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 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 provision. RESULTS Of 1682 clinical notes (nurse prescribers=743, 44%; patient group directions=939, 56%), 879 involved 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 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=1640 of 1682 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.

<h4>Aim</h4>To explore nurse prescribing in an emergency department using patient group directions versus independent nurse prescribing.<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.

<h4>Background</h4>Non-medical prescribing (NMP) qualifications extend prescribing authority to nurses, pharmacists, and other allied health professionals and are advocated as a means to help improve healthcare efficiency and access to services. However, despite non-medical prescribers (NMPs) being utilised in some countries for more than two decades, less is known about their role and impact in the mental health context. This scoping review therefore aims to map published research evidence concerning NMP for patients with mental illness.<h4>Methods</h4>Five electronic databases were searched from January 2003 to July 2024. Reference lists of identified papers were also checked for relevant studies. Full text primary research studies exploring the nature, impact, and implementation of NMP services for patients with mental illness and dementia in community settings were included.<h4>Results</h4>From 22,547 retrieved papers, 63 studies were included. Of these, 57 (90.4%) detailed the nature (including the service or team they were based in, medicines prescribed, and main role(s)) of NMPs, 45 (71.4%) assessed the impact of services, and 16 (25.3%) explored factors influencing service implementation and delivery. The majority of studies originated from the USA (30/63, 47.6%), or the United Kingdom (27/63, 42.8%). Either nurse (44/63, 69.8%), pharmacist (16/63, 25.3%) or non-medical prescribing models featuring both professionals were exclusively studied (3/63, 4.7%). In the UK and USA, antidepressants (60%, 54.5%) were the most prescribed by NMPs. Although the conditions of patients managed by both nurse and pharmacist prescribers were reported to be well managed based on clinical outcomes (3/24, 12.5% and 3/13, 23%, respectively), few studies evaluated health outcomes. Training-related barriers to service delivery were commonly mentioned in UK studies (4/9, 44.4%), with financial issues reported in the USA (2/4, 50%).<h4>Conclusions</h4>This review highlights the diverse roles of NMPs in the care of people with mental illness. Whilst the limited evidence suggests a positive impact on patient care, more quantitative research is needed. Given the focus on nursing prescriber models in this review, along with rising mental health demand and continuing staff shortages, future research should prioritise exploring and evaluating the contribution of pharmacist NMP services as well other healthcare professionals' NMPs.

Abstract Background Local services in the United Kingdom National Health Service enable autonomous provision of medication by nurses, supporting individual nurses to gain prescribing qualifications or by introducing local patient group directions. Aim To compare nurse prescribing and patient group directions about clinic processes, patients' experiences, and costs from the perspectives of providers, nurses, and patients. Design Mixed methods, comparative case study in five urban sexual health services in the United Kingdom. Methods Data were collected from nurse prescribers, patient group direction users and their patients July 2015 to December 2016. Nurse questionnaires explored training (funding and methods). Nurses recorded consultation durations and support from other professionals in clinical diaries. Patient notes were reviewed to explore medication provision, appropriateness and safety; errors were judged by an expert panel. Patients completed satisfaction questionnaires about consultations and information about medications. Results Twenty‐eight nurse prescribers and 67 patient group directions users took part; records of 1682 consultations were reviewed, with 1357 medications prescribed and 98.5% therapeutically appropriate. Most medication decisions were deemed safe (96.0% nurse prescribers, 98.7% patient group directions, Fisher's Exact Test p = .55). Errors were predominantly minor (55.6% nurse prescribers, 62.4% patient group directions) and related to documentati

dressings plus a few Prescription-only Medicines (POMs). The Nurse Prescribers' Extended Formulary (NPEF), a formulary from which independent nurse prescribers can prescribe medicines for conditions in the following categories: minor ailments; minor injuries; health promotion; palliative care. Other categories are soon to be added. These nurses can prescribe all Pharmacy-only (P) medicines and General Sales List (GSL) medicines that are prescribable by doctors for conditions within the above categories, together with about 140 POMs. Currently in the UK there are about 1000 qualified independent nurse prescribers, 850 independent nurse prescribers in training, 750 practice nurse prescribers, and 120 A & E/Minor Injuries Unit nurses and 80 Walk-In-Centre nurses trained or being trained as independent nurse prescribers. Cost–benefit of nurse prescribing In 1991 the UK Department of Health commissioned a cost–benefit analysis by Touche Ross [ 5 ]. They concluded that some nurses were already de facto prescribers, since many nurse-generated prescriptions were being signed by GPs, and both GPs and pharmacists trusted nurses to recommend prescribed medicines, which were then supplied without a formal prescription, or at least in advance of one. They also concluded that nurse prescribing would save time and that patients would have faster access to medicines, but that nurse prescribing would not save money. The time saving estimated by Touch Ross was not large: GPs, they thought, would save less than 15 min a week and Community and Practice Nurses less than 1 h a week. Since then the Prescribing Support Unit has reviewed Nurse Prescribing from 1998 to 2001 and has concluded that: prescribing by Community Nurses accounted for only 1.9% of the total expenditure on medicines in their Formulary in 1999, rising to 4% in 2001; prescribing by Practice Nurses accounted for 0.06% of total expenditure; nurse prescribing had not affected national costs; most nurse prescribing substit

contains directions to the patient and is often abbreviated "Sig." or "Signa." It also obviously contains the signature of the prescribing medical practitioner A prescription in the medical context, often abbreviated ℞ or Rx, is a formal communication from physicians or other registered healthcare professionals to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ (a capital lett In law, a prescription in the medical context is a written or electronic order for a medicinal product or medical device issued by a health professional—such as a physician, physician assistant, dentist, or veterinarian—who is legally entitled to prescribe within the jurisdiction where it is issued. In pharmacy usage, the term prescription generally refers to instructions for medicines that patients obtain from a pharmacy or doctor's office and take themselves outside the hospital. This contrasts with medication orders, which are recorded in hospital or institutional charts to guide nurses and other staff in administering medicines directly to inpatients. Prescriptions may be issued on paper, electronically, or, where it is permitted, verbally (e.g., by telephone). Paper prescriptions normally require the prescriber's handwritten signature and the date of issue. In some jurisdictions, a digital signature may be accepted, while prescriptions for controlled drugs often carry additional legal requirements, such as a handwritten signature, specified wording, or security features. Electronic prescriptions are accepted in many jurisdictions, and verbal prescriptions, when accepted, are subject to restrictions and read-back procedures to reduce error. The content of a prescription includes the name and address of the prescribing provider and any other legal requirements, such as a registration number (e.g., a DEA number in the United States). Unique to each prescription is the name of the patient. In the United Kingdom and Ireland, the patient's name and address must also be recorded. Each prescription is dated, and some jurisdictions may place a time limit on the prescription. Due to the addictive properties of certain drugs, incidents where security hackers have compromised online prescription accounts and employees have forged paper scripts to be sold on the black market have occurred. In the past, prescriptions contained instructions for the pharmacist to use for compounding the pharmaceutical product, but most prescriptions now specify pharmaceutical products that were manufactured and require little or no preparation by the pharmacist. Prescriptions also…

<h4>Aim</h4>To examine nurse practitioner opioid prescribing authority across three countries, analyzing safety outcomes, workforce distribution patterns, access equity, and service to vulnerable populations using integrated nursing policy and patient-centered access frameworks.<h4>Design</h4>Comparative policy analysis employing Russell and Fawcett's nursing policy framework overlaid on Levesque's access framework.<h4>Methods</h4>We analyzed regulatory documents, national prescribing databases, and published literature from New Zealand, United States, and Australia. Systematic searches identified 14 studies meeting inclusion criteria. We synthesized evidence across four policy analysis levels: efficacy, effectiveness, equity, and social justice. Data collection occurred January through December 2024.<h4>Results</h4>Evidence demonstrated safety and quality outcomes comparable to physician prescribing, with population-level prescribing decreases and no increase in overdose mortality. Nurse practitioners concentrated in rural areas at 34% compared to the 23% national average, with growth occurring during physician workforce decline. Patient panels showed 44% Medicaid coverage compared to 31% for physicians, with 88% versus 71% new Medicaid patient acceptance despite lower reimbursement. However, racial prescribing disparities persisted across all provider types, indicating systemic rather than individual-level determinants.<h4>Conclusion</h4>Expanded prescriptive authority advanced multiple policy objectives while revealing distinctive nursing contributions beyond physician substitution. Workforce distribution and patient panel patterns reflected professional values translating into measurable practice serving vulnerable populations.<h4>Impact</h4>Evidence does not support restrictive policies based on safety concerns. Findings position the nursing workforce as an essential solution for health equity goals, requiring regulatory reform combined with institutional barrier removal and continuing attention to systemic inequities.