You should only prescribe drugs to meet the identified needs of the patient and which will be in their best interest. Doctors on the Trainee Specialist division of the Medical Council’s Register are not permitted to practise medicine outside their particular training post and hence should not prescribe drugs other than in connection with their training post. You should avoid treating yourself or anyone close to you. Doctors with full registration may prescribe all medicines, except those set out in the Misuse of Drugs Act (Amendment) 1984.
Ensure you are familiar with current guidance from the Irish Medicines Board, including the use, side effects and contraindications of the medicines you are intending to prescribe. You should also be aware of guidance relating to the clinical and cost-effectiveness of the medicines you are prescribing.
It is important to be aware that the person who signs the prescription is the one who will be held accountable, should something go wrong. If you prescribe at the recommendation of a nurse or other healthcare professional who does not have prescribing rights, you must be personally satisfied that the prescription is appropriate for the patient concerned and that you were in a position to exercise sound clinical judgment.
Checking the dosage
You should check that you are prescribing the correct dose of the medicine; this includes checking the strength, frequency and route. This is especially important in prescribing for children.
Checking for contraindications
You need to ensure that the patient:
- is not allergic to the proposed medication
- is not taking any medication (prescription, over-the-counter or alternative medicine) which may interact with the proposed medication
- does not have an illness that may be exacerbated by the medication.
The principle of informed consent applies as much to the prescribing of medication as it does to the performance of a surgical procedure. Patients should be fully informed about: their condition; the reason for recommending the proposed treatment; what they can expect in terms of improvement; symptoms to report; the need for any monitoring and review, and side effects that may occur – including on interactions with other drugs, such as over-the-counter medicines and alcohol. It may be appropriate to warn the patient of potential adverse effects, eg, that driving and/or handling dangerous machinery would be contraindicated.
Monitoring and follow-up arrangements
You should agree with the patient the appropriate arrangements for follow-up and monitoring. Patients need to know under what circumstances they need to come back, and what the consequences of failing to attend for review could be.
Computer-generated prescriptions are now common; however, if you are writing a prescription, there are some key points you should remember:
- use indelible ink
- do not abbreviate drug names
- do not use decimal places if it is not necessary
- clearly state the drug, dose, strength, route and frequency
- if amending the prescription, draw a line through the incorrect part and initial the change.
Prescriptions should be dated, and should include the full name and address of the patient. For patients under 12 years old, you are required to include the patient’s age or date of birth. Blank prescription forms should be kept in secure conditions. A clear record should be made in the patient’s notes of all medicines prescribed.
Prescribing on the recommendation of a specialist
It is common for general practitioners to be asked to continue prescribing a medication started in the secondary care setting, and it is important to ensure that, as a GP, you obtain adequate information before you agree to prescribe the drug, and that as a specialist you provide enough relevant information to enable the GP to prescribe safely.
Important points to consider are:
- aim of treatment
- dose and frequency
- risks and benefits
- proposed duration
- arrangements for any monitoring that is required
- potential side effects
- what the patient has been told.
It is important that healthcare professionals are clear as to who will be undertaking any required monitoring and review of medication.