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Safe prescribing

The issue is not “giving information” but ensuring that the patient has received the information, absorbed it and acquired it as knowledge

Time

It takes time to make sure that the patient understands what the medication is intended to do, how to take it properly, what side-effects it may have and what to do if they appear, etc. Gaining informed consent for medication is as important as it is when discussing a procedure. And the issue is not “giving information” but ensuring that the patient has received the information, absorbed it and acquired it as knowledge. Compliance rates are much higher when patients understand why their medication was prescribed and how to take it properly.

Prescribing for children

While all the general advice on avoiding medication errors applies to both children and adults, special care is needed when prescribing, preparing and administering drugs to children. Drugs that are relatively innocuous in adults may have adverse effects in children. Variations in height, weight and body mass can make them more susceptible, or they may quickly accumulate toxic levels as a result of lower metabolism and excretion. In many cases referred to MPS, errors occurred because the doctor failed to check the appropriateness of the drug and its route of administration in children or infants, or to prescribe the correct dose.

Advice for safer paediatric prescribing

  • Refer to a paediatric formulary when appropriate.
  • Limit the drugs you use to a well-tried few and familiarise yourself with their dosages, indications, contraindications, interactions and side-effects.
  • When writing a prescription, include the child’s age and write the exact dose in weight and (if liquid) volume required for administration.
  • Always calculate doses on paper and, if possible, get a competent colleague to check your arithmetic.
  • Check the units – eg, should it be micrograms or milligrams?
  • When writing the dosage, take special care not to lead with a decimal point – put a zero in front of it, eg, 0.2mg.
  • Never abbreviate micrograms.
  • For amounts less than 1 milligram, prescribe in micrograms to avoid confusion over the placing of decimal points.
  • When prescribing for a child, it is particularly important to give the parents all relevant information such as:
    • The name of the drug.
    • The reason for the prescription.
    • How to store and administer the drug safely (if appropriate).
    • Common side-effects.
    • How to recognise adverse reactions.

Acting within your competency

Unless the situation is a life-or-death emergency, you should not carry out procedures or treatment on patients if you lack the necessary skills or knowledge. This is particularly relevant for purely elective surgical procedures such as cosmetic surgery.

You should not carry out procedures or treatment on patients if you lack the necessary skills or knowledge