Careful prescribing

The financial costs associated with adverse events and inappropriate prescribing amount to hundreds of millions of pounds every year. In a study of 2,400 junior doctors by Edinburgh University, published in the British Journal of Clinical Pharmacology in 2008, over 40% did not feel they would achieve the minimum competencies on drug prescribing set by the GMC.

Prescribing should always set off hazard warning lights in your mind. Danger areas include transferring information to new charts, team handovers, over-prescribing, forged prescriptions and prescribing for the wrong patient.

Doctors with full registration may prescribe all medicines, except those set out in Schedule 1 of the Misuse of Drugs Regulations 2001. Only prescribe drugs to meet the identified need of the patient. The GMC demands that, wherever possible, doctors should avoid treating those with whom they have a close personal relationship, and should be registered with a GP outside their family.

SURVIVAL TIPS

• Prescriptions should clearly identify the patient, the drug, the dose, frequency and start/finish dates, be written or typed and be signed by the prescriber.
• Be aware of a patient’s drug allergies.
• Refer to the BNF. It is accessible online.
• Verbal prescriptions are only acceptable in emergency situations and should be written up at the first available opportunity. Particular care should be taken that the correct drug is used.
• Be sure to take our online training course, developed around safer prescriptions. This course explores why and how medication errors occur, identifies common mistakes in the prescribing process and goes on to provide practical suggestions around how to prescribe more safely. This course also addresses some of the issues in the medicine management process that doctors, their patients, and their patients’ carers should be aware of.

CASE STUDY

Dr S is on duty in the children’s area in ED. He has just seen Jack, a two-year-old child with a high temperature. He sits down to write his notes and takes the opportunity to ask one of the nurses to give Jack 180mg of paracetamol (appropriate for his weight). The nurse asks for it to be prescribed, but Dr S insists that he needs the ED card to write his notes, and the child is in the cubicle opposite the nursing station (he points to it), “you cannot miss him”, he says. The nurse agrees reluctantly and goes to get the medicine and Dr S concentrates on writing on the card.

The nurse walks into the cubicle and gives the child the paracetamol. Dr S finishes his writing and approaches the cubicle to find out that there is now a different child sitting there – Alex. He anxiously turns to the nurse and asks her if she has given the medication to the boy who is now in the cubicle, and she says “yes”.

Dr S informs Alex’s family of what has happened and explains that the paracetamol was not prescribed for their child. He apologises profusely. Luckily Alex is a bigger child, and has not taken any paracetamol recently, so no harm has been done. Dr S makes sure Jack gets his paracetamol, and fills in an incident form; he apologises to the nurse involved and they discuss what happened, and agree that it was an easily preventable mistake. Later that day Dr S discusses the incident with his consultant.