Prescribing Safely

Question 1

System for prescribing

Answer 1

Fill in demographics information
Date
Chart number

Check ALLERGIES box and fill in

Prescribe once only drugs

Prescribe antibiotics (checking for allergies): - Confirm length of course with microbiology

• IV 5 days
• Oral 7 days

Prescribe other new medications

‘Normally I would now check drug interactions using the BNF - would you like me to do that now or go on to write up regular medications’

Prescribe regular medications

Prescribe PRN as rquired medication

Prescribe oxygen

Prescribe fluids

Question 2

Frequency

Answer 2

OD - Once daily
OM - Once morning
ON - once nightly
BD - twice daily
TDS - 3 times daily
QDS - 4 times daily
X hourly
PRN - as required
STAT - immediately

Question 3

Rules

Answer 3

Black CAPITALS
Micrograms, nanograms, UNITS in full
Generic drug names except for inhalers, insulin, psychiatric, epilepsy drugs, narrow therapeutic range - write generic name (brand name)
Review date for abx in 48h when results for cultures back
All medications reviewed weekly
Allergy box filled with any allergeis (not just drug) and reaction in brackets - sign and date in bottom right corner
Times written in 24h format 1300
When stopping drug, cross out and line through - sign and date - document in notes
If re-writing chart include all start dates

Question 4

Narrow therapeutic range drugs

Answer 4

Gentamycin
Warfarin
Lithium
Digoxin
Theophylline
MEthotrexate
Phenytoin
Insulin
Ciclosporing

Guys with large dongles make totally perfect internet connection

Question 5

Solutions

Answer 5

Write drug and concentration in drug box and how many mls in the dose box

ORAMORPH 5mg/ml

DOSE: 5ml

Question 6

Inhalers

Answer 6

Write the inhaler and puff content in the drug box and how many puffs in dose box

SALBUTAMOL 100 MICROGRAMS

DOSE 2 PUFFS

Question 7

Combined drugs

Answer 7

COmbination specifics in the drug box and how many tablets in dose box

CO-CODAMOL 8/500

DOSE 2 TABLETS

Question 8

Complex analgesia

Answer 8

Prescribe background analgesia regularly and breakthrough PRN dose (1/6 of total daily dose up to 4 hourly)

Question 9

Oxygen

Answer 9

Include device to be used, final concentration and flow rate

Question 10

Fluids

Answer 10

Include fluid
Volume
Additives
Flow rate

Question 11

Outpatient controlled drug prescriptions

Answer 11

Include patient name and address
Dose must be spelled out as well as numeric 5 (FIVE) mg
Total quantity must be spelled out as well as numeric

Question 12

FP10 sections to fill

Answer 12

Patient details:
Name, address, age (years and months if <5), DOB

Medication details:
Drug prescription

Prescriber details:
Signature, date, name, address

Question 13

FP10 drug prescription box

Answer 13

DRUG:
Strength (40mg) preparation (TABLETS)

DOSING:
Dose in numbers followed by frequency in words (1 TABLET FOUR TIMES A DAY)

QUANTITIY:
Quantity to be dispensed in numbers (28 TABLETS)

Question 14

FP10 PRN prescription

Answer 14

Include minimum dose interval and maximum total daily amount

DRUG TRAMADOL
DOSE 100mg
FREQUENCY As required every 6 hours (maximum 400mg in 24 hours)

Question 15

Controlled drugs FP10

Answer 15

Spell out everything as well as numeric - strength, dose, total quantity

Question 16

Process

Answer 16

Read and summarise Hx and Ex
ORder appropriate Ix - writing forms
Receive results - prescribe drug
Ask for local guidelines for ABX and sensitivites
Beware dose adjustments in hepatic/renal impairment!