Introduction
There are several considerations to make before prescribing. Many physicians do this instinctively, but this article will provide you some tips and reminders to keep in mind while writing prescriptions.
The admonition of Hippocrates, “Primum non nocere” – “First, do no harm” – still holds true today. Only prescribe when absolutely necessary, and weigh the benefits against the risks. Involve the patient in healthcare decisions and respect their autonomy.
Take note of the patient’s age, medical history (particularly any hepatic or renal failure), and any medications he or she is taking. Consider the dosage; manufacturers’ recommendations are based on demographic research and believe that “one dose fits all.” There are, however, genetic distinctions. Companies are not obligated to submit data on the lowest effective dose when marketing new medications since they are frequently sold at the maximum therapeutic level to demonstrate effectiveness in large numbers of patients.
If this is a new – and perhaps long-term – medication, evaluate the patient for effectiveness, adverse effects, and the need to continue.
Prescriptions that are safe
As demonstrated by its rising importance in the undergraduate medical curriculum, this is becoming a significant concern. Prescribing within boundaries of competence is an issue that must be examined.
• Prescriptions that are based on scientific evidence.
• Interactions with other medications
• Consistency, tolerance, and formulation
• Negative consequences.
• Keeping track of doses.
• Making use of prescribed formularies
Following clinical guidelines from the National Institute for Health and Care Excellence (NICE) or the Scottish Intercollegiate Guidelines Network, when available (SIGN).
When electronic systems are available, they should be used to improve the safety of prescription.
Prescription administration and dispensing are delegated responsibly.
- Prescribing guidance
- Writing prescriptions
Many prescriptions are now written by computer, but if you’re writing one by hand, be sure to write legibly in indelible ink, date the prescription, and include the patient’s full name and address. Prescriber signature is required on all prescriptions. In the case of prescription-only drugs, it is a legal obligation to mention the age of children under the age of 12, although it is good practise to do so in all situations. There are also a few other things to consider:
Unless there are bioavailability concerns, write generics since this allows the pharmacist to dispense any acceptable preparation, saving money and time.
Excessive usage of decimal points should be avoided (eg, 3 mg, not 3.0 mg). Write in milligrammes for quantities less than 1 gramme (eg, 500 mg, not 0.5 g). Write in micrograms for amounts less than 1 milligramme (eg, 100 micrograms, not 0.1 mg). Micrograms, nanograms, and units should not be abbreviated. Instead of cubic centimetres or cc, use millilitres (ml or mL).
Computer-issued prescriptions
Recommendations include:
Minimum data requirements:
- Date.
- Patient’s surname, one forename, other initials.
- Address, title.
- Date of birth.
Children under the age of 12 and adults over the age of 60 must have their ages printed in the available box; children under the age of 5 should have their ages printed in years and months.
The doctor’s name, surgery address, phone number, reference number, and primary care organization must all be put at the bottom of the prescription form. The name of a responsible principal should appear on all prescriptions written by GP registrars, assistants, locums, or deputizing doctors.
The dose must be in numbers, the frequency in words, and the amount in numbers in brackets, and the prescription must be stated in English without abbreviation (eg, 40 mg four times daily).
All of the aforementioned criteria concerning dosage, frequency, strength, preparation, and units must be adhered to.
Additional cautions or advice should be written in its entirety.
Only in extreme situations may handwritten changes be made, and any changes must be countersigned in the doctor’s own handwriting.
Duplicates should be clearly labelled as such.
Unused space must be cancelled, or the prescription’s termination must be specified.
Shared care prescriptions
It’s possible that continuous prescriptions for a medication for a disease that’s being handled by a hospital team will cause some misunderstanding. In the end, the responsibility is shared, and it is your obligation to be educated about the nature of the medications given and their adverse effects. You should also be aware of the clinical monitoring arrangements and strategy, as well as any relevant clinical recommendations that have recently been updated.
In practice, this can be problematic since you may not know about the hospital visit until days or weeks afterwards. If you have any questions regarding the management plan or any of the treatment options, speak with the hospital staff.
The General Medical Council (GMC) states that:
Decisions regarding who should be in charge of ongoing care or treatment after an initial diagnosis or evaluation should be made with the patient’s best interests in mind, rather than your convenience or the expense of the drug and any related monitoring or follow-up.
All parties involved, including the patient, must agree to share care. A shared care agreement requires effective communication and ongoing contact between all parties.
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