A Mixed Methods Investigation of Paramedic Independent Prescribing by Advanced Paramedics in Emergency and Urgent Care.

Background Paramedic independent prescribing (PIP) is currently practised by advanced paramedics (APs). However, further research is required to evaluate the benefits and limitations within emergency and urgent care.

Research Question: What are the benefits and the limitations of paramedic independent prescribing in emergency and urgent care?

Research Objectives: 1) To evaluate the scope and scale of PIP in emergency and urgent care, including the range and frequency prescriptions and conditions treated. 2) To explore key stakeholder and AP views of the benefits and limitations of PIP in emergency and urgent care, alongside if/how it is contributing to patient care and service delivery. 3) To explore key stakeholder and AP views on training and education to support PIP 4) To investigate if and how PIP has changed practice, confidence and autonomy. 5) To examine whether APs working in emergency and urgent care can access support for their prescribing decisions.

Methods A mixed methods exploratory sequential design will be used.

Work Package (WP) 1- Systematic Literature search and narrative review A systematic literature search will be undertaken, to identify, critically appraise and synthesise relevant independent prescribing (IP) research. This will inform data collection and analysis in WPs 2-4. A narrative review will be written, to evaluate the evidence base surrounding key areas of IP.

These include any benefits and limitations of IP in emergency and urgent care, controlled drug restrictions, prescriber training and in accessing medical support.

WP 2 - Semi structured interviews with key stakeholders A sample of key stakeholders will be interviewed to obtain insights into emerging key issues associated with PIP (Objectives 2 and 3). A framework approach to data analysis will be used.

WP 3 - Case Studies Case studies of PIP within an emergency department, an urgent care service and an ambulance Trust will be conducted. Data triangulation and cross case analysis will be undertaken to compare data within and across sites.

Within each site: 3.1 PIP prescribing data from electronic databases such as the ePACT2 system for the previous twelve months will be analysed to address objective 1. 3.2.

To obtain data to address objectives 1-5, the practice of 2-4 APs will be observed at each site using non-participant observation over 4-6 shifts. The views of APs and other site-based health professionals regarding PIP will also be explored. Field notes will be generated, coded and categorised during analysis.

WP 4 - Online questionnaire.

Building on key issues from WPs 1-3, and to provide generalisable data on objectives 1-5, an online questionnaire will be administered to all APs using PIP in emergency departments, ambulance Trusts and urgent care settings. Timelines for delivery- Please also refer to research timetable.

WP 1 - 04/2022- 08/2022 WP 2- 09/2022-12/2022 WP 3- 01/2023-05/2024 WP 4 - 06/2024 - 12/2024 Anticipated impact and dissemination Through ongoing collaboration with the PIP key stakeholders, the research findings will inform future PIP policy and guidance. Dissemination will be achieved by publications in BMC Emergency Medicine, conference presentations and a study website.