An investigation into patient safety with non- medical prescribing

Abstract

Background: Non-medical prescribing is undertaken by an appropriately qualified healthcare professional (HCP) who is not a doctor or dentist. Non-medical prescribers (NMPs) must meet set competencies and maintain these via continuing professional development. Prescribing errors (PEs) are a principal cause of preventable harm in healthcare and are a threat to patient safety. To date, almost all research in this area has been on PEs made by doctors. Aim: The aim of this programme of research was to explore patient safety with non-medical prescribing. Methods: Three studies were carried out to attempt to address the aim of the programme. Study One Views and experiences of stakeholders of non-medical prescribing regarding patient safety were explored via a scoping review of current literature. The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 was used as a framework to facilitate the understanding of the interrelatedness of the processes and outcomes of non-medical prescribing with patient safety. Study Two The self-efficacy of NMPs to prescribe, their preparedness to take responsibility for their prescribing decisions, and the causes, types and outcomes of PEs made by them were explored by surveying a purposive sample of NMPs prescribing on acute medical units across the UK. Bandura’s Social Cognitive Theory and Reason’s Human Error Theory informed the structure of the questionnaire. Study Three A qualitative prospective longitudinal cohort study was carried out using semi-structured telephone interviews to explore the views and experiences of nurses and pharmacists on patient safety with non-medical prescribing, first as trainee and then as novice NMPs. SEIPS 2.0 was used to structure the study. Approval was obtained from the University’s Research Ethics Committee and National Health Service hospitals for all studies where appropriate. Results: Study One 75 papers were included. The individual NMP received the most attention in the literature; information technology (IT) less so, the internal environment, within which the NMP prescribed, very little. The literature also drew attention to the need for clarification around responsibilities for NMPs’ CPD, and communication of prescribing governance systems within organisations. Study Two 99 valid responses were obtained. Overall, the self-efficacy of NMPs to prescribe was high; the longer qualified as a prescriber was associated with increased self-efficacy in certain aspects of prescribing. All physiotherapists, and more nurses than pharmacists were fully responsible for their prescribing decisions; if not fully responsible, this was partial or shared. PEs included slips, lapses, and mistakes. Error-provoking conditions were multifactorial, interrelated and included workload, interruption, tiredness, stress, and IT. Most PEs did not reach the patient. Some NMPs were distressed that their PE could have caused patient harm. Few NMPs formally reported their PE. Study Three 18 nurses and pharmacists took part. Trainee NMPs appeared to ‘transition’ from trainee to novice NMP as self-awareness of competence, confidence and cautiousness increased. Resultant key themes included organisational factors, key prescribing tasks, the individual NMP, and the non-medical prescribing course. Outcomes included, increased accessibility to medicines by patients, increased efficiency of HCPs, and the enablement of HCPs to carry out a complete episode and continuation of care. Conclusion: This programme of research has demonstrated that the relationship between patient safety with non-medical prescribing is complex and dynamic, and that the individual NMP is at its core. It has provided further knowledge of NMPs’ perceptions of themselves as both prescribers and trainee prescribers, the types, causes and outcomes of PEs made by them, and the ‘system’ within they prescribe. Such knowledge will enable further understanding of the barriers and enablers faced by NMPs to pr

Date of Award	1 Aug 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Mary Tully (Supervisor) & Jason Hall (Supervisor)