Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review

Noblet, Tim; Marriott, John; Graham-Clarke, Emma; Rushton, Alison

doi:10.1016/j.jphys.2017.09.001

Cited by 40 publications

(77 citation statements)

References 62 publications

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“…Building a supportive culture for independent prescribing relies upon IPs establishing strong inter‐professional relationships with colleagues (Smith et al, ; Stenner et al, ). However, fostering inter‐professional relationships could be challenging for IPs in primary care settings such as community pharmacy where contact with physicians and other healthcare professionals is often limited (Bradley, Ashcroft, & Crossley, ; Hindi, Jacobs, & Schafheutle, ; Noblet, Marriott, Graham‐Clarke, & Rushton, ). Moreover, IPs could also encounter difficulties accessing patient records, ongoing training and clinical supervision depending on their healthcare settings (Courtenay et al, ; Hindi, Schafheutle, & Jacobs, ; Stenner et al, ; Weeks, George, Maclure, & Stewart, ).…”

Section: Discussionmentioning

confidence: 99%

“…Patient awareness of independent prescribing was perceived to be a barrier by both IPs and colleagues in this study. Research investigating patient and public awareness of independent prescribing remains limited (Noblet et al, ). However, strategies to enhance patient and public awareness of independent prescribing should be considered given the increasing number of professions which can now prescribe.…”

Section: Discussionmentioning

confidence: 99%

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Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences

Hindi

Seston

Bell

et al. 2019

Health Soc Care Community

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Besides doctors and dentists, an increasing range of healthcare professionals, such as nurses, pharmacists and podiatrists, can become independent prescribers (IPs). As part of an evaluation for independent prescribing funded training, this study investigated views and experiences of IPs, their colleagues and patients about independent prescribing within primary care. Questionnaires capturing quantitative and qualitative data were developed for IPs, their colleagues and patients, informed by existing literature and validated instruments. IPs were identified following independent prescribing training funded by Health Education England Northwest in 2015-2017.Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Twenty-four patients, 20 IPs and 26 colleagues responded to the questionnaires. Most patient respondents had a long-term medical condition (n = 17) and had regular medicines prescribed (n = 21). IPs were nurses (n = 14), pharmacists (n = 4), one podiatrist (n = 1) and one was unknown. Half of the IPs were current prescribers (n = 10), the other half were still training (to become) IPs (n = 10).Colleague respondents were doctors and nurses (n = 15) other healthcare professionals (n = 8) and practice managers (n = 3). Both current IPs (n = 9) and colleague respondents (n = 25) (strongly) agreed that independent prescribing improved the quality of care provided for patients. Nearly all colleagues were supportive of independent prescribing and believed that they worked well with IPs (n = 25). Patients' perceptions and experiences of their consultations with the IP were mostly positive with the vast majority of respondents (strongly) agreeing that they were very satisfied with their visit to the IP (n = 23). Key barriers and enablers to independent prescribing were centred on IPs' knowledge, competence and organisational factors such as workload, effective teamwork and support from their colleagues. Findings from this study were mainly positive but indicate a need for policy strategies to tackle longstanding barriers to independent prescribing. However, a larger sample size is needed to confirm findings. K E Y W O R D Scolleagues, independent prescribers, independent prescribing, non-medical prescribing, patients, primary care e460 | HINDI et al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences

Hindi

Seston

Bell

et al. 2019

Health Soc Care Community

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“…This reduced patient waiting time and improved continuity of care whereby patients were seen for the whole episode by the same nurse prescriber. Patients also received comprehensive education and advice on prescribed medication with 90% of patients indicating an intention to comply with medication advice (Armstrong, 2015; Courtenay, Carey, Stenner, Lawton, & Peters, 2011; Courtenay, Stenner, & Carey, 2010; Drennan et al., 2009, 2011; Graham‐Clarke, Rushton, Noblet, & Marriott, 2018; Noblet, Marriott, Graham‐Clarke, & Rushton, 2017). Patients with long‐term illnesses when describing their satisfaction in extending prescribing authority to nurses highlighted continuity of care from, and ease of access to, nurse prescribers that they were familiar with as key issues (Drennan et al., 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical practice in our study reflects many of these attributes, whereby patients’ were reviewed by the nurse prescriber every month, changes made to the anaemia prescription following review of their bloods, so ensuring speeder care delivery and continuity of care whereby patients did not have to be reviewed by various members of the renal medical team. In addition, extending prescriptive authority to nurses is known to enhance their professional development, confidence, job satisfaction, professional autonomy and results in better use of their skills (Drennan et al., 2009; Noblet et al., 2017).…”

Section: Discussionmentioning

confidence: 99%

A nurse prescriber‐led protocol for anaemia management in established haemodialysis patients: A retrospective study

George

McCann

2020

Journal of Clinical Nursing

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Aim and objective To evaluate the impact of a nurse prescriber‐led protocol compared to a traditional physician‐led nonprotocol‐based approach had on maintaining targeted haemoglobin levels in patients on maintenance haemodialysis. Background Anaemia is a common complication of chronic kidney disease and has a profound impact on the patients’ well‐being. Current practices place a greater emphasis on the decision‐making role of nurses in renal anaemia management. The introduction of nurse prescribing in this area is a relatively new concept. Design A retrospective cohort design, covering an eight‐month period pre‐ and post introduction of a nurse prescriber‐led anaemia protocol; study adheres to the STROBE Statement. Methods Using a nonprobability convenience sample, data extracted from the medical records and electronic patient records system (eMed) related to 74 patients at a single outpatient haemodialysis centre located within an acute general teaching hospital. The primary outcome was patients’ haemoglobin level pre‐ and post introduction of the protocol. Secondary outcomes included erythropoietin‐stimulating agent and iron dosage, and serum ferritin and transferrin saturation levels. Results There were no statistically significant differences between pre‐ and post protocol serum haemoglobin level and erythropoietin‐stimulating agent dosage. Under the management of the nurse prescriber, patients experienced a significant improvement in serum ferritin and transferrin saturation levels and required significantly less intravenous iron dosage. Conclusions This study, the first of its kind, found that patients receiving haemodialysis experience a significant improvement in iron indices while receiving a significantly lower amount of intravenous iron when managed by a nurse prescriber. Furthermore, the nurse prescribers’ decision‐making capacity is as effective as a physician‐led nonprotocol‐based approach in achieving haemoglobin target levels. Relevance to clinical practice Nurse prescribers have a role in implementing a safe, standardised and sustained approach to anaemia management in outpatient haemodialysis settings without compromising patient care.

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“…Their main roles vary, although certain tasks and responsibilities may overlap. Besides, some activities seem to be too complex and not entirely clear [4,5]. In particular, the role of nurses seems to be wider than described so far [6,7].…”

Section: Introductionmentioning

confidence: 99%

Advanced nurses’ practices related to pharmaceutical care in the Czech Republic

Heczková

Dilles

2020

Pielegniarstwo XXI Wieku / Nursing in the 21st Century

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Introduction. The use of pharmaceutical products is a very complex part of healthcare, where a variety of healthcare professionals collaborate. Unfortunately, the role of all professional groups does not seem to be entirely clear despite of the high regulation. Evidence suggests that the role of nurses can be much wider than expected and specified by the related policies.Aim. The aim of the study was to explore nurses’, physicians’ and pharmacists’ perspectives of nurses’ practices related to pharmaceutical care (PC) in the Czech Republic.Methods. A cross-sectional online survey was conducted. Qualified nurses (629), physicians (69) and pharmacists (39) were questioned about their views on the nurses’ involvement in various advanced activities related to PC.Results. Participation on the advanced activities related to PC during the last month was high (providing information and patient education 80%; monitoring medication adherence 72%; monitoring medication effects 56% and participation on prescribing medication 19%). Nurses were most likely to see the investigated PC aspects as part of their nursing tasks when compared to the physicians’ or pharmacists’ point of view. However, a substantial part of participants believed in the positive impact of nurses’ involvement in activities related to PC. On the other side, interprofessional collaboration remains unsatisfactory and communication within an interprofessional team was rated as being very poor.Conclusions. The need to increase the nurses’ involvement in PC exists. Optimising formal nurses’ competencies, revising the skills mix in different types of workplaces and revising the nursing curricula, as well as improving the interprofessional collaboration, could result in a positive effect on patient outcomes.

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Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review

Abstract: PROSPERO CRD42015017212. [Noblet T, Marriott J, Graham-Clarke E, Rushton A (2017) Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. Journal of Physiotherapy 63: 221-234].

Cited by 40 publications

References 62 publications

Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences

Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences

A nurse prescriber‐led protocol for anaemia management in established haemodialysis patients: A retrospective study

Advanced nurses’ practices related to pharmaceutical care in the Czech Republic

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