SCRIPT: prescription documentation

Question 1

Basic prescription requirements.

Answer 1

• Name and address of the patient
• Age or date of birth if under 12
• Signed by the prescriber
• Dated (prescriptions for Schedule 2, 3 and 4 CDs are only valid for 30 days)
• Be written legibly and so as to be indelible
• Contain a perscriber identifier

Question 2

Controlled drugs.

a) Misuse of Drugs Act 1971 - classification
b) Misuse of Drugs Regulations 2001 - schedules
c) Additional CD prescription requirements

Answer 2

a) - Classifies CDs into Class A, Class B and Class C
- These Classes reflect the level of harm the drug may cause to an individual
- The higher the Class, the higher the penalty applied for possession and supply (i.e. dealing)

b) - Schedule 1 - rarely used in healthcare (need Home Office exemption, e.g. LSD, ecstasy, raw opium)
- Schedule 2, 3 and 4 = controlled drugs (CDs) - CD prescription requirements
- Schedule 5 = technically ‘controlled’ but basically normal use (eg. codeine)

c) - Type of preparation (eg. capsules, tablets, oral liquid)
- Dose (eg. ‘as directed’ is NOT acceptable, but ‘One as directed’ or ‘One as required’ are legal)
- Strength (eg. 100 mg/5 ml)
- The total quantity or the number of dose units to be supplied must be stated in both words and figures*

• Example 1:
• Morphine Sulfate MR capsules 10mg BD
• Supply 14 (fourteen) capsules
• Example 2:
• Morphine Sulfate Concentrated Oral Solution 100 mg/5 ml
• 1ml four times a day when required for breakthrough pain
• Supply 30 (thirty) mls**

**always give total volume for liquid

Question 3

Inpatient drug charts vs. FP10

Answer 3

FP10 = legal prescription (bound by prescribing legality)

Inpatient drug chart = order for administration (bound by hospital trust policy)

Question 4

Drugs that FY1 doctors cannot prescribe

Answer 4

• Cytotoxics - methotrexate

- Immunosuppressants (eg. DMARDs, tacrolimus) other than corticosteroids

Question 5

Abbreviation use.

a) Units - which are the only 2 permissible
b) Frequency
c) Route
d) Decimals

Answer 5

a) mg and g
NOT…
- mcg - write ‘micrograms’
- U - write ‘units’

b) OD, BD, TDS, QDS, PRN
c) PO, SC, IM, IV, Top*
* For topical medication, must specify where (to skin, to eye, to ear, etc.)

d) Avoid leading decimals
- write 500 micrograms (NOT… 0.5 mg)

Avoid trailing decimals
- write 40 mg (NOT… 40.0 mg)

Acceptable if writing a range.
- eg. 0.5 - 1 g

Question 6

Seven deadly sins of prescribing

Answer 6

1. Not knowing your drug.
2. Not knowing your patient.
3. Failing to take an accurate drug history.
4. Writing an illegible prescription.
5. Using inappropriate abbreviations, decimals and leading zeros.
6. Failing to calculate and check drug doses accurately.
7. Failing to give clear instructions and using inappropriate verbal orders.

Question 7

PRN drugs.

- what information should be documented

Answer 7

• Maximum dose (eg. max dose 4 g in 24 hours)*
• Minimum dose interval (eg. every 1 - 4 hours)

*Will need to account for any regular medications and other similar medications (eg. may have multiple opiates - consider total opiate dose), or if same drug given by >1 route

Question 8

Route of administration

Answer 8

• Specify route
• If the same dose irrespective of route, can put more than one route on the same prescription - e.g. IV/PO (cannot be done if dose is different, eg. morphine)
• May put instructions for alternative route (eg. give IV if patient is vomiting)

Question 9

Variable dosing regimes

Answer 9

Amiodarone

• 200 mg TDS for 1/52
• Then 200 mg BD for 1/52
• Then 200 mg OD for 1/52 (maintenance dose; may be lower than 200 mg - lowest dose to control arrhythmia)

Steroid-reducing regimes

Warfarin
- based on INR

Question 10

Changing/ stopping medications

Answer 10

• Cross through the entire entry* (it should still be legible below as this is part of the patient’s medical hx)
• Annotate the entry with your signature and a date
• Document rationale in the notes

*This must be done even if it is just the dose that is being changed - rewrite it in full

Question 11

10 principles of good prescribing

Answer 11

1. Be clear about the reasons for prescribing.
2. Take into account the patient’s medication history before prescribing.
3. Take into account other factors that might alter the benefits and risks of treatment.
4. Take into account the patient’s ideas, concerns and expectations.
5. Select effective, safe, and cost-effective medicines, individualised for the patient.
6. Adhere to national guidelines and local formularies where appropriate.
7. Write unambiguous, legal prescriptions using the correct documentation.
8. Monitor the beneficial and adverse effects of medicines.
9. Communicate and document prescribing decisions and the reason for them.
10. Prescribe within the limitations of your knowledge, skills and experience