Objective: After formal training, Parkinson’s Nurse Specialists (PNS) can act as independent and supplementary prescribers and initiate/titrate medication. This paper will discuss the impact of PNS prescribing.

Background: Parkinson’s medication is complicated and rarely taken in isolation. NMC guidance[1] states nurses who prescribe/advise on medication only do so if qualified and ensure treatment advised/prescribed is compatible with other care/treatment[1]. Nurse prescribing has been demonstrated to provide a positive effect on patients, practitioners, and services, albeit can create internal professional/cultural tension[2].

Method: Realist approaches explain how/why programmes work (or not) through asking: what works, for whom and under what circumstances[7]. USP included four phases: (1) developing resource sensitive initial programme theories (IPTs) and surveys to understand costs/benefits of PNSs; (2) testing IPTs in qualitative interviews; (3) evaluating the costs, resources, and benefits, and (4) refining the IPTs. USP explains how PNSs work in the UK, what impact they have, and at what cost[8]. 1232 participants contributed to the survey stage and 45 participants were recruited through a stratified random sample to the in-depth interview stage.

Results: PwP can have extensive medication needs; nurse prescribers often prescribe for Parkinson’s medication and other health/well-ness needs. Results suggested due to the trust in the nurse/PwP relationship and specialist knowledge, that medication is a central component of the PNS role. Also, that PNS input enabled fast and attuned medication change and is linked to increased concordance. Those who did not prescribe may still advise consultants, who may have less time, appointments with, and personal knowledge of PwP. PNS also advise/liaise with GPs to improve adherence. PNS who had not undertaken training to demonstrate their competence to make medication changes were at risk due to the indistinct boundaries of this practise.

Conclusion: PNS prescribers can significantly improve speed of treatment, reducing long chains of prescription which added time and opportunity for fragmentation. Concordance was improved because of high levels of information sharing, similarly adherence was improved through trust and respect. PNS are highly involved in medication change and decision making and, as such, should not be encouraged or advised to do so without appropriate formal qualification.

References: [1] NMC. (2018). The Code Professional standards of practice and behaviour for nurses, midwives and nursing associates. The nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [2] Nuttall D. (2018). Nurse prescribing in primary care: a metasynthesis of the literature. Primary health care research & development, 19(1), 7–22. https://doi.org/10.1017/S1463423617000500 [3] Pawson, R. and N. Tilley. (1997). Realistic Evaluation. London: Sage. [4] Brown, S., Dalkin, S., Bate, A., Bradford, R., Allen, C., Brittain, K., Clarke, A., & Hand, A. (2020). Exploring and understanding the scope and value of the Parkinson’s nurse in the UK (The USP Project): a realist economic evaluation protocol. BMJ Open, 10(10), [e037224]. https://doi.org/10.1136/bmjopen-2020-037224

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