Abstract
Improving access to timely and appropriate medications has increased the quality of patient care in a variety of environments and further advanced the scope of nursing practice. Globally, legislation has been developed to enable non-medical health professionals such as paramedics, pharmacists and registered nurses (RN) to supply or prescribe medications, circumventing the requirement for a traditional prescription from a doctor. Depending on their scope of practice, the methods by which non-medical professionals may initiate medication is by Standing Order (SO), or by utilising their own prescribing rights.
The research occurred in an urban urgent care (UC) facility that did not encompass other advanced nursing roles other than Nurse Practitioners (NP). The primary aim of this research was to retrospectively analyse patient access to medications prescribed by a Registered Nurse Designated Prescriber (RNDP) compared with SO at an acute, urgent care facility. Objectives were (1) to identify the value of RNDP in the UC facility by comparing the prescriptions generated versus the available SO for non-prescribing RNs, (2) utilise the findings to help inform the development of advanced nursing roles within the researcher's UC team.
Methods: A quantitative descriptive research method was used to analyse data numerically on an Excel spreadsheet after every RNDP patient consultation. The data collected consisted of the medication prescribed, it's availability as a SO and reason for prescription. All data was anonymised and stored in a password protected database and was analysed retrospectively.
Key results: The key findings were that; 1) 96% of the medications prescribed for patients by the RNDP are not accessible to patients via SO at the urgent care facility, 2) if the UC facility expanded the SO available as per the DHB, patients would still be disadvantaged due to the red flag limitations incorporated into each SO. RNDP is a more practical solution to improving medication accessibility and utilises RNs to increase the breadth of their scope. Training is substantial and does incur financial and time costs and commitment, but the benefit is that the RN is able to prescribe a wider range of appropriate medications, and also identify where non-pharmacologic treatments are necessary. Conclusion: An RNDP does improve patient access to medications at an UC facility. SO are effective when used for stratum dosing of analgesia, to aid patient comfort prior to being assessed by an advanced clinician. However, a RNDP is able to prescribe a broader range of medications including for take home use. Thus, increasing the benefit to patients with uncomplicated problems.