Safe Prescribing

A guide for staff

The Medicines Policy consists of four Codes of Practice:
1. Safe Prescribing 2. Administration 3. Prescribing Controlled Drugs 4. Supply, Storage and disposal of Medicines It is your responsibility to understand what is expected of you in each of the Codes. These are available on GTi. Below are key points for Safe Prescribing, including Controlled Drugs (CD).

Responsibility and consequences for prescribing

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions (GMC).

Patient Allergy Status

It is mandatory that this section is completed on all drug charts and checked before any medicine is prescribed. If incomplete then medicines must not be prescribed, supplied or administered.

1. Everyone is responsible for documenting allergies and significant adverse drug reactions on admission
and at any time during the admission should a previously unknown reaction occur.

2. If patient has no known drug allergies or the information could not be ascertained (e.g. comatosed
patient), then write No Known Drug Allergy. 3. State the drug(s) involved and the nature of reaction. 4. Penicillin Allergy Sticker must be placed on the front of the drug chart and subsequent sheets for patients with known allergy to penicillin or penicillin related medicines, by the person completing the allergy statement. 5. It is important that any allergic reaction is also clearly documented in the Health Records.

General prescription writing standards all prescriptions must:

Be written legibly in black or dark blue indelible ink (electronic prescriptions are permitted) if your

handwriting is not clear then write in block capitals.

Specify patient demographics including: name, hospital number, NHS number, gender and date of birth

(addressograph label or pre-populated data is permissible, except for discharge CD prescriptions).

Specify the patients age and weight (if under 16 and for all weight based prescriptions e.g. gentamicin). Be signed, name printed (with Registration Number if appropriate) and dated by the prescriber. Specify the prescribers contact details on the front of the drug chart (e.g. bleep), the consultant

responsible for that patients care and the ward/clinic from where the prescription originates (ensure that this is kept up to date when then patient moves wards / teams). Use the generic drug name. There are uncommon circumstances where you should prescribe by brand; this should usually only be on the instruction of a more senior colleague. Examples of these include: IV amphotericin (include Fungizone or AmBisome in the prescription to distinguish between formulations), similarly, inhaled beclometasone (include QVAR or Clenil in the prescription), modified release (MR) preparations, medicines with a narrow therapeutic index e.g. lithium or theophylline preparations and combination products. Specify the dose, formulation, frequency, and route of administration. If the medicine is to be administered as required, specify the minimum dose interval and the indication (and ensure this does not duplicate a regular prescription). State the duration (or stop date) and indication where appropriate e.g. antimicrobials; short courses of medicines should have a stop date e.g. prednisolone.

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Safe Prescribing a guide for staff

Important points when prescribing:
ONLY prescribe in your field of competency; if not sure refer to a senior. You are permitted to prescribe medicines (including CDs) on in-patient drug administration charts and
on discharge prescriptions (except those below). You should stop prescriptions by striking through with a single line only; the change must be signed, name printed and dated by the doctor. If space allows, enter the reason for stopping. Do not use ink erasers or correction fluid. You should mark the administration record with an X in the relevant time slot(s) if a dose is to be omitted intentionally, e.g. medicines that are given once a week only. You must fasten all current drug charts together for a patient and marked them 1 of 2 and 2 of 2 etc. You must understand and follow the Trusts Unlicensed Medicines protocol. You must be aware of the Trusts Approved Prescribing List (Formulary) and the procedure for prescribing outside of this list.

Do not abbreviate always write in full:

Micrograms / nanograms Units (e.g. for insulin or heparin) Drug names (do not use DF118 or MMF)

FY1 doctors are NOT permitted to prescribe:

For out-patients. For own use or relatives / family members. For other staff unless the staff member is being treated as a patient. Systemic Anti-Cancer Therapy (SACT). Only appropriately trained and Trust accredited staff can prescribe SACT. Immunosuppressive agents except corticosteroids.

Report Adverse Drug Reactions (ADRs)

Please report suspected ADRs onto Datix (Trust reporting system) and if relevant, to the MHRA at www.yellowcard.gov.uk or by completing the Yellow Cards that are available at the back of the BNF. Criteria for reporting to the MHRA: All serious and minor ADRs relating to children. All serious ADRs in adults. Any reaction to an intensively monitored medicine (denoted by a black triangle in the BNF, which indicates that it is a new medication or has a new change in its licence / indications).

Controlled Drugs for discharge complete the prescription fully & accurately:
State the total quantity in figures and in words. The prescription is only valid for a maximum of 28 days. Methadone maintenance therapy is only supplied if patient has no access to normal supply route. Only

prescribe the minimum number of days required, considering doses that can be administered on ward (e.g. one dose prescribed if discharged on Saturday and will obtain supply on Monday.) The prescription cannot be amended by anyone except the prescriber.

Pharmacy annotations on drug charts

DH drug history: to note that the patient was already taking the medicine on admission. New to note that the medicine was initiated following admission. POD patients own drug; POD-H patients own drug at home.

Further information
Full details of the Medicines Policy, Unlicensed Medicines Protocol and Trust approved guidelines can be found using the Clinical Guidance search engine on GTi
Guys and St Thomas NHS Foundation Trust St Thomas Hospital, Westminster Bridge Road, London SE1 7EH Guys Hospital, Great Maze Pond, London SE1 9RT Switchboard: 020 7188 7188

www.guysandstthomas.nhs.uk

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