Summary
This factsheet gives advice about avoiding prescription errors, which account for a large number of clinical negligence claims against doctors in both primary and secondary care.
Before prescribing
A doctor must only prescribe medicines that are legally available in Singapore and must comply with all statutory requirements governing their use. You should only prescribe drugs to meet the identified need of the patient and in their best interest. You should avoid treating yourself or anyone close to you.
Ensure you are familiar with current guidance, including the use, side effects and contraindications of the medicines you are intending to prescribe. According to the Singapore Medical Council (SMC) a doctor must refrain from improperly prescribing drugs or appliances in which he has a financial interest.
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 whether or not that individual has prescribing rights, you must be personally satisfied that the prescription is appropriate for the patient concerned.
Dangerous drugs
You should not permit unqualified assistants to take charge of any location in which scheduled poisons and dangerous drugs, or preparations containing such substances, are supplied to the public.
When prescribing potentially addictive substances, such as benzodiazepines and codeine-containing cough medicines, you should ensure you follow the guidelines issued by the Ministry of Health. It is important to make detailed notes in a patient’s record when prescribing these drugs.
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) that may interact with the proposed medication
- does not have an illness that may be exacerbated by the medication.
Consent
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 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. All warnings and explanations given should be documented in the patient records.
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. This should be clearly recorded in the patient notes.
A decision to prescribe solely based on information provided by telephone or any electronic means is allowable for continuing care, or for exceptional situations where a patient’s best interests are being served by doing so. Treatment should not be initiated on the basis of remote consultations.
Writing prescriptions
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
- avoid abbreviations, such as mg and μg
- 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.
Further information