A comparison in independent nurse prescribing and patient group directions by nurse practitioners in the emergency department: a cross sectional review.

AIM

To explore nurse prescribing in an emergency department using patient group directions versus independent nurse prescribing.

BACKGROUND

Patient group directions allow restricted access to medication in unselected patients using pre-set criteria. Independent nurse prescribing is a flexible method of medication provision. Limited data exists on the application of either method in clinical practice.

METHODS

Exploration of patient group directions and independent nurse prescribing application in an emergency department using 617 nurse practitioners' clinical notes; 235 and 382 respectively. Patient attendances from 01/07/2009 to 30/06/2010 were randomly sampled. Prescribing frequency; range of medications and diagnoses; independent episode completion and prescribing safety was explored.

RESULTS

Statistical difference exists in prescribing frequency between the independent nurse prescribers (51.6%, n = 197) and patient group directions (32.3%, n = 76). Appropriate medication given by 99.7% (n = 381) of independent nurse prescribers, with 1 contraindicated drug provided. The limitations of patient group directions was highlighted in 11.8% (n = 9) of cases, however all drugs given were appropriate for the diagnosis. No statistical difference in independent episode completion.

CONCLUSIONS

Nurses provide appropriate medication in an emergency department. Patients being managed by nurse prescribers were more likely to receive medication. Further investigation is required to justify this.