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

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.

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.

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).

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.