Consultation skills - Writing the perfect prescription

Good prescribing minimises the risk of fraud and ensures patient safety, explains Dr Sara Whitburn.

Good prescribing practice is one of the criteria of the GMC's Good Medical Practice guidance. When things go wrong, medication errors can cause side-effects, hospitalisations and complaints.

Good prescribing practice involves taking steps to prescribe safely, including writing clear prescriptions, reducing prescription fraud and having policies for repeat prescribing.

Writing prescriptions
As well as the general rules outlined above, writing clear prescriptions is also an important part of good prescribing practice.

GP prescriptions are made on prescription forms called FP10SS and bear a GP's name, prescribing number and surgery contacts. GP trainees and locums do not have prescribing numbers and so will not have their own prescription pads.

The prescription should be written in indelible ink and in the top corner contain the patient's full name, address and age or date of birth. Documenting the birth date or age is especially important on prescriptions for children as many dosages are calculated on age.

In the prescription area the medicine name, formulation, route of administration, dose and frequency needs to be clearly written.

Measures
Small measures such as micrograms or nanograms should be written out in full. It is recommended to avoid use of decimals but when used ensure a 0 goes before the dot, i.e. 0.5ml not.5ml.

Medicine names should not be abbreviated but common Latin abbreviations for dosing are acceptable (BD, TDS, QDS).

The duration of course and quantity of medicine should also be noted. Finally, finish the prescription with your signature, name and date. If your name is not on the FP10SS it is good practice to add it in block capitals just below the signature area so the pharmacist can identify you. If using a computerised prescription always check the printed prescription for errors prior to signing.

STEPS FOR GOOD PRESCRIBING

1. Take time to consider if pharmaceutical treatment is really indicated and desired by the patient or are there other non-medicinal options that might be suitable.

2. If, after discussion with the patient, the management plan involves a prescription then always have current, reliable and evidence-based drug information available. This may be drug information data sheets available on the computer software you use or from MIMS.

3. Prescribe safely - specifically check for allergies, interactions with existing medication and if female patients are pregnant, trying to conceive or breastfeeding.

4. Try to prescribe generically unless specific branded drugs are needed (e.g. modified-release antihypertensives).

5. If concerned about possible misuse of medication, limit the amount issued and stress to the patient the need to return to discuss the next allocation if they are requesting further prescriptions.

6. Document all treatment fully in the medical record with clear follow-up arrangements.

7. Document medication reviews or changes to existing medication.

8. Update prescribing records following home visits or patient hospitalisation discharge, specialist reviews and out-of-hours contact.

9. Develop an awareness of drug costs (but remember cheaper is not always better).

10. Be aware of and try to prescribe within surgery or PCT formularies.

Reducing fraud
In 2007/8 prescription theft and fraud cost the NHS £15 million, therefore good prescribing practice should include steps to limit fraud.

When writing prescriptions circle the quantity or duration of the course and rule a diagonal line through any blank space (computer prescriptions do this automatically). If you make any alterations these should be countersigned or initialled.

It is good practice to protect against theft by keeping pads out of sight or even locked away and only take a few prescriptions on home visits. These should be kept securely in your doctor's bag.

Repeat prescribing safety
Repeat prescribing enables patients to obtain further supplies of ongoing medication without having to see a doctor. It accounts for 70 per cent of prescriptions and 80 per cent of GP prescribing costs. All practices should have a written policy and you should familiarise yourself with it. The policy should cover production of repeat requests including handling the request, prescription production, mechanism for review and clinical management.

If asked to sign repeat prescriptions it is good practice to check all details as you would with any new prescription.

If you have a concern or query about a prescription then you may wish to access the medical record, discuss the prescription with another GP in the surgery that knows the patient well or ask the patient to make an appointment to discuss the repeat prescription request.

Don't sign a prescription if you are not confident of its safety as clinical responsibility for the prescription lies with the signing practitioner.

Good prescribing practice is a fundamental part of good medical care. This can be achieved by prescribing in a systematic way, by writing clear prescriptions, prescribing safely, taking steps to reduce fraud and having policies to improve repeat prescribing.

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