Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of
consultations
Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of
consultations
OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals.
METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England.
RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills.
CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.
149-156
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b
Smith, Alesha
a3abdb79-1a87-46c6-a4a4-ee364a9886dc
Blenkinsopp, Alison
12c72c8c-3d75-432f-9097-4776af11b5d1
Nicholls, Peter G.
524cf465-2f84-41f4-9580-94abed4c3f65
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Chapman, Stephen
290e8911-c318-49a4-bcf0-9a12e8df5bf2
July 2012
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b
Smith, Alesha
a3abdb79-1a87-46c6-a4a4-ee364a9886dc
Blenkinsopp, Alison
12c72c8c-3d75-432f-9097-4776af11b5d1
Nicholls, Peter G.
524cf465-2f84-41f4-9580-94abed4c3f65
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Chapman, Stephen
290e8911-c318-49a4-bcf0-9a12e8df5bf2
Latter, Sue, Smith, Alesha, Blenkinsopp, Alison, Nicholls, Peter G., Little, Paul and Chapman, Stephen
(2012)
Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of
consultations.
Journal of Health Services Research & Policy, 17 (3), .
(doi:10.1258/jhsrp.2012.011090).
(PMID:22734082)
Abstract
OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals.
METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England.
RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills.
CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.
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e-pub ahead of print date: 25 June 2012
Published date: July 2012
Organisations:
Faculty of Health Sciences
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Local EPrints ID: 341029
URI: http://eprints.soton.ac.uk/id/eprint/341029
PURE UUID: fc4f7efc-ca13-45fb-a064-bbab6b303cd9
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Date deposited: 11 Jul 2012 09:09
Last modified: 15 Mar 2024 03:06
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Author:
Alesha Smith
Author:
Alison Blenkinsopp
Author:
Peter G. Nicholls
Author:
Stephen Chapman
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