Characteristics of prescribing activity within primary care in Scotland 2013-2022 of general practitioners, nurse, pharmacist and allied health prescribers: A retrospective cross-sectional study.

BACKGROUND: Independent prescribing by nurses, pharmacists and allied health professionals is diversifying into a variety of healthcare settings as pressures mount on existing resources. Primary care was an early adopter of prescribing by non-medical professionals with resulting improvements in accessibility and flexibility of services but also noted barriers. Exploring existing prescribing activity within primary care can support future initiatives that are cognisant of the needs of this specific population and targeted in the use of finite resources. AIM: To explore the characteristics of prescribing activity of common drugs dispensed by community pharmacies in Scotland by prescribing groups of general practitioners, nurses, pharmacist and allied health professionals. Specifically, to compare overall drug prescribing frequency by prescriber group and identify emergent prescribing patterns of individual drugs. DESIGN: A cross-sectional study. METHODS: The data from Public Health Scotland on frequency of the ten most common drugs prescribed and dispensed from community pharmacies between 2013 and 2022 by prescriber group were examined, applying descriptive statistics using secondary data analysis. RESULTS: Prescribing activity in non-medical prescribing groups accounted for 2%-3% of overall prescribing activity in primary care. There is a growing interprofessional approach to prescribing in chronic disease. Proton pump inhibitors were the most commonly prescribed medication overall with a 4-fold increase in nurse prescribing. The decline in prescribing frequency caused by COVID 19 restrictions has since returned to pre-pandemic levels. CONCLUSION: There is a growing contribution of nurse independent prescriber activity within primary care although still a relatively small proportion compared to medical practitioners. The pattern of increased prescribing of medications for long term and chronic conditions such as proton pump inhibitors by all prescribers is suggestive of multi-disciplinary professionals supporting increased patient demand. This study provides a baseline to evaluate current service provision in further research and enable professional, service and policy development.

The listening project: A qualitative study on the experiences of pre-registered nurses during the Covid-19 pandemic in Scotland.

Background: During the COVID 19 pandemic academic institutes worldwide were forced to shift to online or socially distanced learning. Nursing students faced unique challenges due to the limited practical learning environment and removal of supernumerary status to meet increased pressure on health care resources. Aim: To explore the experiences and perceptions of pre-registered nurses in relation to their university education during the COVID-19 pandemic. Methods: Underpinned by Lizzio (2006) [1] five senses of student success model, a novel qualitative approach using peer-to-peer discussion was utilized to explore the experiences of pre-registered nurses during the COVID-19 pandemic. Students who were on their second and final year in the nursing program were invited to participate. Interviews were conducted and transcribed using an online meeting platform. Data were analyzed using the five main stages of framework analysis. Results: Eleven peer-to-peer discussion with 22 students were conducted. The five themes were linked with the five senses student success model: capability, connectedness, purpose, resourcefulness, and culture. Six sub-themes emerged in the data: confidence and learning process, building relationships, communication, student as health professional and mental health consequences of COVID-19 pandemic. Conclusion: Whilst there was strength in university provision, the pandemic was an opportunity for students and academics to reflect and learn about how to further programme resilience and enhance student support processes. We recommend that nursing programmes should include concepts of transition, pandemic preparedness, collaboration with professional partners, and provision of catch-up sessions to analyse gaps on their skills and knowledge.

Effectiveness of Digital Simulation on Student Nurses' Knowledge and Confidence:An Integrative Literature Review.

Digital simulation is an emerging innovation with the potential to address the limitations to traditional clinical simulation. The pandemic has accelerated teaching on digital platforms, which is now embedded in pedagogic practice. This integrative review will evaluate the effectiveness of digital simulation on nursing students' knowledge and/or confidence. The electronic database search carried out between October 3 and 7, 2021. We included primary research articles published in English language between January 2012 and October 2021. From 14,369 citations, 10 full-text documents were included in our final analysis and synthesis. Results suggest that digital simulation with realistic, immersive and interactive characters had a positive impact on students' learning outcome in terms of knowledge acquisition and self-confidence. Therefore, combining digital simulation with face-to-face simulation will enhance learning.

The views of non-medical prescribing students and medical mentors on interprofessional competency assessment - A qualitative exploration.

BACKGROUND: The United Kingdom (UK) is one of the least restrictive countries in terms of scope of prescribing practice for non-medical prescribers and is a rapidly expanding group of professionals. In the United Kingdom nurse prescribers are assessed in practice by Designated Medical Practitioners (DMP) (doctors) which is a unique approach. In light of proposals to permit nurses to assess each other the benefits and challenges associated with current approach to interprofessional assessment warranted further exploration. OBJECTIVE: The aim was to explore interprofessional competency assessment with nurse non-medical prescribing students and their DMPs. DESIGN: A descriptive qualitative research design was undertaken using semi-structured interviews and focus groups. SETTING: The study was completed in a Scottish University that provides non-medical prescribing education to nurses, midwives and allied health professionals. PARTICIPANTS AND METHODS: Students (n=6) participated in two focus groups at the start and end of their supervised learning and assessment in practice. DMPs (n=6) participated in semi structured telephone interviews on completion of supervision. Utilising Clark's theory of interprofessional education, a thematic analysis was conducted. FINDINGS: Professional identity influenced interpretation of prescribing competence with regards assessment and scope of practice. Students and DMPs learned with, from and about each other, and provided a platform for two-way learning and mutual professional respect. The interprofessional learning experience developed relationships and provided ratification for the prescribing role post qualification. CONCLUSIONS: Further exploration with key stakeholders and service users is recommended, prior to any changes to the designated professional group assigned to assessing non-medical prescribing competence.

Non-medical prescribing assessment - An evaluation of a nationally agreed multi method approach.

UNLABELLED: In the United Kingdom, legislation permits nurses and allied health professionals to prescribe for patients within their care. Preparation for this role includes learning, teaching and assessment that is embedded in practice, supervised by a designated medical practitioner (DMP) and evidenced in a reflective learning in practice portfolio. AIM: The objectives were to explore; (1) which assessment in the practice portfolio was ranked most valuable in terms of achieving safe, effective prescribing practice and, (2) whether a practice based assessment (SDEP) was an acceptable alternative to an Observed Simulated Clinical Examination (OSCE). METHODS: Online surveys were conducted and follow up semi structured telephone interviews were conducted across 5 universities in Scotland with students, DMPs and line managers. RESULTS: Students ranked the learning log most valuable and DMPs and line managers ranked the SDEP most valuable. Survey and follow up interviews suggested that the portfolio provided the opportunity to develop prescribing skills and knowledge relevant to their specific clinical speciality. There was agreement amongst all participants that clinical assessment in the practice portfolio effectively enable non-medical prescribing students to evidence prescribing competence. SUMMARY: The novel use of the SDEP and reflective summary offers a viable alternative to an OSCE and was viewed as one of the most valued components of the assessment strategy.