Co-funded by MDMJ Accountants, Belgium
PhD - Elyne De Baetselier
Pharmaceutical care necessitates significant efforts from patients, informal caregivers, the interprofessional team of health care professionals and health care system administrators. Collaboration, mutual respect and agreement amongst all stakeholders regarding responsibilities throughout the complex process of pharmaceutical care is needed before patients can take full advantage of modern medicine. Based on the literature and policy documents, in this position paper, we reflect on opportunities for integrated evidence-based pharmaceutical care to improve care quality and patient outcomes from a nursing perspective. Despite the consensus that interprofessional collaboration is essential, in clinical practice, research, education and policy-making challenges are often not addressed interprofessionally. This paper concludes with specific advises to move towards the implementation of more interprofessional, evidence-based pharmaceutical care.
Dilles, T.; Heczkova, J.; Tziaferi, S.; Helgesen, A.K.; Grøndahl, V.A.; Van Rompaey, B.; Sino, C.G.; Jordan, S. Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes. Int. J. Environ. Res. Public Health 2021, 18, 5973. https://doi.org/10.3390/ ijerph18115973
Start: 01-09-2018 - End: 31-12-2021
Project Reference: 2018-1-BE02-KA203-046861
Nurses’ role in interdisciplinary pharmaceutical care is not transparent and varies between European countries. Similarly, in nurse education, a clear description of specific learning outcomes on pharmaceutical care is lacking and curricula in pharmaceutical care vary a lot. Furthermore, the match with the needs of the labour market and society is insufficient. The lack of transparency and recognition, together with the variation between countries, in nursing practice and nurse education, has a major impact. It hinders collaboration on different levels: interdisciplinary collaboration in clinical practice; transnational collaboration in research, education and innovation in Europe; labour mobility of nurses. As a result patient safety is threatened, development and innovation are slowed down, and healthcare budgets are not used in the most efficient way. Preliminary analysis of EUPRON data of 3300 European nurses, doctors and pharmacists, in preparation of DeMoPhaC, shows nearly all participants are convinced of the positive impact on quality of care of increased nurse involvement in pharmaceutical care. Interprofessional communication in pharmaceutical care scored 5,2/10, an alarming score given the link between patient safety and interprofessional communication.
DeMoPhaC objectives and related outputs:
1. to develop a model for nurses’ role in interprofessional pharmaceutical care, a framework for collaboration in pharmaceutical care on the different levels aforementioned, based on the needs and context of the labour market and society, in a qualitative interview study
→ A scientific report on the results of the EUPRON study
→ A scientific report on the qualitative study results
→ A validated model for nurses’ role in interprofessional pharmaceutical care in Europe
2. to specify and validate learning outcomes for nurse education in pharmaceutical care, which meet the learning needs of students, matched to the labour market and societal needs, in a Delphi study
→ Validated learning outcomes for nurse education in Europe on pharmaceutical care, framed in the European Qualification Framework
3. to develop an assessment to evaluate competences in pharmaceutical care, as a guidance to evaluate nurse education, as a tool for nurse educators, for benchmarking, and nurse labour mobility
→ An assessment to evaluate nurse competences in pharmaceutical care
4. to strengthen an international network for pharmaceutical care in nursing, to collaborate on nurse education, research, practice and policy
→ A sustainable European network on nurse and pharmaceutical care, NuPhaC
5. A strong involvement of students in the projects, connecting research, education and policy in Europe
→ About 80 European nurse students trained in and contribute to nurse research, education and policy in Europe
6. to describe nurses’ role, nurse education and student nurses’ competences in interdisciplinary pharmaceutical care in the European partner countries, necessary to reach objectives 1-3, and allowing benchmarking, a clarification of differences and similarities, essential for international collaboration, in 3 large-scale international cross-sectional studies
→ 3 scientific reports + benchmarking in Europe on: 1) nurses’ role in in interprofessional pharmaceutical care; 2) nurse educational programs in pharmaceutical care; 3) nurse students’ competences in pharmaceutical care.
Summary of the project results
The DeMoPhaC project allowed us to build a stronger international network of expertise on ‘Nurse and Pharmaceutical Care’. In a partnership with representatives of 14 European countries and in collaboration with students, the role of nurses in pharmaceutical care (PC) was investigated. As a result the NuPhaC-EU framework on nurses’ role in interprofessional PC was developed. This framework shows responsibilities and tasks in PC for nurses expected by health care providers in clinical practice, the labour market. The application of the NuPhaC EU-framework is an essential step towards more competency based education. Therefore, each of these responsibilities and tasks were linked to the competences they require. In the last stage of the project, a website with a competency test was created, allowing nurse students to evaluate and benchmark their competences. Transnational project meetings facilitated the planning of the studies and activities and international discussions about the meaning and the interpretation of study results. Students were trained in intensive study programs on nurse pharmaceutical care and research methodology. Partners and students had the opportunity to learn from exchanging knowledge, experiences and ideas. Results were disseminated through open acces, peer reviewed publications, the NuPhaC website, mailings to stakeholders, videos, the DeMoPhaC assessment website, ‘the NuPhaC winter conference’, a doctoral thesis, presentations at national and international conferences, contacts with professional organisations and several other initiatives.
A first study in 4888 nurses, 974 physicians and 857 pharmacists showed providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 77%, 85%, 81% and 23% respectively. Most respondents were convinced that quality of PC would be improved by increasing nurses' involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, ≤4/10, <6/10 for all four aspects of PC.
In a second study, in 340 interviews, health care providers reflected on the preferential role for nurses in PC. Nurses' autonomy varied across Europe (none, limited, a few tasks, in case of emergency, a broad range of tasks and responsibilities). Respondents reported when nurses would assume more pharmaceutical care responsibilities this could have a positive effect on quality of care and patient outcomes. However, when translating the preferential role for nurses into clinical practice several contextual factors such as education, team characteristics, country-specific regulations, and types of medications for which nurses are held responsible have to be taken into account.
In a third study, a scoping review was performed to corroborate the evidence and to extract the responsibilities and tasks described in literature. Seven responsibilities were identified: management of therapeutic and side effects of medications; management of medication adherence; management of patient medication self-management; management of patient education/information about medications; prescription management; management of medication safety; and care coordination. Within these seven responsibilities 26 tasks were described.
The first three studies resulted in the development of the NUPHAC-EU framework. Following its' development, the framework was evaluated by 923 nurses, 240 physicians, and 199 pharmacists. No responsibilities, tasks or contextual factors had to be removed after evaluation.
In a fourth study, through literature review and a Delphi procedure, competences required for nurses to take up the responsibilities and tasks of the NuPhaC-EU framework were described. The expert panel reached consensus on the relevance of 60 competences for 22 nursing tasks.
In a fifth study, applying the NuPhaC-EU framework and related competences, the level of integration into nursing curricula and the extent to which nurse students master these competences at different educational levels was questionned in 1939 students. The results showed that the embedding of PC courses in nurse curricula should be extended. PC knowledge of final year students was assessed as limited with regard to the expectation of the labour market.
Finally, considering the studies performed in the DeMoPhaC project, a position paper was published on the implementation of more interprofessional, integrated, evidence-based PC, together and with a shared focus on what is best for the patient.