Beginners in prescribing practice: Experiences and perceptions of nurses and doctors

Lim, Anecita Gigi; North, Nicola; Shaw, John

doi:10.1111/jocn.14136

Cited by 16 publications

(17 citation statements)

References 39 publications

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“…Prescribing practices across professions have not been well studied (Lim, North, & Shaw, ). The fact that most respondents in the present study were hospital‐based, in urban areas and employed in the public sector is in keeping with the existing emphasis on acute care.…”

Section: Discussionmentioning

confidence: 99%

“Providing a complete episode of care”: A survey of registered nurse and registered midwife prescribing behaviours and practices

Casey

Rohde

Higgins

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices. Background The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision. Design Cross‐sectional national survey of registered nurse and midwife prescribers. Methods Data were collected through an online survey between April–July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study. Results Respondents estimated that two‐fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criterion for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents' clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations. Conclusion Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remain significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing. Relevance to clinical practice Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services.

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Section: Discussionmentioning

confidence: 99%

“Providing a complete episode of care”: A survey of registered nurse and registered midwife prescribing behaviours and practices

Casey

Rohde

Higgins

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…One reason for this phenomenon may be that a huge proportion of chart review and prescribing in hospitals is performed by novice physicians [5,17]. In surveys, advanced medical students have reported a feeling of unpreparedness to manage patients safely [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Most patient hazards do not arise from single drugs or diseases, but rather from the context [17,23]. Practice and experience are required to develop the expertise to manage patients with multiple morbidities [17,23]. However, studies have shown that with practice and training, advanced students can acquire the skills necessary to identify patient hazards during chart review and to safely and context-independently prescribe medications [24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

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Electronic charts do not facilitate the recognition of patient hazards by advanced medical students: A randomized controlled study

et al. 2020

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Chart review is an important tool to identify patient hazards. Most advanced medical students perform poorly during chart review but can learn how to identify patient hazards context-independently. Many hospitals have implemented electronic health records, which enhance patient safety but also pose challenges. We investigated whether electronic charts impair advanced medical students' recognition of patient hazards compared with traditional paper charts. Fifth-year medical students were randomized into two equal groups. Both groups attended a lecture on patient hazards and a training session on handling electronic health records. One group reviewed an electronic chart with 12 standardized patient hazards and then reviewed another case in a paper chart; the other group reviewed the charts in reverse order. The two case scenarios (diabetes and gastrointestinal bleeding) were used as the first and second case equally often. After each case, the students were briefed about the patient safety hazards. In total, 78.5% of the students handed in their notes for evaluation. Two blinded raters independently assessed the number of patient hazards addressed in the students' notes. For the diabetes case, the students identified a median of 4.0 hazards [25%-75% quantiles (Q25-Q75): 2.0-5.5] in the electronic chart and 5.0 hazards (Q25-Q75: 3.0-6.75) in the paper chart (equivalence testing, p = 0.005). For the gastrointestinal bleeding case, the students identified a median of 5.0 hazards (Q25-Q75: 4.0-6.0) in the electronic chart and 5.0 hazards (Q25-Q75: 3.0-6.0) in the paper chart (equivalence testing, p < 0.001). We detected no improvement between the first case [median 5.0 (Q25-Q75: 3.0-6.0)] and second case [median, 5.0 (Q25-Q75: 3.0-6.0); p < 0.001, test for equivalence]. Electronic charts do not seem to facilitate advanced medical students' recognition of patient hazards during chart review and may impair expertise formation.

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“…There is some evidence available that has explored the factors that influence the use of prescribing by specific healthcare professional groups. For example, strong relationships with other prescribers 20 21 and the importance of trust in these relationships 22 have been reported to influence the integration of prescribing into practice by nurses. There is also evidence available that has examined the implementation of prescribing by specific healthcare professional groups working in certain services and settings.…”

Section: Introductionmentioning

confidence: 99%

Classic e-Delphi survey to provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services in Wales

et al. 2018

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ObjectiveTo provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services.DesignClassic e-Delphi survey.SettingNational study in Wales.ParticipantsPharmacists, nurses and allied health professionals with the independent/supplementary prescribing qualification.ResultsA total of 55 non-medical prescribers agreed to become members of the expert panel of whom 42 (76%) completed the round 1 questionnaire, 40/42 (95%) completed round 2 and 34/40 (85%) responded to round 3. Twenty-one statements were developed, and consensus was achieved on nine factors representing those necessary for the successful implementation of non-medical prescribing and five representing actions required for its continued development. Strategic fit between non-medical prescribing and existing service provision, organisation preparedness, visible benefits, good managerial and team support, and a clear differentiation of roles were each important influences.ConclusionGiven the high degree of consensus, this list of factors and actions should provide guidance to managers and commissioners of services wishing to initiate or extend non-medical prescribing. This information should be considered internationally by other countries outside of the UK wishing to implement prescribing by non-medical healthcare professionals.

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Beginners in prescribing practice: Experiences and perceptions of nurses and doctors

Cited by 16 publications

References 39 publications

“Providing a complete episode of care”: A survey of registered nurse and registered midwife prescribing behaviours and practices

“Providing a complete episode of care”: A survey of registered nurse and registered midwife prescribing behaviours and practices

Electronic charts do not facilitate the recognition of patient hazards by advanced medical students: A randomized controlled study

Classic e-Delphi survey to provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services in Wales

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