Promoting non-medical prescribing practice using targeted education and prescribing tools in an MSK assessment service (MSK CATS)

Purpose

The uptake of non-medical prescribing (NMP) practice in MSKCATS was noted to be low based upon prescription data, despite there being a high number of qualified prescribers. The aim of this project was to assess the barriers to prescribing in this service and to implement a targeted education programme and a series of prescribing tools to facilitate practice.

3.4% of qualified NMP staff never prescribed
and 66% only prescribed occasionally.
50% of qualified NMP staff occasionally de-prescribed
and 30% never de-prescribed.

Approach

The literature regarding barriers to NMP was reviewed. A survey was designed based upon the barriers to prescribing that have been previously identified. This was completed by staff with a prescribing qualification. A series of areas for development were identified and several targeted education sessions were planned within the existing education programme. Education sessions included sessions on the evaluation of liver and kidney function, detailed drug information and case specific prescribing discussions. Small group projects relating to NMP development needs were also undertaken primarily aiming to standardise prescribing processes and documentation in order to reduce unwanted variation, ensuring all patients received the same standard of care. This involved developing prescribing tools such as drug specific information documents, checklists, patient electronic record documentation and patient leaflets. This led to the development and implementation of prescribing clinical decision tools.

Outcomes

Results: The initial survey supported the prescription data and suggested that uptake of NMP was low. 33.4% of qualified staff never prescribed and 66% only prescribed occasionally. There was variable uptake in medicines optimisation. 50% occasionally de-prescribed and 30% never de-prescribed. 33% had average confidence in NMP and 34% were not confident at all. Overall, staff had a positive attitude to NMP but 64% felt that safety concerns prevented prescribing and that it was a source of stress and anxiety. There was variable self-rating of knowledge. Staff felt challenged by complex/polypharmacy patients and it was felt that there was the need for more CPD, case discussion and prescribing resources/documentation. Staff will be fully surveyed again, allowing for enough time for the new learning and clinical decision tools to become fully embedded in practice. Short term feedback from staff suggests that confidence in prescribing has improved and safety concerns are reduced, thereby improving our effectiveness within the wider system and reducing referrals back to GPs

Conclusion(s): NMP practice was evaluated in MSKCATS and barriers were identified and addressed through education and small group projects. Short term results suggest that a tailored education and comprehensive supporting guidance/documentation have made a positive impact on staff safety concerns, confidence with prescribing and increased prescribing activity, whilst improving the services’ effectiveness in the wider healthcare syste

Cost and savings

There were no additional costs as this project was run as part of our exisiting CPD structure.

Implications

Increased understanding of NMP uptake and barriers to prescribing. Further analysis to follow

Top three learning points

No further data.

Funding acknowledgements

None