Early adopters of paramedic prescribing: a qualitative study

Abstract

Aims: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the United Kingdom.Methods: Following a public consultation by NHS England in 2015, the decision was made in March 2018 to amend legislation to enable advanced paramedics to independently prescribe medicine in UK settings. Capturing the experience of these ‘early adopters’ will help to identify where paramedic prescribing can produce optimum benefits in healthcare systems, as well as enabling early scoping out of challenges to implementation and strategies for resolving challenges. This exploratory qualitative study involved interviews with 17 paramedics who have undertaken the independent prescribing programme in the United Kingdom. Participants were recruited via social media and regional paramedic networks between May and July 2019. Interviews were conducted by telephone or video call and explored use/anticipated use of prescribing, benefits and challenges to prescribing and support for the prescribing role. Thematic analysis was conducted to identify key themes.Results: Of the 17 participants, six were currently prescribing and the remainder were awaiting annotation. Participants worked in a range of settings, including: primary care, emergency departments, urgent care, walk in centres and rapid response services. Key benefits to prescribing were similar to those reported by other non-doctor prescribers and included: streamlining care for patients, improving safety, improving efficiency and facilitating new advanced clinical practice roles. Key challenges included: administrative IT issues, lack of ability to prescribe controlled drugs and managing patient/colleague expectations around paramedic prescribing. In general, participants felt supported in their prescribing role, both by doctors and other non-doctor prescribers, and felt confident to prescribe following the prescribing course. Concerns were raised about potential isolation in some settings, lack of parity in prescribing legislation across different professions and the way this is taught in prescribing programmes.Conclusion: Indications are that paramedic prescribing is rolling out successfully in line with expectations. Barriers and facilitators are similar to those reported by other non-doctor prescribers and independent prescribing is already an essential component to advanced practitioner roles in settings such as primary care. Findings highlight a need for greater alignment of prescribing legislation across non-doctor prescribers from different professions undertaking advanced roles.

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

“… 177 178 Early data suggesting challenges around role isolation, team expectations of paramedic IP and lack of legislative parity for controlled drugs warrants further exploration to determine whether paramedics too, face similar barriers identified by this review. 175 179 …”

“…While its affective nature169 170 and need for bespoke support systems has been previously recognised,171 172 few studies have specifically sampled novice prescribers170 173 to ascertain optimal supervisory requirements 169. Despite extension of IP rights to optometrists, physiotherapists, radiographers, podiatrists and paramedics over the past 13 years, focus on implementation issues during transition within each profession has been limited 43 174 175. This is likely to be especially important for paramedics who, awarded IP rights in 2018 have not been subject to the supplementary prescribing lead in period that characterises other professions176 and who are historically less well established in the primary care workforce 177 178.…”

Impact of a Mobile App on Paramedics’ Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial

“…They had undergone a 3-year education program and were trained in advanced life support procedures, including defibrillation, airway management, peripheral intravenous line cannulation, and the administration of medications to ensure advanced independent emergency prehospital care. Similar to the Anglo-American model [ 40 , 41 ], paramedics in Switzerland constitute the initial response team and are qualified to independently administer a range of medications. To achieve adequate participant enrolment to reach the target sample size (ie, 120 paramedics [ 39 ]), shift-working paramedics were randomly recruited weeks before the start of the study by a blinded noninvestigator in each EMS center.…”

Paramedic independent prescribing in primary care: seven steps to success

“…Nevertheless, evidence indicates some students lack understanding of NMP (Ross and Kettles, 2012;Ross, 2015), and whilst training clarifies expectations (Carey et al, 2017), having a clear understanding of the commitment level necessary relative to overall work-life balance in advance is highly advisable. Early reports suggest strategies to deal with course demands (Dixon, 2019b) and promote common understanding of paramedic prescribing role capabilities (Stenner et al, 2019) may be beneficial. For example, the "Preparing to Prescribe" toolkit (Carey and Stenner, 2020), a relatively new and freely available resource, has been designed specifically to help ensure consistency in the information provided and facilitate preparation for the prescribing role (AFP, 2019).…”

“…It remains to be seen if this change in strategy results in unique, profession specific barriers. Nevertheless a small qualitative study exploring the experiences of an early cohort of qualified PIPs points to transitional problems (Stenner et al, 2019), suggesting organisational readiness that builds capacity for implementation is important (Shea et al, 2014). The full cost of training an individual NMP is around £10,000 (Latter et al, 2010) and if implementation fails or is partially successful there is risk of loss of investment to practitioners, patients and the wider NHS (Bowskill et al, 2014;Courtenay et al, 2018).…”