Experiences, challenges, perceptions and facilitators associated with paramedic medication prescribing: A scoping review

Introduction: The evolving role of paramedics now encompasses the ability to prescribe medication. The development and further implementation of this capability should be informed by existing experiences of paramedics capable of medication prescribing and relevant literature. Aims: This scoping review aims to explore paramedic experiences and perceptions of medication prescribing, identifying challenges and facilitators to inform future policy and practice. Methods: A scoping review methodology was employed, adhering to the JBI's framework. A search of six electronic databases, and grey literature sources was conducted. Inclusion criteria focused on studies exploring paramedic prescribing experiences, perceptions, and impacts on the healthcare system. Data extraction and descriptive content analysis was performed. Results: The database search yielded 193 non-duplicate articles, with 36 meeting the inclusion criteria. Grey literature searches found four additional documents. Key categories generated included the importance of mentoring, a sense of vulnerability and frustration and the importance of supportive systems and role understanding. Mentorship was crucial for building confidence and competence, while role ambiguity and systemic barriers were challenges. Systemic barriers included difficulties in accessing patient histories and outdated or incompatible IT systems. Administrative hurdles, including cumbersome regulatory requirements and limited recognition of their prescribing role, further complicated practice. The fear of litigation was a concern, heightened by inadequate guidelines and support systems. Robust organisational policies and comprehensive legal frameworks were highlighted as crucial, though often perceived as insufficient. Facilitators included strategic leads and multidisciplinary collaboration, enhancing skill integration, and support within organisations. Conclusion: This review highlights the critical need for structured support, clear role definitions, and robust legal frameworks to empower paramedic prescribers. Addressing technological and systemic barriers will be essential for the successful integration of prescribing roles within paramedic practice.