Safe prescribing

Question 1

Describe the scope of the problem with unsafe prescribing. (3)

Answer 1

1 in 20 prescriptions have errors, which is a common cause of negligence, and costs the NHS lots.

Question 2

Describe the four principles of good prescribing. (4)

Answer 2

Respecting patients choic
Maximising effectiveness
Minimise cost
Minimise risk

Question 3

Describe patient factors as source of error in prescribing. (6)

Answer 3

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

Question 4

Describe the healthcare professional factors as a source of error in prescribing. (5)

Answer 4

Knowledge
Tired or str seed
Distracted
Technical skill failure
Communication skill failure

Question 5

Describe the healthcare system factors as a source of error in prescribing. (4)

Answer 5

Team working failure
Too high a workload
Hierarchy
Culture

Question 6

Describe 5 factors of how a healthcare professional can minimise risk. (5)

Answer 6

Recognise the professional needs to focus and take their time.
Ask for tea imput.
Check the patients details: allergies, dose, route, drug choice, frequency, duration, side effects, DDIs, monitoring.
Double check all work.
Check concordance of taking the medication.

Question 7

Describe the purpose of medication reviews. (5)

Answer 7

Compliance 
Technique
ADRs
DDIs
Economic viability

Question 8

Describe the criteria for specific targeting of patients who need more regular medication reviews. (5)

Answer 8

Polypharmacy our complex regimes
Recently discharged from long term care
Frequent admissions to hospital
Long term use of psychoactive drugs 
High risk medications - narrow therapeutic windows or severe side effects.

Question 9

Describe the 8 things a medication review needs to cover. (8)

Answer 9

Time limited medications eg clopidogrel for 12 months only.
Life expectancy of patient and risk benefit.
Functionality eg through measurable outcomes
Cost
DDIs / ADRs / contraindications
Concordance
OTC medications
Lifestyle modifications

Question 10

Describe the methods for reviewing medications in older people. (3)

Answer 10

STOPP-START
Screening Tool for Older People’s Prescriptions - stop unnecessary medications
Screening Tool to Alert to Right Medication - start new appropriate medications