Advanced practice physicians (APPs), who have the authority to prescribe chemotherapy, reported lower event rates compared with physicians, a study published in the Journal of the American College of Cardiology found. Oncology Nursing Clinical Journal.
Additionally, APPs reported confidence, preparation, and satisfaction with independent chemotherapy prescribing authority.
Over the 3-year period, the Reporting to Improve Safety and Quality (RISQ) event rate from 2021 to 2023 was 0.4%, with 482 of 111,076 orders, compared with a physician RISQ event rate of 0.6%, with 4148 of 752,067 orders (P ≤ .001).
“The lower RISQ event rates among APPs compared with physicians highlights APPs' ability to prescribe chemotherapy safely. Responses from APPs who participated in the survey positively portrayed their preparedness, confidence, and satisfaction with a high degree of authority,” the study authors wrote.
The findings of this study suggest expanding the role of APPs to include independent chemotherapy prescribing and highlight areas where improvements are needed during the process of obtaining advanced privileges.
Of note, the odds of a reported RISQ event 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%) were related to intravenous chemotherapy, and 91% of events were reported by chemotherapy verification nurses, suggesting a key role for nurses in the verification process.
Additionally, 98% of RISQ events were classified as near misses, including frequency/date/time errors, dosage errors (10% or more), omitted medications/dosages, medication errors, duplicate orders, etc. The remaining events were deemed to be without clinically significant harm, the researchers noted.
The APP Satisfaction Survey was completed by 82 of 109 potential respondents (78%). All respondents strongly agreed that “independent ordering authority allows me to operate at the highest level of my license.”
Positive responses to the survey (strongly agree or agree) included the following:
- “When empowered, I felt prepared to independently direct chemotherapy” (n = 77).
- “I feel confident in my ability to independently prescribe chemotherapy” (n = 81).
- “Independent ordering authority increases efficiency” (n = 81).
- “I feel comfortable directing my own chemotherapy” (n = 80).
Data on RISQ events were collected using MSK's electronic RISQ system, which allows staff to report actual events and near misses. Surveys were distributed to APPs with independent chemotherapy prescribing authority and contain a 4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree).
To obtain independent chemotherapy prescribing authority, APPs must meet several requirements, including completing educational requirements, one-on-one training with an application analyst to review order entry, at least six months of experience in a specific disease area, and entering at least 100 parenteral chemotherapy orders for physician co-signature.
“By leveraging APPs' expertise, healthcare organizations can optimize resources, improve patient access, and enhance care delivery,” the study authors wrote. “As APPs maintain close collaboration with physicians while gaining greater autonomy in patient care, they can maintain their vital role in ensuring all patients receive timely, high-quality, and safe care.”
The number of uniquely prescribing APPs ranged from 54 to 109, while the number of physicians ranged from 348 to 394, a limitation noted by the researchers in their study. Other limitations include a homogenous sample size of APPs with 5 or more years of experience, which may have led to bias toward more experienced physicians. The RISQ score relies on manual reporting of occurrences, which may result in unreported or underreported events.
“Findings from this project may influence future practice and policy involving APPs,” the study authors concluded. “Based on the results of this project, APPs with independent chemotherapy prescribing authority are able to provide safe care and are comfortable with this high level of responsibility.”
reference
LeStrange N, Walton A, Watson JL, Sklarin NT, Thompson JA, Affronti ML. Impact of independent chemotherapy prescribing by advanced practice providers on patient safety and physician satisfaction. Clinical Oncology Nursing2024;28(4):397-405. doi:10.1188/24.CJON.397-405