Abstract
Background: United Kingdom legislation allows nurses to autonomously provide medications as indepen- dent nurse prescribers or using patient group directions. Evidence of medication safety and appropriate- ness is limited. We compared nurse prescribers and patient group direction users in terms of prevalence, types and severity of medication provision errors. Methods: Objectives: Compare safety and appropriateness of medication provision between nurse pre- scribers and patient group direction users. Design: Mixed methods: clinical notes review and nurse-patient consultation observations. Setting: Five United Kingdom sexual health services. Selection criteria: ‘Clinical notes review’ included a random selection of nurse-patient consultations July- December 2015, 743 consultations managed by nurse prescribers and 939 consultations by patient group direction users. ‘Observation study’ involved 15 nurse prescriber and 15 patient group direction user nurse-patient medication consultations. Patients aged under 16 or non-English speaking were excluded. Measurements: Medication safety/appropriateness was compared between nurse prescribers and patient group direction users. Medication provision errors were categorised and assigned severity ratings. The Medication Appropriateness Index and the Prescribing Framework were used to assess medication provi- sion. Results: Of 1682 clinical notes (nurse prescribers = 743, 44%; patient group directions = 939, 56%), 879 in- volved the provision of 1357 medications (nurse prescribers = 399, 54%; patient group directions = 480, 51%). The overall error rate was 8.5% (1844 errors from a potential 21,738 errors), predominantly re- lated to documentation omissions. Nurse prescribers were more likely to make an error compared to pa- tient group directions users (error rates 9% versus 8%, respectively; p = 0.001); most were ‘minor’ (nurse prescribers = 489, 56%; patient group directions = 602, 62%). Both nurse prescribers and patient group di- rection users made safe medication decisions ( n = 1640 of 1682 patient care episodes, 98%); however, patient group directions users worked outside patient group directions restrictions in 39 (8%) of consul- tations. In 101 consultations, medication was indicated but not documented as offered/provided. From 30 observed consultations assessed against the Prescribing Framework, nurse prescribers’ and patient group directions users’ clinical practice were comparable (maximum score 46: nurse prescribers = 44.7; patient group direction = 45.4, p = 0.41).