Stenner Karen, van Even Suzanne, Collen Andy
University of Surrey.
College of Paramedics.
Br Paramed J. 2019 Dec 1;4(3):57. doi: 10.29045/14784726.2019.12.4.3.57.
To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the United Kingdom.
Following a public consultation by NHS England in 2015, the decision was made in March 2018 to amend legislation to enable advanced paramedics to independently prescribe medicine in UK settings. Capturing the experience of these 'early adopters' will help to identify where paramedic prescribing can produce optimum benefits in healthcare systems, as well as enabling early scoping out of challenges to implementation and strategies for resolving challenges. This exploratory qualitative study involved interviews with 17 paramedics who have undertaken the independent prescribing programme in the United Kingdom. Participants were recruited via social media and regional paramedic networks between May and July 2019. Interviews were conducted by telephone or video call and explored use/anticipated use of prescribing, benefits and challenges to prescribing and support for the prescribing role. Thematic analysis was conducted to identify key themes.
Of the 17 participants, six were currently prescribing and the remainder were awaiting annotation. Participants worked in a range of settings, including: primary care, emergency departments, urgent care, walk in centres and rapid response services. Key benefits to prescribing were similar to those reported by other non-doctor prescribers and included: streamlining care for patients, improving safety, improving efficiency and facilitating new advanced clinical practice roles. Key challenges included: administrative IT issues, lack of ability to prescribe controlled drugs and managing patient/colleague expectations around paramedic prescribing. In general, participants felt supported in their prescribing role, both by doctors and other non-doctor prescribers, and felt confident to prescribe following the prescribing course. Concerns were raised about potential isolation in some settings, lack of parity in prescribing legislation across different professions and the way this is taught in prescribing programmes.
Indications are that paramedic prescribing is rolling out successfully in line with expectations. Barriers and facilitators are similar to those reported by other non-doctor prescribers and independent prescribing is already an essential component to advanced practitioner roles in settings such as primary care. Findings highlight a need for greater alignment of prescribing legislation across non-doctor prescribers from different professions undertaking advanced roles.
探讨在英国一系列医疗环境中率先采用独立处方权的护理人员的经历。
在英国国家医疗服务体系（NHS）英格兰分部2015年进行公众咨询后，于2018年3月做出决定，修订立法以使高级护理人员能够在英国的医疗环境中独立开药。了解这些“早期采用者”的经历将有助于确定护理人员开处方在医疗系统中何处能产生最佳效益，同时也能尽早梳理出实施过程中的挑战以及应对挑战的策略。这项探索性定性研究包括对17名在英国参加了独立处方项目的护理人员进行访谈。2019年5月至7月间，通过社交媒体和地区护理人员网络招募了参与者。通过电话或视频通话进行访谈，探讨了处方的使用/预期使用情况、开处方的益处和挑战以及对处方角色的支持。进行了主题分析以确定关键主题。
17名参与者中，6人目前正在开处方，其余人正在等待注册。参与者工作于一系列环境中，包括：初级保健、急诊科、紧急护理、随诊中心和快速反应服务。开处方的主要益处与其他非医生开处方者所报告的类似，包括：简化患者护理、提高安全性、提高效率以及促进新的高级临床实践角色。主要挑战包括：行政信息技术问题、无法开具管制药品以及管理患者/同事对护理人员开处方的期望。总体而言，参与者感到在开处方角色方面得到了医生和其他非医生开处方者的支持，并且在完成处方课程后有信心开处方。有人对某些环境中可能出现的孤立情况、不同职业开处方立法缺乏平等性以及在处方课程中的教学方式表示担忧。
有迹象表明护理人员开处方正按预期成功推行。障碍和促进因素与其他非医生开处方者所报告的类似，并且独立开处方已经是初级保健等环境中高级从业者角色的重要组成部分。研究结果凸显了不同职业承担高级角色非医生开处方者的开处方立法需要更好地保持一致。
