title: Multi-disciplinary perceptions of patient group directions as a replacement for the pro re nata prescribing of antipsychotic medications in acute mental health settings.
abstract: BACKGROUND
  Patient group directions have been used in the NHS for 10 years. Despite high levels of reported use, few studies have examined staff perceptions or evaluated them in practice. In mental health services, pro re nata prescriptions continue to contribute to high doses and polypharmacy of antipsychotics. Replacing pro re nata with patient group directions might improve the quality and safety of care associated with this practice.
  
  
  OBJECTIVE
  This study aimed to explore the acceptability of patient group directions in acute mental health services.
  
  
  METHODS
  Qualitative methods were used. Data were analysed using thematic content analysis. Twenty-six members of the multi-disciplinary team (doctors, nurses and pharmacists) participated in either focus groups or individual interviews in 2009.
  
  
  RESULTS
  A broad range of benefits were suggested, including improved safety and access to treatments, and the professional development of nurses. However, concerns also emerged about the need for a culture shift in thinking, and the danger of multiple systems for the supply of medicines.
  
  
  CONCLUSIONS
  Despite the widespread use of patient group directions in clinical settings in the last 10 years, limited research has examined their development and potential. Patient group directions can potentially give a rigorous means of supplying or administering medicines. However, their development requires careful consideration.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, UK. john.a.baker@manchester.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Baker
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000451:nursing*; D017144:Focus Groups; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D024802:Nurse's Role; D015279:Organizational Culture; D010348:Patient Care Team; D019338:Polypharmacy; D011568:Psychiatric Nursing; D036301:Qualitative Research; D013222:State Medicine; D006113:United Kingdom
chemical_list: D014150:Antipsychotic Agents