There are many things to think about when prescribing so it is perhaps worth reminding you of a few. All PCTs should have had a prescribing policy and it would be wise to adopt this at practice level with local adaptation. There are plenty of references on the subject and guidance from organisations like the National Prescribing Centre.
Acute vs Repeat. If the treatment is a single short course or you want to review before continuing, use the acute prescription facility in the clinical system.
Always write instructions. Apart from good practice, it allows the system to calculate expected usage and feeds into the calculation of adherence. Make sure the administration staff understand this and can point out when a patient is collecting significantly more or less than intended.
Develop your repeat prescribing policy that includes the following information:
- Who can re-authorise a repeat prescription and their competences
- Drugs not suitable and prescribing periods for key drugs
- How you plan for regular review
- How you intend to audit process
- Always prescribe within your comfort zone and take care when prescribing medicines in conditions which you are clinically unfamiliar.
- Take note of the clinical risk traffic light system.
- Never prescribe medicines considered ‘red’ and use shared care arrangements where available.
The majority of medicines on repeat systems are for the elderly and/or for long term conditions. Studies suggest that a breakdown in repeat prescribing accounts for a fifth of drug related preventable admissions and a quarter of adverse drug events. Use the practice medicines optimisation pharmacist to carry out regular prescription review and audit.