Lecture 6 - Prescriptions & Drug Charts

Prescriptions & Drug Charts

Precribing

Prescribers must:

• Electronically generate and/or write legible, unambiguous  and complete prescriptions which must meet legal requirements

• Effectively use the systems necessary to prescribe medicines

• Document accurate, legible and comtemporaneous clinical records

Who can prescribe?

• Medical practitioners: Doctors & dentists

• Vetirinary surgeons

• Non-medical prescribers: nurses, optometrists, pharmacists, physiotherapists, etc

Non-medical prescribers

Primary Care

NHS Prescription Documentation

Standardised to:

• Minimise risk of fraudulency

• Reduce error

• Identify elements of accountability

• Facilitate remuneration for medicines

• Allow for the collection of data on precribing patterns and costs

Legal requirements

• Patient identification: name & address

• Age or DOB - if under 12 it’s a legal requirement to have the age written on the prescription

• Signed - can’t be erasable

• Dated

• Name and address of practioner

• Be written in idelible ink

• Additional requirements for controlled drugs

Requirements for a safe prescription

1. The right drug

2. At the right does

3. By the right route

4. At the right time

5. To the patient

6. The right to refuse

considering contraindications, interactions, adverse effects and allergies

NHS FP10 Precription - Green

NHS FP10 Precription - Blue

NHS FP10 Precription - Yellow

NHS FP10 Precription - Lilac

Requirements of the FP10

1. Patient name

2. Patient address

3. Age or DOB

4. Signature of the prescriber

5. Date

6. Name/qualifications of prescriber

7. Address of practitioner 

Electronic Prescription Service

• EPS allows the prescription to be sent electronically from the GP to a nominated community pharmacy

• The pharmacist can prepare prescriptions in advance

• The pharmacist can monitor medicine use as they are the consistent supplier for a patient

• The legalities of the prescription remain the same 

Secondary Care

Patient Specific Directions (PSD)

• PSDs are issued in hospital 

• Written or electronic instructions from a doctor, dentist or non-medical prescriber for a medicine to be supplied or administered to a named patient after the prescriber has assessed the patient on an individual basis

Unlike primary care:

• There’s no standard documentation for the PSD in English hospitals

• Hospitals design, maintain, monitor and enforce their own documentation

Inpatient Drug Charts

Patient demographics - they must allow for the documentation of:

• Patient identifiable information

• The allergy status of the patient

• Patient information to inform the calculation of doses (height, weight, BSA)

Content - paper-based or electronic

Must allow for the instruction of:

• Regular medicines

• Variable regimens

• Single, one-off doses

• When required medicines

• Infusions

And

• What is to be given? drug name, form)

• Why? (indication)

• When? (date and time)

• How? (route)

• How often? (frequency)

• Until when? (for a week, or to continue long-term?)

Requirements of the PSD

1. Patient name

2. Patient address

3. Age or DOB

4. Hospital number

5. Signature of prescriber

6. Date 

7. Nam/qualifications of prescriber

8. Address of practitioner

PSD Documentation

Although not standardised, all are designed to:

• Facilitate the documentation of a complete prescription

• Reduce the risk of error

• Minimise the risk of fraudulency

• Identify elements of accountability

• Documetn a patient’s pharmacological history for a single hospital admission

Outpatients

• Hosptial specific outpatient prescription can only be given in the hosptial pharmacy

• Medicines intended to treat the condition for which the patient was referred

• Hosptial only medicines

• Medicines requiring monitoring

• Medicines required urgently

• Or a hosptial FP10 may be issued

Prescribing for Discharge

• TTO’s (to take out), TTH (to take home)

• A direction for the pharmacy to supply

  • States all drug treatments that are to continue on discharge

• States any changes in drug treatment during the hospitale stay

  • Why has a medicine been stopped?

  • Why has a dose been increased?

  • Why has adoes been reduced?

  • Why has a new drug been started?

Private practice

Private prescriptions

Who?

• Can be issued by any prescribing practitioner

• The patient pays for the cost of the medicines and for the pharmacists time

Why?

• Private healthcare

• Items that can’t be prescribed on the NHS

How?

• There is no standard prescription documentation

Private CD Prescriptions

• Controlled drugs

• Pink

• Ensures the supply of controlled drugs is auditable through the NHS Business Services Authority