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Prescribing

When you are doing a prescription on Symphony, please make sure that it is for the right patient (i.e. the screen has not refreshed as you click on the screen). Please concentrate and ensure you have the right drug, the right strength and the right amount (don't mix up milligrams and tablets, e.g. don't put 10 tablets when you mean 10mg). This can result in serious life threatening errors, for which you would be responsible.

Prescribing Notes from BNF:

Prescription writing

Shared care

In its guidelines on responsibility for prescribing (circular EL (91) 127) between hospitals and general practitioners, the Department of Health has advised that legal responsibility for prescribing lies with the doctor who signs the prescription.

Prescriptions should be written legibly in ink or otherwise so as to be indelible, should be dated, should state the full name and address of the patient, and should be signed in ink by the prescriber. The age and the date of birth of the patient should preferably be stated, and it is a legal requirement in the case of prescription-only medicines to state the age for children under 12 years.

The following should be noted:

  1. The unnecessary use of decimal points should be avoided, e.g. 3 mg, not 3.0 mg.
    Quantities of 1 gram or more should be written as 1 g etc.
    Quantities less than 1 gram should be written in milligrams, e.g. 500 mg, not 0.5 g.
    Quantities less than 1 mg should be written in micrograms, e.g. 100 micrograms, not 0.1 mg.
    When decimals are unavoidable a zero should be written in front of the decimal point where there is no other figure, e.g. 0.5 mL, not .5 mL.
    Use of the decimal point is acceptable to express a range, e.g. 0.5 to 1 g.
  2. ‘Micrograms’ and ‘nanograms’ should not be abbreviated. Similarly ‘units’ should not be abbreviated.
  3. The term ‘millilitre’ (ml or mL) is used in medicine and pharmacy, and cubic centimetre, c.c., or cm3 should not be used.
  4. Dose and dose frequency should be stated; in the case of preparations to be taken ‘as required’ a minimum dose interval should be specified.
    When doses other than multiples of 5 mL are prescribed for oral liquid preparations the dose-volume will be provided by means of an oral syringe.
    Suitable quantities:
    • Elixirs, Linctuses, and Paediatric Mixtures (5-mL dose), 50, 100, or 150 mL
    • Adult Mixtures (10-mL dose), 200 or 300 mL
    • Ear Drops, Eye drops, and Nasal Drops, 10 mL (or the manufacturer’s pack)
    • Eye Lotions, Gargles, and Mouthwashes, 200 mL
  5. For suitable quantities of dermatological preparations, see section 13.1.2.
  6. The names of drugs and preparations should be written clearly and not abbreviated, using approved titles only (see also General Guidance to avoid creating generic titles for modified-release preparations).
  7. The quantity to be supplied may be stated by indicating the number of days of treatment required in the box provided on NHS forms. In most cases the exact amount will be supplied. This does not apply to items directed to be used as required—if the dose and frequency are not given then the quantity to be supplied needs to be stated.
    When several items are ordered on one form the box can be marked with the number of days of treatment provided the quantity is added for any item for which the amount cannot be calculated.
  8. Although directions should preferably be in English without abbreviation, it is recognised that some Latin abbreviations are used.
  9. Medical and dental practitioners may prescribe unlicensed medicines (i.e. those without marketing authorisation) or withdrawn medicines. The prescriber should inform the patient or the patient’s carer that the product does not have a marketing authorisation.

Prescribing Notes from GMC:

Keeping up to date and prescribing in patients' best interests

  1. When prescribing medicines you must ensure that your prescribing is appropriate and responsible and in the patient's best interests. To do this you must:
    1. Ensure you are familiar with current guidance published in the British National Formulary and BNF for Children, including the use, side effects and contraindications of the medicines that you prescribe. You should be aware of the guidance about the clinical and cost-effectiveness of interventions published by the National Institute for Health and Clinical Excellence (NICE) in England & Wales; in Wales by the All-Wales Medicines Strategy Group; in Northern Ireland by Department of Health, Social Services and Public Safety; and in Scotland by the Scottish Medicines Consortium and NHS Quality Improvement Scotland (including Scottish Intercollegiate Guidelines Network). In addition the Department of Health has published a report Building a Safer NHS: Improving Medication Safety on the safe use and administration of medicines.
    2. Be in possession of, or take, an adequate history from the patient, including: any previous adverse reactions to medicines; current medical conditions; and concurrent or recent use of medicines, including non-prescription medicines.
    3. Reach agreement with the patient on the use of any proposed medication, and the management of the condition by exchanging information and clarifying any concerns. The amount of information you should give each patient will vary according to factors such as the nature of the patient's condition, risks and side effects of the medicine and the patient's wishes. Bearing these issues in mind, you should, where appropriate:
      1. Establish the patient's priorities, preferences and concerns and encourage the patient to ask questions about medicine taking and the proposed treatment
      2. Discuss other treatment options with the patient
      3. Satisfy yourself that your patient has been given appropriate information, in a way they can understand, about: any common adverse side effects; potentially serious side effects; what to do in the event of a side-effect; interactions with other medicines; and the dosage and administration of the medicine; (see Consent: patients and doctors making decisions together)
      4. Satisfy yourself that the patient understands how to take the medicine as prescribed
      5. Satisfy yourself that the patient is able to take the medicine as prescribed.
  2. When prescribing for a patient you should:
    1. Prescribe dosages appropriate for the patient and their condition
    2. Agree with the patient arrangements for appropriate follow-up and monitoring where relevant. This may include: further consultations; blood tests or other investigations; processes for adjusting the dosage of medicines, changing medicines and issuing repeat prescriptions.
    3. You should inform the Committee on the Safety of Medicines of adverse reactions to medicines reported by your patients in accordance with the Yellow Card Scheme. You should provide patients with information about how to report suspected adverse reactions through the patient Yellow Card Scheme.
    4. Make a clear, accurate, legible and contemporaneous record of all medicines prescribed.
  1. If you prescribe at the recommendation of a nurse or other healthcare professional who does not have prescribing rights, you must be satisfied that the prescription is appropriate for the patient concerned and that the professional is competent to have recommended the treatment.