Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

BACKGROUND: The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. OBJECTIVE: To develop consensus guidance to facilitate service redesign around pharmacist prescribing. SETTING: UK hospital practice. METHODS: The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. MAIN OUTCOME MEASURES: Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. RESULTS: Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic 'service development' (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and 'pharmacist prescribing role development' (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. CONCLUSION: Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.

Exploring pharmacists' perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland.

OBJECTIVES: The introduction of non-medical prescribing in the UK has provided opportunities and challenges for pharmacists to help ensure prudent use of antimicrobials. The objective of this research was to explore pharmacists' perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland. METHODS: Pharmacists' perceptions were explored using focus groups in five Scottish regions representing (a) urban and rural areas and (b) district general hospitals and large teaching centres. Senior hospital pharmacists, both prescribers and non-prescribers, working in specialities where antimicrobials are crucial to patient management, were invited to participate. A topic guide was developed to lead the discussions, which were audio-recorded and transcribed. The framework approach to data analysis was used. KEY FINDINGS: Six focus groups took place and some emerging themes and issues are presented. Pharmacists believed that the feasibility of antimicrobial prescribing is dependent upon the patient's clinical condition and the area of clinical care. They identified potential roles and opportunities for pharmacist prescribing of antimicrobials. Perceived benefits included giving patients quicker access to medicines, reducing risk of resistance and better application of evidence-based medicine. CONCLUSIONS: Pharmacists feel they have a good knowledge base to prescribe and manage antimicrobial treatment, identifying possible opportunities for intervention. Roles within a multidisciplinary antimicrobial team need to be clearly defined.

Antimicrobial optimisation in secondary care: the pharmacist as part of a multidisciplinary antimicrobial programme--a literature review.

The aims of this literature review were: (i) to determine what roles have been supported by evidence for the pharmacist in optimising antimicrobial treatment as part of an antimicrobial multidisciplinary team (AMDT) in secondary care; and (ii) to describe the outcomes of interventions of an AMDT in secondary care with pharmacy involvement. Both descriptive and primary research reports were identified and included. The hospital pharmacist emerged as a key member of the AMDT. The dispensary pharmacist was mainly involved in the screening processes and was crucial in implementing restriction policies. The general ward-based clinical pharmacist was involved in guideline development, formulary management, intravenous-to-oral conversions and evaluations of programme outcomes through monitoring of drug usage, and also facilitated identification of patients with specific needs who could be referred to the specialist pharmacist. A role emerged for the specialist pharmacist who was an integral part of the AMDT and was involved in activities including reviewing of more complex patients, attending ward rounds and streamlining of initial empirical antimicrobial treatment. Outcomes of interventions reported in primary research have been classified into: drug outcomes, where most trials measured and reported an increase in adherence to guidelines; microbiological outcomes, only considered in a few trials; clinical outcomes, with different parameters measured and a maintenance or improvement reported; and financial outcomes. The latter were reported in all trials with numerous cost savings, although not all were statistically significant. Moreover, the cost of the intervention was not always considered.

A novel framework for reflecting on the functioning of research ethics review panels.

In the past decade structures and processes for the ethical review of UK health care research have undergone rapid change. Although this has focused users' attention on the functioning of review committees, it remains rare to read a substantive view from the inside. This article presents details of processes and findings resulting from a novel structured reflective exercise undertaken by a newly formed research ethics review panel in a university school of nursing and midwifery. By adopting and adapting some of the knowledge to be found in the art and science of malt whisky tasting, a framework for critical reflection is presented and applied. This enables analysis of the main contemporary issues for a review panel that is primarily concerned with research into nursing education and practice. In addition to structuring the panel's own literary narrative, the framework also generates useful visual representation for further reflection. Both the analysis of issues and the framework itself are presented as of potential value to all nurses, health care professionals and educationalists with an interest in ethical review.

An evaluation of the first year of family health nursing practice in Scotland.

Scotland has led enactment of the new World Health Organisation (Europe) Family Health Nurse (FHN) concept. This paper presents research which evaluated the initial operation and impact of the role in remote and rural regions of Scotland. Through use of a multiplex research design informed by ideas from realistic evaluation, fourth generation evaluation and case study research, an initial typology of practice was constructed. The new FHN role typically supplemented, rather than supplanted, pre-existing community nursing services. Implications arising from key findings are discussed in relation to Scottish, UK and European nursing and primary care perspectives.

Evaluation of a clinical leadership initiative.

AIM: To evaluate a clinical leadership initiative in mental health and care of older people settings. METHOD: Clinical leaders (n=15), clinical nurse managers (n=6), and mentors (n=4) involved in the initiative received three questionnaires assessing perceived change, occupational stress and burnout. A nurse, a support worker and a doctor or therapist with whom the clinical leaders worked, each received the perceived change questionnaire (n=45). A comparative group of senior nurses (n=6) who were not part of the initiative received all three questionnaires. A comparative group of clinical nurse managers (n=3) not involved in the initiative received the perceived change questionnaire. RESULTS: Major improvements in direct care management, communication processes, decision-making, clinical nursing care, reporting and evaluation practices, and support strategies and processes at ward level were indicated. The evaluation also identified evidence of stress, potential burnout and job dissatisfaction. CONCLUSION: A customised design was negotiated between the evaluators and the NHS trust, and recommendations were made for wider introduction of the initiative, with enhanced planning, an integrated evaluation process and a systematic approach to job redesign.

An evaluation of an educational programme to prepare family health nurses.

In 1998 the World Health Organisation (WHO) Europe proposed a new type of community based nurse called the family health nurse (FHN). Although it was initially envisaged that 18 European countries would take part in the development of the FHN role through parallel processes of education and implementation, Scotland has been significantly ahead of other countries in enacting this plan. A pilot project involving community nurses from four remote and rural regions of Scotland was conducted between 2001 and 2003. A Scottish University was commissioned to provide a degree-level course for registered nurses with a minimum of two years post-registration qualifying experience. This paper summarises the main findings and issues arising from an external research evaluation of this educational programme. The programme was found to differ substantially in focus and format from other specialist community nursing programmes available in Scotland. Moreover there were key differences from the curriculum proposed by WHO Europe, in that there was more grounding in North American family nursing models and less focus on management and leadership. This customized degree programme provides a precedent for other educational providers in the UK to reconsider their approach to specialist practice degree level education.

Work life and psychological health: the experiences of Thai women in deprived communities.

I discuss women's work life and the psychological health of women in low-income communities in Northeast Thailand. Previous research has shown that low-income women are part of a disadvantaged group who struggle against several problems in their everyday life, and who work hard to survive. These women worked as either manual laborers in agriculture or factories or as self-employed vendors, and were busy Ha Yoo Ha Kin (working and earning a living). The women's way of life was complex and involved being responsible for their children, husband, extended family, work, and themselves. Understanding women's beliefs and practice relating to work life and health is essential in designing effective intervention programmes to promote the health and well-being of low-income women in Thailand.

Developing the use of poetry within healthcare culture.

While the visual arts are often given consideration as an important feature of healthcare environments, the literary arts remain an underdeveloped resource. This article describes recent nurse-initiated developments in Aberdeen which attempt to integrate poetry into the culture of hospitals so that patients, visitors and staff can be involved. In particular, the 'Poem Post' project is described. This project makes a selection of short poems available on postcards in wall-mounted racks within local hospitals, and incorporates a facility for feedback of comments and new poems. Feedback has been generally very positive and over 100 new poems have been submitted to the project. Issues arising from evaluation of the project are discussed, and lessons learnt from the experience are reviewed in order to encourage nurses to consider the possibilities that poetry can offer in the workplace.

Role development in acute nursing in Scotland.

Aim This research was designed to evaluate innovative roles underpinning successful nurse-led services in nursing and midwifery in Scotland. Method A dual methodological approach encompassing a national survey and detailed case studies was adopted. The survey of all NHS trusts in Scotland was designed to profile role developments and extended practices in nursing and midwifery practice. The survey data were used to identify case studies that reflected innovative roles within nursing and midwifery. Twenty semi-structured interviews were undertaken with clinical nurse specialists and analysed using the constant comparative approach of grounded theory. Results Three case studies in acute care were identified for in-depth study. The key themes to emerge were the specific nature of the work, the professional merit associated with each role, benefits to patients and the importance of objective evaluation of the role. Conclusion The findings from the acute care case studies strongly support the importance of nurses promoting and developing patient-focused initiatives in acute care.