This roundup will focus on some of the most recent literature published on mental health prescribing. It will report on four articles: one systematic review, one mixed methods study, one quantitative study and one qualitative study. The majority of research reported in these four articles were conducted in the UK.
Mental health nurse prescribing: a qualitative systematic review
Australian researchers carried out a systematic qualitative synthesis of 12 samples (Cleary et al, 2017). Using the Critical Appraisal Skills Programme (CASP) for qualitative studies, all were deemed to have met criteria for quality research. All 12 studies were conducted in the UK, which reflects the level of engagement with mental health nurse prescribing compared to other countries. Three main themes emerged from the data abstraction and synthesis: patient-centred care, professional role and professional support. Participants perceived that the implementation of nurse prescribing resulted in a higher quality service, with improved patient–prescriber rapport, continuity of care and greater support with medicines information from the prescriber as key features. Professionally, participants described how their role had become more autonomous and one that had earned the respect of the medical profession, as they were now perceived as a professional peer rather that the more traditional role of a nurse. With role development participants recognised a need for support, supervision and education to maintain patient safety and, although data suggested that sometimes this was addressed, on occasion it was inconsistent and sporadic. The review concluded that although the role of a prescriber was deemed valuable by service users and other key stakeholders, education and maintaining competence is vital for role safety. It also highlighted the absence of research on the effect of nurse prescribing in mental health services on clinical and financial outcomes.
National survey of nurse prescribing in mental health: a follow up of 6 years on
Researchers carried out a national survey in the UK as a follow up of two previous surveys that were conducted in 2005 and 2008 (Dobel-Ober and Brimblecombe, 2016). The survey was a mixed methods design and distributed to directors of nursing in 52 hospital Trusts. The response rate was high at 75%. Respondents reported an increase in the numbers of active prescribers and a decrease in use of supplementary prescribing. They also reported a high proportion of services having policies and a prescribing lead to support the development and expansion of the role. With regards to development of the workforce, the data suggested that they had a formal programme of continuing professional development and that most prescribers were UK band 6 or greater, indicating that the prescribing role was perceived to be that of a senior nurse. This study is of particular interest because comparing results from two previous surveys, it charts the progression and development of mental health prescribing in the UK. With the changes to the prescribing standards allowing nurses to undertake prescribing earlier in their career, it will be interesting to repeat this survey in 5 years to establish whether there is a shift towards more junior nurses becoming prescribers. Furthermore, the move from supplementary to independent prescribing reflects findings from the systematic review by Cleary et al (2017), suggesting that mental health prescribers are becoming more autonomous in their role.
Perception of nurse prescribing among nurses and psychiatrists in a developing country: a cross-sectional survey
This article is of interest because it took place in Qatar, which has a population of 2.6 million and a large expatriate workforce; the majority originating from the Middle East, Africa and Asia (Badnapurkar et al, 2018). The study sought to establish the views of clinicians with regard to nurse prescribing, a practice not yet implemented in Qatar. A 65-item survey was distributed to 196 registered nurses working in mental health services and 68 psychiatrists; an overall response rate of 79% was reported. Its findings suggest that there was encouragement for prescribing provided appropriate education and support was in place. Acute psychiatry and substance misuse were perceived to benefit most from the role. Respondents reported that they perceived the role as a positive step towards increased autonomy, improved patient experience and better use of nurses' time. An interesting finding was that nurse respondents believed that psychiatrists would be held to account if they made a prescribing error. This finding suggests that clear policies and procedures including clarification of liability would have to be in place before changes in prescribing authority are implemented in Qatar.
Prescribers' views and experiences of assessing the appropriateness of prescribed medications in a specialist addiction service
Since changes to legislation in 2012, there has been a growth in substance misuse prescribing by mental health nurses. The final article in this month's roundup focuses on this sub-speciality of mental health care (Oluyase et al, 2017). The study was an in-depth qualitative study with four nurse prescribers and eight doctors who were working in a specialist substance misuse clinic in the UK. Data were collected using semi-structured interviews and thematically analysed. The study sought to establish whether the drugs prescribed for people presenting to a specialist substance misuse service maximised effectiveness, minimised risk and cost and respected patient choice. Although the study sample was small, and thus not generalisable, findings suggested that mental health nurse prescribers had limited skills and knowledge with regards history-taking and consideration of comorbidities alongside their primary substance misuse condition. The data suggested that nurses adopted a cautious approach to medicines review and acknowledged that this was a limitation to their practice. With the reduction in consultant-led substance misuse services, the author highlighted that nurses working in this area may require additional skills and knowledge or a more interprofessional approach, supported by pharmacists, to fully address the needs of service users. With an increasingly complex substance misuse population, the study reinforces a more integrated approach to pre-registration prescribing preparedness education and evidence of the ability to carry out health assessment before commencing a prescribing programme.
Conclusion
Similar to other areas of non-medical prescribing practice, the research evidence to support this practice is limited. Nonetheless, there is a growth in numbers of prescribers in mental health in the UK, and growing support for the practice worldwide. To optimise safe effective practice, a pre-registration prescribing preparedness programme covering physical and mental health assessment and medicines review may be necessary. Moreover, a sufficiently powered study to evaluate the effect of non-medical prescribing on clinical and financial outcomes would empirically demonstrate its safety and efficacy.