Pharmacist prescribing within a UK NHS hospital trust: nature and extent of prescribing, and prevalence of errors
01 Mar 2015-European Journal of Hospital Pharmacy (British Medical Journal Publishing Group)-Vol. 22, Iss: 2, pp 79-82
TL;DR: It is suggested that prescribing pharmacists can provide a valuable role in safely prescribing for a broad range of inpatients in UK general hospitals.
Abstract: Objectives Suitably qualified pharmacists in the UK are able to prescribe all medicines. While doctors’ prescribing errors are well documented, there is little information on the rate and nature of pharmacists’ prescribing errors. Our aim was to measure the prevalence of prescribing errors by pharmacists. Methods Prescribing by pharmacists, for inpatients admitted to three hospitals in North East England was studied. Part one measured the extent of prescribing by pharmacists as a proportion of all prescribing on a single day. The number of medication orders, reason for prescribing and therapeutic category were collected by the researcher (OC). In part two, pharmacist prescribing was reviewed for safety and accuracy by ward-based clinical pharmacists over 10 days; errors were documented and categorised as per EQUIP study. Results Part 1: Pharmacists prescribed one or more medication orders for 182 (39.8%) of 457 patients, accounting for 12.9% (680 from 5274) of all medication orders prescribed on a single census day. Pharmacists prescribed medicines from 12 out of 15 British National Formulary categories (no prescribing of drugs used in malignancy, immunology and anaesthetics). Part 2: 1415 pharmacist-prescribed medication orders were checked by clinical pharmacists, with four errors (0.3%) reported. Conclusions This study suggests that prescribing pharmacists can provide a valuable role in safely prescribing for a broad range of inpatients in UK general hospitals.
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TL;DR: The processes required to qualify as a NMP in the UK are described, potential influences on nonmedical prescribing and the impact of non medical prescribing on patient opinions and outcomes and the opinions of doctors and other healthcare professionals are compared.
Abstract: Nonmedical prescribing has been allowed in the United Kingdom (UK) since 1992. Its development over the past 24 years has been marked by changes in legislation, enabling the progression towards independent prescribing for nurses, pharmacists and a range of allied health professionals. Although the UK has led the way regarding the introduction of nonmedical prescribing, it is now seen in a number of other Western-European and Anglophone countries although the models of application vary widely between countries. The programme of study to become a nonmedical prescriber (NMP) within the UK is rigorous, and involves a combination of taught curricula and practice-based learning. Prescribing is a complex skill that is high risk and error prone, with many influencing factors. Literature reports regarding the impact of nonmedical prescribing are sparse, with the majority of prescribing research tending to focus instead on prescribing by doctors. The impact of nonmedical prescribing however is important to evaluate, and can be carried out from several perspectives. This review takes a brief look back at the history of nonmedical prescribing, and compares this with the international situation. It also describes the processes required to qualify as a NMP in the UK, potential influences on nonmedical prescribing and the impact of nonmedical prescribing on patient opinions and outcomes and the opinions of doctors and other healthcare professionals.
121 citations
Cites background or result from "Pharmacist prescribing within a UK ..."
...Baqir and colleagues [Baqir et al. 2014] do however advocate that further larger controlled studies are recommended to validate the results of this study....
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...A study by Baqir and colleagues [Baqir et al. 2014] focused on the nature and extent of prescribing and prevalence of errors by pharmacist NMPs, specifically within a UK NHS hospital....
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TL;DR: A strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.
Abstract: In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.
40 citations
TL;DR: A future perspective on NMP is provided in light of findings of an umbrella review of aspects of NMP, and challenges to implementing NMP into working practice are met by considering the theoretical basis for implementation, and robust and rigorous evaluation.
Abstract: Many countries have implemented nonmedical prescribing (NMP) and many others are scoping prescribing practices with a view to developing NMP. This paper provides a future perspective on NMP in light of findings of an umbrella review of aspects of NMP. This is followed by coverage of the Scottish Government strategy of pharmacist prescribing and finally, consideration of two key challenges. The review identified seven systematic reviews of influences on prescribing decision-making, processes of prescribing, and barriers and facilitators to implementation. Decision making was reported as complex with many, and often conflicting, influences. Facilitators of NMP included perceived improved patient care and professional autonomy, while barriers included lack of defined roles and resource pressures. Three systematic reviews explored patient outcomes that were noted to be equivalent or better to physician prescribing. In particular, a Cochrane review of 46 studies of clinical, patient-reported, and resource-use outcomes of NMP compared with medical prescribing showed positive intervention-group effects. Despite positive findings, authors highlighted high bias, poor definition and description of 'prescribing' and the 'prescribing process' and difficulty in separating NMP effects from the contributions of other healthcare team members. While evidence of benefit and safety is essential to inform practice, for NMP to be implemented and sustained on a large scale, there needs to be clear commitment at the highest level. The approach being taken by the Scottish Government to pharmacist prescribing implementation may inform developments in other professions and countries. The vision is that by 2023, all pharmacists providing pharmaceutical care will be pharmacist-independent prescribers. There are, however, challenges to implementing NMP into working practice; two key challenges are the need for sustainable models of care and evaluation research. These challenges could be met by considering the theoretical basis for implementation, and robust and rigorous evaluation.
37 citations
London School of Economics and Political Science1, University of Exeter2, University of Cambridge3, John Radcliffe Hospital4, University of Birmingham5, University of Southern Denmark6, Imperial College Healthcare7, Glasgow Caledonian University8, University of York9, Cardiff University10, Belfast Health and Social Care Trust11, University of New South Wales12, University of Southampton13, Imperial College London14, University of London15, Public Health England16, Queen's University Belfast17, University College London18, University of Edinburgh19
TL;DR: The UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to the pandemic or by excess mortality as mentioned in this paper.
35 citations
TL;DR: There is a limited evidence base on NMP's' prescribing decision-making, and it appears that this is complex with NMPs influenced by many and often opposing factors.
Abstract: Background - Suitably qualified non-medical healthcare professionals may now prescribe medicines. Prescribing decision-making can be complex and challenging; a number of influences have been identified among medical prescribers but little appears to be known about influences among non-medical prescribers (NMPs). Objective - To critically appraise, synthesize and present evidence on the influences on prescribing decision-making among supplementary and independent NMPs in the UK. Methods - The systematic review included all studies between 2003 and June 2013. Included studies researched the prescribing decision-making of supplementary and independent NMPs practising in the UK; all primary and secondary study designs were considered. Studies were assessed for quality and data extracted independently by two researchers, and findings synthesized using a narrative approach. Results - Following duplicates exclusion, 886 titles, 349 abstracts and 40 full studies were screened. Thirty-seven were excluded leaving three for quality assessment and data extraction. While all studies reported aspects of prescribing decision-making, this was not the primary research aim for any. Studies were carried out in primary care almost exclusively among nurse prescribers (n = 67). Complex influences were evident such as experience in the role, the use of evidence-based guidelines and peer support and encouragement from doctors; these helped participants to feel more knowledgeable and confident about their prescribing decisions. Opposing influences included prioritization of experience and concern about complications over evidence base, and peer conflict. Conclusion - While there is a limited evidence base on NMPs' prescribing decision-making, it appears that this is complex with NMPs influenced by many and often opposing factors.
22 citations
References
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TL;DR: A general definition of a prescribing error has been developed, which allows the comparison of prescribing error rates among different prescribing systems and different hospitals, and is suitable for use in both research and clinical governance initiatives.
Abstract: N Barber, professor of the practice of pharmacy
M Schachter, senior lecturer and honorary consultant physician
Objective—To develop a practitioner led definition of a prescribing error for use in quantitative studies of their incidence.
Design—Two stage Delphi technique.
Subjects—A panel of 34 UK judges, which included physicians, surgeons, pharmacists, nurses and risk managers.
Main outcome measures—The extent to which judges agreed with a general definition of a prescribing error, and the extent to which they agreed that each of 42 scenarios represented a prescribing error.
Results—Responses were obtained from 30 (88%) of 34 judges in the first Delphi round, and from 26 (87%) of 30 in the second round. The general definition of a prescribing error was accepted. The panel reached consensus that 24 of the 42 scenarios should be included as prescribing errors and that five should be excluded. In general, transcription errors, failure to communicate essential information, and the use of drugs or doses inappropriate for the individual patient were considered prescribing errors; deviations from policies or guidelines were not.
Conclusions—Health care professionals are in broad agreement about the types of events that should be included and excluded as prescribing errors. A general definition of a prescribing error has been developed, together with more detailed guidance regarding the types of events that should be included. This definition allows the comparison of prescribing error rates among different prescribing systems and different hospitals, and is suitable for use in both research and clinical governance initiatives.
(Quality in Health Care 2000;9:232–237)
Key Words: prescribing errors; medication errors; definition of error
402 citations
TL;DR: Overall, it is clear that prescribing errors are a common occurrence, affecting 7% of medication orders, 2% of patient days and 50% of hospital admissions, however, the reported rates of prescribing errors varied greatly and this could be partly explained by variations in the definition of a prescribing error, the methods used to collect error data and the setting of the study.
Abstract: Prescribing errors affect patient safety throughout hospital practice. Previous reviews of studies have often targeted specific populations or settings, or did not adopt a systematic approach to reviewing the literature. Therefore, we set out to systematically review the prevalence, incidence and nature of prescribing errors in hospital inpatients. MEDLINE, EMBASE, CINAHL and International Pharmaceutical Abstracts (all from 1985 to October 2007) were searched for studies of prescriptions for adult or child hospital inpatients giving enough data to calculate an error rate. Electronic prescriptions and errors for single diseases, routes of administration or types of prescribing error were excluded, as were non-English language publications. Median error rate (interquartile range [IQR]) was 7% (2-14%) of medication orders, 52 (8-227) errors per 100 admissions and 24 (6-212) errors per 1000 patient days. Most studies (84%) were conducted in single hospitals and originated from the US or UK (72%). Most errors were intercepted and reported before they caused harm, although two studies reported adverse drug events. Errors were most common with antimicrobials and more common in adults (median 18% of orders [ten studies, IQR 7-25%]) than children (median 4% [six studies, IQR 2-17%]). Incorrect dosage was the most common error. Overall, it is clear that prescribing errors are a common occurrence, affecting 7% of medication orders, 2% of patient days and 50% of hospital admissions. However, the reported rates of prescribing errors varied greatly and this could be partly explained by variations in the definition of a prescribing error, the methods used to collect error data and the setting of the study. Furthermore, a lack of standardization between severity scales prevented any comparison of error severity across studies. Future research should address the wide disparity of data-collection methods and definitions that bedevils comparison of error rates or meta-analysis of different studies.
349 citations
01 Jan 2007
TL;DR: Overall it is clear that prescribing errors are a common occurrence affecting 7% of orders, 2% of patient days and 50% of hospital admissions, however, the reported rates of prescribing errors varied greatly and this could be partly because of the number of studies conducted.
Abstract: Prescribing errors affect patient safety throughout hospital practice. Previous reviews of studies have often targeted specific populations or settings or did not adopt a systematic approach to reviewing the literature. Therefore, we set out to systematically review the prevalence, incidence, and nature of prescribing errors in hospital inpatients. MEDLINE, EMBASE, and International Pharmaceutical Abstracts (1985 Oct 2007) were searched for studies of prescriptions for adult or child hospital inpatients giving enough data to calculate an error rate. Electronic prescriptions and errors for single diseases, routes of administration, or types of prescribing error were excluded, as were non-English language publications. Median error rate (interquartile range, IQR) was 7% (2-14%) of medication orders, 52 (8-227) errors per 100 admissions, and 24 (6-212) errors per 1000 patient days. Most studies (84%) were conducted in single hospitals and from the USA or UK (72%). Most errors were intercepted and reported before they caused harm although two studies reported adverse drugs events. Errors were commonest with antimicrobials and commoner in adults (median 18% of orders (10 studies, IQR 7-25%)) than children (median 4% (6 studies, IQR 2-17%)). Incorrect dosage was the commonest error. Overall it is clear that prescribing errors are a common occurrence affecting 7% of orders, 2% of patient days and 50% of hospital admissions. However, the reported rates of prescribing errors varied greatly and this could be partly
346 citations
01 Aug 2012
TL;DR: Report prepared by the University of Nottingham, University of Reading and University of Hertfordshire shows that in the next five years the number of young people aged under the age of 18 will be higher than in the previous five years.
Abstract: Report prepared by the University of Nottingham, University of Reading and University of Hertfordshire
172 citations