Thursday, 4 January 2018

Commentary on Abuzour et al (2018) A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisions

Julian Barratt

Abuzor, Lewis, and Tull (2018) have provided a much-needed comparative analysis of the different clinical reasoning processes used to support the prescribing decisions of pharmacists and nurses working in advanced clinical roles. Their main findings, namely that clinical reasoning is contextually dependent upon clinicians’ experiential and theoretical knowledge has resonance with a previous comparative study of the clinical decision-making processes of nurse practitioners and medical doctors I contributed to (Thompson, Morley, & Barratt, 2017). In that study, in contrast to the findings of Abuzor, Lewis, and Tull (2018), it was highlighted that both groups of professionals had similar approaches and cognitive models for decision-making processes, whereas Abuzor, Lewis, and Tull (2018) note that the pharmacists in their study focused on looking at medical notes and laboratory the basis for their clinical reasoning, whilst the nurses prioritised examining and interacting with patients.

As Abuzor, Lewis, and Tull (2018) note pharmacists’ reluctance to examine patients is a limiting factor upon their clinical reasoning skills in comparison to other prescribing clinicians such as nurses and doctors. This limitation is important to highlight as the General Pharmaceutical Council’s indicative content of pharmacist independent prescriber programmes requires pharmacists to learn clinical examination skills relevant to the condition(s) for which the pharmacist intends to prescribe for, including recognition and responding to common signs and symptoms that are indicative of clinical problems, including the use of common diagnostic aids for assessment of a patient’s general health status, such as stethoscopes, sphygmomanometers, tendon hammers, and examination of the cranial nerves. As such clinical examination combined with focused history taking, ensures safe prescribing practice, and thus should provide the fundamental basis of clinical reasoning for all prescribing clinicians, including pharmacists; otherwise a potentially serious impediment to the quality of clinical reasoning skills could occur (Simmons, 2010).

I know from my own clinical academic work supporting experienced pharmacists to become advanced clinical practitioners, as part of the General Practice Forward View (NHS England 2016), that they are often initially reluctant to move their clinical focus away from medicines management towards engaging in clinical skills that require interacting with and touching patients, such as clinical examination. However with encouragement, guidance, and practising under supervision in the University skills lab, and with appropriate support from mentors out in practice, pharmacists can also begin to develop the same positive attitude towards the critical necessity for clinically examining patients to essentially inform their prescribing decisions that nurse practitioners and doctors typically have.

Julian Barratt
Head of Academic Business and Workforce Development
Institute of Health
University of Wolverhampton, UK


Abuzour A.S.Lewis P.J.,Tully M.P. (2018) A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisionsJournal of Advanced Nursing, 74, 6574

General Pharmaceutical Council. Pharmacist independent prescribing programme - learning outcomes and indicative content [Online]. Retrieved from [accessed 28 December 2017].

NHS England (2016). General Practice Forward View (GPFV) [Online]. Retrieved from [accessed 28 December 2017].

Simmons, B. (2010). Clinical reasoning: concept analysis. Journal of Advanced Nursing, 66, 1151–1158. doi: 10.1111/j.1365-2648.2010.05262.x

Thompson S.Moorley C., & Barratt J. (2017A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environmentJournal of Advanced Nursing, 7310971110. doi: 10.1111/jan.13206

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