Are nurse prescribers issuing prescriptions in palliative care?

Abstract

Prescribing in palliative care was an ‘early candidate’ area for the extension of nurse prescribing authority, but has failed to meet expectations. The low number of nurse prescribers working in palliative care, and the impact of the lack of this kind of professional, has received little attention. This paper gives details of an ‘in-depth service evaluation project’ relating to the prescribing activity of specialist palliative care nurse independent prescribers (SPCNIPs) in one community palliative care team to ascertain the volume of their prescribing activity as well identifications of the outcomes and influences to their prescribing activity.

Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

“…While staff clarity on their roles in relation to IP positively influenced willingness to provide enabling supports such as clinical administration, 136 149 record access 144 and clinical supervision/pharmaceutical advice 140 146 lack of team understanding of IP was a barrier that was cited repeatedly across the review decade. 132 136 137 139 140 143 144 146 147 149 …”

“… 128 Prepared practice mentors with clarity on their role obligations in general provided a higher level of input to students, 127 and good mentor–student relationships that continued post-training facilitated transition. 132 Additional training buddying schemes helped students better manage the competing demands of training while working, although time constraints limited their uptake. 129 …”

“…Reports of poor transition support pervaded the review decade 130 132 135 136 139 140 146 147 and there was limited evidence of pre-emptive, formalised supervision provision. 132 Nurses reported this absence as immediately impactful, 139 especially in isolated roles and in services with few prescribers. 130 147 While nurses and pharmacists desired structured and informal supervision, 140 147 in all seven studies addressing this theme, 130 132 136 139 140 146 147 most could only access a variable level of informal support.…”

“… 132 139 140 146 147 150 Seeking clinical information caused significant delays, in some cases causing IPs to revert to GP referral for prescribing needs. 132 139 146 147 However, recent IT accessibility was suggested to mitigate retrieval problems. 144 …”

Community palliative care clinical nurse specialists as independent prescribers: part 2

“…One participant interviewed felt that it was safer if the GP prescribed as it could be entered straight onto the patient's record. The difficulties associated with access to patients' records is well documented (Cole and Gillett, 2015;Smith et al, 2011;Downer and Shepherd 2010;Stenner and Courtenay, 2007;Hall, 2006) and is a specific concern associated with supporting patients in the community. Despite Hall's (2006) study identifying these concerns a decade ago, it would appear that Clinical Commissioning Groups and palliative care providers have some way to go before this issue can be resolved.…”