10 top tips for good prescribing

10 top tips for good prescribing

Here are 10 top tips for good prescribing.

1. Be clear about the reasons for prescribing

• Establish an accurate diagnosis wherever possible – but not all diagnoses need treatment
• Don’t just prescribe because the patient asks for it, or you need to ‘do something’.

2. Benefit-harm analysis

• Be clear in what way the patient is likely to gain from prescribing the medicine (benefits) and what harms may occur from treating, or not treating
• These two principles form the benefit-harm balance. Do the likely harms of treatment outweigh the likely harms of no treatment? This is a key question

3. Take into account the patient’s medication history before prescribing

• Their current and recent medications, and also any over-the-counter (OTC) drugs

• Previous adverse reactions (ADRs), and allergies.

4. Take into account other factors that might alter the benefits and harms of the treatment

• For example, age, ethnicity, pregnancy, impaired liver or kidney (CKD) function

5. Consider the patient’s ideas, concerns and expectations (ICE)

• Form a partnership with the patient when selecting treatments, making sure they understand and agree the reasons for treatment
• Also, will they do anything in return to help themselves, e.g. stop smoking?

6. Select safe and effective medicines that you know well and have used before

• Wherever possible base your assessment of benefit-harm on published evidence
• Where possible use a licensed medicine. Only prescribe medicines that are unlicensed, ‘off label’, or outside standard practice if you’re satisfied that there is no licensed alternative to meet the patient’s needs
• Use reliable, validated sources of information, e.g. BNF.

7. Monitor the outcomes of treatment

• Identify how you will know whether the drug is working, and not causing harm

8. Communicate and document prescribing decisions

• Communicate clearly with the patient and with colleagues

• Give patients important information about what adverse effects to look out for (especially those that need urgent action) and any monitoring that is needed.

9. Prescribe within the limits of your knowledge and experience

• Keep knowledge and skills relevant to practice up-to-date
• Be prepared to seek the advice and support of senior colleagues
• Make sure that (where appropriate) prescriptions are checked (e.g. calculations of intravenous doses).

10. Follow CKDEx’s 3 top prescribing tips below.

Summary

Other resources

This article was adapted from the British Pharmacological Society’s Ten Principles of Good Prescribing
These are CKDEx’s 3 top prescribing tips