9.6.2 The impact of nurse supplementary prescribing on safety and mental health service users' health outcomes: an experimental study (23)

Ian Norman, Professor of Nursing & Interdisciplinary Care, Florence Nightingale School of Nursing and Midwifery, King's College London, London, United Kingdom Co authors: Samantha Coster ian.j.norman@kcl.ac.uk

Abstract:

Background:

The introduction of non-medical prescribing into the British NHS (1) raises unanswered questions about the safety of nurses compared with doctors and the benefits for patients (2, 3). This paper addresses these concerns with reference to findings from a DH commissioned evaluation of the impact of mental health nurse supplementary prescribing (MHNSP).

Aim:

To compare MHNSP with established medical prescribing on service users’ safety and health outcomes.

Design & methods:

Using an equivalent post-test control group experimental design, this study compared the health and social care outcomes of 45 randomly selected service users whose medication was managed through MHNSP for at least six months with a matched sample of service users whose medication was managed by doctors. Users’ medical records were also audited against relevant National Institute of Clinical Excellence guidelines to determine the appropriateness and safety of prescribing by both nurses and doctors. Structured interviews were utilised to collect data on users’ treatment satisfaction, side effects, knowledge of and adherence to medication and health status. Data was collected between August 2006 and February 2007.

Results:

No significant differences were found between services users receiving MHNSP or medical prescribing on measures of: health status, social functioning, treatment satisfaction, reported adherence to medication or satisfaction with medication information. The record audit found no significant difference in the safety of MHNSP and independent medical prescribing, but highlighted issues of poor documentation from both nurses and doctors.

Discussion:

The effects of transferring over to MHNSP for service users’ appear negligible and where the therapeutic relationship with the nurse is already good, may increase satisfaction with care. The researchers discuss the implications of these findings and make recommendations for improving the quality of documentation to inform safe prescribing.

Biography:

Ian Norman is a social scientist with a professional background in mental health, general and learning disability nursing and social work. He was appointed Professor of Nursing and Inter-disciplinary Care at King’s in 1997, and is currently Head of the Mental Health Section and Head of Graduate Research Studies in The Florence Nightingale School of Nursing. Ian Norman’s research programme is concerned primarily with the study of educational and workforce related initiatives for improving the delivery of health care, and the outcome of these initiatives for staff, patients and services. He has a particular research interest in inter-professional education and working amongst health and social care professionals, and the education and work of mental health nurses. His completed research studies include evaluations of quality assessment instruments in nursing (for DH), Nursing Development Units (for DH), clinical competence assessment measures (for National Board for Scotland), and NHS Cadet Schemes (for DH). His recent research includes an evaluation of family interventions for people suffering from schizophrenia, a trial of a computerised cognitive-behavioural therapy package as a teaching intervention for nursing students (funded by the British Academy) and an evaluation of mental health nurse supplementary prescribing (for DH.)