Background Patients with life-limiting conditions often have rapidly changing symptoms and benefit from access to medication for symptomatic relief. However, access to prescribers out of hours is limited and can lead to delays (Webb & Gibson, 2011. Int J Palliat Nurs. 17:537; Latham & Nyatanga, 2018. Br J Comm Nurs. 23:94; Latham & Nyatanga, 2018. Br J Comm Nurs. 23:126).
Aims To test and implement procedures which enable hospice prescribers to prescribe medication in a timely manner for symptomatic relief for patients at home, supporting patients, families and primary care teams.
Methods A standard operating procedure (SOP) was developed to allow medical/non-medical prescribers access to hospital-based prescriber (HBP) pads (Hardman, Foot, Hillan et al., 2012). When hospice prescribers review a patient at home who requires medication, they can then prescribe via the HBP pad within their competency (Royal Pharmaceutical Society. Competency framework for all prescribers [Internet]; 2021 September [cited 2022 May 16]), which can be dispensed from a community pharmacy.
Evaluation of non-medical prescribing and SOP compliance was undertaken. Audit of carbonated copies of the HBP prescriptions measured documentation compliance, medication prescribed and rationale for the prescription. Reflective case note review, case studies and stakeholder feedback were used to determine user experience and whether access to hospice prescribers was beneficial for patients and primary care teams.
Positive feedback indicates a seamless, holistic approach describing benefits from prompt availability of medications that aid symptom control thereby reducing patient and family anxiety.
All prescriptions were issued at weekends when access to primary care prescribers was limited. These were issued by the Community Advanced CNS, a non-medical prescriber, providing weekend cover for the seven day-a-week, hospice CNS service.
Often the prescription issued was for Just in Case medication.
Audit demonstrated good governance via high compliance with the SOP and documentation requirements.
Conclusions Patients benefitted from immediate review and issue of prescriptions from the hospice non-medical prescriber, thus ensuring patients were prescribed medications to relieve symptoms in a timely manner and reducing potential delays. Access to the hospice non-medical prescriber at weekends was beneficial, leading to the SOP being applied beyond this test of change.
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