Understanding non-medical prescribers' antimicrobial prescribing and stewardship competency: A scoping review.

OBJECTIVES

To map international evidence on non-medical prescribers' (NMPs) antimicrobial stewardship (AMS) knowledge, competencies, and prescribing behaviours, and to examine how these are assessed across professional groups and healthcare settings.

METHODS

A scoping review was conducted following Arksey and O'Malley framework and PRISMA-ScR guidelines. Six databases and grey literature were searched using a Population-Concept-Context strategy. Eligible studies addressed independent non-medical antimicrobial prescribing in high-income countries (2016-2026). Records were screened and data charted using a piloted standardised form. Findings were synthesised using framework analysis.

RESULTS

Twenty papers from 19 studies across five countries (USA, UK, Canada, New Zealand, the Netherlands) were included. In one Canadian community-pharmacy sub-study, pharmacist prescribers achieved 95% concordance with provincial guidelines for uncomplicated UTI - a single-setting figure not generalisable beyond it. Pharmacist-led interventions reduced inappropriate prescribing. Nurse prescribers showed greater variability by experience and patient expectations. Cross-country differences in prescribing authority followed a consistent classification structure. In UK dispensing data, NMP antibiotic prescribing fell 12% in 2020 while the high-risk share rose modestly (5.3% to 6.4%; descriptive only).

CONCLUSIONS

Antimicrobial stewardship knowledge among NMPs is generally high, but its application varies across settings and professional groups. This variability is one of capability, not competence: adaptive stewardship in ambiguous presentations, not the bounded knowledge that frameworks already articulate. NMPs should adopt validated antimicrobial prescribing and stewardship competency (NMP-APSC) assessment tools, and capability development in early-career prescribers warrants further empirical study. The Ahmed classification offers a workable shared vocabulary for regulatory comparison, pending empirical test of its discriminative validity beyond pharmacist prescribing.