Adam is a Paramedic Advanced Clinical Practitioner (Urgent and Emergency Care) working across ambulance, urgent and primary care services in the UK. He is in the final stages of his PhD in Health Sciences, researching paramedic independent prescribing in emergency and urgent care settings.
A Mixed Methods Investigation of Paramedic Independent Prescribing in Emergency and Urgent Care
Mr Adam Bedson1,2, Professor Susan Latter2, Dr Joanne Turnbull2
1South Western Ambulance Service Nhs Foundation Trust, United Kingdom, 2The University of Southampton, Southampton, United Kingdom
Abstract
Introduction
This study aimed to explore the benefits of paramedic independent prescribing (PIP) in emergency and urgent care (EUC) settings in England, whilst ascertaining any facilitators or barriers.
Methods
A purposive sample of key stakeholders (n= 15) were interviewed, and detailed, mixed methods case study research was undertaken in an emergency department (ED) and an urgent care service. Data collection included non-participant observation, interviews and quantitative analysis of prescribing data.
Results
PIP enhanced paramedic autonomy and improved patient access to medicines in EUC. A diverse range of conditions were prescribed for in ED including acute infections, cardiac emergencies and trauma. In urgent care, largely through remote prescribing by telephone, acute infections were frequently encountered, alongside less urgent cases and repeat prescription requests that had not been managed in primary care.
PIP implementation had been slower and more challenging than anticipated within the ambulance sector. However, benefits from the use of remote prescribing to resolve lower acuity emergency calls by telephone were reported. Important facilitators of PIP included sufficient access to detailed patient records and medical support. Current legislation restricts prescribing of Controlled Drugs for PIPs. This impacted on paramedic autonomy and delayed patient access to important treatments including end of life care.
Conclusions
The introduction of PIP has enhanced the contribution of paramedics in EUC, although the benefits are yet to be fully realised in the ambulance sector. A clear case of need exists for further changes to legislation to enable PIPs to prescribe a wider range of Controlled Drugs.