A Guide to Prescribing for 5th Year Medical Students by guy21


									Controlled Drugs:
 Specify whether tablets, capsules or liquids are required
 Specify slow (modified) release or fast-acting
 Some drugs should be prescribed as brand names
 Write doses in figures and words, and if the dose is to be
  changed, cross out and date the old dose, and start the new
  dose on a new line.
 Start patients on 10mg every four hours with 10mg PRN
                                                                         A Guide to Prescribing for 5th
  available hourly
 After 24 hours divide the total morphine given by 6 to give new
                                                                            Year Medical Students
  4 hourly dose, with the same dose PRN
 Diamorphine dose – divide oral morphine dose by three
 Outpatient prescription – must be hand-written
 Fentanyl patches – write patch strength & duration
 Avoid using decimal points in doses

Error Reporting:
If you make or spot a mistake, even if the patient wasn’t affected,
                                                                       It would be impossible to write a guide detailing how to
report it. Most errors are currently reported by nursing and
pharmacy staff. By reporting errors, action can be taken so that       prescribe all types of drugs for every scenario – that’s what
other staff become aware of problems, and prevent them from            the BNF is for. Instead, this is a collection of useful hints from
recurring. Also record any adverse drug reactions – yellow card        nursing and pharmacy staff on how to avoid the most common
scheme.                                                                errors made by PRHOs, and how to make your life (and
                                                                       everyone else’s lives) a bit easier. And hopefully help you
Help:                                                                  pass the drug chart OSCE station! The BNF remains the first
If you are uncertain about something, contact the ward or an on-call   place to look for drug doses, interactions and
pharmacist, or a senior doctor. Senior nurses are also a mine of       contraindications, including the appendices at the back. As
information. Never write a prescription if you are unsure – if         drug charts differ between trusts, I haven’t included any
something goes badly wrong, the blame will fall to whoever signed      specific drug charts in this guide.
the prescription.

Pharmacy phone/bleep number……………………………..
General Hints for Drug Charts:                                                  Therapeutic Drug Monitoring:
 Check the patient’s name is correct and is on every page                       aminophylline, theophylline, digoxin, gentamicin, lithium, phenytoin,
 Check that any allergies are documented in the notes and on every                vancomycin all require blood tests to check their levels. Hospitals
   page of the drug chart (and document reaction)                                  have protocols of when to check blood levels and how often.
 Weigh patient if possible and record weight
 On admission, record drug history carefully – including doses                 Warfarin:
 Sign and date everything – including when stopping a drug or                   Follow hospital guidelines and don’t just guess
   changing a dose. Write in bleep number too                                    New patients need counselling – lots still drink alcohol
 Write legibly in pen, preferably in capital letters – nurses will refuse to    Timing of blood tests: try to get them done early enough so the
   give drugs if they can’t read it properly, and it must be fax-proof             medical team can prescribe (not the on call team)
 Write out nanograms and micrograms in full to avoid confusion                  Use LMWH with Warfarin for at least 5 days, until there have been two
 Route of administration is important, especially if patient is NBM               consecutive therapeutic INRs
 When changing a dose, ideally cross through the old drug and rewrite           Write on main drug chart that patient has separate Warfarin chart
   it on a new line. One dose change on the same line is acceptable – so         Arrange an INR appt around 2 days after discharge
   long as date of change is recorded                                            Ensure that patient knows what dose to take – not just with “as
 Rewrite charts when they’re about to run out – nursing staff cannot              directed” written on the box
   give drugs if there’s nowhere to sign for them                                Sort out who will monitor INR (GP/clinic), and make sure patients
 Write charts up to cover weekends – shouldn’t be the job of the on-call          knows to chase their INR results
 Inform nursing staff of any changes to medication                             Antibiotics & Steroids:
 Avoid overdosing patients by putting drugs on regular and PRN                  Remember to write in the course length and stop date
   prescriptions – especially paracetamol                                        Check hospital antibiotic policy – eg UBHT provide stickers
 Remember to write patients up for Warfarin and insulin every day               Steroids – write down options for weaning off steroids
 Prescribe by generic name except lithium, theophyllines, slow release
   Ca channel blockers and some controlled drugs                                Unusual medications:
 Think about the timing of drugs around food and sleep – eg don’t give          Some drugs cannot be prescribed by GP – ensure patient is covered
   frusemide at night, or steroids after lunch.                                    until next Outpatient appointment
                                                                                 Doset boxes – arrange for GP to take over after 1 week’s supply
 Holistic prescribing – write up something PRN for common side effects
   of drugs. Most patients should have paracetamol, a laxative and an            Write down drug regimes and indications for uncommon drugs – helps
   antiemetic written up PRN                                                       pharmacy know how much to supply
 Remember to write maximum frequency for PRN drugs                              NEVER GIVE VINCRISTINE INTRATHECALLY
 When rewriting charts, write on the original drug start dates
 Review medications on discharge – discontinue IV drugs
 Document drug changes and reasons in GP discharge letter

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