Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations

J Health Serv Res Policy. 2012 Jul;17(3):149-56. doi: 10.1258/JHSRP.2012.011090. Epub 2012 Jun 25.


Objectives: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals.

Methods: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England.

Results: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills.

Conclusions: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence*
  • Drug Costs
  • Drug Prescriptions / economics
  • Drug Prescriptions / nursing
  • Drug Prescriptions / standards*
  • England
  • Health Services Research
  • Humans
  • Nursing Assessment
  • Pharmacists*
  • Practice Patterns, Nurses' / standards*
  • Practice Patterns, Physicians' / standards*
  • Referral and Consultation
  • State Medicine