A mixed methods investigation of paramedic independent prescribing in emergency and urgent care

Abstract

Introduction
This research investigated paramedic independent prescribing (PIP) in emergency and urgent care (EUC), examining any benefits, limitations, facilitators or barriers. Previous PIP research was limited, and it was unclear if and how PIP benefits patients and EUC services. Potential issues were also identified in previous research, including low uptake of PIP across the ambulance sector, restrictions on the prescribing of Controlled Drugs (CDs), and that paramedics are not following national recommendations by completing master’s level education before adopting PIP.

Methods
A sample of key stakeholders with strategic insights on the research topic were interviewed (n=15), using a Framework approach for data analysis. Mixed methods case study research was then undertaken in an emergency department (ED) and an out-of-hours urgent care service. A detailed and comprehensive insight into PIP in each setting was obtained through observation of practice, semi-structured interviews, and analysing site documents and prescribing data. Quantitative data were analysed using descriptive statistics, with qualitative data being coded and categorised to facilitate thematic analysis.

Findings
PIP enabled a wide range of drugs to be prescribed, enhancing paramedic practice and improving patient access to medicines. These benefits were valued given the high levels of demand being faced by EUC services. PIPs managed a broad range of presentations, including high acuity conditions in the ED. In urgent care, the scope of PIP was influenced by wider pressures in primary care, and a range of acute problems, longer-term medical issues, and repeat prescription requests were managed by PIPs. Key facilitators of PIP included access to detailed patient information and to medical support. Despite national policy stipulating master's education is required for PIP, most participants did not perceive this to be necessary. Restrictive organisational governance and the utility of existing methods of medicines supply appear to be limiting the uptake of PIP in the ambulance sector. However, increasing the use of remote prescribing may result in benefits to patient care and service delivery. The experience paramedics develop in ambulance services also equips them with a unique and transferable skill set as PIPs in other EUC settings. Since 2024, PIPs can now prescribe the most frequently required CDs in EUC. However, a wider range of CDs are required in practice, resulting in barriers to patient care, and frustration for PIPs, emphasising the need for further legislative changes.

Conclusions
This research provides the first, detailed insight into PIP in EUC, highlighting the resulting benefits for patients and services from an enhanced scope of practice and use of medicines. Further legislative changes to expand CD prescribing and addressing implementation challenges in the ambulance sector could enhance the potential of PIP in EUC.

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Identifiers

ORCID for Sue Latter: orcid.org/0000-0003-0973-0512

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