| Objective:The purpose of this study is to explore the prescription content and prescription forms of digestive system drugs that can be prescribed by a nurse in the digestive department of tertiary hospitals,and medications that can be prescribed by nurses in general surgery of tertiary hospitals to correct water,electrolytes,acid-base disorders,blood volume expansion drugs,and nutritional drugs in China.It will provide a reference for the implementation of nurse prescription rights and the formulation of a list of drugs for nurse prescription rights in China in the future.Research object:During the expert consultation of “Nurse’s Digestive System Drug Prescription Contents”,30 medical and nursing experts from the Department of Gastroenterology were selected.A total of 14 nursing experts and 11 medical experts participated in 2rounds of expert consultation.“Research on the contents of prescription rights of nurses to correct water,electrolytes,acid-base disorders,blood volume expansion drugs and nutrition drugs” expert consultation,selected 30 medical and nursing experts in general surgery.There were 14 nursing specialists and 12 medical experts participating in the 2rounds of consultation.All experts agreed to grant nurses prescription rights.All experts are satisfied:(1)Bachelor degree or above;(2)10 years or above work experience in corresponding departments and related fields;(3)Intermediate title with professional titleor clinical experience equivalent to deputy senior title or above;(4)Have a rigorous and realistic attitude and volunteer to participate.The first three items should satisfy two items.Methods:Literature research methodThrough searching domestic and foreign databases and browsers,consulting foreign nurses ’prescription rights related documents,collating a list of foreign nurses’ drug prescriptions,translating digestive system,correcting water,electrolytes,acid-base balance disorders,blood volume expansion drugs,and nutritional nurse prescription drugs.Based on this,combined with the two major systemic drugs commonly used in clinical practice in China,the first draft of the questionnaire was prepared with reference to the fifth edition of the Manual of Clinical Medicine published by Shanghai Science and Technology Press.Semi-structured interviewThe purpose sampling method was used to interview three nursing experts and three medical experts in the Department of Gastroenterology,four nursing experts and four medical experts in general surgery in three tertiary hospitals,and analyze and summarize based on the results of the interviews.After the discussion,the research team revised the initial questionnaire to form the first round of expert consultation questionnaires for the right to drug prescription for nurses in the gastroenterology department and the first round of expert questionnaires for the right to prescription drugs for nurses in the general surgery department.Delphi methodFor the expert consultation questionnaire of “Nurse’s Digestive System Drug Prescription Contents”,30 experts from 12 third-level hospitals in Beijing,Shanghai,Shanxi,Shaanxi,Gansu,Shandong,and Jiangsu were selected.A total of 25 experts completed 2 rounds of expert consultations,including 14 nursing experts and 11 medical experts.For the questionnaire of "Nurse’s Correction of Water,Electrolyte,Acid-base Disorder Drugs,Blood Volume Expansion Drugs and Nutrition Drugs" expert consultation questionnaire,30 general medical and nursing experts were selected.They belong to 10 tertiary hospitals in 6 provinces or municipalities in Beijing,Tianjin,Fujian,Hubei,Inner Mongolia and Shanxi.Among them,12 medical experts and 14 nursing experts participated in 2 rounds of expert consultation.Finally,according to the results of the questionnaire consultation,data analysis and statistical calculation were performed to obtain various index parameters,expert positive coefficient,expert authority(Cr),judgment basis(Ca),familiarity(Cs),and expert approval rate.Results:1.Prescription content and prescription form of digestive system drugsThe effective recovery rates of the two rounds of expert consultation were 83.33%and 100%,and the authoritative coefficients(Cr)of the two rounds of experts were 0.82 and 0.85,respectively.Medical and nursing experts suggest that qualified and trained digestive nurses can prescribe all digestive aids,intestinal microbial regulators;some cathartic drugs,antidiarrheal drugs,gastrointestinal motility drugs,antacids,gastric mucosa protectants,antiulcer agents,adjuvant drugs for treating liver diseases;nurses are not recommended to prescribe drugs for inflammatory bowel disease drugs,smooth muscle antispasmodics,cholagogue,and pancreatic medicines.It is recommended that digestive medicines that can be prescribed by a Gastroenterology Nurse are 37 types of drugs in 9 categories,4were determined to be independently prescribed,24 collaboratively,and 9 either collaboratively or independently.The drugs recommended for independent prescriptions were yeast,glycerol,lactasin,and lactulose;The drugs recommended for collaborative prescriptions were pancreatin,compound azelimide enteric-coated tablets,magnesium sulfate,metoclopramide,Domperidone,cisapride,mosapride,itopride,sodium bicarbonate,aluminum hydroxide,sucralfate,tri-potassium dicitratobismuthate,colloidalbismuth pectin,colloidal bismuth subcitrate,bismuth citrate potassium,hydrotalcite,cimetidine,famotidine,nizatidine,omeprazole,lansoprazole,pantoprazole,rabeprazole,and esomeprazole;Dages,macrogol,dioctahedral,bifidobacterium triplet live tablets,bifid triple viable,clostridium butyricum,compound calcium carbonate chewable tablets,ranitidine,and omeprazole magnesium tablets tend to be either independent or protocol prescriptions.2.Prescription contents and prescription forms of drugs to correct water,electrolyte,acid-base balance disorders,blood volume expansion drugs,and nutritional drugsThe effective recovery rates of the two rounds of expert consultation questionnaires were 86.67% and 100%,and the coefficients of expert authority were 0.85 and 0.86,respectively.Medical and nursing experts recommend that qualified and trained general surgery nurses may prescribe some of the drugs that correct water,electrolytes,acid-base disorders and nutritional drugs,and do not recommend prescribing blood volume expansion drugs.It is recommended that general surgery nurses prescribe water,electrolytes,acid-base balance disorders,blood volume expansion drugs,and nutritional drugs in 2 categories and 25 drugs.Among them,5 kinds of drugs are preferred for independent prescription: glucose injection,sodium chloride injection,glucose sodium chloride injection,compound sodium chloride injection,potassium chloride sustained-release tablets.11 drugs recommended for collaborative prescriptions were Potassium chloride,potassium citrate,calcium gluconate,gluconate calcium chloride injection,enteral nutrition emulsion(TPF-D),enteral nutrition liquid,Enteral Nutritional Suspension II(TP),enteral nutrition emulsion(TPF-T),lipid emulsion,omegaven,fat emulsion,amino acids(17)and glucose(11%)injection.Drugs that prefer independent / collaborative prescription: oral saline supplements,glutamine granules,enteral nutritional suspension(SP),Short peptide enteral nutrition / pepsin,enteral nutritional suspension(TPF),intacted protein enteral nutrition powder,Ensure Powder,enteral nutritional emulsion(TP-HE),enteral nutritional emulsion(TP)9 kinds.Conclusion:In this study,the Delphi method was used to preliminarily determine the content and form of prescriptions for digestive medicines that can be prescribed by nurses of digestive medicine in China and general surgery nurses that can be prescribed to correct water,electrolytes,acid-base disorders,blood volume expansion drugs,and nutritional drugs.It is scientific and reliable,which can provide a reference for the implementation of related policies for nurses’ prescription rights. |
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