Intro To Prescribing

Question 1

Ethical pillars

Answer 1

Beneficence
Non-maleficence
Autonomy
Justice

Question 2

What does good prescribing look like according to Barber’s goals?

Answer 2

Maximise effectiveness
Minimise cost
Respect Patient choice
Minimise risk

Question 3

Sources of errors: patient factors

Answer 3

Pregnancy/ breast feeding
Elderly
Children 
Palliative care
Polypharmacy
Hepatic/ renal impairment

Question 4

Sources of error: health professional factors

Answer 4

Knowledge 
Tired
Stressed
Distracted
Technical skills
Communication skills

Question 5

Sources of error: system factors

Answer 5

Team and inter professional working

Workload
Hierarchy
Culture/ ethos

Question 6

What does a prescription have to go through before it reaches the patient in the ‘error and cheese’ model?

Answer 6

Admitting team

Medical team responsible for patient

Prescribing Dr

Nursing team

Pharmacist

-> patient

Question 7

Types of error

Answer 7

Errors (actions intended but not performed) -> skill- based (errors in executing correctly planned actions) OR mistakes (errors in planning actions)

Mistakes: knowledge- based OR
rule-based -> good rules not applied/ misapplied OR bad rules

Skill- based: memory- based (lapses) OR action- based (slips) -> technical errors

Question 8

How does adherence change as a patient is prescribed more drugs?

Answer 8

adherence decreases

1 drug = 97.7% adherence
4 drugs = 65.9%
7 drugs = 0%

Question 9

How to minimise prescribing risks?

Answer 9

Recognise high risk activity

Give task attention and focus

Ask for help from team

Check: meds history/ allergies, drug/ dose/ route/ frequency/ duration, interactions/ side effects, correct instructions/ monitoring, local/ national guidance/ policies

Shared decision making

Ask patient to check prescription and drugs dispensed

Double check