Supporting prescriber progression: a group concept mapping study
Authors: Souter C , Scott J , Johnson C 
Published: November 2024

Abstract

Introduction
Education reforms allow pharmacists to become prescribers earlier in their career and from 2026, new registrants will be independent prescribers.1 In NHS Scotland, an operational framework supports the development of pharmacist independent prescribing.2 We wanted to supplement the operational framework by identifying our core areas of prescribing to articulate prescribing progression and inform education and training provision.

Aim
To develop a core prescribing framework to support safe prescribing and a spiral approach to expanding scope of practice.

Methods
We conducted a participatory mixed-method approach using group concept mapping methodology.3
Phase 1 (brainstorming): all hospital pharmacists working in a patient-facing clinical role were invited to enter statements on a cloud-based platform (Padlet®) using the prompt ‘In my day-to-day practice I prescribe and/or make prescribing recommendations about the following medicines / conditions …’. The statements were triangulated with electronic inpatient pharmacist prescribing data over the previous three months.
Phase 2 (sorting and rating): a project group comprised of pharmacists with different levels of practice and areas of clinical expertise, individually sorted the statements into groups based on the statements’ conceptual similarity and rated each statement by level of practice (post-registration foundation, advancing, advanced) and importance for including in a core framework (5-point Likert scale). R software applied multidimensional scaling to sorting data to create a similarity matrix, cluster map and Go-Zones. ChatGPT generated cluster titles.
The project group discussed the results and following a few revisions, consensus was achieved on the content of the prescribing framework.
This study was not considered research and was approved by the pharmacy quality improvement team in line with local governance process.

Results
Forty-three pharmacists participated in the brainstorming phase and generated 158 statements. Fourteen pharmacists participated in the sorting and rating phase. Multidimensional scaling analysis identified three clusters of prescribing activities: initiating, adjusting and deprescribing. The data identified activities involving initiating medicines and autonomous decision making rated at advancing/advanced level practice while adjusting/deprescribing medicines (often with the caveat of within guidelines, protocols or team decisions) was rated at post-registration foundation level. The prescribing framework includes the activities considered important and is organised by cluster and level of practice.

Discussion / Conclusion
This study provides a structured conceptualisation of prescribing across the levels of practice. The prescribing framework reflects the needs of our patients and hospital inpatient service and provides a scaffolded approach to progressing from inexperienced to more advanced prescribing roles. Post-registration foundation prescribing activities focus on processes or types of prescribing, whilst advanced are more autonomous and complex.

Limitations
we didn’t collect clinical area of practice as part of the demographic information for the brainstorming phase and some specialities may not be represented.
Further work includes a training needs analysis and developing entrustable professional activities for core and higher risk areas of prescribing (e.g. post-operative pain).

References
1. General Pharmaceutical Council. Guidance to support the implementation of the standards for education and training of pharmacist independent prescribers [online] Oct 2022 [Accessed 7 June 2024]. Available from: https://assets.pharmacyregulation.org/files/document/guidance-to-support-the-implementation-of-the_standards-for-the-education-and-training-of-pharmacist-independent-prescribers-october-2022.pdf
2. The National Acute Pharmacist Group and Scottish Practice Pharmacy and Prescribing Advisor Group. An operational framework to support the development of pharmacist independent prescribing in NHS Scotland. Version 1, May 2022
3. Trochim W. M., McLinden D. Introduction to a special issue on concept mapping. Evaluation and Program Planning, 2017; 60: 166–175.