What should you consider when prescribing medications?
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Your limitations of knowledge, skills, and experience.
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What should you consider when prescribing medications?
Your limitations of knowledge, skills, and experience.
Which drug should be prescribed using the BRAND name in the NHS?
Oral tacrolimus.
Why should oral tacrolimus be prescribed by brand name only?
To minimize the risk of inadvertent switching between products, which can lead to toxicity and graft rejection.
What is the legal requirement regarding the date of birth on a prescription for patients under 12?
The date of birth must be stated if the patient is under the age of 12.
Why is a hospital inpatient drug chart not subject to the same legal requirements as an NHS prescription issued by a GP?
Because the inpatient chart is a Patient Specific Direction (PSD), which is an instruction for the administration of a drug to a patient.
Is the patient's NHS number a legal requirement on a prescription?
No, it is not a legal requirement, but it is typically present on computer-generated prescriptions.
What are Patient Specific Directions (PSD)?
Directions to supply or administer a medicine to a named patient.
What is the status of controlled drugs in terms of prescription?
They are POM status and can only be prescribed by registered practitioners.
What should be avoided when writing prescriptions?
Illegible handwriting and inappropriate abbreviations.
Can advanced electronic signatures be used for electronic prescriptions?
Yes, they can be used and are linked uniquely to the signatory.
What documentation prevents consecutive doses of diazepam from being administered close together?
The minimum dose interval.
What must a prescriber provide when using the abbreviation TOP for topical?
Additional information about where the topical medicine is to be applied.
What must be included in a prescription regarding the prescriber's information?
The prescriber's address and professional registration number (e.g., GMC number).
What is an unlicensed drug?
A drug that does not have a UK marketing authorization.
Which professionals cannot prescribe unlicensed medicines?
Physios, chiropodists, therapeutic radiographers, and optometrists.
What is the recommendation for writing drug names on prescriptions?
Write all drug names in full and in capital letters.
What is a key consideration for a healthcare professional reviewing a patient's pain control?
They need to know how long the patient has been on the 75 micrograms patch.
What does circling 'no' for readmission indicate on a prescription?
It indicates that the patient was not on this treatment prior to admission, although this should be confirmed.
What does TDS mean in a prescription context?
Three times a day, often interpreted as every 8 hours.
What is considered good practice regarding the date of birth on a prescription?
It is considered good practice to always state the date of birth on a prescription.
What should be sought if prescribing against formulary recommendations?
Permission from the approved committee, documented in medical notes.
What additional requirements do prescriptions for controlled drugs have?
They have additional requirements above standard prescriptions.
What legislation governs the authorization of medicines for human use in the UK?
The Human Medicines Regulation 2012.
What should be done when referring to the number of dosage units?
Write it out in words (e.g., use 'two' instead of '2').
What uncertainty exists regarding the 75 micrograms patch?
It may have been prescribed in error and not administered.
What additional requirements apply to the prescribing of Schedule 2 and 3 controlled drugs?
Additional prescription requirements must be followed.
What is a key consideration when prescribing Naspetin nasal cream?
Documentation of drug and non-drug allergies.
What is the initial dosing schedule for a patient commencing treatment?
200 mg twice a day for seven days, then 200 mg once daily thereafter.
What method can be used to create a prescription that is maintainable and controlled by the prescriber?
Smart card.
What is the significance of the maximum dose to be administered in 24 hours?
It helps prevent overdosing by limiting the total amount of medication given.
What does off-label prescribing refer to?
Using a drug that has a marketing authorization outside the terms of its license.
What must prescriptions be for supply?
Physically signed.
What do local and national prescribing policies aim to encourage?
Evidence-based practice and cost-effective prescribing.
Which abbreviation is approved for milligrams?
mg.
What details must be included in a legal prescription for controlled drugs?
Drug name, strength, form, dose, and total quantity supplied in words and figures.
What type of prescription forms are primarily used in the NHS?
NHS approved prescription forms.
What is Neomag® licensed for?
Management of hypomagnesaemia.
What processes are prescribers involved in according to the Human Medicines Regulation?
Supply, administration, and monitoring of medicines.
How long should the doctor wait to assess pain control after initiating a new patch?
At least 72 hours.
Which abbreviations are acceptable for strength in prescriptions?
Only 'g' for grams and 'mg' for milligrams.
What is off-label prescribing?
Prescribing a drug outside the terms of its license.
Why is arachis oil a concern in Naspetin cream?
It is contraindicated in patients with a nut allergy, which could cause severe allergic reactions.
Why should the reducing dose schedule be annotated?
To avoid continued administration at a high dose.
What must be included in the address of the prescriber?
The address must be in the UK.
What must be ensured before prescribing an off-label drug?
It must be indicated in the BNF and approved for use.
What is a legal requirement for NHS prescriptions issued by a GP for a 10-year-old?
The age or date of birth must be present.
What must be satisfied prior to issuing a prescription for an unlicensed medicine?
There are no suitable alternatives to meet the patient’s needs.
What are the basic prescription requirements for all drugs?
Name and address of patient, age or DOB if under 12, prescriber signature, dated, written indelibly, and contain a prescriber identifier.
What color code is used for prescriptions issued by GPs, hospitals, and independent prescribers?
Green (e.g., DP10NC, FP10HNC, FP10SS).
What is the correct way to write 0.1 mg?
It is better to write 0.1 g than 100 mg.
What should a prescriber do if unsure about a prescription?
Seek advice from more senior medical colleagues or a hospital pharmacist.
What are TTOs and TTAs used for?
To prescribe medication for inpatients upon discharge.
Which organization provides guidance on good practice in prescribing for doctors?
The General Medical Council (GMC).
What is the status of GTN patches for Raynaud's phenomenon?
They are used off-label.
What should be done to ensure the prescription cancellation is clear?
The cancellation should be signed and dated to identify the prescriber.
How should doses be stated to avoid confusion?
Clearly, without using leading or trailing zeros.
Can drug names be abbreviated in prescriptions?
No, abbreviations for drug names should not be used due to the risk of misinterpretation.
What should be obtained prior to generating a prescription for Naspetin cream?
Cultures from the nasal swab.
What additional identifying details may prescribers add?
Their professional number or prescribing status (e.g., independent nurse prescriber).
What should be done when reviewing prescriptions?
All medications must be reviewed regularly, unnecessary medications must be stopped, and review dates should be documented.
What are the GMC guidelines regarding unlicensed medicines?
You must ensure no suitable licensed alternatives exist, have sufficient evidence for use, and document the decision.
What is required regarding patient consent for unlicensed medicines?
Written consent is not necessary, but the patient should be informed and consent gained where possible.
What color code is used for prescriptions issued by nurse independent and supplementary practitioners?
Lilac (e.g., F10PN, SP10SP).
Is it a legal requirement to include the patient's date of birth for patients under 12 years on a prescription?
Yes, it is a legal requirement, and good practice for all prescriptions.
What responsibility does a prescriber bear when issuing a prescription?
The responsibility for that treatment.
What is the recommended minimum duration for medication prescribed upon discharge?
14 days.
Is 'mcg' an approved abbreviation?
'mcg' is not approved.
What type of guidance does the Royal Pharmaceutical Society provide?
Guidance on the administration of medicines in healthcare settings.
How long are prescriptions for Schedule 2-4 controlled drugs valid?
28 days.
What is the correct concentration of chloramphenicol eye drops for treating infective conjunctivitis?
0.5%.
What is the licensed use of oral hyoscine hydrobromide?
Prevention and relief of travel sickness.
What is the purpose of a hospital formulary?
To limit the number of drugs available for prescribing, managing risks and healthcare costs.
What is the difference between generic and branded drugs?
Generic drugs are non-proprietary, while branded drugs are proprietary.
What is the guideline regarding decimal points in handwritten prescriptions?
Refrain from using decimal points where possible.
What must be documented on a prescription for Schedule 2 or 3 controlled drugs?
The form of the preparation (e.g., tablets, capsules).
When can a frequency be abbreviated in a prescription?
If it is an approved Latin abbreviation.
Do hospital prescriptions require additional details?
No, the address is identified by the hospital-approved stationery.
How should a prescription be cancelled on an inpatient drug chart?
Cross through it entirely, annotate with your signature and date, and document any changes in the medical notes.
What should be done before prescribing an unlicensed medicine?
Inform the patient and obtain consent where possible.
What color code is used for prescriptions issued by dentists?
Yellow (e.g., FP10D).
Who is permitted to prescribe unlicensed medicines?
Registered doctors or dentists, and non-medical prescribers under certain restrictions.
What is necessary for good prescribing beyond legal requirements?
Adherence to best practice elements.
What should be documented regarding a patient's allergy status?
Both drug and non-drug allergies should be documented in medical notes and inpatient charts.
What are the ten principles of good prescribing focused on?
Clarity, patient history, risk factors, patient expectations, effective medicine selection, adherence to guidelines, legal documentation, monitoring effects, and communication.
What is the recommended dosage for chloramphenicol eye drops in this case?
ONE drop into both eyes QDS for 5 days.
What additional legal requirements exist for Schedule 2 and 3 controlled drugs?
Dose, form of preparation, strength (unless only one is available), and total quantity in both words and figures.
How is medication dispensed for outpatients?
Using a hospital approved outpatient prescription at the hospital pharmacy department.
What is oral propranolol licensed for?
Migraine prophylaxis.
What is a PSD in emergency situations?
A verbal direction issued by an independent prescriber to administer a medicine.
Is the abbreviation 'QDS' approved for prescriptions?
Yes, it is approved.
Is it a legal requirement for the date of birth to be stated on an inpatient drug chart?
No, it is not a legal requirement, but it is good practice.
What is required to prescribe non-formulary drugs?
Permission from the Pharmacotherapy Committee or Drugs and Therapeutics Committee.
Why is it good practice to prescribe generically?
It allows any suitable presentation of the drug to be supplied, providing flexibility and assisting in managing healthcare costs.
Which dose units can be abbreviated?
Only milligrams and grams; micrograms must be written out in full.
Is it necessary to document the strength of a controlled drug preparation if only one form is available?
No, it should only be stated if there is more than one available.
Why is it important to document changes in medication?
To prevent confusion among healthcare providers and to maintain accurate medical history.
What is the typical duration of training for healthcare professionals to prescribe?
Typically a 6-month course.
What is the requirement for the date on a prescription?
It must be valid and may be computer-generated.
What guidance did the Royal Pharmaceutical Society issue in 2016?
Guidance for the prescribers of Specials to help in safe and appropriate prescribing.
What are Schedule 1 controlled drugs (CDs) in terms of prescribing?
They are rarely used in medicine and require a license from the Home Office to prescribe.
What is the purpose of the FP10MDA prescription form?
To prescribe drugs of misuse for managing opioid dependence (e.g., methadone, buprenorphine).
What is the first line of treatment regarding licensed medicines?
Licensed medicines are always first line compared to unlicensed alternatives.
Why is it important to write 'both eyes' in full instead of using 'BE'?
Because 'BE' can also mean both ears, leading to potential confusion.
What should be included in the allergy documentation?
The type of reaction should be clearly documented.
What is a common prescription error related to quantity?
Not prescribing the total quantity or number of dosage units in both words and figures.
What should be monitored after prescribing medication?
Beneficial and adverse effects of medicines.
What is the FP10HNC outpatient prescription used for?
To prescribe medication that will be obtained from a community pharmacy.
What is the licensed use of salbutamol nebulas?
Management of chronic bronchospasm and acute severe asthma.
How are verbal PSDs documented?
They are retrospectively documented on the drug chart.
Is 'ISMN' an approved abbreviation for prescriptions?
No, it is not approved; drug names should not be abbreviated.
What should all prescriptions contain regarding patient details?
Full patient details, including full name, address, and hospital number in a hospital setting.
What happens if a hospital formulary needs to be amended?
An application and submission of new evidence must be made.
What should be avoided when indicating doses in prescriptions?
Abbreviations for doses, as they can lead to misinterpretation.
What must be stated in words and figures on a prescription for controlled drugs?
The total quantity, not the dose.
When should brand names be used in prescribing?
When different preparations of the same drug have different release mechanisms or bioavailability profiles.
What should be done when altering a dose or frequency?
Re-write the prescription in full and make an entry in the medical notes.
What are the two types of non-medical prescribers (NMPs)?
Supplementary prescribers (SP) and independent prescribers (IP).
Is oral carbamazepine for mood stabilization considered licensed or unlicensed?
Licensed.
What color code is used for private sector prescriptions for Schedule 2 and 3 controlled drugs?
Pink (e.g., FP10PCDNC/SS).
What type of ink must prescriptions be written in?
Indelible ink.
What is oral vancomycin licensed for?
Treatment of Clostridium difficile.
What should be included in the inpatient chart for variable dosing regimens?
Clear instructions to prevent administration errors.
Which schedules of controlled drugs are most relevant for prescribing?
Schedule 2 and 3.
What is essential when writing prescriptions?
To write unambiguous, legal prescriptions using the correct documentation.
What should be noted if a patient has no known allergies?
The section should be completed to say 'no known allergies.'
How should solid preparations be prescribed?
Prescribe the number of dosage units in both words and figures.
What do Medicines Policies provide?
Guidance and procedures for medicine management in different situations.
What should be included on a prescription if available?
The NHS number.
Who is not permitted to prescribe on an FP10HNC?
FY1 doctors.
What should be done to prevent administration errors when changing doses?
The new dose should be prescribed and the chart annotated.
Can the topical route be abbreviated in prescriptions?
No, it should not be abbreviated simply to TOP without additional information.
Which patients may require brand prescribing?
Patients requiring critical doses, such as those on immunosuppressants or anti-epileptics.
What does 'SC' stand for in prescription abbreviations?
Subcutaneous administration.
Which healthcare professionals can be supplementary prescribers (SP)?
Dieticians, nurses, midwives, and radiographers.
What is the current licensing status of carbamazepine for prophylaxis of manic-depressive episodes?
It is now licensed for this use in patients unresponsive to lithium.
What are Patient Specific Directions (PSDs)?
Written instructions from a prescriber for a medicine to be supplied or administered to a named patient.
What is required for patients under 12 on a prescription?
Their age or date of birth must be present.
Why is it important to consider future prescription/dosing instructions?
To prevent potential dosing errors later on.
What factors should be considered before prescribing?
Patient’s medication history and other factors that might alter treatment benefits and risks.
Who can prescribe controlled drugs?
Doctors, dentists, and veterinary surgeons can prescribe CDs, except for Schedule 1.
What is the aim of the Medicines Policy?
To lay out principles for medicine prescription, storage, transportation, supply, and administration.
What is one of the seven deadly sins of prescribing?
Not knowing your drug.
What is the correct way to write 500 micrograms?
0.5 milligrams.
How should liquid preparations be prescribed?
Prescribe the total quantity in both words and figures.
What could result from incorrectly or poorly completed patient information?
Medication being given to the incorrect patient.
Is a computer-generated signature sufficient on a printed FP10 prescription?
False; the signature must be handwritten.
What should be indicated when prescribing 'as required' (PRN) medication?
The maximum dose and frequency to avoid excessive dosing.
Which healthcare professionals can be independent prescribers (IP)?
Optometrists, pharmacists, physiotherapists, and podiatrists.
Why is it important to include the age or date of birth for patients under 12?
It enables accurate dosing verification.
What regulations do PSDs exempt from?
Many restrictions stated in the Human Medicines Regulations 2012.
What should be considered for TTOs/TTAs regarding variable dosing?
Extending the supply of medication to cover the relevant period.
What should be communicated and documented in prescribing?
Prescribing decisions and the reasons for them.
Can F1 doctors prescribe controlled drugs?
No, they cannot prescribe CDs within the supervisory conditions of their employment.
What do Medicines Policies ensure for hospital staff?
That they are aware of their roles, responsibilities, and limitations regarding medication.
What is another deadly sin of prescribing?
Not knowing your patient.
What identifies the prescriber as responsible on a prescription?
The signature of the prescriber.
What does the Human Medicines Regulations 2012 state about advanced electronic signatures?
They must be uniquely linked to the prescriber and capable of identifying the prescriber.
What is the correct way to write 3 mg?
3.0 mg.
Why is it important to document the route of administration?
Omission can lead to administration errors, so it should always be clearly documented.
Who can be both supplementary and independent prescribers?
Optometrists, pharmacists, physiotherapists, and advanced paramedics.
What patient identifier is recommended to include on prescriptions for controlled drugs?
NHS number.
What can omissions of required details on prescriptions lead to?
Delays in supply or administration errors, which can be fatal.
What is the purpose of a 'Medicines policy' or 'Medicines Code' in hospitals and prisons?
To define the authorizations to supply and administer medicines.
What is the purpose of providing an auditable trail for handling medicines?
To ensure accountability and safety in medication management.
How can you identify Schedule 2 and 3 preparations in the BNF?
They are identified by symbols (CD2 and CD3 in a square box) next to the drug.
What is a potential risk when prescribing drugs with variable dosing regimens?
Administration errors.
What is the purpose of the prescriber identifier?
To identify the prescriber responsible for the prescription.
Are inpatient drug charts subject to the same prescription requirements?
No, they are orders for administration, not for supply.
What is a common error in prescribing related to patient history?
Failing to take an accurate drug history.
What should be done if multiple routes of administration are prescribed?
They should be documented separately and cross-referenced to prevent accidental overdose.
What should be avoided when writing dosages?
Avoid trailing zero and decimal point.
How are controlled drugs classified in the UK?
Under the Misuse of Drugs Act 1971 into three classes: A, B, and C.
What risks do Medicines Policies help manage?
Risks that medicines can pose to patients, service users, residents, and staff.
What must always be stated on a prescription for a Schedule 2 controlled drug?
The strength of the preparation.
What is the importance of reviewing 'as required' drugs?
To remove them when no longer required and consider converting them into a regular prescription.
What is essential to know about the patient's treatment before prescribing?
Whether the patient is commencing treatment or has received it IV or if it is longer term.
What is a legal requirement for prescribing Schedule 2 and 3 CDs?
The patient's address must be included.
What is meant by unlicensed and off-label prescribing?
Unlicensed prescribing refers to using a medication that has not been approved for a specific indication, while off-label prescribing involves using a licensed medication for an indication not specified in its approved labeling.
What does the Misuse of Drugs Regulations 2001 define?
The groups of individuals authorized to apply for and possess controlled drugs.
What is the Inpatient Prescribing and Administration Chart?
A PSD used to document drug treatment for a patient during their inpatient stay.
When is it a legal requirement to state the strength of a controlled drug preparation?
If there is more than one strength available.
Is it a legal requirement to include the indication for treatment on a prescription?
No, it is not a legal requirement.
How can electronic prescribing systems help?
They can reduce documentation and administration errors associated with the route of administration.
What role do good practice guidelines play in prescribing?
Good practice guidelines provide a framework to ensure safe and effective prescribing, helping to minimize risks associated with unlicensed and off-label use.
What must be stated for the total quantity of Schedule 2 and 3 CDs?
The total quantity or number of dose units must be stated in both words and figures.
What is the purpose of NHS England’s Single Operating Model?
To strengthen the governance arrangements for the use and management of controlled drugs.
How can inpatient drug charts be formatted?
They can be paper-based or electronic.
What is the minimum legally acceptable dosing instruction for a Schedule 2 controlled drug?
'ONE when required.'
What does the phrase 'Maximum 30 day supply' indicate?
The quantity supplied must not exceed a 30-day supply.
What additional requirement was introduced for prescribing from June 1, 2015?
Temazepam and tramadol were included in the additional prescription writing requirements.
What standards are expected of hand-written prescriptions?
Hand-written prescriptions should be clear, legible, and include all necessary information such as patient details, medication name, dosage, and administration route.
What is a Discharge Summary?
A document summarizing the medication prescribed upon a patient's discharge.
What is the maximum quantity of Schedule 2, 3, and 4 controlled drugs that can be prescribed?
Should not exceed 30 days.
What is a key area of focus in good prescribing practice?
The underpinning knowledge required to prescribe legally, safely, and unambiguously.
What change occurred in April 2018 regarding pregabalin and gabapentin?
They were reclassified as Class C controlled drugs.
What standards are expected of computer-generated prescriptions?
Computer-generated prescriptions must be accurate, legible, and include all required information, ensuring they comply with legal and clinical guidelines.
What is the advised quantity limit for controlled drugs in NHS hospitals?
Between 7-14 days.
What is the most common therapeutic intervention in the NHS?
The use of medicines.
What should be done with any unused space on a prescription for controlled drugs?
It should be blocked out to prevent additional prescriptions from being added fraudulently.
Why is it important to prescribe within the limits of your knowledge, skills, and experience?
Prescribing within these limits ensures patient safety, reduces the risk of errors, and promotes effective treatment outcomes.
