Writing Rx, Making a patient record and using local formularies and national guidance to support prescribing decisions

Ten Principles of good prescribing

What is Prescribing?

The professional/intellectual process of (differential) diagnosis/(shared) decision making

The technical process of making a legal/complete/accurate record of the medicine to be supplied/administered

What is needed on a Rx?

• Signature of prescriber:

  • In INK in his/her own name

  • Most prescriptions now signed electronically; prescriber enters their smart card authorisation code.

• Address of prescriber

• Date

  • Valid up to 6 months (as long as not a Schedule 2,3 or 4 CD)

• Particulars of prescriber – CAREFUL!!!!

  • Type of appropriate practitioner

• Patient name

• Patient address

• Patient age

  • If under 12 years old

What is needed for a CD Rx?

• Signature

  • In INK in his/her own name (CAN be using ‘advanced electronic signature’ for sch. 2 or 3 CDs with EPS)

• Date

  • Valid for 28 days after the ‘appropriate date’

• Address

• Dose

  • Must be clear: NOT ‘as directed’, but ‘1 as directed’ okay…

• Formulation

  • Must always be stated

• Strength

  • If more than one strength

• Total quantity

  • Words and figures…

• Quantity prescribed

  • Should not be more than 30 days – not legal requirement

• Patient name

• Patient address

• (Dental wording) and (Instalment wording)

What are the key points of record keeping?

• Quality of record must reflect the care given

• Write legibly

• Include details of the patient, date and time

• Avoid or be careful with abbreviations

• Do not alter an entry or disguise an addition

• Keep it simple and avoid abbreviations

• Keep it simple and avoid unnecessary info

• Remember patients can read their own notes

• Write down what you said, what you did, what you were told and what you observed

• Be familiar with Data Protection Act 1998

How do you ensure your notes are accurate?

• It is easier to take notes throughout the consultation but might lose eye contact and rapport and non-verbal cues

• Could ask permission from the patient to note down a key point

• Not taking notes relies on good memory!!

• Highlights the importance of summarising within the consultation and allow the patient to correct you

Key points to keep in mind when note taking

• Must be able to be read and understood easily and quickly

• Not too long, not too short

• Have a clear plan and follow up

• Don’t speculate on the future

• Consider any necessary blood tests

• In primary care there are section headers and templates to work from.

• You have seen secondary care notes on your hospital placements.

A local formulary

the output of processes to support the managed introduction, utilisation or withdrawal of healthcare treatments within a local healthcare system, service or organisation.

Why do we need formularies?

• improving patient outcomes by optimising the use of medicines

• supporting the inclusion of patient factors in decision-making about medicines

• improving collaboration between clinicians and commissioners

• improving quality by reducing inappropriate variations in clinical care

• improving quality through access to cost-effective medicines

• supporting the supply arrangements of medicines across a local health economy

Who decides on formularies

Local Drug and Therapeutics Committee

Traffic Light Status of Drugs

• RED: Secondary-care only. NOT to be prescribed by Primary Care

• AMBER: Initiated by consultants, then prescribing can be passed onto GPs. Shared care agreements can be used.

• GREEN (or blue): Can be used across primary & secondary care.