School of Nursing, Midwifery and Health Systems, University College Dublin (UCD), Belfield, Dublin, Ireland.
J Adv Nurs. 2013 Jul;69(7):1478-88. doi: 10.1111/jan.12004. Epub 2012 Sep 19.
To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice.
The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain.
A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients' records and 208 medications prescribed by 25 Registered Nurse Prescribers.
Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen's kappa statistic (inter-rater reliability).
Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria.
The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.
评估护士和助产士处方实践的临床适宜性和安全性。
越来越多的国家引入了护士和助产士的处方权；然而，人们仍然对患者的安全感到担忧。
采用有针对性和随机抽样的方法，进行了多地点文件评估。样本包括 142 名患者的记录和 25 名注册护士处方开具的 208 种药物。
2009 年 3 月至 5 月期间，从患者和处方记录中提取数据。两位专家评审员应用改良的药物适宜指数工具（8 项标准）对每种药物进行评估。报告了每个标准的适当或不适当反应的百分比。使用 Cohen's kappa 统计量（组内一致性）来衡量评审员的一致性。
纳入了来自 8 家医院的 25 名从事 17 种不同实践领域的护士或助产士。评审员判断，95-96%开具的药物对诊断出的疾病是有针对性和有效的。与剂量、用药说明、药物-药物或疾病状况相互作用以及治疗重复有关的标准在 87-92%的处方中被认为是适当的。治疗持续时间的得分最低，为 76%。总体而言，评审员表示，2 位评审员（评审员 2）中有 69%-80%（评审员 1）的处方决策符合所有 8 项标准。
大多数护士和助产士的处方决策被认为是安全和临床适宜的。然而，发现了潜在的不适当处方和药物错误风险。需要继续进行教育和处方实践评估，特别是与药物和疾病相互作用相关的内容，以最大限度地提高适当和安全的处方。
