Nurse independent prescribing and nurse supplementary prescribing practice: national survey

Title. Nurse independent prescribing and nurse supplementary prescribing practice: national survey Aim. This paper is a report of a survey to provide an overview of nurse independent prescribing and nurse supplementary prescribing across the United Kingdom. Background. Evidence examining the frequency of prescribing by nurses is conflicting, and it is evident that several factors hamper prescribing practice. As of May 2006, legislative changes gave appropriately qualified nurses virtually the same independent prescribing right as doctors. However, there is currently no evidence available about the prescribing practices of these nurses. Method. A random sample of 1992 qualified Nurse Independent/Nurse Supplementary Prescribers registered with the Nursing and Midwifery Council was sent a postal questionnaire in 2006. A total of 1400 (70%) questionnaires were returned, of which 1377 were completed. Findings. Eight hundred and ninety‐one (65%) respondents worked in primary care, and 333 (24·3%) worked in secondary care. Three quarters of the sample had more than 5‐year clinical experience in the area in which they prescribed prior to entering the prescribing programme. One thousand one hundred and seven (87%) participants had used nurse independent prescribing and 568 (44·6%) nurse supplementary prescribing. Restriction of local arrangements, implementation of the Clinical Management Plan and access to doctors hampered or prevented prescribing. Conclusion. The adoption of prescribing by nurses in the United Kingdom has increased patient choice with regard to access to medicines. A number of factors which hamper or prevent prescribing require further exploration.     

Evaluating nurse prescribing behaviour using constipation as a case study

Non-medical nurse prescribing in the UK continues to evolve with new legislative frameworks. Studies evaluating patterns of prescribing by nurses remain scarce. This secondary data analysis of national prescribing data investigated the prescribing behaviours of community-based nurses and general practitioners (GPs), using constipation as a case study. Currently, 37 683 registered nurses, midwives and health visitors are qualified to independently prescribe in the UK; however, only 16.6% of nurses prescribed items for constipation. Prescribing practices differed between nurses employed by primary care trusts (PCTs) and general practice, between nurses and GPs, and across regions. PCT-employed nurses undertook 83% of nurse prescribing although activity increased steadily among general practice-employed nurses. Pharmacological treatment choices differed between nurses and GPs. Over 60% of all nurses predominantly prescribed from one class of laxative compared with a wider range prescribed by GPs. The extent, impact and outcomes of medical prescribing need further study.     

Nurse prescribers' experiences of prescribing

Background. Nurse prescribing has advanced rapidly over the previous decade and is clearly on the agenda for the future. Previous research considers nurse prescribing from the patient's perspective, the medical professions’ stance and the legal and ethical implications. However, there is a paucity of literature that explores the experiences of nurse prescribers’ within their current role. These experiences need investigating to ensure nurse prescribing is able to advance in ways that provide benefit to nurses and thus provides the impetus for the study. Aim. To explore and review nurse prescribers’ experiences of prescribing. Design methods. A purposeful sample of seven nurse prescribers currently prescribing within a West Midlands Community Trust underwent minimally structured interviews in this qualitative study. Transcribed interviews were analyzed using thematic analysis. Findings. Four themes were generated from analysis of the interviews, ‘patient centred care’, ‘benefits of nurse prescribing’, ‘support and role satisfaction’ and finally ‘prescribing difficulties’. Conclusions. Nurse prescribers’ perceive prescribing as a predominantly positive experience, frequently asserting the advantages that prescribing saves the patient and nurse time, is more convenient for the patient and increases the nurses’ autonomy and role satisfaction. However, negative experiences of restrictions to practice as a result of nurse prescribers’ formulary limitations and duplication of documentation were also described. Relevance to clinical practice. Nurse prescribing is a rapidly evolving area of practice with the potential to advance nursing roles. This research aims to provide an insight into the experiences of current nurse prescribers that may then be disseminated and applied to future practice.     

Nurse practitioner prescribing practice in Australia: Confidence in aspects of medication management

The findings of the 2010 national survey of nurse practitioner (NP) prescribing in Australia related to confidence in prescribing are reported. A significant correlation between years endorsed as a NP and prescribing confidence was found. NPs in Australia were significantly more confident in the prescribing aspects of commencing a new medication than adjusting or ceasing a medication prescribed by others. These findings are discussed in relation to promotion of the quality use of medicines and identification of potential strategies to promote the ongoing positive evolution of NP practice in Australia.     

护士独立处方权在中国实施的现状分析

随着国际护士处方权的发展,我国在面临医疗资源配置的不均衡,护理群体的职业需求无法得到充分满足的前提下,通过分析国内外护士独立处方权的发展现状,得出在中国实施护士处方权的必要性,护士处方权的落实和立法工作应尽快开展。     

Nurse supplementary prescribing for patients with diabetes: a national questionnaire survey

Aims and objectives. To examine the prescribing practices of nurse supplementary prescribing in diabetes. Background. Nurses in several roles are involved in the management of medicines for patients with diabetes. Nurse prescribing should help optimise these roles. Nurses in the UK have virtually the same independent prescribing rights as doctors. There is little or no evidence on the extent to which nurse supplementary prescribing is used, or the impact and activity of nurse supplementary prescribing for patients with diabetes. Design. Survey. Method. A random sample of 214 nurse supplementary prescribers self‐completed a written questionnaire. Results. The majority of nurses held an academic qualification at degree level or higher, had a wealth of clinical experience, worked full‐time, were based in primary care and worked in general practice. The majority of nurses prescribed between one and five items a week. Oral anti‐diabetic drugs, hypertension and lipid‐regulating drugs and insulins were the products most often prescribed. Over 85% had undertaken specialist training in diabetes prior to undertaking the prescribing programme. Conclusion. Supplementary prescribing provides a practical and useful framework within which to prescribe medicines for patients with diabetes and its associated complications. Specialist diabetes training is a necessary prerequisite for nurses prescribing in this area. It is evident that there is still a place for supplementary prescribing. Implications for clinical practice. ? Recent legislative changes mean that nurses can now independently prescribe practically any drug. ? Nurses in general practice appear to prescribe most frequently as a nurse supplementary prescriber for patients with diabetes. ? Nurse supplementary prescribers are likely to use this mode of prescribing to deliver medicines to patients with diabetes. ? Over two‐thirds prescribe for common but serious complications of diabetes, e.g. hypertension, hyperlipidaemia and cardiovascular disease     

Nurse and midwifery prescribing in Ireland: A scope‐of‐practice development for worldwide consideration

For 10 years, select Irish nurses and midwives who pass a rigorous 6 month theory and practical program can prescribe medications and other medicinal products. Given the need for timely, accessible, and affordable health‐care services in all countries, this nursing/midwifery education and practice development is worthy of examination. Irish nurse/midwife prescribing occurred following long‐term deliberative nursing profession advocacy, nursing education planning, nursing administration and practice planning, interdisciplinary health‐care team support and complementary efforts, and government action. A review of documents, research, and other articles was undertaken to examine this development process and report evaluative information for consideration by other countries seeking to improve their health‐care systems. Nurse/midwife prescribing was accomplished successfully in Ireland, with the steps taken there to initiate and establish nurse/midwife prescribing of value internationally.     

Nurse prescribing in specialist mental health (part 2): the views and experiences of psychiatrists and health professionals

The establishment of working relationships between nurse prescribers and other health professionals, particularly psychiatrists offering supervision, can be a rewarding one. However there remains little guidance in terms of how this can be achieved and the opinions of those from different disciplines in specialist mental health teams. This study aims to look at the views and experiences of psychiatrists and other mental health professionals regarding nurse prescribing. Nine health professionals from a multidisciplinary mental health team attended a focus group; and two psychiatrists were interviewed, both with varying degrees of supervision experience. Psychiatrists reported concerns about prescribing in terms of themselves needing better support and communication, and perhaps having an involvement in the selection process. Nonetheless, the psychiatrist who had experience of supervision reported that this was highly positive. Overall, health professionals stated that nurse prescribing enhanced team working; however, most had limited knowledge about the role. Further training for teams, and the establishment of a good supervisory relationship and an agreed working structure are required to fully integrate this competency into specialist mental health services.     

Developing prevalence-based prescribing units for analysing variations in general practitioner prescribing: a case study using statins

OBJECTIVE: To develop regionally specific prevalence-, age- and sex-standardized prescribing units (PASS-PUs) and to relate these to statin prescribing. DESIGN: Cross-sectional. SETTING: Ninety-four general practitioner (GP) practices within one health authority in the north-west of England. MAIN OUTCOME MEASURES: Comparisons between specific therapeutic group age-sex-related prescribing units (STAR-PUs) and PASS-PUs for statin prescribing. RESULTS: STAR-PUs and PASS-PUs were calculated for all GP practices and there was a high degree of correlation (Spearman's rank coefficient 0.88; P < 0.001). Using actual prescribing data for statins for a 12-month period, a statistically significant correlation was found between net ingredient cost per patient and STAR-PUs per patient (Spearman's rank coefficient 0.36; P < 0.01). However, the correlation between average daily quantities per patient and PASS-PUs per patient was not statistically significant. A scatter plot revealed a pattern whereby GP practices with high proportions of patients aged over 75 years exhibited low statin prescribing in relation to the expected prevalence of treated coronary heart disease (CHD) in their patient population. CONCLUSIONS: Low weightings for patients aged over 75 years in calculating STAR-PUs lead to a much lower number of prescribing units within GP practice populations when compared with PASS-PUs. Current statin prescribing across GP practices in this study correlates with national prescribing cost patterns (as measured by STAR-PUs) although not with expected prevalence of treated CHD (as measured by PASS-PUs). PASS-PUs reflect prevalence of treated CHD and may therefore be used to monitor and predict GP prescribing arising from the implementation of the National Service Framework targets for CHD. In addition, PASS-PUs maybe derived for a wide range of therapeutic areas.     

Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views

Title.  Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views.
Aim.  This paper is a report of a study conducted to explore doctor and non-prescribing nurse views about nurse prescribing in the light of their experience in dermatology.
Background.  The cooperation of healthcare professionals and peers is of key importance in enabling and supporting nurse prescribing. Lack of understanding of and opposition to nurse prescribing are known barriers to its implementation. Given the important role they play, it is necessary to consider how the recent expansion of nurse prescribing rights in England impacts on the views of healthcare professionals.
Method.  Interviews with 12 doctors and six non-prescribing nurses were conducted in 10 case study sites across England between 2006 and 2007. Participants all worked with nurses who prescribed for patients with dermatological conditions in secondary or primary care. Thematic analysis was conducted on the interview data.
Results.  Participants were positive about their experiences of nurse prescribing having witnessed benefits from it, but had reservations about nurse prescribing in general. Acceptance was conditional upon the nurses' level of experience, awareness of their own limitations and the context in which they prescribed. Fears that nurses would prescribe beyond their level of competence were expected to reduce as understanding and experience of nurse prescribing increased.
Conclusion.  Indications are that nurse prescribing can be acceptable to doctors and nurses so long as it operates within recommended parameters. Greater promotion and assessment of standards and criteria are recommended to improve understanding and acceptance of nurse prescribing.     

Nurse prescribing: a policy overview

Nurses play an important role in ensuring that patients receive the maximum benefit from any medicines they are prescribed. This includes administering them, ensuring that patients understand how to take and store their medication, and recognising and acting on any side-effects. Some nurses also prescribe medicines. The NHS Plan envisages most nurses being qualified to prescribe or supply medicines (under patient group directions) by 2004. This article discusses current developments in policy on nurse prescribing and the implications for nurses.     

Supplementary nurse prescribing for patients with skin conditions: a national questionnaire survey

Aim. To examine the prescribing practices of supplementary nurse prescribers (working in both primary and secondary care) who prescribe medicines for patients with skin conditions and the factors that facilitate or inhibit this mode of prescribing. Background. Nurses work in a variety of roles, with varying levels of expertise, are involved in the treatment management of a broad range of skin diseases. Skin conditions are those for which independent nurse prescribers prescribe most frequently. The role of the nurse, limitations of the formulary and inter‐professional relationships influence the prescribing practices of these nurses. There is no evidence currently available examining the impact and activity of supplementary nurse prescribing for patients with skin conditions. Methods. A convenient sample of 580 nurses who prescribed for skin conditions and were qualified supplementary nurse prescriber, self‐completed a written questionnaire. Results. Five hundred and twenty (89·7%) nurses were based in primary care and worked in general practice. Four hundred and thirty‐six (75%) held a degree level qualification or higher, 41 (7%) had specialist dermatology training and 512 (88·3%) had more than 10 years postregistration nursing experience. Supplementary prescribing was used by a minority of nurses. Nurses who had specialist dermatology training used this mode of prescribing most frequently. Doctor and pharmacists lack of understanding of supplementary prescribing, lack of peer support and clinical management plans prevented the implementation of this mode of prescribing. Conclusions. Supplementary prescribing is used by a minority of nurses to treat skin conditions. A number of factors prevent nurses from using this mode of prescribing including lack of specialist training and lack of support in practice. Relevance to clinical practice. Specialist dermatology training, an understanding of supplementary prescribing by the members of the healthcare team, and support in practice are required if supplementary prescribing is to be implemented effectively for the treatment of skin conditions.