30%, mostly in general practice, prescribe medicines for patients with diabetes. DESIGN: A comparative case study. METHOD: Nurses managing care of people with Type 2 diabetes were recruited in twelve general practices in England; six could prescribe, six could not. Patients, recruited by nurses, were followed up for 6 months (2011-2012). RESULTS: The patient sample comprised 131 in prescriber sites, 83 in non-prescriber sites. Patients of prescribers had been diagnosed and cared for by the nurse longer than those of non-prescribers. There were no differences in reported self-care activities or HbA1c test results between the patients of prescribers and non-prescribers. Mean HbA1c decreased significantly in both groups over 6 months. Patients of prescribers were more satisfied. Consultation duration was longer for prescribers (by average of 7·7 minutes). Non-prescribing nurses sought support from other healthcare professionals more frequently. Most prescribing nurses were on a higher salary band than non-prescribers. CONCLUSION: Clinical outcomes of patients managed by prescribing and non-prescribing diabetes nurses are similar. Prescribing nurses had longer relationships with their patients and longer consultations, possibly contributing to higher satisfaction with care. Employment costs of prescribing nurses are potentially higher.

The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey.

AIMS AND OBJECTIVES: To explore the practice of nurses who prescribe medication for patients with skin conditions. BACKGROUND: Nurses have lead roles in dermatology services. In the United Kingdom, nurses in primary care frequently prescribe medicines for skin conditions, but there are concerns about role preparation and access to continuing professional development. The prescribing practices of nurse independent supplementary prescribers who care for patients with skin conditions are under-researched. DESIGN: Cross-sectional survey. METHODS: An online questionnaire was used to survey 186 nurses who prescribed for skin conditions from May-July 2010. Data were analysed using descriptive statistics and nonparametric tests. RESULTS: The majority worked in primary care (78%) and general practice (111, 59.7%). Twenty (10.8%) had specialist modules (at diploma, degree or master's level), 104 (55.9%) had dermatology training (e.g. study days), 44 (23.7%) had no training, and a further 18 (9.6%) did not respond. Oral antibiotics, topical antifungal and antibacterial drugs were frequently prescribed. Nurses with specialist dermatology training used their qualification in a greater number of ways, prescribed the broadest range of products and prescribed more items per week. Over 70% reporting on continuing professional development had been able to access it. CONCLUSIONS: A large number of nurses in primary care prescribe medicines for skin conditions and are involved in medicines management activities. Lack of specialist dermatology training is a concern and associated with lower prescribing-related activities. Access to dermatology training and continuing professional development are required to support nurse development in this area of practice and maximise benefits. RELEVANCE TO CLINICAL PRACTICE: Nurse prescribers' involvement in medicines management activities has important implications in terms of improving access to services, efficiency and cost savings. To maximise their contribution, improved provision of specialist dermatology training is required. This will be of interest to education providers and service planners in the UK and countries around the world.

Roles of the non-medical prescribing leads within organisations across a Strategic Health Authority: perceived functions and factors supporting the role.

OBJECTIVES: Extending the roles of nurses, pharmacists and allied health professionals to include prescribing has been identified as one way of improving service provision. In the UK, over 50 000 non-medical healthcare professionals are now qualified to prescribe. Implementation of non-medical prescribing ( NMP) is crucial to realise the potential return on investment. The UK Department of Health recommends a NMP lead to be responsible for the implementation of NMP within organisations. The aim of this study was to explore the role of NMP leads in organisations across one Strategic Health Authority (SHA) and to inform future planning with regards to the criteria for those adopting this role, the scope of the role and factors enabling the successful execution of the role. METHODS: Thirty-nine NMP leads across one SHA were approached. Semi-structured telephone interviews were conducted. Issues explored included the perceived role of the NMP lead, safety and clinical governance procedures and facilitators to the role. Transcribed audiotapes were coded and analysed using thematic analytical techniques. KEY FINDINGS: In total, 27/39 (69.2%) NMP leads were interviewed. The findings highlight the key role that the NMP lead plays with regards to the support and development of NMP within National Health Service trusts. Processes used to appoint NMP leads lacked clarity and varied between trusts. Only two NMP leads had designated or protected time for their role. Strategic influence, operational management and clinical governance were identified as key functions. Factors that supported the role included organisational support, level of influence and dedicated time. CONCLUSION: The NMP lead plays a significant role in the development and implementation of NMP. Clear national guidance is needed with regards to the functions of this role, the necessary attributes for individuals recruited into this post and the time that should be designated to it. This is important as prescribing is extended to include other groups of non-medical healthcare professionals.

Non-medical prescribers and pharmacovigilance: participation, competence and future needs.

OBJECTIVE: To determine UK non-medical prescribers' (NMPs) (supplementary or independent) current participation and self-reported competence in pharmacovigilance, and their perceptions of training and future needs. SETTING: Non-medical prescribers in health care in the United Kingdom. Awareness of and participation in the Yellow Card Scheme (YCS); attitudes towards ADR reporting; strategies to encourage reporting; pharmacovigilance training; and demographics. The sample comprised nurse (n = 912) and pharmacist (n = 2,439) NMPs in the UK. MAIN OUTCOME MEASURES: Self-reported competence in pharmacovigilance, knowledge of and participation in the YCS, attitudes towards ADR reporting; strategies to encourage ADR reporting; pharmacovigilance training during NMP training. RESULTS: Six hundred and thirteen responses were received giving an overall response rate of 20.4 %. Response rates for nurse and pharmacist prescribers were 32.2 % (n = 293) and 13.1 % (n = 320) respectively. Three hundred and fifty-nine respondents (58.6 %) had submitted a Yellow Card. Although the majority of respondents (70.4 %) felt competent in pharmacovigilance, a third (34.2 %) said they needed further training. Respondents reported a positive attitude towards ADR reporting, yet only a minority (22.9 %) correctly answered factual questions about the YCS. Approximately a third of respondents (35.6 %) "couldn't remember" if pharmacovigilance was covered in their prescribing training. Publicity and education were commonly suggested measures to enhance contribution to the YCS. CONCLUSION: While NMPs report participation and competence in ADR reporting, there are several key issues to consider including the need for further training and support to optimise their role in pharmacovigilance.

An overiew of non medical prescribing across one strategic health authority: a questionnaire survey.

BACKGROUND: Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA. METHODS: NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011. RESULTS: The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p < 0.001). CONCLUSION: NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This workforce is contributing to medicines management activities in a range of care settings. If non-medical prescibers are to maximise their contribution, robust governance and support from healthcare organisations is essential. The continued use of supplementary prescribing is questionable if maximum efficiency is sought. These are important points that need to be considered by those responsible for developing non-medical prescribing in the United Kingdom and other countries around the world.

Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views.

BACKGROUND: There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients' views about their consultations with a nurse prescriber. OBJECTIVE: To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management. DESIGN: A qualitative study involving semi-structured interviews and thematic analysis. SETTING: Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009. PARTICIPANTS: Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers. RESULTS: Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment. CONCLUSIONS: The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses' interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients' requirements.

Nurse prescribing and community practitioners.

More than 30,000 nurses across the United Kingdom are qualified to prescribe from the Nurse Prescribers' Formulary for Community Practitioners. Approximately 14,000 nurses have become qualified to prescribe as both independent and supplementary prescribers. The numbers of community nurses undertaking independent/supplementary prescribing training and extending their prescribing skills has increased. Prerequisites for nurses wishing to undertake independent/supplementary prescribing training include the ability to study at level3 (degree level), at least three years' experience as a qualified nurse, agreement from a doctor that they will contribute to the 12/13 days' learning in practice, and occupying a post in which they would be expected to prescribe. The 39-day training programme leading to the dual qualification of independent/supplementary prescriber generally runs over 3-6 months, but must be completed within one year. Although the initial implementation of nurse prescribing was slow, changes surrounding prescribing policy have been rapid over recent years. Prescribing is now an extended role for many thousands of nurses, and independent supplementary prescribers have virtually the same prescribing rights as doctors. The many benefits of prescribing as predicted by the Government have been achieved and additional benefits have been reported. A number of benefits have been reported by nurses who prescribe from the Community Practitioners' Formulary. These benefits include time savings and convenience, a belief that patients receive better information from nurses about prescriptions, as well as an increased sense of satisfaction, status and autonomy. However, it is apparent that many of these nurses are not utilising their prescribing skills and this needs further exploration.

An exploration of the continuing professional development needs of nurse independent prescribers and nurse supplementary prescribers who prescribe medicines for patients with diabetes.

BACKGROUND: Nurse Independent and Nurse Supplementary Prescribing has extended the role that nurses in the UK have in the management of care for patients with diabetes. Concerns surround nurses' pharmacological knowledge and provision of continuing professional development to meet the needs of nurse prescribers. AIM: To examine the continuing professional development needs of nurses who prescribe medicines to patients with diabetes. DESIGN: A questionnaire survey. METHODS: The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. One thousand and four hundred questionnaires were returned. Medicines for patients with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. RESULTS: The majority (63%) of nurses worked in general practice. Over 80% reported continuing professional development was available and that they had accessed it to support their prescribing role. Over 40% of nurses had continuing professional development needs in the areas of prescribing policy, pharmacology for diabetes and the management and treatment of diabetes related conditions. Senior nurses reported fewer continuing professional development needs. CONCLUSION: Access and provision of continuing professional development for nurse prescribers has improved since the initial implementation of nurse prescribing. However, nurse's pharmacological knowledge and the provision of continuing professional development continue to be an area of concern which warrant further investigation. RELEVANCE TO CLINICAL PRACTICE: Previous concerns have been identified about the provision of continuing professional development to meet the needs of nurse prescribers. Pharmacological knowledge is still the greatest continuing professional development requirement of nurses who prescribe for patients with diabetes. Education providers may wish to consider developing the content of continuing professional development programmes to meet these needs.

Implementing nurse prescribing: a case study in diabetes.

AIM: This paper is a report of a study exploring the views of nurses and team members on the implementation of nurse prescribing in diabetes services. BACKGROUND: Nurse prescribing is adopted as a means of improving service efficiency, particularly where demand outstretches resources. Although factors that support nurse prescribing have been identified, it is not known how these function within specific contexts. This is important as its uptake and use varies according to mode of prescribing and area of practice. METHOD: A case study was undertaken in nine practice settings across England where nurses prescribed medicines for patients with diabetes. Thematic analysis was conducted on qualitative data from 31 semi-structured interviews undertaken between 2007 and 2008. Participants were qualified nurse prescribers, administrative staff, physicians and non-nurse prescribers. FINDINGS: Nurses prescribed more often following the expansion of nurse independent prescribing rights in 2006. Initial implementation problems had been resolved and few current problems were reported. As nurses' roles were well-established, no major alterations to service provision were required to implement nurse prescribing. Access to formal and informal resources for support and training were available. Participants were accepting and supportive of this initiative to improve the efficiency of diabetes services. CONCLUSION: The main factors that promoted implementation of nurse prescribing in this setting were the ability to prescribe independently, acceptance of the prescribing role, good working relationships between doctors and nurses, and sound organizational and interpersonal support. The history of established nursing roles in diabetes care, and increasing service demand, meant that these diabetes services were primed to assimilate nurse prescribing.