Abstract
Background The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. Objective To develop consensus guidance to facilitate service redesign around pharmacist prescribing. Setting UK hospital practice. Methods The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. Main outcome measures Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. Results Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic ‘service development’ (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and ‘pharmacist prescribing role development’ (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. Conclusion Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.
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Stewart D, MacLure K, George J. Educating non-medical prescribers. Brit J Clin Pharm. 2013;74(4):662–7.
Latter S, Blenkinsopp A, Smith A, Chapman S, Tinelli M, Gerard K, Little P, Celino N, Granby T, Nicholls P, Dorer G. Evaluation of nurse and pharmacist independent prescribing. London: Department of Health; 2010.
Department of Health (2014) Non-medical prescribing programme. http://www.dhsspsni.gov.uk/non-medical-prescribing. Accessed Jul 2014.
Tonna AP, Stewart D, West B, McCaig D. Pharmacist prescribing in the UK—a literature review of current research and practice. J Clin Pharm Ther. 2007;32:545–56.
Cooper RJ, Anderson C, Avery T, Bissell P, Guillaume L, Hutchinson A, James V, Lymn J, McIntosh A, Murphy E. Nurse and pharmacist supplementary prescribing in the UK—a thematic review of the literature. Health Policy. 2008;85:277–92.
General Pharmaceutical Council (2014) Indicative curriculum for the education and training of pharmacist independent prescribers, London. http://www.pharmacyregulation.org/sites/default/files/Pharmacist%20Independent%20Prescribing%20-%20Learning%20Outcomes%20and%20Indicative%20Content.pdf. Accessed Jul 2014.
George J, McCaig D, Bond C, Cunningham S, Diack L, Watson A, Stewart D. Supplementary prescribing: early experiences of pharmacists in Great Britain. Ann Pharmacother. 2006;40:843–1850.
Smalley L. Patients’ experiences of pharmacist-led supplementary prescribing in primary care. Pharm J. 2006;276:567–9.
Hobson RJ, Sewell GJ. Supplementary prescribing by pharmacists in England. Am J Health Syst Pharm. 2006;63(3):244–53.
George J, McCaig D, Bond C, Cunningham S, Diack L, Stewart D. Benefits and challenges of prescribing training and implementation: perceptions and early experiences of RPSGB prescribers. Int J Pharm Pract. 2007;15:23–30.
George J, Bond C, McCaig D, Cleland J, Cunningham S, Diack L, Stewart D. Experiential learning as part of pharmacist supplementary prescribing training: feedback from trainees and their mentors. Ann Pharmacother. 2007;41:1031–8.
Cooper R, Lymn J, Anderson C, Avery A, Bissel P, Guillaume L, Hutchinson A, Murphy E, Ratcliffe J, Ward P. Learning to prescribe–pharmacists’ experiences of supplementary prescribing training in England. BMC Med Ed. 2008;8:57.
Stewart DC, George J, Bond CM, Cunningham ITS, Diack LH, McCaig DJ. Exploring patients’ perspectives of pharmacist supplementary prescribing in Scotland. Pharm World Sci. 2008;30:892–7.
Stewart DC, George J, Bond CM, Diack LH, McCaig DJ, Cunningham ITS. Views of pharmacist prescribers, doctors and patients on pharmacist prescribing implementation. Int J Pharm Pract. 2009;17:89–94.
Hobson RJ, Scott J, Sutton J. Pharmacists and nurses as independent prescribers: exploring the patient’s perspective. Fam Pract. 2010;27(1):110–20.
Ross S, Bond C, Rothnie H, Thomas S, MacLeod MJ. What is the scale of prescribing errors committed by junior doctors? A systematic review. Brit J Clin Pharm. 2009;67(6):629–40.
NHS Institute for Innovation and Improvement (2014) Quality and service improvement tools. http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/role_redesign.html. Accessed Jul 2014.
Campbell SM, Cantrill JA. Consensus methods in prescribing research. J Clin Pharm Ther. 2001;26:5–14.
James DH, Hatten S, Roberts D, John DN. Identifying criteria for assessing the quality of medicines use review referral documentation by community pharmacists. Int J Pharm Pract. 2008;16:365–74.
Franklin BD, O’Grady K. Dispensing errors in community pharmacy: frequency, clinical significance and potential impact of authentication at the point of dispensing. Int J Pharm Pract. 2007;15:273–81.
Pfleger DE, McHattie LW, Diack HL, McCaig DJ, Stewart DC. Developing consensus around the pharmaceutical public health competencies for community pharmacists in Scotland. Pharm World Sci. 2008;30:111–9.
Power A, McKellar S, Hudson S. A consensus model for delivery of structured pharmaceutical care for the patient with type 2 diabetes mellitus by Scottish community pharmacists. Int J Pharm Pract. 2007;15:283–90.
McDermott JH, Caiola SM, Kuhn KF, Stritter FT, Beza J. A Delphi survey to identify the components of a community pharmacy clerkship. Am J Pharm Ed. 1995;59:334–41.
Meadows AB, Maine LL, Keyes EK, Pearson K, Finstuen K. Pharmacy executive leadership issues and associated skills, knowledge, and abilities. J Am Pharm Ass. 2005;45:55–62.
Meadows AB, Finstuen K, Hudak RP. Pharmacy executives: leadership issues and associated skills, knowledge and abilities in the US Department of Defense. J Am Pharm Ass. 2003;43:412–8.
Chan A, Tan S, Wong CM, Yap KY, Ko Y. Clinically significant drug–drug interactions between oral anticancer agents and nonanticancer agents: a Delphi survey of oncology pharmacists. Clin Ther. 2009;31:2379–8627.
Jones J, Hunter D. Consensus methods for medical and health services research. Brit Med J. 1995;311:376–80.
Tonna AP, Stewart DC, West B, McCaig DJ. Exploring pharmacists’ perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland. Int J Pharm Pract. 2010;18:312–9.
Crisp J, Pelletier D, Duffield C, Adams A, Nagy S. The Delphi Method? Nurs Res. 1997;46:116–8.
Von Der Gracht HA. Consensus measurement in Delphi studies: review and implications for future quality assurance. Technol Forecast Soc Change. 2012;79:1525–36.
NHS Health Development Agency. Clarifying health impact assessment, integrated impact assessment and health needs assessment. London: Health Development Agency; 2003. ISBN 1-84279-242-3.
Tolson D, West B. An exploration of role development in nursing and midwifery. Edinburgh: NHS Health Scotland; 2002.
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The authors would like to acknowledge the participation of all external opinion holders.
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The research was funded by Robert Gordon University.
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Tonna, A., McCaig, D., Diack, L. et al. Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice. Int J Clin Pharm 36, 1069–1076 (2014). https://doi.org/10.1007/s11096-014-9996-8
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DOI: https://doi.org/10.1007/s11096-014-9996-8