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Independent nurse medication provision: A mixed method study assessing impact on patients' experience, processes, and costs in sexual health clinics

Research output: Contribution to journalArticlepeer-review

Adam Black, Molly Courtenay, Christine Norton, Bryony Dean Franklin, Trevor Murrells, Heather Gage

Original languageEnglish
Pages (from-to)239-251
Number of pages13
JournalJournal of Advanced Nursing
Volume78
Issue number1
Early online date15 Oct 2021
DOIs
Accepted/In press2021
E-pub ahead of print15 Oct 2021
PublishedJan 2022

Bibliographical note

Funding Information: This study was funded by the National Institute for Health Research (NIHR) Integrated Clinical Academic Programme (project reference CDRF‐2013‐04‐052) as part of a Clinical Doctoral Research Fellowship. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This article represents independent research supported by the NIHR Imperial Patient Safety Translational Research Centre and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, PHE or the Department of Health and Social Care. 1, 2, 4 3 Publisher Copyright: © 2021 John Wiley & Sons Ltd

King's Authors

Abstract

BACKGROUND: Local services in the United Kingdom National Health Service enable autonomous provision of medication by nurses, supporting individual nurses to gain prescribing qualifications or by introducing local patient group directions.

AIM: To compare nurse prescribing and patient group directions about clinic processes, patients' experiences, and costs from the perspectives of providers, nurses, and patients.

DESIGN: Mixed methods, comparative case study in five urban sexual health services in the United Kingdom.

METHODS: Data were collected from nurse prescribers, patient group direction users and their patients July 2015 to December 2016. Nurse questionnaires explored training (funding and methods). Nurses recorded consultation durations and support from other professionals in clinical diaries. Patient notes were reviewed to explore medication provision, appropriateness and safety; errors were judged by an expert panel. Patients completed satisfaction questionnaires about consultations and information about medications.

RESULTS: Twenty-eight nurse prescribers and 67 patient group directions users took part; records of 1682 consultations were reviewed, with 1357 medications prescribed and 98.5% therapeutically appropriate. Most medication decisions were deemed safe (96.0% nurse prescribers, 98.7% patient group directions, Fisher's Exact Test p = .55). Errors were predominantly minor (55.6% nurse prescribers, 62.4% patient group directions) and related to documentation omissions (78.0%); no patients were harmed. Consultation durations and unplanned re-consultations were similar for both groups. Nurse prescribers sought assistance from colleagues less frequently (chi-squared = 46.748, df = 1, p < .001) but spent longer discussing cases. Nurse prescribing training required more resources from providers and nurses, compared with patient group directions. Nurse prescribers were on higher salary bands. Patient satisfaction was high in both groups (>96%).

CONCLUSIONS: Nurse medication provision by both nurse prescribers and patient group direction users is safe and associated with high patient satisfaction; effects on clinic processes and costs are similar. Undertaking the prescribing qualification involves independent study but may bring longer-term career progression to nurses.

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