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Safe Prescribing: Prescribing Guidance Writing Prescriptions

The document provides guidance on safe prescribing practices including prescribing within competence, using evidence-based practices, checking for drug interactions, considering patient adherence and side effects, keeping updated on clinical guidelines, and responsibly delegating tasks. It also outlines best practices for writing prescriptions such as providing all relevant patient information, using generic drug names when possible, avoiding unnecessary abbreviations, and specifying dosages clearly. Computer-generated prescriptions should also include minimum data requirements for safety.

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Anant Khot
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72 views4 pages

Safe Prescribing: Prescribing Guidance Writing Prescriptions

The document provides guidance on safe prescribing practices including prescribing within competence, using evidence-based practices, checking for drug interactions, considering patient adherence and side effects, keeping updated on clinical guidelines, and responsibly delegating tasks. It also outlines best practices for writing prescriptions such as providing all relevant patient information, using generic drug names when possible, avoiding unnecessary abbreviations, and specifying dosages clearly. Computer-generated prescriptions should also include minimum data requirements for safety.

Uploaded by

Anant Khot
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Hippocrates' advice 'primum non nocere' - First, do no harm - still holds today.

Prescribe only
where necessary, and consider benefits versus risks. Involve the patient in decisions about their
care and respect patient autonomy.
Note the patient's age, medical history (especially of any hepatic or renal dysfunction) and any
concurrent medication. Think about dosage carefully; manufacturers' recommended doses are
based on population studies and assume 'one dose fits all'. However, there are genetic
differences. New drugs are often marketed at the highest therapeutic level to demonstrate
effectiveness in large numbers of patients but companies are not required to provide data on
lowest effective dose.
If this is a new - potentially long-term - prescription, review the patient to assess for effect, side-
effects and the need to continue.
Safe prescribing
This is becoming an important issue, as evidenced by its increasing prominence in the
undergraduate medical syllabus. Issues which need to be considered include [1]:
Prescribing within limits of competence.
Evidence-based prescribing.
Interaction with other drugs.
Concordance, tolerability and formulation.
Adverse effects.
Checking dosages.
Using prescribing formularies.
Keeping up to date and following clinical guidelines, where available, from the National Institute
for Health and Care Excellence (NICE) or Scottish Intercollegiate Guidelines Network (SIGN).
Using electronic systems where available that can enhance the safety of prescribing.
Responsible delegation of prescribing administration and dispensing.

Prescribing guidance
Writing prescriptions
Many prescriptions are now computer-produced but, if you are writing one by hand, write legibly
in indelible ink, date the prescription and state the full name and address of the patient. All
prescriptions should be signed by the prescriber. It is a legal requirement in the case of
prescription-only medicines to state the age for children under 12 years, but it is good practice to
do so in all cases. Other things to take care of include:
Write generics unless there are bioavailability issues, as this will enable the pharmacist to
dispense any suitable preparation, avoiding expense and delay.

Avoid unnecessary use of decimal points (eg, 3 mg, not 3.0 mg). For quantities less than 1 gram,
write in milligrams (eg, 500 mg, not 0.5 g). For quantities less than 1 milligram, write in
micrograms (eg, 100 micrograms, not 0.1 mg). Don't abbreviate micrograms, nanograms or
units. Use millilitres (ml or mL) not cubic centimetres or cc.

Schedules should be written in English, without abbreviation but some Latin abbreviations are
acceptable. The British National Formulary (BNF) lists these in full, but common ones in use
include:

stat = immediately.

p.r.n. = pro re nata = when required.

o.d. = omni die = every day.

o.n. = omni nocte = every night.

b.d. = bis die = twice daily.

t.d.s. = ter die sumendum = to be taken three times daily.

q.d.s. = quater die sumendum = to be taken four times daily.

State minimum dose interval and maximum total amount when prescribing p.r.n items.

The 'number of days of treatment' box can be used on NHS forms.

Specify the strength and quantity. In the absence of this information the pharmacist will attempt
to contact you. If unable to do so, they can use their discretion and professional judgement to
dispense up to five days' worth of treatment or appropriate amounts of combination packs or oral
contraceptives. If they have insufficient information to make a judgement, they will return the
prescription to you.

Write on the prescription in inverted commas anything other than the name, strength and dosage
of the tablets that you want to appear on the label - e.g., 'Sedative Tablets'.
Avoid abbreviations of drug names and preparations as these can be misinterpreted - eg, Mist.
Expect. Don't invent compound generic names, especially for sustained-release preparations.

Computer-issued prescriptions

Recommendations include:

Minimum data requirements:

Date.

Patient's surname, one forename, other initials.

Address, title.

Date of birth.

The age of children under 12 years and of adults over 60 years must be printed in the box
available; the age of children under 5 years should be printed in years and months.

Doctor's name must be printed at the bottom of the prescription form, surgery address, telephone
number, reference number and primary care organization. Prescriptions issued by GP registrars,
assistants, locums, or deputizing doctors should bear the name of a responsible principal.

The prescription must be printed in English without abbreviation, the dose must be in numbers,
the frequency in words, and the quantity in numbers in brackets (e.g., 40 mg four times daily).

All points about dose, frequency, strength, preparation, units above must be followed.

Supplementary warnings or advice should be written in full.

Handwritten alterations should only be made in exceptional circumstances and any alterations
must be countersigned in the doctor's own handwriting.

Clearly mark duplicates as such.

Unused space must be cancelled, or the end of the prescription indicated.


Repeat prescriptions [1]

It is not unusual for other members of staff to write or for computers to generate repeat
prescriptions for you to sign. This can be an efficient time-saving measure but you must ensure
that:

You have the correct prescription for the correct patient.

The patient is being regularly reviewed both in terms of side-effects and with regard to the
ongoing need for this medication.

The correct dose is issued if there are changing doses over time.

Staff are adequately trained in this role.

NB: You are ultimately responsible for these prescriptions.

Repeat dispensing is a type of repeat prescribing which allows community pharmacists to


dispense regular medications to suitable patients without the direct involvement of the GP
surgery on each occasion the prescription is needed. This is done according to an agreed protocol
for patients with stable conditions for periods of time up to one year. The patient is given a batch
of prescriptions to take to the pharmacy to be dispensed at regular intervals over the agreed
period of time.

Electronic prescriptions [2]

Increasingly, electronic prescribing is being rolled out in England, where prescribers can send
prescriptions electronically to a chemist of the patient's choice. This potentially improves safety,
efficiency and convenience. Prescribing organizations must be authorized to use the service by
NHS England.

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