Non‐medical prescribing: audit, practice and views

Abstract

Non-medical prescribing is increasingly utilized in clinical care and UK Standards have been produced for this. This study was undertaken to investigate compliance with these standards which were adopted by one mental health service and to review whether any changes were necessary to existing arrangements monitoring this compliance. A questionnaire was distributed to all 24 non-medical prescribers from one UK Mental Health Trust. Participants were asked to respond to questions about demographic data and prescribing practices. We also asked them to rate their experience on a 5-point scale. In all, 83% of non-medical prescribers responded. The UK Standards were met even though there was a shortfall in the uptake of training and supervision. Non-medical prescribers from the Community Drug Team and Older People's Service prescribed a narrow range of speciality drugs than any other category of drugs, but prescribed more often. UK Standards were met by the majority of non-medical prescribers. However, concerns were noted about a shortfall in training, supervision and experience of some non-medical prescribers. Conflict with psychiatrists was reported but their availability for support when necessary was valued. Non-medical prescribers believed that their input with non-medical prescribing had benefited patients.

Nonmedical prescribing: where are we now?

“…Experience in practice is working within context, and may lead NMPs to gain more confidence as prescribers in their area of work. This is observed when NMPs report themselves as becoming more familiar with certain drugs and conditions [Gumber et al 2012], and become more readily able to identify appropriate occasions on which to prescribe [Goswell and Siefers, 2009]. It must also be acknowledged that NMPs are healthcare professionals, who before entering a prescribing programme will have acquired a high degree of professional experience within their differing fields.…”

“…Other factors influencing the practical element of prescribing include time since qualifying [Ross and Kettles, 2012], training [Ross and Kettles, 2012;Boreham et al 2013], good grounding in knowledge [Green et al 2009;Stewart et al 2013;Hurst and Marks-Maran, 2011;Meade et al 2011;Gumber et al 2012], continuous practice [Dobel-Ober et al 2013;Green et al 2009;Stewart et al 2013], multidisciplinary support [Green et al 2009] and the use of formularies or guidelines [Dobel-Ober et al 2013].…”

Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences

“…Inadequate support from authorities, employers, pharmacists, other health professionals and the public : Of 23 studies reporting this, most were from the UK, followed by Canada, NZ and Australia . From the number of articles mentioned this theme, other health professionals, including pharmacists, were nominated as providing the least support, followed by authorities, employers, and patients or the public . Insufficient support from organisation and management teams was reported in the UK, including allocated time for required training or prescribing practice, or support staff to check prescriptions.…”

“…Reservations from other health professionals, doctors in particular, were a barrier in the UK, Canada, NZ, and Australia . Reasons given by Canadian and NZ physicians included risks to patient safety, extra burden to physicians and potential threat to physician–pharmacist relationships .…”

“…Inadequate training regarding diagnostic knowledge and skills : Twenty‐six studies reported inadequate training related to diagnostic knowledge and skills as a barrier to PP practice (from the UK, Canada, NZ and Australia). Provision of training and regular review of clinical skills were seen as steps to enhance the competence and confidence of pharmacist prescribers …”