Exploring the educational and support needs of nurse non-medical prescribers working within HIV care

Gary Barker-Begley
Community Matron, North West Boroughs Healthcare Trust, UK

Historically, the nurses’ involvement in medication management has been that of administration. A series of legislation changes over the past 30 years has resulted in significant advancements that have led to the nurses’ ability to train to practice as a non-medical prescriber (NMP). The introduction of NMPs saw a change in legislation to initially enable nurses to independently prescribe [1]. Further developments in 2003 then enabled pharmacists to supplementary prescribe with independent pharmacist prescribing being introduced in 2005 [2,3]. A Department of Health (DH) paper in 2005 recommended that NMPs would be able to prescribe any licenced medication for any medical condition (and some specified controlled drugs for specified medical conditions). The DH paper also enabled allied health professionals (AHPs) such as physiotherapist, podiatrist and paramedics to prescribe [3].
Within HIV care there are limited data on the NMPs’ role or how NMPs have been utilised within HIV care to improve patient outcomes. Bennett and Jones in 2008 identified that NMPs working in HIV had experienced positive benefits of being able to prescribe, which had resulted in a reduction in time trying to find a doctor to prescribe for them [4]. Participants within the study also articulated that being able to prescribe allowed them to manage stable patients, giving doctors more time for complex patients. A number of the NMPs within Bennett and Jones’ study expressed concerns about making a diagnosis as a result of their lack of formal training in clinical examination skills. Other barriers that the NMPs identified within this study were from their employers who required NMPs to produce a personal formulary, with some employers limiting what NMPs could prescribe. Barker, in 2015, within his survey of NMPs also highlighted a reduction in time spent waiting for prescriptions, which had a positive impact on patient care with an increase in patient satisfaction [5]. This study also identified that 75% of responders received in-house training with most of those also accessing external training in order to maintain their competencies, it also highlighted that there was no specific HIV-related continuing professional development with regards to prescribing. The results of this 2015 survey will be used to examine how NMP prescribing, training, prescribing practicalities and views on prescribing had changed over a 2-year period up till 2017.
The National HIV Nurses Association (NHIVNA) recommend non-medical prescribing for nurses working at advanced practice and suggest that nurses should be prescribing and monitoring antiretroviral medication in nurse-led clinics [6]. This is supported by the British HIV Association (BHIVA), who recommend that nurses working in advanced practice should undertake non-medical prescribing qualifications [7]. However, both of these documents do not give guidance on how NMPs in HIV care should be supported, once they have qualified as prescribers. Read more…