An audit of independent nurse prescribing in a critical care outreach team

Background: In 2006, legislative changes enabled independent prescribers to prescribe any licensed medication within their field of expertise. This has transformed nurse prescribing and opened up more opportunities for nurses to develop their practice in acute care settings. The need for further evaluation in this developing area of advanced practice was highlighted in the British Association of Critical Care Nurses (BACCN) position statement published in 2009. Aims: The aims of this audit were to describe the prescribing practices of nurses working in a critical care outreach (CCO) team by exploring: which medications were prescribed; the number of prescribing decisions being made and if prescribing practice changed during the out of hours period. The findings can be used to inform practice, develop CCO services, provide a basis for further research, and contribute to the debate in this developing area of CCO practice. Methods: The prescribing practices of two independent non‐medical prescribers in a CCO team were audited from January to April 2011. Results: The findings showed that; there were a wide range of medications prescribed, that prescribing decisions increased over time and that the majority of prescriptions were written out of hours. Conclusions: This preliminary audit has shown that prescribing in a CCO setting which covers a wide patient population is manageable. By evaluating drug prescribing patterns, a ‘critical care outreach formulary’ can be developed to guide individuals and the team in their continuing professional and service development. The CCO teams ability to prescribe could have the potential to improve the patients' experience and outcome, and positively affect the efficiency of service delivery; however, an increase in CCO referrals can have an impact on the CCO service resource. Further evaluation and study are needed to explore this developing area of critical care delivery.