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.