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

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    Publication date
    2012
    Author
    Latter, S.
    Smith, A.
    Blenkinsopp, Alison
    Nicholls, P.
    Little, P.
    Chapman, S.R.
    Keyword
    Clinical competence
    ; Drug costs
    ; Drug prescriptions; Economics; Nursing; Standards
    ; England
    ; Health services research
    ; Humans
    ; Nurse's practice
    ; Nursing assessment
    ; Pharmacists
    ; Physician's practice
    ; Referral and consultation
    ; State medicine
    ; REF 2014
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    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.
    URI
    http://hdl.handle.net/10454/6062
    Citation
    Latter S, Smith A, Blenkinsopp A, Nicholls P, Little P and Chapman S (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.
    Link to publisher’s version
    http://dx.doi.org/10.1258/jhsrp.2012.011090
    Type
    Article
    Collections
    Life Sciences Publications

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