Políticas públicas de medicamentos e a relação de medicamentos essenciais / Public policies on medicines and the list of essential medicines / Las políticas públicas sobre medicamentos y la lista de medicamentos esenciales

Através da edição da Norma Operacional de Assistência à Saúde realizada em 2001 e da publicação do Pacto pela Saúde realizado em 2006 o processo de acesso à saúde, ganhou maior ênfase no quesito de inovações e melhorias do sistema de saúde. A assistência farmacêutica sobreveio como parte fundamental nos serviços e programas de saúde. Neste sentido, o objetivo do presente estudo foi de expor as principais políticas públicas acerca da temática de medicamentos essenciais. Para tanto, foi realizada uma revisão integrativa de literatura, tendo como base de dados o Ministério da Saúde, as Resoluções da Agência Nacional de Vigilância Sanitária, artigos científicos e as publicações da Relação Nacional de Medicamentos (RENAME). No ano de 1998 através da portaria nº 3.916, de 30 de outubro 1998, apresenta-se a população a terminologia de Políticas públicas e, como resposta às diretrizes resultantes desta política, no presente artigo teremos ênfase na RENAME, criada através da portaria nº 3.047, de 28 de novembro de 2019, a qual atende aos princípios básicos e fundamentais do Sistema Único de Saúde: universalidade, equidade e a integralidade, para atender aos tratamentos das diversas doenças e agravos que acometem a população brasileira. Sendo assim, conclui- se que não se trata apenas de políticas públicas, e sim de manter o direito do cidadão estabelecidos pela Constituição da República Federativa do Brasil, para que o paciente consiga adquirir a medicação adequada e na quantidade necessária, permitindo aos profissionais alcançar mais aproveitamento no gerenciamento do ciclo da assistência farmacêutica.

Through the edition of the Operational Norm for Health Care carried out in 2001 and the publication of the Pact for Health carried out in 2006, the process of access to health gained greater emphasis on the issue of innovations and improvements in the health system. Pharmaceutical assistance emerged as a fundamental part of health services and programs. In this sense, the objective of the present study was to expose the main public policies on the subject of essential medicines. Therefore, an integrative literature review was carried out, using the Ministry of Health, the National Health Surveillance Agency's Resolutions, scientific articles and the publications of the National Medicines List (RENAME) as a database. In 1998, through ordinance nº 3.916, of October 30, 1998, the public policy terminology is presented to the population and, in response to the guidelines resulting from this policy, in this article we will emphasize RENAME, created through ordinance nº 3.047 , of November 28, 2019, which meets the basic and fundamental principles of the Unified Health System: universality, equity and integrality, to meet the treatments of the various diseases and conditions that affect the Brazilian population. Therefore, it is concluded that it is not just about public policies, but about maintaining the right of the citizen established by the Constitution of the Federative Republic of Brazil, so that the patient can acquire the appropriate medication and in the necessary quantity, allowing professionals to achieve more use in the management of the pharmaceutical care cycle.

A través de la edición de la Norma Operativa de Atención a la Salud realizada en 2001 y de la publicación del Pacto por la Salud realizada en 2006, el proceso de acceso a la salud ganó mayor énfasis en el tema de innovaciones y mejoras en el sistema de salud. La asistencia farmacéutica surgió como parte fundamental de los servicios y programas de salud. En este sentido, el objetivo del presente estudio fue exponer las principales políticas públicas sobre el tema de los medicamentos esenciales. Para ello, se realizó una revisión bibliográfica integradora, utilizando como base de datos el Ministerio de Salud, las Resoluciones de la Agencia Nacional de Vigilancia Sanitaria, artículos científicos y las publicaciones de la Lista Nacional de Medicamentos (RENAME). En 1998, a través de la ordenanza nº 3.916, de 30 de octubre de 1998, se presenta a la población la política pública de terminología y, en respuesta a las directrices resultantes de esta política, en este artículo haremos hincapié en el RENAME, creado a través de la ordenanza nº 3.047, de 28 de noviembre de 2019, que cumple con los principios básicos y fundamentales del Sistema Único de Salud: universalidad, equidad e integralidad, para atender los tratamientos de las diversas enfermedades y afecciones que afectan a la población brasileña. Por lo tanto, se concluye que no se trata sólo de políticas públicas, sino de mantener el derecho del ciudadano establecido por la Constitución de la República Federativa de Brasil, para que el paciente pueda adquirir el medicamento adecuado y en la cantidad necesaria, permitiendo que los profesionales logren un mayor aprovechamiento en la gestión del ciclo de atención farmacéutica.

Understanding pharmaceutical care and nurse prescribing in Spain: A grounded theory approach through healthcare professionals' views and expectations.

BACKGROUND: Pharmaceutical care has been implemented and regulated differently across Europe with no consensus among countries in relation with professional competencies and especially on nurse prescribing. Demophac Project funded by the European Commission aims to develop a Pan-European Pharmaceutical Care Model with collaboration of 14 partner teams across Europe including Spain where nurse prescribing is starting its implementation at regional level. The aim of the study was to increase understanding of the role of nurses in Pharmaceutical care in Spain after the Nurse Prescribing Regulation approved in 2018 throughout exploring the views and expectations of health professionals involved in the representative settings. METHODS AND FINDINGS: In depth interviews were conducted in a structure previously agreed by the European Demophac partnership around four topics associated with the Nursing ideal role in pharmaceutical care and the ideal interaction with other healthcare professionals. A grounded-theory approach based on Corbin & Strauss was conducted to interpret collected data from the Spanish most representative settings (primary care, specialized care and residential care for older population). Participants were health professionals involved in pharmaceutical care that accepted to participate (nurses (n = 7), physicians (n = 8) and pharmacists (n = 9)). A pharmaceutical care comprehensive model for the Spanish context considering the recently approved Nurse Prescribing role and the interprofessional collaboration and communication was developed towards facilitating the understanding in such context and the contribution to the unified European Demophac Framework. CONCLUSIONS: Nurses are primarily responsible for population's Pharmaceutical Care while other professionals pivot on them to provide quality healthcare on a multidisciplinary level. Nurse prescribing may contribute efficiently to the Spanish Health System though more consensus in terms of nurses' training nationwide and enhancement in communication among different professionals within healthcare organizations is required to achieve adequate integrated care into practice.

Eventos adversos em uma unidade de internação psiquiátrica / Eventos adversos en una unidad de hospitalización psiquiátrica / Adverse events in a psychiatric hospitalization unit

RESUMO Objetivo descrever os eventos adversos presentes na internação psiquiátrica, analisando-os à luz da teoria do erro humano. Método pesquisa qualitativa, realizada em 2018 em um hospital psiquiátrico. Os dados foram coletados por entrevistas semiestruturadas com 15 profissionais de saúde da equipe multidisciplinar. A análise foi lexical por meio do software Alceste. Resultados evidenciaram-se eventos adversos medicamentosos por erros de administração ou por reações adversas a medicamentos, que produzem danos como impregnação, reações extrapiramidais associadas aos riscos de queda e broncoaspiração pela sonolência e/ou sedação. Outros danos relacionam-se à agressividade do paciente, que produz lesões corporais a si ou a outro, como durante uma tentativa de suicídio ou uso de violência como comportamento de fuga ou defesa. Considerações finais e implicações para a prática existem eventos adversos mais comuns nos ambientes de internação psiquiátrica que precisam ser de conhecimento da equipe de saúde mental porque demandam ações de mitigação por meio do fortalecimento dos sistemas de segurança do paciente. Os dados subsidiam ações para o fortalecimento dos sistemas de segurança nos ambientes de internação psiquiátrica e contribuem à reflexão do conceito de segurança do paciente na psiquiatria.

RESUMEN Objetivo describir los eventos adversos presentes en la hospitalización psiquiátrica, analizándolos a la luz de la teoría del error humano. Método investigación cualitativa, realizada en 2018 en un hospital psiquiátrico. Los datos se recolectaron a través de entrevistas semiestructuradas con 15 profesionales de la salud del equipo multidisciplinario. Se llevó a cabo el análisis léxico por medio del software Alceste. Resultados se evidenciaron eventos adversos por errores de administración o reacciones adversas al fármaco, que producen daños como impregnación y reacciones extrapiramidales asociadas al riesgo de caídas y broncoaspiración por somnolencia y / o sedación. Otros daños se relacionan con agresividad por parte del paciente, que produce daño corporal a sí mismo o a otro, como durante un intento de suicidio o uso de violencia como conducta de fuga o defensa. Conclusión e implicaciones para la práctica hay eventos adversos más comunes en entornos de hospitalización psiquiátrica que deben ser conocidos por el equipo de salud mental porque exigen acciones de mitigación a través del fortalecimiento de los sistemas de seguridad del paciente. Los datos reflejan la necesidad de implementar acciones para fortalecer los sistemas de seguridad en entornos de hospitalización psiquiátrica y contribuyen a la reflexión del concepto de seguridad del paciente en psiquiatría.

ABSTRACT Objective to describe the adverse events found in psychiatric hospitalization, analyzing them in the light of the human error theory. Method a qualitative research study, carried out in 2018 in a psychiatric hospital. The data were collected through semi-structured interviews with 15 health professionals from the multidisciplinary team. Analysis was of the lexical type using the Alceste software. Results adverse drug events were evidenced due to administration errors or adverse drug reactions, which produce harms such as impregnation and extrapyramidal reactions associated with the risks for falls and bronchoaspiration due to drowsiness and/or sedation. Other harms are related to the patient's aggressiveness, which produce bodily self-harm or harms to another person, such as during a suicide attempt or use of violence as an escape or defense behavior. Conclusion and implications for the practice some adverse events are more frequent in psychiatric hospitalization settings; such events need to be known by the mental health team, as they require mitigation actions through the strengthening of patient safety systems. The data subsidize actions for strengthening safety systems in psychiatric hospitalization settings and contribute to reflecting on the concept of patient safety in Psychiatry.

Prevalência dos fatores de risco para trombose venosa profunda em pacientes cirúrgicos em unidade de terapia intensiva / Prevalence of risk factors for deep venous thrombosis in surgical patients in intensive care unit

Objetivo: Avaliar a prevalência dos fatores de risco e medidas de prevenção para trombose venosa profunda de pacientes cirúrgicos em Unidade de Terapia Intensiva. Métodos: Estudo transversal, conduzido em 2019, com utilização da escala de Caprini para classificação de cada paciente quanto ao risco para trombose venosa profunda, e análise das intervenções adotadas. Resultados: Foram avaliados 68 pacientes. Os fatores de risco mais prevalentes foram procedimento cirúrgico de grande porte (96%) e restrição ao leito (90%). O risco para tromboembolismo venoso foi alto (62/91%), moderado (5/7%) e baixo (1/2%). A mobilização de membros foi aplicada a todos os pacientes, deambulação precoce foi realizada em 62% e 56% foram submetidos à profilaxia medicamentosa. Conclusão: A alta prevalência dos fatores de risco para trombose venosa profunda em pacientes cirúrgicos e a baixa aplicabilidade de medidas preventivas demonstram a importância da implementação de programas de educação continuada e medidas de monitoramento desses eventos.

Objective: To assess the prevalence of the risk factors and preventive measures for deep venous thrombosis in surgical patients in the Intensive Care Unit. Methods: Cross-sectional study held in 2019 using the Caprini scale to classify each patient regarding their risk for deep venous thrombosis, and analysis of the actions taken. Results: A total of 68 patients were evaluated. The most prevalent risk factors were being submitted to major surgical procedures (96%) and bed restriction (90%). The risk for venous thromboembolism was high (62/91%), moderate (5/7%), and low (1/2%). Limb mobilization was applied on all patients; early ambulation was performed in 62%; and 56% were submitted to drug prophylaxis. Conclusion: The high prevalence of risk factors for deep vein thrombosis in surgical patients and the low applicability of preventive measures show the importance of implementing continuing education programs and measures to monitor such events.

Nurse Practitioner Scope-of-Practice Laws and Opioid Prescribing.

Policy Points The increased use of nurse practitioners represents a viable policy option to address continuing access-to-care deficiencies across the United States, but state scope-of-practice laws limit the ability of nurse practitioners to deliver health care. Groups in favor of restrictive scope-of-practice laws have argued that relaxing these laws will lead to increases in opioid prescriptions during an already severe opioid crisis, implicating patient safety concerns. An examination of a data set of 1.5 billion opioid prescriptions demonstrates that relaxing nurse practitioner scope-of-practice laws generally reduces opioid prescriptions. This evidence supports eliminating restrictive scope-of-practice laws that currently govern nurse practitioners in many states. CONTEXT: As many parts of the United States continue to face physician shortages, the increased use of nurse practitioners (NPs) can improve access to care. However, state scope-of-practice (SOP) laws limit the ability of NPs to provide care by restricting the services they can provide and often requiring physician supervision of their practices. One important justification for the continuation of these restrictive SOP laws is preventing the overprescription of certain medications, particularly opioids. METHODS: This study examined a data set of approximately 1.5 billion individual opioid prescriptions between 2011 and 2018, which were aggregated to the individual provider-year level. A series of difference-in-differences regression models was estimated to examine the association between laws allowing NPs to practice independently and opioid prescribing patterns among physicians and NPs. Opioid prescriptions were measured in total annual morphine milligram equivalents (MMEs) prescribed by individual providers. FINDINGS: Across all NPs and physicians, independent NP practice was associated with a statistically significant decline of 6%, 2%, 3%, 7%, and 5% in total annual MMEs prescribed to commercially insured, cash-paying, Medicare, government-assistance, and all patients, respectively. Medicaid patients saw no statistically significant change in annual MMEs. Across all payers, NPs generally increase and physicians generally decrease the number of opioids they prescribe following a grant of NP independence. These counterbalancing changes result in an overall net decline in MMEs. CONCLUSIONS: No evidence supports the contention that allowing NPs to practice independently increases opioid prescriptions. The results support policy changes that allow NPs to practice independently.

APRNs' controlled substance prescribing and readiness following Florida legislative changes.

ABSTRACT: Two years after the Florida legislature expanded APRN prescribing to include schedule II-IV drugs in 2017, we studied APRN utilization of this prescriptive authority. Study results reveal that Florida APRNs are meeting the educational requirements to prescribe and apply the use of these drugs in practice, improving patient access to care.

Expanding access to nurse-managed medication for opioid use disorder.

BACKGROUND: Advanced practice registered nurses (APRNs) are increasingly caring for individuals with opioid use disorder. Advances have been made to increase APRN education, outreach, and prescribing privileges, but as demand for medication for opioid use disorder (MOUD) grows, evidence suggests that policy and care barriers inhibit the ability of APRNs to support MOUD. PURPOSE: This paper highlights the significant challenges of expanding access to buprenorphine prescribing by APRNs. FINDINGS: Barriers and recommendations were derived from the culmination of literature review, expert consensus discussions among a diverse stakeholder panel including patient representatives, and feedback from community webinars with care providers. DISCUSSION: We provide an overview of existing care barriers, promising practices, and proposed recommendations to enhance the care of individuals and communities with opioid use disorder.

The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation.

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.

Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives.

BACKGROUND: In 2010, the Nursing and Midwifery Board of Australia introduced a new registration standard: Endorsement for scheduled medicines for midwives. The endorsement enables midwives to provide women with Medicare-rebatable care, prescribe relevant medications, and order relevant Medicare-rebatable diagnostics. Translating endorsement education into clinical midwifery practice has been slow, indicating the presence of barriers affecting midwives' ability to use this standard, despite it increasing their scope for service provision. AIM: To discover the mechanisms affecting midwives' ability to work to full scope of practice after completing a programme of study leading to endorsement. METHODS: An observational (non-experimental) design was used. Midwives who had completed an education programme leading to endorsement were invited to complete a survey. Descriptive statistics were used to analyse the quantitative questions and content analysis was conducted on the qualitative data. FINDINGS: Results indicated that barriers - such as the limitations of Medicare provisions for endorsed midwives and a general lack of support for the role - restrict endorsed midwives' ability to provide quality maternity services. Having some form of support for the role may act as an enabler, in addition to midwives having personal determination and confidence in their ability to use the endorsement. Recommendations to strengthen the endorsed midwife's role include facilitating endorsement use in the public sector, relaxing Medicare Benefit Schedule and Pharmaceutical Benefit Scheme restrictions, raising awareness of the role and scope, and improving midwives' pre-endorsement preparation. CONCLUSION: This study highlights the need for an all-of-system approach to support and develop the endorsed midwife's role.

Enfermagem e o tratamento medicamentoso da sífilis sob a ótica da Teoria Sócio-Humanista / Nursing and drug treatment of syphilis from the perspective of Socio-Humanist Theory / Enfermería y tratamiento farmacológico de la sífilis según la perspectiva de la teoría socio-humanista

Objetivo: analisar o papel da enfermagem acerca da farmacoterapia da sífilis no âmbito da atenção primária em saúde. Método: investigação de abordagem qualitativa, com nove enfermeiros da atenção primária de município da Região Centro-Oeste do Brasil, realizada no período de agosto de 2018 a julho de 2019, por meio de entrevistas. A análise de dados apoiou-se na Teoria de Enfermagem Sócio-Humanista. Resultado: o papel da enfermagem esteve circunscrito à consulta de enfermagem, mediantes ações de acolhimento, escuta, detecção da sífilis, prescrição e administração de medicamento e práticas educativas. O aporte institucional caracterizou-se pela elaboração de protocolo sobre prescrição de medicamentos pelo enfermeiro e construção de fluxo de atenção ao usuário com sífilis. Conclusão: a enfermagem atua com autonomia na farmacoterapia da sífilis pautada em suas experiências e conhecimentos, aporte institucional, trabalho em equipe, procurando atender às necessidades de saúde do usuário.

Objective: to examine nursing's role in syphilis drug therapy in the primary health care context. Method: this qualitative study of nine primary care nurses in a municipality in Brazil's Midwest Region was conducted, by interview, from August 2018 to July 2019. Data analysis was based on the Social-Humanist Nursing Theory. Result: nursing's role was limited to nursing appointments, and took the form of welcoming reception, listening, syphilis detection, medication prescription and administration, and educational activities. The institutional contribution was characterized by preparation of a protocol on medication prescription by nurses and construction of the care flow for users with syphilis. Conclusion: nursing operates autonomously in syphilis drug therapy, seeking to meet user health needs based on its experience and knowledge, institutional support, and teamwork.

Objetivo: examinar el papel de la enfermería en la terapia con medicamentos para la sífilis en el contexto de la atención primaria de salud. Método: este estudio cualitativo de nueve enfermeras de atención primaria en un municipio de la Región Medio Oeste de Brasil se realizó, por entrevista, de agosto de 2018 a julio de 2019. El análisis de datos se basó en la Teoría de Enfermería Social-Humanista. Resultado: la función de la enfermería se limitó a las citas de enfermería y se concretó en la recepción de bienvenida, la escucha, la detección de la sífilis, la prescripción y administración de medicamentos y actividades educativas. El aporte institucional se caracterizó por la elaboración de un protocolo de prescripción de medicamentos por enfermeras y la construcción del flujo de atención a usuarios con sífilis. Conclusión: la enfermería opera de manera autónoma en la terapia con medicamentos para la sífilis, buscando satisfacer las necesidades de salud de los usuarios a partir de su experiencia y conocimiento, apoyo institucional y trabajo en equipo.

Práctica avanzada de la enfermera en urgencias extrahospitalarias y comparación con la casuística atendida por equipos con médicos / Advanced practice of the nurse in out-of-hospital emergencies and comparison with the casuistry attended by teams with doctors

OBJETIVO: Explorar la práctica enfermera en urgencias extrahospitalarias y comparar su casuística con la de equipos con médico presencial. METODOLOGÍA: Estudio transversal, con pacientes del Distrito Málaga atendidos por una enfermera (2012-2016) y por 6 equipos con médico presencial (2012). VARIABLES: prioridad, motivo de asistencia, diag-nósticos enfermeros, medicamentos y derivación. Estadística descriptiva e inferencial multivariante. RESULTADOS: La enfermera atendió 2253 pacientes. Los equipos con méicos atendieron 21226, presentando patologías similares el 34,8%. Motivos de asistencia: cérvico-dorso-lumbo-ciatalgia (12,6%), mareos/vértigo (9.6%), sin patología urgente (9,2%), etc. El 63,9% de pacientes precisó medicación: diazepam (19,3%), metoclopramida (13,6%), metamizol (12,5%), etc. El manejo del tratamiento y de dispositivos sanitarios, junto al afrontamiento de problemas se asociaron a los motivos de asistencia. El 92% de avisos fueron resueltos in situ. CONCLUSIÓN: La enfermera es una opción muy eficiente para la atención compartida de la demanda, aún con la legalización de la prescripción de medicamentos pendiente

OBJECTIVE: To explore prehospital emergency nursing and to compare the case-mix attended with prehospital medical teams. METHODS: Cross-sectional study, including patients from Málaga District attended by a prehospital nurse (2012 - 2016), and by prehospital medical teams (2012). MAIN VARIABLES: priority, cause of the demand, nursing diagnosis, medication and referral. Descriptive and multiple inferencial analyses. RESULTS: The nurse attended 2253 patients. Medical teams attended 21226 patients, and 34.8% presented similar pathologies. Case-mix: Cervical-back-sciatica pain (12.6%), dizziness/vertigo (9.6%), no urgent pathology (9.2%), etc. 63.9% of patients needed medication: Diazepam (19.3%), metoclopramida (13.6%), metamizol (12.5%), etc. Management of medication or healthcare devices, and problem coping were usually associated to assistance demands. 92% of demands were resolved in situ. CONCLUSIONS: The emergency nurse turns out to be an efficient choice for sharing prehospital demands, even with nursing prescription not yet legalized

Percepção do graduando de Enfermagem na segurança do paciente com sistema de medicamentos por dose unitária / Perception of nursing students in patient safety with unit dose medication system / Percepción de estudiantes de enfermería en seguridad del paciente con sistema de medicación de dosis unitaria

Objetivos: Descrever a percepção do graduando de enfermagem sobre a segurança do paciente no Sistema de distribuição de Medicamentos por Dose unitária - SDMDU. Método: Pesquisa de campo exploratória, quantitativa, qualitativa, não probabilística intencional. Realizada em um hospital infantil que utiliza o SDMDU. Foram entrevistados 126 graduandos de enfermagem. Resultados: Percepção positiva para 99(78,57%) dos graduandos de enfermagem, categorizado por Sistema Seguro 45 (45,45%) e, 30(30,30%) relatam que o SDMDU diminui erros. Entretanto 21(16,67%) referiram percepção negativa, afirmam que o Preparo e Administração dos medicamentos 10(47,61%) devem ocorrer pela enfermagem e, consideram o Sistema inseguro, 9(42,85%) entrevistados. Considerações Finais: O SDMDU é um processo que traz maior segurança ao paciente. O enfermeiro deve conhecer a responsabilidade sobre a administração de medicamentos como algo importante dentro do conjunto de atividades que realiza, uma vez que a implantação do SDMDU reflete diretamente nas atividades da equipe de enfermagem.(AU)

Objectives: To describe the perception of nursing students on patient safety in the Distribution System of Medicines by Unit Dose - SDMDU. Method: Exploratory, quantitative, qualitative, non-probabilistic, intentional field research. Held in a children's hospital that uses the SDMDU. 126 nursing graduates were interviewed. Results: Positive perception for 99 (78.57%) of nursing students, categorized by Sistema Seguro 45 (45.45%) and 30 (30.30%) report that the SDMDU decreases errors. However, 21 (16.67%) reported a negative perception, affirm that the Preparation and Administration of medicines 10 (47.61%) must be performed by nursing staff and, considering the System unsafe, 9 (42.85%) interviewed. Final Considerations: The SDMDU is a process that brings greater safety to the patient. The nurse must know the responsibility for medication administration as something important within the set of activities that he performs, since the implementation of the SDMDU reflects directly on the activities of the nursing team.(AU)

Objetivos: Describir la percepción de los estudiantes de enfermería sobre la seguridad del paciente en el Sistema de Distribución de Medicamentos por Unidad Dosis - SDMDU. Método: Investigación de campo exploratoria, cuantitativa, cualitativa, no probabilística e intencional. Se lleva a cabo en un hospital de niños que utiliza la SDMDU. Se entrevistaron 126 graduados en enfermería. Resultados: La percepción positiva para 99 (78.57%) de estudiantes de enfermería, categorizados por Sistema Seguro 45 (45.45%) y 30 (30.30%) informan que el SDMDU disminuye los errores. Sin embargo, 21 (16,67%) informaron una percepción negativa, afirman que la preparación y administración de medicamentos 10 (47,61%) debe ser realizada por personal de enfermería y, considerando que el sistema no es seguro, 9 (42,85%) entrevistados. Consideraciones Finales: SDMDU es un proceso que brinda mayor seguridad al paciente. La enfermera debe conocer la responsabilidad de la administración de medicamentos como algo importante dentro del conjunto de actividades que realiza, ya que la implementación de la SDMDU se refleja directamente en las actividades del equipo de enfermería.(AU)

Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: an acceptability and feasibility experimental study using mixed methods.

OBJECTIVES: To assess the acceptability and feasibility of using a theory-based electronic learning intervention designed to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers for patients presenting with common, acute, uncomplicated self-limiting respiratory tract infections (RTIs). DESIGN: Experimental with mixed methods; preintervention and postintervention online surveys and semistructured interviews. SETTING: Primary care settings across the UK. PARTICIPANTS: 11 nurse and 4 pharmacist prescribers. INTERVENTION: A theory-based brief interactive animation electronic learning activity comprised a consultation scenario by a prescriber with an adult presenting with a common, acute, uncomplicated self-limiting RTI to support a 'no antibiotic prescribing strategy'. OUTCOME MEASURES: Recruitment, response and attrition rates were assessed. The overall usefulness of the intervention was assessed by analysing prescribers' self-reported confidence and knowledge in treating patients with RTIs before and after undertaking the intervention, and views on the relevance of the intervention to their work. Acceptability of the intervention was assessed in semistructured interviews. The feasibility of data collection methods was assessed by recording the number of study components completed by prescribers. RESULTS: 15 prescribers (maximum sample size) consented and completed all four stages of the study. Prescribers reported high to very high levels of confidence and knowledge preintervention and postintervention, with slight postintervention increases in communicating with patients and a slight reduction in building rapport. Qualitative findings supported quantitative findings; prescribers were reassured of their own practice which in turn increased their confidence and knowledge in consultations. The information in the intervention was not new to prescribers but was applicable and useful to consolidate learning and enable self-reflection. Completing the e-learning intervention was acceptable to prescribers. CONCLUSIONS: It was feasible to conduct the study. The intervention was acceptable and useful to prescribers. Future work will add complex clinical content in the intervention before conducting a full trial.

The Educational Terrain of Preparing Registered Nurses to Prescribe: An Environmental Scan.

Expanded nursing roles are being explored in Canada as a means to better support the health of the population, enable access to quality care and contribute to the sustainability of the healthcare system. As Canada embarks on a process of developing and implementing registered nurse (RN) prescribing roles, gathering evidence from jurisdictions with established nurse prescribing is helpful to inform policy development. Of particular interest is literature from the UK, with more than 20 years of experience with nurse prescribing, which identifies the importance of completing graduate pharmacological education and building on existing clinical knowledge and experience. Similar models of RN prescribing education have been adopted in New Zealand and Ireland. Within Canada, the RN prescribing role is still in its infancy, and there is some variation among provinces in the approach to prescribing practices and in RN prescribing education. This paper describes the results of an environmental scan that sought to explore the educational practices of national and international jurisdictions through published and grey literature sources. Findings from this environmental scan will support nurse leaders as they develop RN prescribing regulation and education in Canada and will highlight important areas for further knowledge development.

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.

Nurse-initiated pre-prescribed antibiotic orders to facilitate prompt and appropriate antibiotic administration in febrile neutropenia.

PURPOSE: To assess the impact of a pathway allowing nurse initiation of first dose intravenous (IV) antibiotics on time to antibiotic administration (TTA) in adult inpatients with febrile neutropenia (FN). METHODS: This study evaluated the impact on TTA of a clinical pathway (November 2017 to April 2018) allowing nurse initiation of pre-prescribed antibiotics in adult haematology patients with FN, compared with a prior cohort (November 2016 to April 2017) in which antibiotics were only prescribed and administered after medical review. The primary endpoint for comparison was TTA, calculated as the time between the first recorded fever and IV antibiotic administration. Secondary endpoints included appropriateness of initial antibiotic choice, 30-day all-cause mortality and admission to intensive care unit (ICU). RESULTS: Forty-seven eligible FN episodes in 40 patients and 61 episodes in 52 patients were evaluated in the pre- and post-implementation groups, respectively. Baseline characteristics were comparable between groups. Median (IQR) TTA, in the pre-implementation group [66 min (40-100 min)] was significantly prolonged versus post-implementation group [29 min (20-41 min); p < 0.001]. A significantly higher proportion of episodes were administered appropriate initial antibiotics in the post-versus pre-implementation groups (100% vs. 89%, p = 0.03). There was no significant change in 30-day all-cause mortality (0% vs. 5%, p = 0.3) or ICU admission within 48 h of fever (0% vs. 2%, p > 0.99) between pre- and post-implementation groups, respectively. CONCLUSIONS: A pathway allowing nurse initiation of pre-prescribed antibiotic orders for FN significantly reduced TTA from first recorded fever and increased the proportion of appropriate initial antibiotic choices without significantly impacting on patient outcomes.

Potentially inappropriate medicine prescribing by nurse practitioners in New Zealand.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs) in New Zealand (NZ) prescribe a broad range of medicines; little is known about their prescribing practice for older adults. Potentially inappropriate medicines (PIMs) can cause more harm than benefit. This study reports on the prescribing of PIMs to older adults (≥65 years) by NPs in NZ. METHODS: A subset analysis using data from NZ Ministry of Health pharmaceutical collection from 2013 to 2015 was completed. Data included NP registration number, medicines dispensed, patient age, sex, and NZ Deprivation level. Those <65 years were excluded. Beers 2015 criteria were used to identify the PIMs. RESULTS: There were 106 NPs that prescribed medicines to 12,410 patients aged ≥65 years. One third of the patients were prescribed ≥1 PIMss. Most (68.4%) were prescribed one PIM; 21.9% two PIMs; 7.1% three PIMs; and 2.6% were prescribed ≥4 PIMs. NPs prescribed an average of 14.9% PIMs. Primary care NPs were more likely to prescribe PIMs, compared to those with a scope of older adults and long-term conditions (p ≤ 0.001). The most common Beers 2015 PIMs prescribed were proton pump inhibitors, non-steroidal anti-inflammatory drugs, alpha blockers, hypnotics, tricyclic antidepressants, and benzodiazepines. IMPLICATIONS FOR PRACTICE: NPs prescribe lower rates of PIMs to older adults than other prescribers in NZ. However, prescribing practices can be improved and the findings indicate that a more specific educational focus on prescribing to older adults is required. The findings provide an important baseline internationally for NP PIM prescribing and can be used by NPs, and educationally to review and improve practices.

Translating Data From an Electronic Prescribing and Medicines Administration System Into Knowledge: Application to Doctor-Nurse Time Discrepancy in Antibiotic Ordering and Administration.

BACKGROUND: Electronic Prescribing and Medicines Administration (EPMA) systems are being widely implemented to facilitate medication safety improvement. However, translating the resulting big data into actionable knowledge has received relatively little attention. OBJECTIVE: The objective of this study was to use routinely collected EPMA data in the study of exact time discrepancy between physicians' order and nurses' administration of systemic antibiotics. We evaluated first and follow-up dose administration and dose intervals and examined multifactorial determinants in ordering and administration explaining potential discrepancy. METHODS: We conducted an observational study of electronic health records for all medical patient stays with antibiotic treatment from January to June 2018 (n=4392) in a large Belgian tertiary care hospital. Using an EPMA system with Barcode Medication Administration, we calculated time discrepancy between order and administration of first doses (n=6233), follow-up doses (n=87 960), and dose intervals. Multiple logistic regression analysis estimated the association between time discrepancy and various determinants in ordering and administration. RESULTS: Time discrepancy between physician order and nurse administration was <30 minutes for 48.7% of first doses and 61.7% of follow-up doses, with large variation across primary diagnoses. Greater dose intervals, oral versus intravenous administration, and order diversion from regular nurse administration rounds showed strongest association with less timely administration. CONCLUSIONS: EPMA systems show huge potential to generate actionable knowledge. Concerning antibiotic treatment, having physicians' orders coincide with regular nurse administration rounds whenever clinically appropriate, further taking contextual factors into account, could potentially improve antibiotic administration timeliness.

Nurse practitioners and barriers to diabetic foot treatment.

BACKGROUND: Even with full practice authority, nurse practitioners (NPs) face limitations in care and treatment options. An example of this is current federal law prohibiting NPs from ordering diabetic shoes. PURPOSE: This study reviewed the background of this problem, potential impacts on patient health and NP practice, and viable solutions for consideration. METHODS: This was a descriptive study of NPs in a northwestern state with full practice authority. An anonymous online survey was used. There were 54 total NP respondents. RESULTS: The potential negative patient outcomes associated with restricted NP ability to prescribe diabetic footwear were supported through the literature review and the survey, including increased foot complications and acuity, translating to increased costs. Of the NPs queried, 80% felt inability to prescribe diabetic footwear was limiting to their practice, and 92% felt this affected patient outcomes. Federal legislative changes with support of bipartisan bills allowing NPs to prescribe diabetic footwear could facilitate timeliness and access to care while reducing costs. IMPLICATIONS FOR PRACTICE: Legislation affecting NP scope of practice is an important issue with implications related to patient outcomes. Nurse practitioners should continue to support legislation at the federal level to pass bills allowing for NPs to certify orders for diabetic shoes.