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ABSTRACT

The poster and presentation will outline selected findings from the first national evaluation of independent nurse prescribing in England, commissioned by the Policy Research Programme the Department of Health.
Research objectives: (i) To establish a method of assessing the clinical appropriateness of nurses� prescribing decisions (ii) To evaluate the prescribing decisions of nurse prescribers, using this method.
Methods: A modified version of the Medication Appropriateness Index (MAI) (Hanlon et al 1992) was used by 7 medical prescribing experts to rate transcripts of nurse prescriber consultations purposively selected from a larger database of 118 audio-recorded consultations collected as part of the national evaluation. Experts were also able to give written qualitative comments on each of the MAI dimensions applied to each of the consultations. Experts� ratings were analysed using descriptive statistics. Qualitative comments were subjected to a process of content analysis to identify themes within and across both MAI items and consultations.
Conclusions: In the majority of instances, experts considered that there was an indication for the medicine prescribed, that it was effective for the condition, that the dosage was correct and that there was no unnecessary duplication with other medicines. MAI items on whether nurses were offering correct and practical directions about the medicines prescribed, as well as whether the duration of therapy prescribed was correct, tended to attract a greater number of negative ratings from experts, although the majority still indicated that nurses� prescribing actions were appropriate in these respects. Additionally, all seven experts made at least one written comment on the assessment and diagnosis aspects of the 12 consultations and in total 20 comments on possible deficiencies of this aspect of nurses' consultations were made.
Overall, the experts' ratings indicated that the nurses' prescribing decisions were generally clinically appropriate across a range of different dimensions, and the results compare favourably with the prescribing practices of doctors and pharmacists.

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