Question 2: evaluation of Process related to nurse
practitioner practice
This involved scrutiny of the clinical practice of nurse
practitioners, including the use of resources, technical
competence, evidence base for practice and conformity to
the parameters of their scope of practice. Evaluation of
Process drew upon data from health records audit, MDT
survey and nurse practitioner interviews. The interview data
revealed that most of the nurse practitioners were fully conversant
with, and reportedly worked from, national and international evidence-based guidelines and frequently
accessed journal literature to ‘stay abreast’ of evolving
knowledge.
Use of resources
Analysis of aggregated data from the health records of
patients gives a snapshot of the way that these nurse practitioners
are delivering clinical care. For the 13 patients
reviewed, there were more than 150 face-to-face occasions
of service within the audit timeframe of 18 months, with
the addition of multiple phone consultations with nine of
these patients. Use of diagnostics over these occasions of
service is presented in Table 3.
All nurse practitioners used therapeutic interventions,
including procedural, counselling and educational intervention
activities. There were 53 interventions with a range of
3–6 per nurse practitioner. There was documentation for
every occasion of service, with documentation of collaboration
with MDT members in 12 patients’ records.
Use of medications included new medicines prescribed
for nine patients, with seven patients having drug titration
on multiple occasions. The data from medical records
showed the nurse practitioners to be assiduous in recognition
of the patients’ primary care physician as the lead
clinician with recommendations on medication change notified
to the physicians for seven patients, four of these on
multiple occasions. Documentation showed that medication
review by the nurse practitioner occurred on all occasions
of service. Table 4 shows that the MDT agreed or strongly
agreed that the nurse practitioner role is valuable in terms
of meeting patient needs, improved access and reduced
delay and service efficiencies.
There is, however, less agreement on the value of the role
in reducing duplication of service and multiple consultations
across disciplines (Fig. 2a,b).