eprintid: 10095056 rev_number: 20 eprint_status: archive userid: 608 dir: disk0/10/09/50/56 datestamp: 2020-04-17 10:21:11 lastmod: 2021-10-03 23:59:14 status_changed: 2020-04-17 10:21:11 type: article metadata_visibility: show creators_name: Black, A creators_name: Gage, H creators_name: Norton, C creators_name: Franklin, BD creators_name: Murrells, T creators_name: Courtenay, M title: A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: a mixed methods study ispublished: pub divisions: UCL divisions: B02 divisions: C08 divisions: D10 divisions: G11 keywords: Health services research, Medication safety, Medication management, Nurse/ non-medical prescribing, Prescribing errors/ severity, Sexual health note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: Background: United Kingdom legislation allows nurses to autonomously provide medications as independent nurse prescribers or using patient group directions. Evidence of medication safety and appropriateness 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 prescribers 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 consutlations 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 provision. / Results: Of 1,682 clinical notes (nurse prescribers=743, 44%; patient group directions=939, 56%), 879 involved the provision of 1,357 medications (nurse prescribers=399, 54%; patient group directions=480, 51%). The overall error rate was 8.5% (1,844 errors from a potential 21,738 errors), predominantly related to documentation omissions. Nurse prescribers were more likely to make an error compared to patient 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 direction users made safe medication decisions (n=1,640 of 1,682 patient care episodes, 98%); however, patient group directions users worked outside patient group directions restrictions in 39 (8%) of consultations. 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). / Conclusion: Sexual health nurse prescribers and patient group direction users provided safe and therapeutically appropriate medication. Improvements in clinical documentation are recommended. Moreover, patient group directions users should be encouraged to adhere to patient group directions’ governance restrictions, such as through regular training, audits and staff updates. date: 2020-07 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/j.ijnurstu.2020.103590 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1776718 doi: 10.1016/j.ijnurstu.2020.103590 lyricists_name: Franklin, Bryony lyricists_id: BFRAN90 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: International Journal of Nursing Studies volume: 107 article_number: 103590 citation: Black, A; Gage, H; Norton, C; Franklin, BD; Murrells, T; Courtenay, M; (2020) A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: a mixed methods study. International Journal of Nursing Studies , 107 , Article 103590. 10.1016/j.ijnurstu.2020.103590 <https://doi.org/10.1016/j.ijnurstu.2020.103590>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10095056/1/1-s2.0-S0020748920300754-main.pdf