DOI: 10.5176/2315-4330_WNC14.48

Authors: Dr. Harald Braun, Keith Davies, Jeanetta McLean, Kayras Bhesania, Joseph McArdle, Michelle Beecroft


Abstract: Background—Prescribing of medicines has traditionally been a GP/medically dominated activity within the English National Health Service (NHS). However, since 1994, UK government policies have focused on expanding the prescribing remit to include nurses, pharmacists, podiatrists, physiotherapists and other non-medical health professionals. Such practice is known as Non-Medical Prescribing or NMP in England and Nurse Prescribing in many other countries. It has helped meet the demands on health care and increased the capacity of health services to deliver more accessible and higher quality care to patients. The provision of efficient access to medicines for patients by expanding the role of existing health care professionals has been evidenced to show an improvement in patient experience, patient safety, cost efficiencies and support of multi-disciplinary teams. The results are reduced risk of harm to the patient, enhanced patient experience and better compliance and monitoring of the therapeutic impact of medication and early identification of harms and risks.
Aim and Methods—Little evidence exists on the economic impact of the aforementioned policy. NHS Health Education England in partnership with i5 Health is undertaking a comprehensive economic review that examines the benefits of prescribing by nurses, pharmacists and other non-medical health professionals, in particular the support to patients across care settings. The North West of England has a longstanding history in the use of nurses and pharmacists to prescribe and manage medicines for the benefit of patients and organisations alike. The quantitative impact on patient outcomes and economics is tested through the use of an annual audit in the North West of clinical practice (Clinicians Audit) (n=19,358 patient episodes) and the use of i5 Health’s Big Data analytical capabilities. This paper sets out the clinical and financial impacts based on quantitative outcomes from the latest Clinicians Audit, the reach of Non-Medical Prescribing (NMP) across England and the educational implications for nurse training to reduce risk of poor practice, using case study examples in asthma and diabetes pathways. It sets out further evidence on how pharmacists and nurses use their prescribing skills to improve medication reviews resulting in improved adherence, identification and reduction of drug interactions and side effects and decrease drug wastage. Medication reviews were performed at 79{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} of appointments recorded in the Clinicians Audit with a reduction of non-adherence rates from 30{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} down to 6{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}.
Results and Conclusion—There is a 93{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} rate of episode completion by nurse prescribers and a positive correlation between NMP utilization and the reduction in surgical procedures e.g. below-the-knee diabetic amputations. The study is being conducted by drawing on the work of others, engaging with individuals and focus groups and applying data analysis. It will contribute towards providing healthcare commissioners with a Decision Support System (DSS) to facilitate cost effective service redesign.

Keywords: nurse prescribing; non-medical prescribing; patient safety; decision support; asthma pathway; diabetes pathway

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