Non-medical prescribing of chemotherapy: engaging stakeholders to maximise success?

AIM: This study report examines the views and experiences of professional stakeholders about non-medical prescribing (NMP) of chemotherapy. BACKGROUND: The introduction of open formulary NMP has created opportunities to radically change health-care delivery. For chemotherapy services, the most recent advice from the National Chemotherapy Advisory Group [Department of Health (2009) Chemotherapy Services in England, ensuring quality and safety: a report from the National Chemotherapy Advisory Group, London Her Majesty’s Stationary Office] clearly endorses the development of nurse- or pharmacist-led chemotherapy clinics. This is very much welcomed but is based on very limited evidence as to their effectiveness. DESIGN: A fourth-generation evaluation study. METHODS: A purposeful sample of 23 stakeholders connected with the chemotherapy service was used. A serial data collection technique with individual interviews followed by uni-professional focus groups was adopted. Finally, a multi-professional focus group was held to determine the strategic way forward. Data were collected in 2009–2010. RESULTS: The study illuminated the key features necessary to maximise success of NMP in chemotherapy clinics and captures the importance of good working relationships. Whilst different practice models will emerge, fundamental and core to services is the need for good team working, established and effective communication strategies, and most importantly avoiding isolation in practice. This study additionally reinforced any evaluation takes place within preexisting political contexts and in particular medical dominance. Not all medical colleagues agreed with or wanted NMP for their patients, highlighting difficulties of developing new models of working within a resisting culture. CONCLUSION: No objections to NMP of chemotherapy were found, but, clearly, the context of practice needs to be agreed and supportedby all professional stakeholders. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC: Open formulary non-medical prescribing has been rapidly introduced over the past decade. Little research has been conducted in acute care and none in the chemotherapy setting. Cancer policy recommends the introduction of nurse-led chemotherapy clinics. WHAT THIS PAPER ADDS: Non-medical prescribing (NMP) in chemotherapy is appropriate with the right model of practice. Well-established professional relationships are a key to success. NMP is not appropriate in isolation of the multidisciplinary team (MDT). IMPLICATIONS FOR PRACTICE AND/OR POLICY: Nurses need to demonstrate the value of non-medical prescribing in chemotherapy using available metrics. Models of practice need to ensure good communication channels, MDT working, and transparency of prescribing.