Background Palliative care patients of Community Specialist Nurse Independent Prescribers (CSNIPs) often have multiple complex symptoms requiring specialist management (Ziegler, Bennett, Blenkinsopp & Coppock, 2015). CSNIPs are key to delivering this care with a timely response. Perceived benefits include faster access to medicines (Tatterton, 2018) and rapid symptom control (Dawson, 2013), supporting end of life patients to remain at home. The challenge for CSNIPs is to maintain specialist knowledge with processes that support their prescribing practice.

Aims Exploring the range of medicines prescribed by a CSNIP in the Community Specialist Palliative Care Team, establishing impact on practice and examining support processes.

Methods An audit was undertaken of CSNIP yearly activity with data collated according to drug monographs in Palliative Care Formulary 6 (Twycross, Wilcock & Howard, 2017). Appropriateness of prescribing was evaluated, including anticipatory and syringe driver prescribing and medicines reconciliation activity.

Qualitative data was gathered regarding patient and carers experience of CSNIP via interviews and written feedback, followed by thematic analyses.

Investigative methods identified processes supporting annual CSNIP prescribing reviews and supervision.

Results Prescriptions demonstrated an appropriate range of medications prescribed and within the CSNIP scope of practice. Analgesics were prescribed in 32% and central nervous system medications in 22% of cases, with increasing anticipatory and syringe driver prescriptions on previous years.

Feedback from patients and carers showed continued positive benefits, especially in managing complex end of life symptoms.

Support for CSNIPs is via partnership working with the local Community Health Care Trust and Medicines Management Team, involving annual mandatory CSNIP ‘Prescribing Reviews’ and supervision.

Conclusions The range of medications prescribed demonstrated appropriate CSNIP practice. Patients and carers valued the CSNIP clinical expertise and prompt receipt of medications. This evidences the value of CSNIP training. Annual reviews of CSNIP prescribing and support is via partnership working.