Advanced Practice

Background As patients approach the end of their life, anticipatory prescribing can be put in place to help support symptom control. This way of prescribing aims to be pre-emptive, in place before symptoms develop. These medicines are therefore at risk of not being required by patients, with associated financial implications of this approach. This clinical audit has evaluated anticipatory prescribing within Jersey, in particular reviewing the administration and waste of anticipatory medications and how the local setting algins with local and national policy. Project design 30 patient records were included in this review, from patients who had anticipatory medications in place and died within the community setting over a 9-month period. Quantitative data was collected from the patient’s anticipatory
prescribing documentation, with descriptive statistical analysis used to explore the data. Qualitative narrative documentation was also extracted to review prescribers’ rationale to evaluate if individualised prescribing is present in the local community. Findings The findings showed that the core medication categories were regularly in place within the reviewed records. However, evidence of individualised prescribing was suggested when individual medications were explored, with differences in medication choice present. A combined total of 2,641 medication vials were prescribed to all patients. More than half (54.6%) were administered to patients, whilst 45.4% did result in medication waste, which was 49.6% of the total cost of all prescribed medications. Over half (53.12%) of all administered anticipatory medications were administered within the last seven days of life. The administration of anticipatory medications showed variation between patient records, with qualitative narrative documentation used to support understanding of this. Limited access to all qualitative narrative documentation did impact the ability to examine the presence of patient specific prescribing. Conclusion The evaluation of anticipatory prescribing within the local setting included quantitative data, supported by qualitative narrative documentation to provide context to prescriber’s decision making. It was shown that prescribing practice largely aligns with local and national policy. The recommendations that arose from this project include continued support for individualised prescribing within the local setting, the introduction of a community symptom assessment tool and a re-audit on this topic.

Background: Advanced practice is a level of practice in multi-professional roles including nurses and AHPs. It is characterised by mapping to advanced practice capabilities within the four pillars of: clinical practice, leadership and management, education and research
(NHE England, 2025). Despite frameworks outlining expected capabilities; the understanding of the Advanced Clinical Practitioner (ACP) role is inconsistent. Design: Service evaluation using a quantitative cross sectional survey. Descriptive statistics and content analysis were used for data analysis. Findings: Key interpretations indicate varying levels of understanding of the ACP role. Some practitioners self identify as ACPs yet do not demonstrate working at this level, whereas others can demonstrate working at this level, but do not necessarily have job titles to reflect this. There is a mismatch between the understanding of the role and employment expectations. Gaps in governance and support from the organisation were highlighted. Conclusion: Variation exists in how advanced practice is understood across the four pillars which needs to be addressed for those within the roles and those recruiting to it. Prioritisation of governance, supervision and leadership is vital to inform workforce development, policy and optimisation of advanced practice roles in the future.