INTRODUCTION: Chronic non-malignant pain poses considerable risk 10 patients and
the health service but its management is still inadequate. The introduction of prescribing
for nurses and pharmacists suggests that non-medical prescribing can improve some
important aspects of healthcare services
AIM : To provide new insights and theory regarding how nurses and pharmacists prescribe
for chronic pain, together with how the service is perceived by chronic pain patients and
to uncover barriers and facilitators encountered when this group is prescribed for.
METHOD: A mixed methods strategy was employed in this study. A grounded theory
approach was used to collect data from non-medical prescribers and patients. Non-medical
prescribes were then surveyed to confirm the emerging theory and determine
barriers and facilitators.
FINDINGS: The theory ‘safety and support within the prescribing environment’ explains
the relationship that non-medical prescribers have with colleagues, patients and other
factors in their prescribing environment in their prescribing for chronic pain. Non-medical
prescribers are motivated by various factors and may adopt an innovative or conservative
approach in their prescribing. Nurses were more likely to engage in informal mentoring
relationships, but were limited by their lack of medication knowledge. Pharmacists were
limited by a lack o f experience with patients, inaccessibility to formal CPD in paid work
time and the threats introduced by concerns around ‘second checking'. Chronic pain
patients had strategies to maintain relationships with their prescribers and this relationship
influenced the likelihood of considering other measures to cope with their pain.
CONCLUSION: Nurses and pharmacists who qualified as prescribers would be more
likely to prescribe for chronic pain if they perceived certain essential elements in their
prescribing environment. This theory can facilitate assessment of non-medical
prescribers’ support, involvement of patients and the development of resources to
encourage prescribing.