Prescribing in Practice Part 1 (a) Introduction The following lead lectures within this OER are referred to it this presentation and may be useful to review Prescribing Triangle, Accountability, Concordance and Team Working

Learning Objectives To understand the principles of good prescribing To be aware of the legal requirements of a prescription To be aware of good standards of practice To be aware of the importance of preventing fraud To discuss how they prospective prescriber feels about prescribing

Facts More nurses have been sent on nurse prescribing courses than are currently prescribing Latter et al (2010) found that 93% of nurse prescribers & 80% of pharmacy prescribers were using their Independent Prescribing qualification. Evidence suggests that acceptability of NMPs is acceptability to patients is high and viewed positively by other HCPs (Latter et al, 2010).

Prescribing errors Those occurring in the decision making process e.g. wrong drug, dose, strength Those occurring during the prescription writing process e.g. illegible prescriptions, inaccurate transcriptions or poor communication Hospital prescribing errors occur in the range of 0.56 to 9.9% of all prescriptions Dean et al (2002) and community 4.35 to 10.2% The rapid development of NMP makes this an area of vital importance as the opening up of the BNF means that there is an even larger potential for mistakes Some research has shown that computerised prescribing reduces errors Cavell and Hughes (1997)

Why do errors occur? Unintentional slips, Omissions Illegible prescriptions Inaccurate transcription Positioning of zero and decimal points causing tenfold errors DISTRACTION Dean (2002) showed that doctors did not regard the task of prescribing as important. These will occur because the prescriber did not adhere to guidelines and relevant rules. Legibility important as if pharmacist cannot read it they will make their own interpretation Not surprising as they are not actually taught how to prescribe…this is an area that NMPs have an advantage over medical colleagues

Computer generated prescriptions All prescriptions include drug name, dose, frequency due to prompts Legible Information about patient is there at time of prescribing Information about the drug is there as well Prescriptions are checked for drug interactions, and cautions Great for audit/pharmacovigilance Relevant prescribing details can be built into system Must not be complacent as errors do occur computer generated scripts will eventually come to secondary care Some people become so dependant on computerised prescriptions they forget how to write then which is a worry when the system goes down. Also its important to check when the prescription is printed that it is correct

Feelings How do you feel about the prospect of prescribing? How will prescribing benefit your practice? What difficulties/conflicts might you encounter? Now that I have scared you how do you feel about it?

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