Prescribing

Your prescribing duties at a glance.

  • Prescription errors are one of the most common reasons doctors seek advice from the MDU.
  • Areas of risk include long-term administration, dose error and allergy.
  • You are responsible for all prescriptions you sign.

Your prescribing duties

You have a duty to understand the drug you are prescribing, including any possible adverse effects, contraindications and the need for appropriate monitoring.

You are responsible for the prescriptions you sign, even if they have been produced by non-clinical staff. You should be sure that the drug and dosage are correct.

Before prescribing

You should familiarise yourself with current national guidance, including:

Check the patient's medical history and current medication, including non-prescription and herbal medications, illegal drugs and medicines purchased elsewhere.

When prescribing drugs you're not familiar with, check contraindications and side effects, and seek advice if necessary. Also, check the automatic drug interaction warnings on computerised prescribing systems before deciding it is safe to override them.

Ensure you have selected the right drug, preparation and strength when picking from the drop-down list.

Make sure that you've also been able to establish a dialogue with the patient and have obtained informed consent.

Types and causes of error

Errors leading to a complaint or claim may arise, for example, if:

  • a busy doctor inadvertently clicks on a similar-sounding drug on the drop-down menu
  • a telephone message is misinterpreted
  • the prescription is issued by non-clinical staff
  • failure to monitor long-term drug administration leads to harmful side effects.

Some of the most common drug-related errors that we see include:

  • prescribing a drug to a patient with a known allergy - penicillins, in particular
  • prescribing the wrong drug due to similar names, such as mefloquine and malarone
  • prescribing the wrong dose of a drug, such as a twice-weekly drug being prescribed daily.

Avoiding errors

Make sure you're satisfied that the prescribed drug is the best option for the patient.

The GMC expects you to talk to the patient about their medication, explaining:

  • the likely benefits, risks and impact, including serious and common side effects
  • what to do if they experience side effects or recurrence of their condition
  • how and when to take the medicine, and how to adjust the dose if necessary
  • the likely duration of treatment
  • arrangements for monitoring, follow-up and review.

GP practices are advised to have a system in place for reviewing patients on long-term medication, and to frequently review patients taking high-risk drugs such as lithium.

When care is shared between primary and secondary care, it is advisable to have a protocol in place setting out who is responsible for prescribing, monitoring and follow-up.

If a patient experiences an adverse reaction to the drug prescribed, you must explain what you think has happened, what you are going to do to help them and apologise if there has been an error. Record all adverse reactions in the patient's records and report them through:

Finally, ensure you and your practice learn from medication errors through significant event audit, to minimise the risk of a repeat incident. Where patient safety has been or could have been compromised, you should report the incident to:

Remote prescribing

Remote prescribing is only appropriate for some drugs and treatments, and for some patients. The GMC stresses that doctors must consider the limitations of electronic communication (phone, internet, Zoom etc) when consulting remotely.

You should only prescribe remotely when:

  • you are satisfied that the mode of consultation you are using is suitable
  • you are sure that you have sufficient information to prescribe safely
  • you are prepared to ask the patient to come in for a physical examination
  • you have adequate knowledge of the patient's health, for example, the patient's medical records
  • you can adequately assess the patient's needs, establish a dialogue, and obtain consent
  • you can appropriately share information after an episode of care.

Patients should also be made aware of the limitations of a remote consultation and given their consent to continue.

Non-surgical cosmetic medicines must not be prescribed remotely.

Remote prescribing for patients overseas may be in breach of ethical and legal obligations if you're only registered to provide medical care in the UK.

A remote consultation, whether by phone, email or web, forms part of the patient's record and should be stored securely. Read our case study on remote prescribing.

Useful links

Read further guides on self-prescribing and prescribing cannabis-based products.

This page was correct at publication on 22/02/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Comments

Login to comment

Be the first to comment