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J Health Serv Res Policy. 2012 Jul;17(3):149-56. doi: 10.1258/jhsrp.2012.011090. Epub 2012 Jun 25.

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

Author information

1
Faculty of Health Sciences, University of Southampton, Southampton, UK. sml@soton.ac.uk

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.

PMID:
22734082
DOI:
10.1258/JHSRP.2012.011090
[Indexed for MEDLINE]

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