Potentially inappropriate medicine prescribing by nurse practitioners in New Zealand

Abstract

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.

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“…In New Zealand, NPs were given prescribing rights in 2002, allowing them to prescribe medicines from a gazetted list of drugs ( Lim et al., 2014 ). In 2014, legislation changes gave NPs full authorized prescribing rights that permitted independent prescribing of any medicine within a specific area of practice ( Poot et al., 2019 ; Nurse practitioner 2020 ). This was revised by the Nursing Council of New Zealand (NCNZ) in 2017 to remove restrictions on specific areas of practice and broadened the scope of prescribing practice to include all medicines within their competence and clinical experience ( Nurse practitioner 2020 ).…”