Did we do everything we could have? Nurses’ contributions to medicines optimization: A mixed‐methods study

Abstract

Aim To explore UK professionals’ interpretations of medicines optimization and expansion of nurses’ roles. Design This mixed‐methods study sought professionals’ views on nurses’ involvement, competency and engagement in monitoring patients for adverse effects of medicines, monitoring adherence, prescribing and patient education. Method An online survey and interviews were undertaken with nurses, doctors and pharmacists in Wales and England, May 2018 to July 2019. Results In all, 220 nurses, 17 doctors and 62 pharmacists responded to the online survey, and 24 professionals were interviewed. Nurses were divided over extending their roles, with 123/220 (55.9%) wishing to extend roles in monitoring patients for possible adverse drug reactions (ADRs), 111/220 (50.5%) in adherence monitoring, 121/220 (55.0%) in prescribing and 122/220 (55.4%) in patient education. The best‐qualified nurses were the most willing to increase involvement in monitoring patients for ADRs (aOR 13.00, 1.56–108.01). Interviews revealed that both nurses and doctors assumed the other profession was undertaking this monitoring. Respondents agreed that increasing nurses’ involvement in medicines optimization would improve patient care, but expressed reservations about nurses’ competencies. Collaboration between nurses and doctors was suboptimal (rated 7/10 at best) and between nurses and pharmacists even more so (6/10 at best). Conclusion Juxtaposition of datasets identified problems with medicines optimization: although most respondents agreed that increasing nurses’ involvement would positively impact practice, their educational preparation was a barrier. Only ~50% of nurses were willing to expand their roles to fill the hiatus in care identified and ensure that at least one profession was taking responsibility for ADR monitoring. Impact To improve multiprofessional team working and promote patient safety, nurse leaders should ensure patients are monitored for possible ADRs by at least one profession. Initiatives expanding nurses’ roles in medicines optimization and prescribing might be best targeted towards the more educated nurses, who have multidisciplinary support.

Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes

“…In line with WHO statements regarding nursing and health care more generally, in pharmaceutical care, nurses provide autonomous and collaborative care in the front lines, including health promotion, illness prevention, treatment and rehabilitation, for most populations. They closely support patients in managing their medicines, monitoring effects and any adverse side effects of medicines and preventing drug-related problems, for example, by checking medicines before administration [ 12 , 13 , 14 , 15 ]. A positive impact on care quality is associated with nurses assuming responsibilities in pharmaceutical care.…”

“… Eliminating inequity The inequity in the outcomes and processes of care is often based on socio-economic or territorial inequalities, resulting in restricted access to quality health care services. Nurses have potential to contribute to pharmaceutical care and to deliver safe and optimal pharmaceutical care [ 14 , 82 ]. There is little evidence that nurse substitutions [ 83 ] or nurse practitioners’ care [ 76 , 84 ] or costs [ 85 ] differ from those of doctors, particularly when prescribing practices are compared.…”

Nobody ever questions—Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative

“…However, the Care Quality Commission [ 60 ] p.16 report that patients in care homes are not monitored because there are no systems to support the process, and professional responsibilities for this are not defined. This may, in part, be attributed to the uncertainty regarding nurses’ roles in several aspects of medicines management [ 61 ], including engagement in monitoring, identifying and reporting potential ADRs [ 62 ].…”

Public Perceptions and Attitudes on the Image of Nursing in the Wake of COVID-19

“…Yet, despite this, the nurse’s image is still perceived by the public as hierarchically subordinate to physicians [ 5 , 6 ]. In order to improve multi-professional teamwork and promote patient safety, nurse leaders should manage the treatment and conduct a prospective follow-up of their patients [ 7 ].…”

“…There is also a “care gap” between nurses and other health professions regarding the nurse’s role, which may relate also to the nursing profession’s image. For example, nurses have more positive attitudes toward expanding nurses’ authority than physicians do, specifically toward drug administration and resuscitation [ 7 , 8 ]. In several studies, nursing is viewed as a subordinate profession that depends on, assists, or helps doctors, with some alluding to a lack of overall autonomy, and, more specifically, to a lack of decision-making autonomy, and others to less responsibility [ 5 , 7 , 8 ].…”