Evidence-informed implementation of nurse prescribing under supervision: An integrative review.

AIM: To explore evidence reporting facilitators and barriers to implementation of nurse prescribing and provide practical recommendations for evidence-informed implementation and adoption of nurse prescribing under a supervision model. BACKGROUND: As demand for access to quality health care services increases, health professional roles are expanding to meet population needs. Nurse prescribing has been effective in some countries and is being considered globally to address growing health care demand. Successful implementation of health service models requires careful planning and consideration. No existing reviews have examined implementation factors in the literature. DESIGN: Integrative review. DATA SOURCES: CINAHL, MEDLINE, PubMed and EMBASE databases were searched from inception to 15 April 2020. REVIEW METHODS: This integrative review is guided by Whittemore and Knafl and adheres to PRISMA reporting guidelines. The sustainability of innovation framework was used to synthesize data concerning implementation and sustainability factors (i.e. innovation, organizational, political, workforce and financial) for nurse prescribing. RESULTS: A total of 39 articles were reviewed with literature predominantly reporting findings related to non-medical and nurse prescribing under various models. Variable evidence was found to inform nurse prescribing across five implementation and sustainability factors identifying several areas that require in-depth consideration. Very little evidence is available on nurse prescribing under supervision. CONCLUSION: Introduction of service reform is often costly. This review highlights gaps in the literature and raises areas for consideration prior to implementation of this new service delivery model. The introduction of nurse prescribing must be planned and informed by available evidence to support effective adoption, practice and patient outcomes. IMPACT: There are significant gaps in evidence related to nurse prescribing under a supervision model. Based on the evidence synthesized in this review, this paper provides practical recommendations for health service providers, managers, clinicians, educators and researchers to support implementation and adoption of nurse prescribing.

Teaching the principles of safe prescribing to a mixed profession postgraduate cohort: program development.

BACKGROUND: Prescribing medicines is a complex task. A robust prerequisite curriculum that enables the efficient and consistent training of safe and effective prescribers is important. Despite differing prescribing contexts and professional attributes, the core elements of safe and effective prescribing relevant to all prescribers can be identified. This article describes the development process and content of a training program for safe prescribing, which was designed for a mixed cohort of allied health professionals in Queensland, Australia. METHODS: The allied health prescribing training program was designed to align with national standards for prescribing and competencies for safe prescribing. International training programs, for nonmedical prescribing, were examined to inform the program development. Content was delivered by experienced prescribers from a range of professions. The inaugural cohort was surveyed before and after training to ascertain their confidence to prescribe. RESULTS: A training program for allied health prescribers was developed and delivered to enable the implementation of a state-sponsored research trial in Queensland public facilities. The program consisted of two modules (the second of which is described in this article) complemented by a mandatory period of supervised workplace learning. Remote blended learning, comprising online prerecorded lectures, self-directed learning, teleconference seminars, and a 2-day on-campus intensive residential, was used to deliver content. A total of 19 allied health professionals (12 physiotherapists and 7 pharmacists) completed the program that equipped them to begin a prescribing trial within their specific practice settings. Post module completion, 90% of the cohort felt confident to prescribe for patients in their practice area. CONCLUSION: Program development and delivery were challenging, requiring attention to both the needs of each profession and those of the individual practitioner who was required to apply generic prescribing principles to their specific practice setting. Further refinement of content, delivery, assessment, and resource allocation is required for future cohorts.

What does advanced practice mean to Australian paediatric pharmacists? A focus group study.

OBJECTIVES: The aim of this study was to explore perceptions and attitudes of Australian paediatric pharmacists about advanced pharmacy practice and to identify suitable methods of assessment for this level of practice. METHODS: Four focus groups (with 31 participants) were held in 2012 with Australian hospital pharmacists who work with children. Written notes and audio recordings were used to produce verbatim transcriptions and extract themes. KEY FINDINGS: There was consensus across groups that formal recognition of advanced pharmacy practice was valuable to the profession and to individuals. Elements should include a strong grounding in clinical practice, commitment to education, research and service improvement outside the department and institution. A framework for career development should be used to describe the levels of practice leading to advanced practice. Assessment should involve multiple separate criteria, and incorporate direct observation, peer review and a professional portfolio. Postgraduate qualifications are desirable but not considered essential. Different knowledge and skills are required in paediatrics; however, the definition of advanced practice remains the same. CONCLUSIONS: Recognition of advanced practice is valuable for the profession and for individuals. Multiple methods of assessment should be used. Specialty areas such as paediatrics can be defined and assessed similar to other specialties, with acknowledgement of the specific paediatric knowledge and skills required.

Use of a general level framework to facilitate performance improvement in hospital pharmacists in Singapore.

OBJECTIVE: To evaluate the acceptability and validity of an adapted version of the General Level Framework (GLF) as a tool to facilitate and evaluate performance development in general pharmacist practitioners (those with less than 3 years of experience) in a Singapore hospital. METHOD: Observational evaluations during daily clinical activities were prospectively recorded for 35 pharmacists using the GLF at 2 time points over an average of 9 months. Feedback was provided to the pharmacists and then individualized learning plans were formulated. RESULTS: Pharmacists' mean competency cluster scores improved in all 3 clusters, and significant improvement was seen in all but 8 of the 63 behavioral descriptors (p ≤ 0.05). Nonsignificant improvements were attributed to the highest level of performance having been attained upon initial evaluation. Feedback indicated that the GLF process was a positive experience, prompting reflection on practice and culminating in needs-based learning and ultimately improved patient care. CONCLUSIONS: The General Level Framework was an acceptable tool for the facilitation and evaluation of performance development in general pharmacist practitioners in a Singapore hospital.