The basics
Prescribing is an important part of good medical practice. The GMC, in Good Medical Practice, states: “You must prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the drugs or treatment serve the patient’s needs.”
When writing a prescription you should:
- Ensure the treatment is indicated.
- Check that the intended drug is not contraindicated and that the patient has not had an adverse reaction to it previously. Ensure it will not interact with the patient’s other medication and warn about the possibility of an interaction with over-the-counter medicines.
- Write legibly, using capital letters (if not using a computer). Use the generic not trade name.
- Check a formulary if you are uncertain, especially for similar-sounding drugs.
- Check you have chosen the correct drug in the correct formulation when selecting drugs from a drop-down menu.
- Write clear, unambiguous instructions for dosage, frequency and route of administration.
- Note the prescription and other relevant information (eg, warnings to patient) in the medical record.
- Ensure the patient is clear on what has been prescribed and why.
- Keep the safety net in place (eg, monitor long-term prescribing).
Don’t rely on computers
Computers are a valuable prescribing tool. They reduce the number of medication errors by ensuring that prescriptions are legible, complete and in a standard format. However, they do not prevent all errors, and computer prescribing programmes can sometimes contribute to errors, eg, doctors may choose the wrong drug, or dose, from a drop-down list.
Research has shown that, while computer prescribing may reduce the error rate, it does not eliminate it. One study in UK primary care found that the error rate was 10.2% for handwritten prescriptions, falling to 7.9% for computerised prescriptions.
Source: Pharm J, 267 860–2 (2001).
Top ten tips for safe prescribing:
- Be aware of the human factors – we are all prone to mistakes
- Have a robust repeat prescribing process
- Monitor patients on toxic medications
- Check the patient’s identity before prescribing
- Verify it is the right drug and correct dosage
- Consider drug interactions and contraindications
- Administer drugs correctly
- Advise the patient
- Develop a clear prescription collection procedure
- Review uncollected prescriptions before shredding.