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Prescribing and Patient Group Direction

Patient Specific Directions (PSD)

"A patient specific direction (PSD) is a written instruction from a qualified and registered prescriber for a medicine including the dose, route and frequency or appliance to be supplied or administered to a named patient." * * (Ref: NMC Medicines Management Standards).

These can be instructions written in the patient's notes, or a note sent to a treatment room for the administration of a medicine or a course of medicine.  The treatment and administration should be documented and auditable. 

In a hospital PSDs are the directions for administration written in the Patient Medicines Administration Chart. Where a PSD exists, there is no need for a Patient Group Direction (PGD). 

The PSD must identify the individual patient, whether on a clinic list such as a vaccine clinic or an eye clinic. In some settings the PSD has been developed for groups of patients and is then individualised and signed by the prescriber when they assess the patient, for example the setting may be a renal dialysis clinic where patients return regularly for treatment. The PSD should be reviewed regularly as with any course of medicine. 

Where a PSD template has been developed for local use it is advisable to have this approved by the organisation to ensure accountability and communications issues are addressed. The template also needs to fit within the local clinical governance framework. 

The healthcare professional administering the medication is accountable for their actions and should be aware of the professional standards for administration of medicines.  Medication administration can be delegated under a PSD, provided the professional delegating is satisfied the person is competent to carry out the task. The delegating professional is responsible for all aspects of the administration.

Delegation cannot take place under a PGD.  Please see the NELM website for delegation of supply or administration of medicines under a PGD