Use of research evidence varied in efforts to expand specific pharmacist autonomous prescriptive authority: an evaluation and recommendations to increase research utilization

Background An expanding body of literature shows that pharmacists’ interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists’ scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study investigated how stakeholders utilized research evidence when developing expanded scope of practice policies in their respective states. Methods Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, semi-structured interviews with policy-makers and pharmacy advocates were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy-making process. Investigators analysed findings from the transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted. Results Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policy-makers and researchers, and leveraging pharmacy practice stakeholders. Conclusions Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practise at the top of their license.

Informing and Supporting the New Clinical Nurse Specialist Prescriber

Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.

Experiences of advanced psychiatric nurses regarding the need for prescriptive authority in KwaZulu-Natal

Background: Nurse prescribing has become a global and transformational practice to ensure the achieving of optimal health outcomes, including advanced psychiatric nurses. Despite the transformational practice globally, South Africa seems to lag behind because nurses do not have permission to prescribe medication.Aim: To describe the experiences of advanced psychiatric nurses regarding the need to prescribe medication treatment in KwaZulu-Natal.Setting: The study took place in three mental healthcare institutions in KwaZulu-Natal in inpatient units.Method: The qualitative, descriptive design was used to collect the experiences of advanced psychiatric nurses in KwaZulu-Natal regarding the need for prescriptive authority. Six focus group interviews were conducted to gather information. The seven steps of Colaizzi’s method were used to analyze the data.Results: The study found two primary themes and two sub-themes. The findings highlighted the necessity for advanced psychiatric nurse role recognition and prescribing. Insufficient use of skilled psychiatric nurses caused delays in addressing mental health patients in emergencies.Conclusion: The two themes, prescribing role of advanced psychiatric nurses and role recognition, revealed that granting advanced psychiatric nurses’ autonomy to prescribe remained a challenge. Advanced psychiatric nurses are expected to provide high-quality care, but they are limited in their abilities. Because advanced psychiatric nurses are not used to prescribe in KwaZulu-Natal, they rely on psychiatrists to manage psychotic patients.Contribution: The evaluation of policies and procedures that guide advanced psychiatric nurses in prescribing psychotropic medications.

Assessment of the Implementation of Pharmacists’ Prescriptive Authority to Furnish Hormonal Contraceptives, Naloxone, and Nicotine Replacement Therapy in California

Background California State Board of Pharmacy passed Senate Bill 493 authorizing pharmacists to furnish self-administered hormonal contraceptives, nicotine replacement products, and naloxone. Although California Senate Bill 493 expanded pharmacists’ scope of practice, limited implementation persists. Objective The objectives of this study were to assess the implementation of pharmacists’ prescriptive authority to furnish hormonal contraceptives, naloxone, and NRT in California as allowed by the Board of Pharmacy and availability of these services to patients in order to facilitate the development of strategies to expand them. The objective of the first part was to investigate reported awareness and barriers to implementation of services, while the second part was to report actual implementation rates. Methods This was an IRB-approved two-part cross-sectional survey that explored factors that may be associated with the limited implementation of the expanded scope of practice services. Results The two-part study had a total of 389 respondents. In the first part of the study, there were a total of 84 respondents. The majority reported that they were aware that pharmacists have the authority to furnish hormonal contraceptives, naloxone, and NRT, but services were limited. In the second part of the study, there were a total of 305 respondents, each responding to questions addressing only one of the three services: hormonal contraceptives (104 respondents), naloxone (101 respondents), and NRT (100 respondents). Within those subgroups, 19% of the respondents stated they offer hormonal contraceptives, 10% offer NRT, and 84% offer naloxone. Conclusion The results of the two-part study suggested that pharmacists’ authority to furnish these services were limited, thus patients’ access to these services were also limited.

Should nurses be given the rights to autonomously initiate medications for adult patients’ experiencing acute pain at triage prior to a physicians’ consult in Singapore’s Emergency Departments? A Systematic Review

Background: Globally, in most countries, nurses are restricted from independent prescribing however, seven countries have achieved legislation to implement prescriptive authority to nurses with more countries in bid to follow suit. Since the inception of nurse-initiated medications in the 1990s, the increase in prescribing authority has shown a positive impact on the measured metrics with evidence improving patient care with timeliness to analgesia and greater pain control. Objectives: The objectives of this review is to rationalise the use of nurse-initiated medications at triage for patients’ presenting with acute pain in the emergency department, to critically analyse the risks and benefits of NIM and to generate ideas and make recommendations about practice implications regarding NIM at triage.Methods: A literature review using a systematic approach was undertaken. Multiple keyword combinations were incorporated, and an inclusion and exclusion criteria were set. All studies chosen were critically appraised using four different toolkits based on research design for rigour & quality. Ten studies were selected for this review. Thematic analysis was conducted, stitching the similarities identified within the studies and a discussion of the results with a conclusion was written. Results: Nurses who were given prescriptive authority significantly decreased time to analgesia in nine studies with the initiation of NIM at triage. There were no complaints or mentions of medication errors, special events or adverse reactions reported in the selected research papers. Thematic analysis identified pain assessment as a key indicator for nurses to initiate medications for patients upon triage. The introduction of NIM has attained clinically significant pain reduction scores and increased patient satisfaction. There was, however, little effect between NIM and ED length of stay. Safety concerns, anxiety, and overwhelming workload were identified as barriers for nurse prescribing with measures set in place to combat these issues.Conclusion: This review has found that nurse-initiated medications are beneficial as it does increase timeliness to analgesia and improve pain control for patients. It also highlights compelling evidence with an increase in timeliness to analgesia and that authority should be given to nurses in Singapore for the rights to autonomously prescribe analgesia for patients’ experiencing acute pain at triage prior to a physicians’ consultation. Prescriptive authority for nurses will be a step forward in contemporary emergency medicine. Further exploration and research should be undertaken about the concept and impact of NIM on safety issues, ED length of stay with randomised studies to solidify this initiation.

Pharmacist Prescriptive Authority for Acne: An Evidence-Based Approach to Policy

The diagnosis of acne is typically straightforward and based on physical signs and symptoms. Some jurisdictions in Canada, the United Kingdom, and United States have enabled a pharmacist treatment model to diagnose and manage patients with mild acne using prescription medications. Studies have found the model to be safe and effective, while simultaneously increasing more timely access to care for patients which may reduce the potential adverse impacts of acne. Further, use of a standardized protocol may alleviate some of the concerns expressed over the model. This paper summarize answers to frequent questions to help policymakers consider the objective evidence for their jurisdiction.

Survey of prescriptive authority among psychiatric pharmacists in the United States

Introduction Despite the high prevalence of those with mental illnesses, there is a critical shortage of psychiatric providers in the United States. Psychiatric pharmacists are valuable members of the health care team who meet patient care needs, especially those practicing with prescriptive authority (PA). Methods A cross-sectional electronic survey was administered to Board Certified Psychiatric Pharmacists (BCPPs) and non-BCPP members of the College of Psychiatric and Neurologic Pharmacists. The objective of this study was to compare demographic and practice characteristics between respondents with and without PA. Results Of the 334 respondents, 155 (46.4%) reported having PA. Those with PA, including those with Veterans Affairs (VA) affiliated PA, had fewer mean number of years of licensure than those without PA (P = .008 and P = .007, respectively). The majority with PA practiced in outpatient settings (53.5%). Respondents with PA (including those with VA-affiliated PA) were more likely to have their positions funded by practice sites (P < .001). The most common referral source for medication management for those with PA were physicians although pharmacists also provided referrals in both VA and non-VA settings. Pharmacists with PA were more likely to track practice outcomes versus those without PA (P < .001). Discussion The current study confirms the variability in PA among psychiatric pharmacists. Demographics of the respondents reflect changes in residency accreditation and increased numbers of psychiatric residencies within VA facilities. Psychiatric pharmacists with PA reported treating psychiatric and medical conditions, creating added value. Psychiatric pharmacists should be empowered to track outcomes and help meet the critical shortage of psychiatric providers.

Use of Research Evidence Varied in Efforts to Expand Pharmacist Prescriptive Authority: Recommendations to Increase Research Utilization

Background: An expanding body of literature shows that pharmacists’ interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists’ scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study hopes to investigate stakeholder utilization of research evidence to expand scope of practice in their respective states.Methods: Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, a systemized review and semi-structured interviews were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy make process. Investigators analyzed findings from the systemize review and transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted. Results: Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. The systemized review yielded no relevant peer-review literature regarding evidence utilization, so gray literature and interviews were analyzed. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policymakers and researchers, and leveraging pharmacy practice stakeholders.Conclusions: Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practice at the top of their license.