Prescribing decisions by non-medical prescribers

Nurse and pharmacist independent prescribers generally make prescribing decisions that are clinically appropriate, according to the results of this evaluation of nurse and pharmacist consultations, undertaken as past of a larger study. There is room for improvement in decisions about the costs of drugs and also history-taking, assessment and diagnostic skills.

A team of independent raters – pharmacists, doctors and nurses – used a version of the Medication Appropriateness Index (MAI) to rate 100 recorded consultations, and the data analysed. On the whole, pharmacist independent prescribers mostly prescribed for long-term conditions such as hypertension; nurse independent prescribers in a walk-in site and out-of-hours site prescribed for acute conditions such as infections and those in general practice for both acute and long-term conditions.

As other studies have commented, there has been a lack of evidence of safety and quality of non-medical prescribing, so this work adds to the evidence base, with its conclusion that both nurses and pharmacists were making clinically appropriate prescribing decisions: the MAI has not been used before to evaluate prescribing by pharmacists; for nurses it was used with the limited formulary, with similar results. Although the authors caution against direct comparison with research into doctors’ prescribing decisions, they say the results are broadly comparable. The consultations also provoked positive qualitative comments from raters.

On the issue of cost, it may be that the prescribers did not consider the costs of medicines to be particularly important, or that as many consultations were for long-term conditions, the prescribers may have been reluctant to change a medicine initially prescribed by someone else. The other area for improvement is history-taking, clinical assessment and diagnosis: the authors suggest that the prescribing training should deliver on these areas for pharmacists whereas organisations should ensure that nurses have these skills before taking up the training.

Latter S et al. Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations. J Health Serv Res Policy 2012; 17(3): 149-156.