References
The views of current and future paramedics on prescribing: a review
Abstract
Background:
Following a change in legislation in 2018, paramedics gained prescribing rights but, as this is a recent change, no reviews have been carried out into their experiences.
Aim:
The overarching aim of this article is to understand the thoughts and opinions of current and future paramedic prescribers on non-medical independent prescribing. It also aims to identify potential barriers to paramedic independent prescribing (PIP), investigating the gaps within medication options, and the role of PIP in the autonomous scope of paramedic practice.
Methods:
A literature search of MEDLINE, CINAHL, PubMed and CENTRAL was undertaken in January 2023, with articles also gathered from grey literature, Google Scholar, citation searching and author contacting to identify literature for review. Six articles underwent thematic analysis, and four themes were identified: advanced practice; improved medication management; barriers to implementation; and effect on current practice.
Findings:
Overall, there are significant positives to paramedic independent prescribing, such as improved patient experiences, more medication options and fewer hospital admissions. However, there were concerns, which centred on the implementation process, underpinning support and increased responsibility.
The approach of paramedics towards patient care has changed since the role emerged in the 1960s, and has evolved rapidly since 2000 (Eaton et al, 2018). In the early days, ambulance staff were no more than first aiders treating life-threatening wounds and injuries (Chamberlain, 2018). The original paramedic formulary was limited, consisting of just four medications (Chamberlain, 2018). This increased to medications identified in schedules 17 and 19 of the Human Medicines Regulations 2012 for the immediate, necessary treatment of patients (England, 2016); however, this formulary is heavily weighted towards emergency care. Additional medications may be incorporated into practice via patient group directions (PGDs); these allow the administration of medications not listed in Schedule 17 or 19, or in any other ruling to a pre-defined group of patients (Medicines and Healthcare products Regulatory Agency, 2017). However, these have inherent issues, including strict criteria, and adding to formularies is a time-intensive process (Price et al, 2012).
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