Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations

Latter, Sue, Smith, Alesha, Blenkinsopp, Alison, Nicholls, Peter, 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 and Policy, 17 3: 149-156.


Author Latter, Sue
Smith, Alesha
Blenkinsopp, Alison
Nicholls, Peter
Little, Paul
Chapman, Stephen
Title Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations
Journal name Journal of Health Services Research and Policy  (ERA 2012 Listed)    (ERA 2010 Rank C)   Check publisher's open access policy
Publication date 2012-07
Sub-type Article
DOI 10.1258/jhsrp.2012.011090
Volume number 17
Issue number 3
ISSN 1355-8196;1758-1060
Start page 149
End page 156
Total pages 8
Place of publication London, United Kingdom
Publisher Royal Society of Medicine Press
Collection year 2013
Language eng
Formatted 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.
Keyword Reliability
Index
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online before print 25 June 2012.

Document type: Journal Article
Sub-type: Article
Collections: Official 2013 Collection
School of Pharmacy Publications
 
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