Читать книгу The Advanced Practice Registered Nurse as a Prescriber - Группа авторов - Страница 20

Changes in evidence‐based practice, patient‐centered outcomes research, and the introduction of new medications require regular review of patient medication regimens. A professional development plan will help the APRN utilize the most current evidence in medication management.

Participation in lifelong learning is the essence of a professional development plan. Different forms of lifelong learning may include collegial mentoring by another APRN, participation in professional organizations, informal networking with colleagues, peer review, and continuing education seminars or online training that focuses on current medication management approaches. Forty states require demonstration of continued competency to maintain licensure/recognition as an APRN; requirements vary from continuing education beyond the RN license requirement, pharmacology education, maintenance of national certification, practice, and peer review (NCSBN, 2020).

Efficient time management hinges on the APRN’s medication management expertise. One approach to enhance prescribing effectiveness is to develop a “personal formulary” of medications one typically prescribes from different drug classes or for specific health conditions. This personal formulary is developed through current evidence, experience, patient feedback and responses to medications, and financial considerations.

Besides the use of a personal formulary, the APRN may employ strategies for prescribing drugs that save time and reduce the incidence of errors in medication management. Electronic prescribing reduces errors associated with illegibly written and improper prescriptions which often require a pharmacist to seek clarification. Nonetheless, errors related to electronic prescribing occur within hospital and community settings from both the provider side and the pharmacist side (Abramson, 2015; Alex et al., 2016). The need to communicate with pharmacists continues and will facilitate medication monitoring and prescription renewal.

In the interest of safety, it is recommended that patients use one pharmacy only. In situations when the APRN is concerned a patient is misusing medications, there are programs through private and public health plans that can mandate use of one pharmacy only. Use of one pharmacy reduces medication errors, drug interactions, and multiple prescriptions from multiple providers for the same medication, particularly scheduled drugs. An example of a public program that can mandate one pharmacy only is the Washington State Medicaid program known as Patient Review and Coordination which addresses overall excess utilization of services including medication use. Clients assigned to the program have had a 33% decrease in emergency room use, 37% decrease in office visits, and 24% decrease in prescriptions (Washington State Health Care Authority, 2020).

Novice prescribers may require an extensive amount of time to consult references, electronic medication guides, and clinical guidelines to select the most appropriate medication and write prescriptions. Electronic health records (EHRs) usually provide medication choices written with the generic rather than the brand name. Sometimes the desired dose or delivery approach is not specified in the dropdown menu, so consultation with peers can be especially useful in adapting to a new EHR. Because the development of expertise will take time and occurs over months and years, APRNs are encouraged to have realistic expectations of the time required to develop competence and be patient with themselves during this process.

An analysis of how patients, prescribers, experts, and patient advocates view the prescription choice process identified five important factors: information, relationship, patient variation, practitioner variation, and role expectations. The researchers noted that “decisions regarding the selection and use of prescription medications are made by multiple individuals, at multiple times, in multiple locations, under different contexts and viewpoints. The prescription choice process may be complicated further by various abilities, beliefs, and motivations held by those involved in the decisions” (Schommer et al., 2009, p. 167). Indeed, prescribing medications may appear easy but in actuality is complex.