SCRIPT: prescription documentation Flashcards
Basic prescription requirements.
- Name and address of the patient
- Age or date of birth if under 12
- Signed by the prescriber
- Dated (prescriptions for Schedule 2, 3 and 4 CDs are only valid for 30 days)
- Be written legibly and so as to be indelible
- Contain a perscriber identifier
Controlled drugs.
a) Misuse of Drugs Act 1971 - classification
b) Misuse of Drugs Regulations 2001 - schedules
c) Additional CD prescription requirements
a) - Classifies CDs into Class A, Class B and Class C
- These Classes reflect the level of harm the drug may cause to an individual
- The higher the Class, the higher the penalty applied for possession and supply (i.e. dealing)
b) - Schedule 1 - rarely used in healthcare (need Home Office exemption, e.g. LSD, ecstasy, raw opium)
- Schedule 2, 3 and 4 = controlled drugs (CDs) - CD prescription requirements
- Schedule 5 = technically ‘controlled’ but basically normal use (eg. codeine)
c) - Type of preparation (eg. capsules, tablets, oral liquid)
- Dose (eg. ‘as directed’ is NOT acceptable, but ‘One as directed’ or ‘One as required’ are legal)
- Strength (eg. 100 mg/5 ml)
- The total quantity or the number of dose units to be supplied must be stated in both words and figures*
- Example 1:
- Morphine Sulfate MR capsules 10mg BD
- Supply 14 (fourteen) capsules
- Example 2:
- Morphine Sulfate Concentrated Oral Solution 100 mg/5 ml
- 1ml four times a day when required for breakthrough pain
- Supply 30 (thirty) mls**
**always give total volume for liquid
Inpatient drug charts vs. FP10
FP10 = legal prescription (bound by prescribing legality)
Inpatient drug chart = order for administration (bound by hospital trust policy)
Drugs that FY1 doctors cannot prescribe
- Cytotoxics - methotrexate
- Immunosuppressants (eg. DMARDs, tacrolimus) other than corticosteroids
Abbreviation use.
a) Units - which are the only 2 permissible
b) Frequency
c) Route
d) Decimals
a) mg and g
NOT…
- mcg - write ‘micrograms’
- U - write ‘units’
b) OD, BD, TDS, QDS, PRN
c) PO, SC, IM, IV, Top*
* For topical medication, must specify where (to skin, to eye, to ear, etc.)
d) Avoid leading decimals
- write 500 micrograms (NOT… 0.5 mg)
Avoid trailing decimals
- write 40 mg (NOT… 40.0 mg)
Acceptable if writing a range.
- eg. 0.5 - 1 g
Seven deadly sins of prescribing
- Not knowing your drug.
- Not knowing your patient.
- Failing to take an accurate drug history.
- Writing an illegible prescription.
- Using inappropriate abbreviations, decimals and leading zeros.
- Failing to calculate and check drug doses accurately.
- Failing to give clear instructions and using inappropriate verbal orders.
PRN drugs.
- what information should be documented
- Maximum dose (eg. max dose 4 g in 24 hours)*
- Minimum dose interval (eg. every 1 - 4 hours)
*Will need to account for any regular medications and other similar medications (eg. may have multiple opiates - consider total opiate dose), or if same drug given by >1 route
Route of administration
- Specify route
- If the same dose irrespective of route, can put more than one route on the same prescription - e.g. IV/PO (cannot be done if dose is different, eg. morphine)
- May put instructions for alternative route (eg. give IV if patient is vomiting)
Variable dosing regimes
Amiodarone
- 200 mg TDS for 1/52
- Then 200 mg BD for 1/52
- Then 200 mg OD for 1/52 (maintenance dose; may be lower than 200 mg - lowest dose to control arrhythmia)
Steroid-reducing regimes
Warfarin
- based on INR
Changing/ stopping medications
- Cross through the entire entry* (it should still be legible below as this is part of the patient’s medical hx)
- Annotate the entry with your signature and a date
- Document rationale in the notes
*This must be done even if it is just the dose that is being changed - rewrite it in full
10 principles of good prescribing
- Be clear about the reasons for prescribing.
- Take into account the patient’s medication history before prescribing.
- Take into account other factors that might alter the benefits and risks of treatment.
- Take into account the patient’s ideas, concerns and expectations.
- Select effective, safe, and cost-effective medicines, individualised for the patient.
- Adhere to national guidelines and local formularies where appropriate.
- Write unambiguous, legal prescriptions using the correct documentation.
- Monitor the beneficial and adverse effects of medicines.
- Communicate and document prescribing decisions and the reason for them.
- Prescribe within the limitations of your knowledge, skills and experience
