Safe Prescribing

Question 1

Define medicines reconciliation

Answer 1

Process ensuring all medication patient is taken is correctly documented on admission and at each transfer care (admission and discharge to and from each health care setting)

Question 2

What does medication history taking allow?

Answer 2

• prescription of usual medication clearly and accurately according to drug chart without delays or omissions
• identify medicated related issues contributing to admission
• identify other medications needed

Question 3

Steps of medication history taking

Answer 3

• collect info with most recent and accurate sources
• check/verify new prescription with initial inpatient one and follow up discrepancies
• communicate history and action taken, omission and discrepancies

Question 4

3 stages of medicine reconciliation

Answer 4

• admission
• post admission verification
• discharge

Question 5

Sources of prescription info

Answer 5

Patient
Patient's own drugs
Summary Care Records
Carer/Nursing or Residential Home
GP surgery
GP referral letters
Previous discharge summary
Community pharmacy
Prescription from another hospital
Repeat prescription list

Question 6

3 sections of the BNF

Answer 6

• guidance on prescribing (palliative care and emergency care on poisoning)
• individual therapeutic areas, monographs
• appendices (interactions)

Question 7

What does a monograph contain?

Answer 7

• A drugs dosing info

- details on indication for use

Question 8

Why may dosing info differ?

Answer 8

• different doses for diff licensed indications and some uses are unlicensed
• different formulations used as different bioavailability
• modified release prep to allow less frequent dosing

Question 9

Define pharmacodynamic interaction

Answer 9

When 2 drugs have additive or antagonistic pharmacological effects, predictable interactions

Question 10

Define pharmacokinetic interaction

Answer 10

When drug increases or decreases amount of another drug available in body by affecting absorption/distribution/metabolism/excretion of other drug

Question 11

What is the main source for prescribing?

Answer 11

BNF!!!

If cannot find - consult ward pharmacist or medicines information department

Question 12

What are the 3 stages in which prescription errors can occur?

Answer 12

• prescribing
• dispensing
• administration

Question 13

What is a prescription error?

Answer 13

When result of prescribing decision/writing results in unintentional but significant reduction in probability of treatment being timely and effective or there is increased risk of harm compared with generally accepted practice

Question 14

What are the 2 main error types?

Answer 14

1) slips and lapses (actions do not go according to plan)

2) mistakes (plan itself is wrong)

Question 15

What factors can cause error?

Answer 15

• inadequate knowledge of patient and clinical status
• inadequate drug knowledge
• calculation errors
• illegible handwriting
• drug name confusion
• poor history taking
• fatigue and workload can contribute to slips and lapses

Question 16

Prescribing top tips

Answer 16

• check allergy status always before prescribing
• legible (black or dark blue)
• sign legibly to legalise with full signature
• use approved names and write in block letters
• sign/date and give reason for discontinuation
• no abbreviations
• write doses in full
• antibiotics state review date/course length