Non-medical Prescribing Research Articles

The role of the designated prescribing supervisor: an evaluation

Aim To understand the experience of non-medical prescribers undertaking the role of designated prescribing supervisor with students on the non-medical prescribing course for the first time. Methods Questionnaire completed by 34 designated prescribing supervisors, followed by semi-structured interviews with 10 designated prescribing supervisors. Findings There were four themes identified from the data. These were: knowledge and experience prior to undertaking the designated prescribing supervisor role; how the role of designated prescribing supervisor was enacted in practice; interactions and engagements necessary to support the designated prescribing supervisor and underpin students' professional development; and the way in which the designated prescribing supervisor role supports personal growth. Conclusion Designated prescribing supervisors in this evaluation described their role as consisting of coaching, advice and pastoral support. The supervision which they provided tended to be unscheduled and informal. Designated prescribing supervisors valued the support they received from the University and their Employer. Undertaking the role of designated prescribing supervisors was described as beneficial to their continuing professional development, it enhanced job satisfaction and provided a greater sense of self-worth.

Adverse drug reactions

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided

Non-medical prescribing in primary care in the UK: an overview of the current literature

Background Non-medical prescribers are perceived as a complement to busy general practice in primary care. Aim To conduct an overview of the literature available on the role and impact of non-medical prescribers on primary care patients. Method A search was conducted using multiple databases to find articles published between January 2015-January 2021. Inclusion criteria: non-medical prescribers in primary care in the UK, written in the English language. Exclusion criteria: research conducted in secondary care or outside the UK. Findings 285 studies were identified; 15 were eligible for critical appraisal. The key themes were: non-medical prescriber's positive perceptions were autonomy, job satisfaction and colleague support. The negative perceptions included risk, lack of continuous professional development and organisational support. Conclusion By reviewing the perceptions of non-medical prescribing in primary care, organisations can ensure when employing new non-medical prescribers that adequate continued professional development and support is in place. Thereby reducing the concerns of non-medical prescribers about the ligation risk of prescribing.

Prescribing in the homeless population

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided

Independent prescribing in the UK: insights from the Department of Health Allied Health Professions Medicines Project team

BackgroundThe UK medicines legislation was amended ten years ago (2013) to allow podiatrists and physiotherapists independent prescribing rights, the first of the allied health professions to do so. Non-medical prescribing formed one part of a broader policy agenda promoting role flexibility in response to the challenge of an ageing population and the need to maintain effective health provision in the face of a contracting workforce.AimThe aim of this study was to outline the experiences of the Department of Health AHP medicines project board team in working towards independent prescribing for podiatry and physiotherapy, with a particular focus on the challenges encountered.MethodsIn depth, open-ended interviews were conducted with eight of the core members of the project team, drawn from those individuals who served throughout the duration of the project (2010–2013). Included were the former Department of Health Chief and Deputy Chief Allied Health Professions Officers; the Department of Health Engagement and Communications Officer; representatives of the Health and Care Professions Council; the Medicines and Healthcare products Regulatory Agency; the Council of Deans of Health; the Royal College of Podiatry and the Chartered Society of Physiotherapy (The team also included the representative of the Allied Health Professions Federation. However, as that representative is also a researcher in this study, he has recused himself from any role as a participant.). Data were transcribed and subject to a thematic analysis.ResultsA complex picture of the project emerged revealing a range of obstacles and challenges, including inter-professional role boundary tensions and negative prior assumptions about the two professions. Success hinged upon the adoption of a dual strategy involving submission of a robust case of need focused on patient benefit coupled with the careful management of professional expectations. Underpinning theory from the sociology of the professions offers a supportive explanatory framework for understanding the relationships between the various stakeholders involved.ConclusionsUltimately, success depended upon aligning the project aims with healthcare policy through a clear focus on patient benefit. Balancing competing professional and policy demands through a continual emphasis on improved patient care laid the foundations for future projects by other allied health professions.

BACCN position statement on non‐medical prescribing in critical care

AbstractBackgroundThe British Association of Critical Care Nurses (BACCN) published its first position statement on non‐medical prescribing (NMP) in critical care in 2009 (Bray et al., Nurs Crit Care. 2009;14:224‐234). Over the years, more nurses and other health care professionals have become non‐medical prescribers, and the BACCN have thus revisited and updated the statement.AimTo update the 2009 position statement on NMP in critical care to reflect contemporary guidance and practice.Study designA working group was established following an expression of interest to BACCN members, and the original BACCN position statement and literature review were updated using key databases. An electronic questionnaire was developed by the working group to describe current NMP practises and the authorization and prescribing of blood and blood components. It was distributed via email to 1861 BACCN members and on BACCN social media in October and November 2021.ResultsTwo hundred and fifty nine health care professionals from the four countries of the United Kingdom completed the survey, and of these 136 (52.5%) respondents were BACCN members. One hundred and five (40.4%) of the respondents described themselves as non‐medical prescribers, and of these, 57 (54.8%) were independent prescribers and 47 (45.2%) were supplementary and independent prescribers, with one respondent not revealing. The remaining 154 (59.4%) respondents were not registered as non‐medical prescribers. Ninety‐one (86.7%) of the respondents who were non‐medical prescribers reported making prescribing decisions on every clinical shift, and 67 (64.4%) of these audited their prescribing practises. Of the 105 who described themselves as non‐medical prescribers, 71 (67.6%) had been in their area of practice for more than 5 years before they became non‐medical prescribers, with 3 (2.8%) being in the practise area for less than 1 year.All seven statements from Bray et al's (2009) position statement were revised and updated following the survey results and review of the literature search.ConclusionsThe updated position statement is based upon new policy documents from a range of sources, including the Nursing and Midwifery Council, the Faculty of Intensive Care Medicine, the Royal College of Emergency Medicine and the Royal Pharmaceutical Society. It takes account of the adult critical care patient pathway before, during and after an admission to critical care.Relevance to clinical practiceNon‐medical prescribing (NMP) should only be implemented to improve the safety and quality of care for the critically ill or deteriorating patient. The requirement for NMP needs to be determined locally by organizations, ensuring that the care of the critically ill and deteriorating patient is the main reason. NMP must not be used as a substitute for unsafe medical practice or poor medical prescribing practice. Non‐medical prescribers must adhere to the current Royal Pharmaceutical Society's Prescribing Competency Framework and must be registered with their professional regulatory body. Non‐medical prescribers must audit and evaluate their practice as well as ensuring continuing professional development. Non‐medical prescribers in critical care must consider how their own professional codes of conduct, scope of practice, standards and guidelines impact their prescribing decisions. Non‐medical prescribers must work collaboratively to ensure that continuity and transfer of care between care settings consider deprescribing and medicines reconciliation.

Independent prescribing for a child with a first diagnosis of asthma: a case study.

Asthma is a chronic condition of varying intensity that is characterised by symptoms including coughing, wheezing, chest tightness and breathlessness. The article details a case study outlining the consultation and prescribing practice for a five-year-old girl who presented with a cough and breathlessness, and who was subsequently diagnosed with asthma. The author assessed and treated this patient while undertaking her non-medical prescribing qualification, and she outlines the diagnostic and prescribing decision-making process. The author also examines the potential drug interactions and adverse drug reactions relevant to the patient's age and comorbidities.

Clinical pharmacists in primary care general practices: evaluation of current workforce and their distribution.

General practices in primary careacross England are increasingly employing clinical pharmacists to help tackle the workforce crisis and alleviate pressure. Clinicalpharmacists can provide administrative and clinical duties, including non-medical prescribing, advice on polypharmacy and medicines optimisation. The aim of this study was to investigate the distribution of clinical pharmacists in general practice across England, and explore the relationship between the distribution and regional demography. This study used publicly available government database from various sources pertaining to primary care general practice workforce and population demographics of England. The number and distribution of pharmacists working within general practices in England were analysed and compared across practices considering general practitioner (GP), nurse and patient population in the practices, patientsage ≥ 65years and over and the Index of Multiple Deprivation (IMD) scores. Twenty two percentage (1469 of 6674)of practices in England were found to have access to a clinical pharmacist, equating to 1358 full-time equivalent (FTE) pharmacists and a mean pharmacist FTE of 10.07 (95% CI 8.40, 11.75, SD = 9.84) per Clinical Commissioning Group (CCG). A significant relationship between pharmacist FTE and the number of patients 65years and older [r (132) = 0.75, P < 0.001)] was observed; however, the distribution was not related to population deprivation scores. Approximately one in five general practices in England have access to a clinical pharmacist. Further research is needed to ensure wider and equitable distribution based on workforce needs and practice population demography.

Deprescribing in practice

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided

Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx (PHOENIx): a study protocol for a pilot randomised controlled trial

IntroductionThe number of people experiencing homelessness (PEH) is increasing worldwide. Systematic reviews show high levels of multimorbidity and mortality. Integrated health and social care outreach interventions may improve outcomes. No...

Exploring the impact of attending an online CPPE return to prescribing (RTP) programme

Abstract Introduction Within the Interim NHS people plan, pharmacist prescribers are described as a central part of the multi professional team across primary care networks.1 Non-medical prescribers (NMP) constitute a small proportion of the pharmacy workforce and a proportion of NMPs do not use their qualification.2 CPPE has designed a series of three online workshops to support return to prescribing by improving NMP’s knowledge of law and ethics, improve confidence and discuss barriers and solutions with peers in a safe supportive environment. We routinely evaluate all of our programmes and used this data to inform this study. Aim To explore the learner’s feedback following attendance at the online CPPE RTP series of workshops by asking for their views on: the impact of the course on their knowledge of the topic, how exploring the barriers and solutions influenced their prescribing practice and the usefulness of the programme and resources. Methods Between March 2020 and July 2022, 119 people attended the CPPE RTP online workshops. Using online post workshop evaluation surveys sent to all attendees, participants were asked to share feedback on their experience of the programme via a course specific survey adapted from the CPPE standard post workshop evaluation. In July 2022 there were 59 responses. The data was analysed using thematic analysis3 to highlight common themes from the free text survey comments. This evaluation considered the intentions of learners at the sessions, follow up surveys would permit the exploration of the impact on sustained practice change. Ethical approval was not required as this was a course evaluation Results 98% of participants felt that the workshops increased their knowledge of the topic and 97% of participants felt the workshops were thought provoking. Barriers to prescribing were identified included: no defined role (26%), no support (32%), no personal confidence (26%), lack of understanding of prescribing role from GP colleagues (10%), prescribing not in job description, therefore not covered by indemnity (6%). After attending the RTP workshops 70% of pharmacists were using their prescribing qualification and 40% were prescribing more often. The programme evaluation showed 56% of participants felt that sharing and listening to others experiences gave them confidence and support to consider starting to prescribe, 21% of participants found the knowledge and enthusiasm of the CPPE tutors supportive and 16% found discussion of the case studies to be useful. 7% of participants found sign posting to resources helpful. Discussion/Conclusion This evaluation demonstrated that the RTP programme helped pharmacists to identify barriers to prescribing and facilitated peer discussion of solutions and of sharing best practice. The course was shown to increase the confidence of participants and facilitate their journey to start prescribing again. Increasing the number of pharmacist prescribers using their qualification has a positive impact on patient care.1 Our research shows that participating in the CPPE return to prescribing workshop series enables pharmacists to return to or start prescribing in practice.

The case to improve technologies for pharmacists' prescribing.

Increased healthcare needs during the COVID-19 pandemic and recent natural disasters have highlighted the value of community pharmacists in the efficient and effective delivery of health services. In Australia, legislative amendments have enabled pharmacists to extend the supply of certain prescription medicines to better address their community’s needs in emergency situations.[1] Authors have argued for longer term and broader expansion of nonmedical prescribing to maintain these efficiencies and enhance the public’s timely and equitable access to essential prescription medicines.[2] This Commentary argues that expanded and fully integrated pharmacist prescribing will require greater access to a range of health information communication technology (ICT) platforms to assist pharmacists’ clinical decision-making and to meet legal and ethical obligations in relation to clinical documentation. Specifically, we call for a tailored evaluation framework for health ICT to support contemporary pharmacy practice and prescribing roles of pharmacists.

The influence of non-medical prescribers on antimicrobial stewardship: a national evaluation of the impact of the COVID-19 pandemic on the prescribing of antibiotics by non-medical prescribers in England in 2020 (part 2)

Background Part one of this study identified that prescribing behaviours during 2020 differed significantly from 2016-2021. Part 2, presented here, covers a more detailed analysis of the impact of the early part of the COVID-19 pandemic is presented here. Aims To describe patterns in community prescribed and dispensed antibiotic volumes attributable to non-medical prescribers during 2020 compared to the previous 4 years and identify any changes of behaviour during this period and their impact on antimicrobial stewardship. Methods An analysis of retrospective non-medical prescribers' prescribing data was performed to determine the numbers of independent non-medical prescribers and the patterns of prescribed community dispensed antibiotic volumes between 2016-2021. The 2020 data were then compared to the data from previous years. Findings The total amount of dispensed non-medical prescribers antibiotic prescription items per 100000 population dropped by 12% in 2020 compared to 2019, driven predominantly by reductions in nurse prescribing. However, high-risk antibiotic prescribing rose from 5.3% of antibiotics prescribed in 2019 to 6.4% in 2020. Seasonal patterns of antibiotic prescribing differed in 2020, with significant reductions in prescribing of antibiotics normally associated with treating LRTI from the first lockdown in March 2020. Conclusions The COVID-19 pandemic forced rapid changes in practice, including increased remote working, which created a challenging prescribing environment that adversely affected the high-risk antibiotic prescribing behaviour of non-medical prescribers more than it affected their medical colleagues. There were unusually low levels of prescribing for respiratory tract infections over the last quarter of 2020 which, although likely multifactorial, may indicate over-prescribing for self-limiting viral infections in previous years. More research is needed to establish ongoing prescribing trends and patient outcomes, and how antimicrobial stewardship programmes and training can be better targeted to support prescribers to address quality and safety issues arising from changing modes of practice.

Polypharmacy and the older adult

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided

The influence of non-medical prescribers on antimicrobial stewardship: a national evaluation of the prescribing of antibiotics by non-medical prescribers in England from 2016 to 2021 (part 1)

Background Non-medical prescriber numbers have increased rapidly over the last 10 years, with increasingly diverse roles and backgrounds. Previous evaluations of their antibiotic prescribing demonstrated it was generally of a high quality and guideline-driven, but recent evidence is lacking and the data are not easily accessible. Aims To describe changes in the non-medical prescriber population and patterns in dispensed antibiotic volumes between 2016–2021, highlighting evidence of good antimicrobial stewardship and where further interventions may be required. Methods An analysis of retrospective non-medical prescriber prescribing data was performed, to determine the numbers of independent non-medical prescribers and the patterns of prescribed community-dispensed antibiotics in England between 2016–2021. Findings Between 2016–2021, it was found that independent non-medical prescriber numbers in England rose by 54%. Whilst they remain predominantly nurses (76%), the numbers of pharmacists and allied health professionals have increased. Non-medical prescribers were responsible for 10.6% of all dispensed antibiotic items prescribed in primary care in England. However, the proportion of dispensed antibiotic items prescribed by these non-medical prescribers reduced by over 50%. Prescribing in 2020 differed from previous years, with increased high-risk antibiotic prescribing. Conclusion The quality of prescribing generally appears good and in accordance with national guidelines and principles of good antimicrobial stewardship. The 2020 COVID-19 pandemic prompted changes in antibiotic prescribing behaviour.

Podiatrist's prescribing practice

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided

An evaluation of a collaborative pharmacist prescribing model compared to the usual medical prescribing model in the emergency department.

Workforce reform has placed a significant focus on the role of non-medical prescribers in the healthcare system. Pharmacists are trained in pharmacology and therapeutics, and therefore well placed to act as non-medical prescribers. To assess the safety and accuracy of inpatient medication charts within a pharmacist collaborative prescribing model (intervention), compared to the usual medical model (control) in the emergency department (ED). Another objective compared venous thromboembolism (VTE) risk assessment and prescribing, between intervention and control groups. Adult patients in ED referred for hospital admission were randomised into control or intervention by a block randomisation method, until the required sample size was reached. Medication charts were audited retrospectively by an independent auditor, using validated audit forms. Intervention group medication charts contained significantly fewer prescribing errors, omissions and discrepancies compared to the control group, and improved documentation of adverse drug reactions. VTE risk assessment and prescribing had higher guideline concordance in the intervention group compared to the control group. This collaborative prescribing trial showed excellent results in safety and accuracy of pharmacist prescribing when compared to the usual medical model of prescribing. The admitting medical practitioner and extended scope pharmacist prescriber worked as a collaborative team in emergency, which improved Australian national prescribing safety indicators.

Prescribing in physiotherapy

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided

Understanding autoimmune diseases: part 2

In the second part of this series on autoimmune diseases, Margaret Perry gives an overview of systemic lupus erythematosus, coeliac disease and ulcerative colitis This article follows on from a previous one looking at some of the more widely seen autoimmune diseases. Autoimmune diseases are highly complex in their pathophysiology, and this together with the variety of signs and symptoms, and variable degrees of severity, often makes diagnosis difficult. This article aims to give a brief insight into the conditions discussed, giving general practice nurses and non-medical prescribers some knowledge and confidence in assessing and advising patients who present, with the aim of getting an earlier diagnosis and treatment, and, ultimately, improving quality of life of all those affected by any of these diseases.

How preceptorships can benefit nurse prescribers

Non-medical prescribers lacked confidence in practising autonomously so one trust devised a support programme