HIV/Sexual Health, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
J Adv Nurs. 2013 Mar;69(3):535-45. doi: 10.1111/j.1365-2648.2012.06028.x. Epub 2012 May 2.
This article is a report of a study to explore the application and safety of non-medical prescribing in an accident and emergency and sexual health department. Background. Since 1 May 2006 non-medical prescribers in the UK have had prescribing powers comparable with doctors. Evidence suggests that nurses give safe, competent, autonomous care packages in their scope of practice but despite the perceived benefits there is limited evidence detailing how it is specifically applied in practice.
Cross-sectional comparative design.
The study explored non-medical prescribing in accident and emergency and sexual health retrospectively reviewing 764 nurse prescribers' case notes. For intra-department comparison 490 case notes from those who could not prescribe were included. Patient attendances from 1 July 2009-30 June 2010 were randomly sampled. Prescribing frequency, range of medications and diagnoses, independent episode completion, and prescribing safety was recorded.
RESULTS/FINDINGS: Over 53·5% (n = 409) of prescribers' patients required medication, with 99·8% (n = 568) being clinically appropriate. Analgesia was most commonly prescribed in accident and emergency (31%, n = 85) and antibiotics in sexual health (55%, n = 162). Intra-department comparison of independent episode completion had statistically significant results using the chi-square test in sexual health, but not in accident and emergency. The use of patient group directions in accident and emergency explains this difference. Safe prescribing practice was evident in 99·4% of cases, with a lack of documentation (n = 2) and a contraindicated prescription (n = 1) identified.
Nurses having access to medication facilitate safe, appropriate, and independent prescribing practice. Further research is advised in this area.
本文是一项研究报告，旨在探讨在急诊和性健康部门中非医疗从业者的处方应用和安全性。背景：自 2006 年 5 月 1 日起，英国的非医疗从业者拥有与医生相当的处方权。有证据表明，护士在其执业范围内提供安全、胜任、自主的护理方案，但尽管人们认为这样做有好处，但目前只有有限的证据详细说明了它在实践中的具体应用。设计：横断面比较设计。方法：该研究通过回顾 764 名护士从业者的病历，对急诊和性健康部门中的非医疗处方进行了回顾性研究。为了进行部门内比较，还纳入了 490 名不能开具处方的从业者的病历。随机抽取了 2009 年 7 月 1 日至 2010 年 6 月 30 日的患者就诊记录。记录了处方频率、药物和诊断范围、独立疗程完成情况以及处方安全性。结果/发现：超过 53.5%（n = 409）的从业者的患者需要药物治疗，其中 99.8%（n = 568）的药物治疗是临床合理的。在急诊中，最常开具的药物是镇痛药（31%，n = 85），而在性健康中最常开具的药物是抗生素（55%，n = 162）。在性健康方面，使用卡方检验对独立疗程完成情况进行部门内比较，结果具有统计学意义，但在急诊方面则没有。这可以用在急诊中使用患者群体指导来解释这种差异。在 99.4%的情况下，处方是安全的，只有 2 例存在缺乏文件记录（n = 2）和 1 例存在禁忌处方（n = 1）的情况。结论：护士获得药物使用权有助于实现安全、适当和独立的处方实践。建议在这一领域进行进一步研究。
