ACCESS TO MEDICINES IN PRIMARY CARE FOR PAEDIATRIC PATIENTS: INVOLVEMENT OF HOSPITAL CLINICAL NURSE SPECIALISTS AND ADVANCED NURSE PRACTITIONERS Terry DRP, Sinclair AG, Marriott JF, Wilson KA, Daniels A. Birmingham Children's Hospital & Aston University, Birmingham, England
Objective: To evaluate the involvement of hospital Clinical Nurse Specialists (CNS) and Advanced Nurse Practitioners (ANP) in the UK in ensuring access to medicines in primary care for paediatric patients.
Methods: A 12 point electronic survey tool was developed and created using LimeSurvey version 1.71+(5498). The development included discussion with CNS/ANPs and was piloted before use. The survey was tokenised to ensure that one invite elicited one response only. The invitation to participate was sent via email with a link to the study, to all 100 of the CNS and ANP employed by Birmingham Children's Hospital commencing September 2008. Two reminders were sent if necessary at weekly intervals. Responses were entered into MS Excel 2003 and SPSS v16 for analysis.
Results: A 78% response rate (n=78) was obtained. Nurses from 23 specialties completed the questionnaire with 49 nurses (63%) working more than 30.1 hours per week (0.8 whole time equivalent): 9 as prescribers. A majority, (n=57, 73%) reported that in the 3 months preceding the study they were called upon to organise repeat prescriptions at least once, with 28 (36%) doing so on 6 or more occasions and 55 (70%) of respondents organized repeat prescriptions for at least 514 patients over the 3 month period. Fifty nurses (64%) described the risk to patients if they did not assist patients in accessing medicines as significant or highly significant. Only 10 nurses (12.8%) considered that this activity was included in their job descriptions. The respondents indicated that the most common reason for such problems was prescriber issue(s). The respondents gave a range of responses when asked in what ways services can be better organised including: require GPs to prescribe all continuing medicines (59% frequency) and require hospitals to prescribe and dispense unlicensed / uncommon medicines (46% frequency).
Conclusions: This study describes the role senior hospital nurses undertake in response to medication issues for patients residing in primary care. Hospital CNS and ANP report frequent interventions to assist patients outside hospital in obtaining the medicines they need.
Prescriber related issues were the most common reason cited for these problems. Further work will be required to identify the rational for this opinion. Hospital CNS and ANP provide an important service to patients in primary care although this may not be reflected in their job description. Pharmacists in all healthcare sectors will benefit from being aware of this activity. The findings of this study suggest that responsibility for prescribing between hospitals and GPs described in 1991  may benefit from review. Hospital CNS and ANP provide an important service to paediatric patients residing in primary care to ensure continuity of therapy.