Introduction: Under UK legislation, nurses independently prescribe or supply medications using PGDs, but evidence on safety in clinical practice is limited.
Methods: Clinical record review across five UK sexual health services, July-December 2015. Sample size quota stratified based on the number of INP/ PGD practising nurses. Documented patient presentations, diagnoses, autonomy and safety/ appropriateness of medication delivery were compared between INP and PGDs.
Results: From 1,851 (INP=711, 38%; PGD=1,140, 62%) clinical records, 50% (n=933) involved medication delivery. INP delivered medication more frequently (INP= 385/711, 54% vs. PGD=548/1,140, 48%; p=0.01). A total of 879 medication assessments were undertaken (INP=399, PGD=480), 70% (n=611/879) were ‘new’ care episodes. Past medical history, concurrent medications and allergy risk assessments were recorded >85% (n=755/879) of cases. INP managed more symptomatic presentations (n=182/399, 46%: asymptomatic n=120/399, 30%); PGD managed marginally more asymptomatic (n=220/480, 46%; symptomatic n=201/480, 42%). INP worked more autonomously than PGDs (INP=310/399, 78%; PGD=308/480, 64%, p<0.01). INP most frequently managed chlamydia (n=53/399, 13%), PGDs most frequently administered vaccinations (n=80/480, 17%). Nurses delivered 66 different products, 1,351 individual medicines, azithromycin being most common (n=231/1351, 17%). Overall, 84% (n=738/879) of episodes were assessed against guidelines as ‘safe and appropriate’ (INP=358/399, 90%; PGD=380/480, 80%). Main reason for not ‘safe and appropriate’ was lack of documentation (n=56/104, 54%). PGDs were, although clinically appropriate, used outside their limits in 13% (n=63/480) of consultations.
Discussion: INP deliver medications more frequently and work more autonomously than PGD users. Both groups were comparable in safe/ appropriate medication delivery. Improved documentation is recommended.