Background The use of non-medical prescribers is explored extensively in the literature with the benefits to patients receiving palliative care grounded in empirical research (Latham & Nyatanga. Br J Comm Nurs. 2018; 23(2): 94–98). A current review of the literature reveals a theme of a range of challenges in practice in palliative care (Dawson. J Prescribing Pract. 2020;2(8): 434–439; Osborne & Kerr. Int J Palliat Nurs. 2021; 27(4): 205–212; Willmott, White, Yates, et al. Palliat Med. 2020; 34(4): 524–532). The benefits of non-medical prescribers to other services and the wider health economy in palliative care at such a challenging time has not recently been demonstrated.
Aim To demonstrate the benefits of non-medical prescribers in out-of-hours specialist palliative care.
Methods Since the pandemic the clinical nurse specialist team have ensured the weekend rota is inclusive of a non-medical prescriber during the working day. Retrospective analysis of six months of non-medical prescribing data from the community clinical nurse specialist team was performed. Correlated with referrals from specialist palliative and end of life telephone coordination service to out-of-hours GP team (ongoing).
Results Data analysis is ongoing but reveals a difference during seven-day week periods. Monday to Friday non-medical prescribing focuses significantly on preventative prescribing, for example, just in-case medications. Weekend non-medical prescribing is predominantly crisis management response. Data from GP out of hours service on referrals from specialist palliative care and end of life coordination service showed no referrals from our service. Comparable pre-existing data not available due to change in practice post pandemic of ensuring an independent nurse prescriber on duty at the weekend.
Conclusion This audit data demonstrates the benefits to other services and the wider health economy, not just the individual patient themselves. This is inclusive of prevention of hospital admissions, impact on pharmacies, and cost effectiveness.
Innovation Learning and innovation is ensuring ongoing training and funding of programmes for clinical nurse specialists for non-medical prescribing in the community. Nationally, pre-pandemic the growth in non-medical prescribers was minimal in relation to total community palliative care prescribing activity in England (Ziegler, Bennett, Mulvey, et al. Palliat Med. 2018;32(4): 767–774) therefore, this needs to be an area of expansion and priority.
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