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Safe Prescribing and Medication Management

Prescribing is a large part of a GP’s practice and includes prescription of medication, medical devices or dressings. As a GP you should have comprehensive knowledge of and comply with the relevant statutes, legislation and guidelines governing the prescribing of medicinal products.1

A recent study into GP prescribing by the General Medical Council found that 1 in 5 prescriptions contained significant errors mainly regarding drug dosage and lack of instructions. Time pressures during consultation, complex computer software that made it easy to select the wrong drug or incorrect dose from drop-down menus and frequent distractions and interruptions during consultations were cited as the main contributing factors.2

Prescribing guidance

Most GP prescriptions are now computer generated but if you are writing one by hand-write legibly in indelible ink. All prescriptions at a minimum should include: the date; the name address and telephone number of your GP practice; the patient’s full name, date of birth and address (DOB or age mandatory if child under 12); the medication, dose, strength, route and frequency should be clearly stated. All prescriptions should be signed by the prescriber and must include Medical Council number.

Safe prescribing-Issues which you need to consider

  • Primum non nocere- First-do no harm and the sound advice of Hippocrates is still relevant today-Prescribe only when necessary taking into account all benefits and risks to the patient. Informed consent of the patient is as important in prescribing as any other aspect of patient care so involve the patient about decisions in their treatment and respect patient autonomy.
  • Note the patient age and medical history (particularly hepatic or renal problems) and any previous adverse reaction to medicines. Before prescribing any medication or treatment ensure that you have adequate knowledge of the patient’s condition and are satisfied that the drug or treatment will serve the patient’s needs.
  • Prescribe effective medication or treatments based on sound up-to-date evidence.
  • Ensure that the medication or treatment you are prescribing is compatible with any other treatment the patient is receiving. Encourage patient’s to disclose if they are taking any other medicines including non-prescription and herbal medicines, illegal drugs or medicines purchased online.
  • Think about dosage carefully and do not assume ‘one dose fits all’. This is particularly important when prescribing for young children or the elderly. Avoid unnecessary use of decimal points when prescribing ie 3mg not 3.0mg or 500mg not 0.5g.
  • Avoid the of use abbreviations except for some acceptable Latin prescribing abbreviations such as prn, qds, tds, od etc
  • Avoid abbreviation of drug names as these can be misinterpreted
  • Clearly document in the patient’s records the relevant clinical finding, the diagnosis made, the information given to the patient and any drugs or treatment prescribed.

Patient information

When issuing a prescription to a patient carefully explain:

  • The likely benefits, risks and common side effects of the treatment.
  • What to do if a side effect occurs.
  • How and when to take the medication and how to adjust the dose if necessary.
  • The likely duration of the medication.
  • Arrangements for monitoring, follow-up and review if necessary.

Repeat prescriptions

It may be routine for other members of staff to write up or computer generate repeat prescriptions for you to sign. Whilst this may save time it is not without risk. Always ensure that:

  • Correct prescription for correct patient
  • That the patient is reviewed regularly in terms of drug side-effects and with regards to the ongoing need for this medication
  • The correct dosage is issued if there are changing doses over time

Remember – You are ultimately responsible for these prescriptions and if a prescribing error occurs you are the one likely to be held accountable.

Prescribing controlled drugs

The full prescription must be handwritten, the drug formulation has to be specified, drug strength and quantity must be detailed in words and figures, the item cannot be repeated and must be dispensed within 2 weeks.

Prescribing for yourself or relatives

According to Medical Council guidance3 you should not self-prescribe and if you become ill should consult another doctor rather than treat yourself. You should also avoid prescribing to relatives except in the case of minor illness or in an emergency. If you do prescribe medication for a relative make a clear record of it including the reason for it, your relationship with the patient, and the reason it was necessary for you to prescribe.

Keeping-up-to-date in prescribing

It is essential that any practitioner prescribing medicines keep-up-to-date with ongoing developments and ensure your prescriptions are appropriate. Stay on the safe side-if you are unsure about interactions or other aspects of prescribing and medication management consult an experienced colleague or look it up. There are a number of sources of information available to support you in this including guidance from the Irish Medicines Board, the Irish Medicines Formulary, the British National Formulary (BNF) the Electronic Library for Medicines, and the National Prescribing Centre (UK).

1Misuse of Drugs Acts 1977 & 1984; Medical Council Guide to Professional Conduct and Ethics 2009 para 59.2
2GMC 2nd May 2012
3Medical Council Guide to Professional Conduct and Ethics 2009 Para 51.2 52.1

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