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Research project: An Evaluation of Extended Formulary Independent Nurse Prescribing - Dormant - Dormant

Currently Active: 
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Recent government policy directives are focused on modernisation of the NHS to ensure its capacity to deliver accessible and quality care to patients. The extension of independent prescribing by nurses is one route to modernising the NHS through developing and enhancing the role of health care professionals and increasing patient access to medicines.

Overview

The extension of prescribing is intended to provide patients with quicker and more efficient access to medicines and to make the best use of nursing skills whilst ensuring that patient safety is paramount (DH 2002). Since early 2002, nurses have been undertaking training to independently prescribe medicines; the numbers of nurses qualified to prescribe a range of medicines independently from the Nurse Prescribers' Extended Formulary (NPEF) has been rising steadily since then.

This research was commissioned to provide a national evaluation of this important development to inform future policy, education and practice.

Main question(s)

Aim: To provide an evaluation of the expansion of extended formulary independent nurse prescribing to inform future developments for prescribing in nursing and other health professions.

Objectives

  1. To evaluate the effectiveness and efficiency of extended formulary independent nurse prescribing training programmes, focusing on selection processes and training programme content and processes.
  2. To provide a national perspective on current extended formulary independent nurse prescribing practice, including data on: prescribing patterns in practice, use and adequacy of knowledge in practice, prescribing within a team context, continuing professional development (CPD) opportunities, and factors facilitating and inhibiting effective prescribing in practice.
  3. To assess whether and how local developments in extended formulary independent nurse prescribing in a range of practice contexts have benefited patients, health professionals and the NHS, with reference to quality of care, safeguarding public health through appropriate antimicrobial prescribing, and value for money.
  4. To obtain the views of extended formulary independent nurse prescribers, and other health care professionals, including doctors, on the form and detail that further development of nurse prescribing should take, including further expansion of independent nurse prescribing for nurses and other health care professionals. 
  5. To identify good practice in nurse prescribing, together with the contextual and other influences that facilitate this, to enable recommendations for future practice.

Methodology

Two phase national study comprising:

Phase 1: a national postal questionnaire survey of nurses who have completed extended formulary independent nurse prescriber training.

Phase 2: Case studies of 10 different practice settings using multiple methods to access the perspectives of a range of stakeholders in each case. Specifically within each case:
Observation of sample of nurse prescribing consultations

Analysis of patient records and nurse prescriptions

Semi-structured interviews in each case study with:

  • Prescribing nurses
  • Doctors
  • Pharmacists
  • Self-administered questionnaires to:
  • Patients after observed prescribing consultation
  • Postally to a sample of patients

Analysis of data included assessments of the clinical appropriateness of nurse prescribing consultations by a panel of medical prescribing experts.

Main outcomes

A national overview of current extended formulary independent nurse prescribing practice. Including:

  • Knowledge of the effectiveness and efficiency of nurse prescribing training programmes.
  • Whether and how local developments in nurse prescribing in a range of practice contexts have benefited patients, health professionals and the NHS.
  • The views of nurse prescribers, and other health care professionals, including doctors, on the form and detail that further development of nurse prescribing should take.
  • Good practice in nurse prescribing will be identified, together with the contextual and other influences that facilitate this.
  • Recommendations for future policy and practice.

Ongoing interests

  • Education related to nurse prescribing.
  • Concordance in relation to nurse prescribing.
  • Supplementary prescribing.
  • Does nurse prescribing enhance concordance and / or compliance. 
     

Project team

Sue Latter, Jill Maben, Michelle Myall, Molly Courtenay, Amanda Young, Nick Dunn

Project funder

Department of Health, Policy Research Programme

Related research groups

Health Work and Systems
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