Potentially inappropriate medicine prescribing by nurse practitioners in New Zealand

Contributions of Specialized Nurses to Medication Management for Older People in Home Care: A Mixed-Method Systematic Review

There is a growing international interest in defining the roles, responsibilities, and contributions of specialized nurses across various aspects of home care to establish them as effective members of multidisciplinary home care teams. This study aimed to identify and describe the contributions of specialized nurses to medication management for older people in home care. This systematic review was performed using a mixed method approach. A thorough search was conducted across PubMed (including MEDLINE), Scopus, CINAHL, ProQuest, and Embase, focusing on studies published in English over the last decade, from 2014 to 2024. The convergent synthesis was used to combine and analyze qualitative and quantitative evidence in parallel to address the review question. The initial search yielded 875 studies, which were then refined to 32 studies selected for data-based convergent synthesis. The findings of the review were organized into three categories: "specialized nurses' identities", "specialized nurses' roles and responsibilities", and "impact of specialized nurses' medication management in home care". Specialized nurses played key roles in enhancing medication safety, improving older adults' quality of life, and reducing emergency visits. Their support in medication management eased the home care burden and ensured timely interventions for better symptom control and healthcare outcomes. Specialized nurses bring vital expertise to home care multidisciplinary medication team, promoting safe medication practices and helping older adults manage chronic conditions effectively at home.

Examining non-medical prescribing trends in New Zealand: 2016-2020

BACKGROUND

Population growth and general practitioner workforce constraints are creating increasing demand for health services in New Zealand (NZ) and internationally. Non-medical prescribing (NMP) is one strategy that has been introduced to help manage this. Little is known about the NMP practice trends in NZ. The aim of this study was to provide a current overview of the scale, scope, and trends of NMP practice in NZ.

METHODS

All claims for community dispensed medicines prescribed by a non-medical prescriber were extracted from the NZ Pharmaceutical Collection for the period 2016-2020. Patient demographics were retrieved from the Primary Health Organisation enrolment collection. These national databases contain prescription information for all subsidised community pharmacy medicines dispensed and healthcare enrolment data for 96% of New Zealanders.

RESULTS

The proportion of prescriptions written by all NMP providers and patients receiving NMP prescriptions increased each year from 1.8% (2016) to 3.6% (2019) and 8.4% (2016) to 14.4% (2019) respectively. From 2016 to 2019, the proportion of NMP patients who had at least one NMP prescription increased from 26% to 39% for nurse prescribers, from 1% to 9% for pharmacist prescribers, from 2% to 3% for dietitian prescribers, and decreased from 47% to 22% for dentists, and from 20% to 12% for midwives. The most commonly prescribed medicines were antibiotics (amoxicillin, amoxicillin with clavulanic acid, and metronidazole), and analgesics (paracetamol, and codeine phosphate). While some NMP providers were prescribing for patients with greater health needs, all NMP providers could be better utilised to reach more of these patients.

CONCLUSIONS

This study highlights that although the NMP service has been implemented in NZ, it has yet to become mainstream healthcare practice. This work provides a baseline to evaluate the NMP service moving forward and enable policy development. Improved implementation and integration of primary care NMP services can ensure continued access to prescribing services and medicines for our communities.

Experiences of registered nurse prescribers; a qualitative study

Aims: This study aimed to investigate the experiences of registered prescribers and their perceptions of the enablers and barriers to registered prescribing and the value of this fledgling role. Background: The role of prescribing has been extended to registered nurses in New Zealand. By adding the designated prescribing role to a nurse's role, their scope of practice expands and nurses are able to provide patients with holistic care while achieving greater independence and role satisfaction. Yet new nurse prescribers can experience anxiety and fear when confronted with the reality of the responsibility of prescribing. Methods: Sixteen semi-structured interviews were conducted with registered nurse prescribers across New Zealand. Data were analysed using a general inductive approach and thematic analysis utilised to identify themes and sub-themes. Results: Sixteen registered nurse prescribers participated in the study. Three main themes emerged with sub-themes: ability to expand practice, improving access to care, and importance of working in a collaborative team. Participants explained how they enjoyed the challenge and responsibility of the new prescribing role yet were frustrated with the realities of the restrictions of what they could actually prescribe and in some cases lack of role recognition. Registered nurse prescribing also improved access to care as nurses felt they provided more comprehensive care, resulting in reduced wait times, better continuity of care and a reduction in patient costs. The participants highlighted the importance of working in a collaborative team and believed their ability to prescribe maximised clinician time, however cautioned the need for on-going clinical mentorship and a prepared and supportive work environment. Conclusions: The addition of registered nurse prescribing provides a number of advantages to individual nurses in terms of career development and job satisfaction, and to patients and the health care system. The benefits to health care consumers and the health care system align directly to health care priorities of improving equity and access to care. Impact statement: Registered nurse prescribers perceive a number of advantages to the addition of prescribing to their own practice and benefits to patients and the health care system by enabling more accessible and cost-effective care.