All About Prescriptions
Workshop
Prescribing in Practice
Part 2
Aims and Objectives
To inform non medical prescribers about:• Types of prescribing in Hospitals
• Prescriptions for non-NHS and AHPs
• Potential areas for error in prescription writing
At the end of the session students will understand all
the above issues and have had practical experience
of writing prescriptions using their BNF.
Hopital Based Nurses
Hospital based nurses may use one of three
methods to prescribe:
• 1) Ward order- to be used for inpatients
and discharge supplies only. A
prescription charge is not levied on
inpatients.
Hospital Nurses (cont.)
• 2) Internal hospital prescription formTO BE USED FOR OUTPATIENTS – but only in cases
where the hospital pharmacy will dispense the
prescription.
A prescription charge may be payable, unless the
patient is exempt from prescription charges.
For this reason these types of form often resemble
an FP10
Hospital Nurses Continued (cont.)
• 3) FP10HP prescription form – to be used where the prescription will be dispensed by a
community pharmacist.
• Managers of hospital based nurses should order
FP10HP which will be supplied ready for hand
stamping with nurse and hospital details:
Non Medical PRESCRIBER NMC No. or other
registration number
Non NHS Nurses & AHPs
• A Non NHS Nurse Prescriber cannot issue
a FP10 type out-patient prescription,
unless the organisation they work for has
an arrangement with the NHS provider
(e.g. Primary Care Trust)
• AHPs: A mechanism is in place for the
Health Professions Council to record the
supplementary prescribing qualification
after AHPs have qualified as prescribers.
Who knows
What the new
system will be in
primary care
Changes of NMP details
• Employers will need to keep a database of
Nurse Prescriber details and inform the
NHSBSA of changes as soon as possible. At
least five days is needed between changes of
details and re-ordering of prescription pads.
• Hospital based nurses will not need to do this
but if names or numbers are changed then
hand stamps will need to be changed
accordingly.
How to write a prescription
• Any IP must only prescribe drugs they are
legally allowed to prescribe, some CDs are
still not allowed, although legislation is due
to change to cover all CDs.
• Dispensers are not legally allowed to
dispense any other items
• If other items are dispensed the NHSBSA
will not reimburse the pharmacist
Challenges & opportunities
• What issues can you envisage in your
practice area?
• How will you feel if you are asked to sign
repeat prescriptions?
• What challenges do the AHPs envisage?
• Chadwick et al (2007) undertook an audit in
NWSHA of practice – one of the authors
works in a diabetic foot team with an IP
Tissue Viability Nurse-potential to reduce
hospital admissions and reduce amputations.
Opportunities for …
• Medication review
• Review care plan
• To ensure all the
information was
obtained by the first
assessor, if you are
following up
• Referral on
• Compliance
• Reflection
“Barometer," © 2005 Matt Wharton, Found at:
http://www.flickr.com/photos/electricinca/5176578/. Used
under a Creative Commons Attribution-ShareAlike 2.0
Generic license: http://creativecommons.org/licenses/bysa/2.0/deed.en_GB
Writing prescriptions
• NMPs are expected to prescribe in
accordance with the information within the
B.N.F., which forms the basis of their
educational preparation, and is the basis
on which their employers have agreed to
include prescribing in the responsibilities
of the post, make sure your job description
reflects this role when you obtain your
prescribing qualification.
Potential areas for error when
writing a prescription
• Name of Prescribed Item – in full without
abbreviations only using approved titles
• Formulation
• Strength (if any)
• Dosage
• Avoid unnecessary use of decimal points e.g. 5mgs
not 5.0mg. If unavoidable a zero in front of the
decimal point e.g. write 0.5ml not .5ml. Acceptable
to use decimal point to express a range e.g. 0.5-1 g
• Frequency
• Quantity or duration of treatment
Grams, milligrams and
micrograms
• Quantities of 1 gram or more should be written in grams e.g.
write 2 g
• Quantities less than 1 gram should be written in milligrams e.g.
write 500mg not 0.5g
• Quantities less than 1 mg should be written in micrograms e.g.
write 100 micrograms and not 0.1 mg
• Micrograms and Nanograms should not be abbreviated, the word
Units should not be abbreviated
• Calculations should be double checked
• The Prescriber should re read the prescription once it is written
Hospital Prescribing
•
•
•
•
•
•
Name of the prescribed item
Formulation
Strength (if any)
Dosage
Frequency
Where a defined length of treatment is required this
should be stated.
• For out-patients and discharge patients the
requirements are the same as for community nurses
Names of Medicines
• Written clearly using approved generic
titles (where available) as specified
throughout the NPF/BNF, and should not
be abbreviated.
• The only exception to this rule is for the
prescribing of some dressings and
appliances, and of compound or
modified release medicines which have
no proprietary name.
Directions
• Directions should be in English and not
abbreviated.
• Where there is more than one item on a
form a line should be inserted between
each item for clarity.
• Unused space should be blocked out with,
for example a diagonal line (to prevent the
fraudulent entry of other items)
Prescriber’s signature
and date
• Legal responsibility lies with the Doctor or
Nurse who signs the prescription.
• Additional items prescribed by a doctor
must be prescribed on a Doctor’s
prescription and not added to an NMP’s
prescription even if countersigned by a
doctor.
Serial Numbers
• Should be recorded by the employer
before issue to the nurse.
• Recorded by the nurse to aid identification
in the case of theft.
• Blank prescriptions should NEVER be presigned.
Nurses leaving their posts
• It is the employers responsibility to retrieve
unused prescription pads from nurses who
are leaving or retiring. These should be
shredded after recording serial numbers.
Licensing of drugs
• Previously known as Product licence nowMarketing Authorisations
• Before a new product can be marketed the company
has to produce evidence of safety and efficacy’.
• The licence also restricts availability by defining the
legal category of the drug.
• All proprietary medicines will therefore bear a
Marketing Authorisation number and a legal status
code.
Legal categories of Medicines
• Prescription Only Medicines – POMs
• No person may administer a POM to another person
(except to himself) unless he is acting in accordance
with the directions of an appropriate practitioner.
This is with the exception of medical emergencies
for the purpose of saving life in an emergency and
applies to certain medicines e.g. epinepherine
• Doctors can administer POMs without a prescription
though it is good practice to keep adequate records.
• NMPs should avoid administration of a POM without
a prescription or PGD.
Legal categories of Medicines (cont.)
• General Sale List Medicines. (GSL)
Can be sold in supermarkets, garages etc.
Legal categories of Medicines (cont.)
• Pharmacy Medicines (P medicines)
• Can be bought in a pharmacy providing
that the pharmacist is there to supervise
the sale.
• Pharmacists have a legal obligation to
refuse the sale if they feel that the sale
would compromise safety or contribute to
abuse.
• P medicine legislation is likely to change in
2012 so watch out for this
Hospitals and the Medicines Act
• All medicines provided to in patients are
“de facto POM’s” this is because hospital
pharmacies cannot sell medicines and
supply is regulated through hospital
policies.
Label 30
• Do not take with any other paracetamol
products
To be used on all containers of dispensed
preparations containing paracetamol
• BNF 60(2010)
Cautionary Labels
• Can be used to give more detail that you
feel strongly should be on the packaging
of the product
• A prescriber may feel on a specific
occasion that a cautionary label should not
be used- can you think of one that may be
put on by the pharmacist? If you do not
want the label to be used you must
endorse your prescription with-’NCL’ but
then the exact wording you want to
replace this has to be specified Source BNF60 2010
Group Activity
• In interprofessional groups you will
complete an activity reviewing 3 written
prescriptions
• You will then develop a poster which
promotes principles for safe prescription
writing practice
Further reading
• Dean B. Barber N. Schachter M (2000) What is a prescribing
error? Quality Health Care 9 pp232-237
• Reddy B. (2006) Prescription writing standards: why they are
important Nurse Prescribing vol.4 No.8 pp330-335
• Maintaining competency in prescribing: An outline framework to
help allied health professional supplementary prescribers
• National Prescribing Centre (2004) Maintaining competency in
prescribing: An outline framework to help allied health
professional supplementary prescribers. Available on line @
http://www.npc.co.uk/maintain_comp_in_prescribing.htm
• Prescribing Self Tests online:
http://learning.north.londonmet.ac.uk/prescribing/prescribing_exe
rcises.htm
References
British National Formulary www.bnf.org.uk
Chadwick P, Stuart L, Fox M, Walley A,
Morris L, Ashton-Mort ,S and McLennon, J
( 20070 An audit to improve the care of the
diabetic foot Wounds UK vol. 3, no.2
pp73-77
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