APPs With Chemo Prescribing Privileges Provide Safe Care With Greater Autonomy

Doctor writing a prescription on Rx form in the consulting room: © omphoto - stock.adobe.com

Advanced practice providers (APPs) with chemotherapy prescribing privileges had a lower reported event rate compared with physicians, according to a study published in the Clinical Journal of Oncology Nursing.

In addition, APPs reported confidence, readiness, and satisfaction with independent chemotherapy prescribing privileges.

Over a period of 3 years, the Reporting to Improve Safety and Quality (RISQ) event rate from 2021 through 2023 was 0.4% with 482 events of 111,076 orders, compared to physicians RISQ event rate of 0.6% with 4148 events of 752,067 orders (P ≤ .001).

“The lower RISQ event rate among APPs compared to physicians underscores the competence of APPs in safely prescribing chemotherapy. Survey responses from participating APPs positively depict their readiness, confidence, and satisfaction with the advanced privilege,” study authors wrote.

Findings in this study suggest expanding the APP role to include independent chemotherapy prescribing while highlighting needs for improvement during the process for obtaining the advanced privilege.

Notably, odds of reported RISQ events were 27% higher for physicians compared with APPs (OR = 1.27, 95% CI, 1.16-1.39). Most events for APPs and physicians (99.46%) involved intravenous chemotherapy, and 91% of events were reported by chemotherapy verification nurses, suggesting nurse’s crucial role in the verification process.

Additionally, 98% of RISQ events were classified as near misses, including wrong frequency/date/time, wrong dosage (10% or more), omitted drug/dosage, wrong drug, and duplicate order. The researchers noted that the remaining events were considered as no clinically significant harm.

APP satisfaction surveys were completed by 82 (78%) of 109 potential respondents. All respondents strongly agreed to “Independent ordering privilege allows me to practice at the top of my license.”

Some of the positive responses (strongly agree or agree) to the survey included the following:

• “I felt ready to progress to independent ordering of chemotherapy when the privilege was granted” (n = 77).
• “I feel confident in my ability to order chemotherapy independently” (n = 81).
• “Independent ordering privilege allows for increased efficiency” (n = 81).
• “I am satisfied with my ability to order chemotherapy independently” (n = 80).

Data on RISQ events were collected using the MSK’s electronic RISQ system, which allows staff to report actual events and near misses. Surveys were distributed to APPs with independent chemotherapy prescribing privileges including a 4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree).

To receive independent chemotherapy prescribing privilege, APPs must complete several requirements such as the completion of educational requirements, 1-on-1 training with an application analyst to review order entry, at least 6 months of experience in their specific disease area, and have entered at least 100 parenteral chemotherapy orders for physician co-signature.

“By leveraging APPs’ expertise, healthcare organizations can optimize their resources, allowing for improved patient access and enhanced care delivery,” study author wrote. “As APPs assume greater autonomy in patient care while sustaining close collaboration with physicians, they can maintain a pivotal role in ensuring that all patients receive timely, high-quality, and safe care.”

The number of independently prescribing APPs ranged from 54 to 109 vs 348 to 394 physicians, which was a limitation researchers noted in the study. Other limitations included a homogenous sample size of APPs with 5 or more years of experience, which potentially led to bias towards more experienced providers. RISQ scores depended on manual reporting of occurrences, which may lead to the possibility of unreported or underreported events.

“The insights derived from this project can influence future practices and policies involving APPs,” the study authors concluded. “Based on the results of this project, APPs with independent chemotherapy prescribing privileges can provide safe care and are satisfied with this advanced responsibility.”

Reference

LeStrange N, Walton A, Watson JL, Sklarin NT, Thompson JA, Affronti ML. The Impact of Independent Chemotherapy Prescribing by Advanced Practice Providers on Patient Safety and Clinician Satisfaction. Clin J Oncol Nurs. 2024;28(4):397-405. doi:10.1188/24.CJON.397-405