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

Black, Adam, Franklin, Bryony, Gage, Heather, Norton, Christine, Murrells, Trevor and Courtenay, Molly ORCID: https://orcid.org/0000-0002-8639-5917 2022. Independent nurse medication provision: a mixed method study assessing impact on patients' experience, processes, and costs in sexual health clinics. Journal of Advanced Nursing 78 (1) , pp. 239-251. 10.1111/jan.15075

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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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Healthcare Sciences
Publisher:	Wiley
ISSN:	0309-2402
Date of First Compliant Deposit:	1 October 2021
Date of Acceptance:	1 October 2021
Last Modified:	06 Nov 2024 16:00
URI:	https://orca.cardiff.ac.uk/id/eprint/144592

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