Prescription Writing

Question 1

Considering the Competency Framework for all Prescribers, RPS 2021how would you assess the patient ?

Answer 1

Introductions, full medical history (biopsychosocial inc medications/ allergies/ intolerances/ previous ADRs)

Examination (inc. weight/ BMI), investigations as appropriate, differential & working diagnosis.

Remember, consultation/ communication skills, documentation, professionalism (capacity, consent, confidentiality etc).

Take guidance if/ when needed.

Question 2

Considering the Competency Framework for all Prescribers, RPS 2021how would you identify evidence-based treatment options available for clinical decision-making?

Answer 2

Considers both pharmacological and non-pharmacological treatment options.

Pharmacological options may include stopping (not just starting) medications and reviewing dosage in addition to an assessment of risk/ benefit taking into account any relevant patient factors e.g. PMH, existing medications, allergies etc.

Requirement to keep up to date with evidence-based practice and consider wider implications of practice e.g. public health issues, antimicrobial stewardship etc.

Treatment options may include:

No intervention
Health education and advice
Wellbeing/ lifestyle changes
Social prescribing
Psychological interventions
Complementary/ herbal therapies
Optimisation of current medication
Prescribe
OTC/ prescription
Refer
A combination of the above

Question 3

Considering the Competency Framework for all Prescribers, RPS 2021how would you present options and reach a shared decision ?

Answer 3

Actively involves the patient/ carer to make informed choices that respects their preferences NB ICE!

Includes appropriate discussion of risks/ benefits of treatment options and consideration of adherence.

Question 4

Considering prescription forms who uses the
- Blue forms
- Yellow forms
- Lilac forms
- White forms

Answer 4

All prescription forms originating in England begin with the code FP10.
Blue forms are used for instalment prescribing/ dispensing of certain controlled drugs for treating addiction.
Yellow forms are used by dentists.
Lilac forms are used by Community/ independent nurse prescribers and AHP prescribers.
White forms are used for controlled drugs (and hospital inpatient prescriptions – they look very different).
NB forms are different in Wales, Scotland and N Ireland.

Question 5

What patient factors do you need to consider when prescribing?

Answer 5

Age
Children and elderly patients are at higher risk of prescribing complications, so take special care.

Weight
Do you have the patient’s current weight for dose calculation?

Renal impairment
Will the excretion of this drug be affected?

Can this drug worsen renal impairment?

Hepatic impairment
Will the metabolism of this drug be affected?

Pregnancy and breastfeeding
Is this drug known to be safe?

What are the benefits vs risks?

Other drugs/ conditions
Are there interactions?

Will this drug worsen another condition (check contraindications and cautions in BNF)?

Question 6

Who does the legal responsibility of the prescription lie with?

As per what act ?

Answer 6

Legal responsibility lies with the practitioner signing prescription
Human Medicines Regulations 2012 & DoH

Question 7

What documentation must a prescription have ?

Answer 7

All prescriptions must:

Be written or printed legibly in ink

State the name and address of the patient

Dated

Address of the prescriber

Indication of the type of prescriber

Signed in indelible ink by the prescriber

State the age of a child under 12

If under 5 years, state years and months of age

Controlled drug
prescriptions have additional legal requirements