Good prescription writing guidelines

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Also refer to ‘Prescription writing’ section in current BNF and General Medical Council guidance ‘Good practice in prescribing and managing medicines and devices’.

GENERAL

 

HIGHLAND FORMULARY
  • Please use/refer to the Highland Formulary or other relevant Highland formulary when choosing appropriate prescription.
  • Prescribers must be aware of the Formulary and license status of any medicine prescribed and must comply with all policies relating to the supply of non-Formulary medicines, see Formulary Introduction.
 2 WRITE LEGIBLY Prescriptions should be:
  • legible
  • in black ink
  • dated
  • include the full name and address of the patient and community health index (CHI) number
  • signed in black ink by the prescriber.
 3 AGE, DATE of BIRTH and CHI Number  
  • These must always be stated. In the case of prescription-only medicines, it is a legal requirement to state the age for children under 12 years of age.
  • For outpatient prescriptions, the PMS (Patient Management System) label should be used.
 4  DOSE  
  • The dose must be stated in the International System of Units (SI units).
  • Abbreviations for grams (g); milligrams (mg), millilitres (mL) and litres (L) may be used.
  • ‘Micrograms’, ‘nanograms’ and ‘units’ must be written in full.
  • State the dosage form, dose, route, timing and frequency.
  • ‘As required’ prescriptions should also specify the maximum dose per specified time period (eg day) and indication.
 5 FREQUENCIES and ROUTES OF ADMINISTRATION  
  • These should be written in full.
  • When an amendment to a medicine currently being prescribed is needed, eg frequency or dose change, a new entry must be made on the Kardex* and the original entry discontinued.
 6 DECIMAL POINTS  
  • Avoid unnecessary zeros, however always precede a decimal point with a zero where there is no other figure.
  • When unavoidable, decimal points should always have a number covering in front eg 0·5mL and not ·5mL.
  • Decimal points should be clear and, ideally, centred.
  • Whole numbers should be kept whole, eg 5mg and not 5·0 mg.
  • Quantities of 1 gram or more should be written as gram/grams.
  • Quantities less than 1 gram should be written as milligrams, eg 500mg.
  • Quantities less than 1mg should be written as micrograms, eg 100 micrograms, not 100mg or 0·1mg. 
 7 AS DIRECTED Avoid writing ‘as directed’ unless clear written direction, which is signed by the prescriber, is provided separately.
 8 NON-PROPRIETARY (GENERIC) NAMES Recommended International Non-proprietary Names (ie generic names as they appear in the British National Formulary) should be used for a medicine and be written in full except for some combination products, some modified-release preparations and where bioavailability is a problem.
 9  ABBREVIATIONS Avoid abbreviations.
 10 WEIGHT OR SURFACE AREA Where the weight or surface area is required to calculate a dose, write this on the prescription
11 CONTROLLED DRUGS For advice on prescribing controlled drugs refer to current BNF and ‘GP Summary; a guide to good practice in the management of CDs in primary care’ at: A_Guide_to_Good_Practice_Summary_for_GPs_v.2.0.doc
HOSPITAL INPATIENT ‘DIRECTION TO ADMINISTER’ (additional advice)
 1. ADMINISTRATION A medicine that is not correctly prescribed must not be administered if it is considered that following the prescribing instruction may be harmful to the patient. If the prescription is unclear or illegible this must be referred to the prescriber before any medicine is administered. 
 2. DRUG KARDEX*  The Drug Kardex* must include the patient's
  • name
  • hospital number (and/or Community Health Index (CHI) number)
  • date of birth and weight must be recorded on the front of the Kardex*, also surface area if a dosage requires it.
 3. PRESCRIBERS Medicines must be prescribed on all appropriate prescription sheets by a registered or provisionally registered medical practitioner, dentist, supplementary or independent non-medical prescriber.
 4. KARDEX* PRESCRIPTIONS  
  • These must be dated and written legibly, typed or electronically produced in indelible black ink specifying the dosage form, dose, route, timing and frequency with the prescriber’s signature and printed name for each item prescribed.
  • Take care to ensure correct section of form is used, eg ‘once only’ and ’pre-med regular therapy’ or ‘as required therapy’.
  • Specify time using the 24-hour clock, eg 22:00 rather than 10pm.
 5. CAPITALS All written prescribing information on the Drug Kardex* must be in capitals.
 6. AS REQUIRED   MEDICINES  
  • For medicines prescribed on an ‘as required’ basis, abbreviations must not be used and dose, dosage interval and indication for the medicine should be clearly stated, eg 500mg every four hours for a headache when required.
  • Indicate the maximum dose in a given time period, if appropriate.
 7. DISCONTINUATION  
  • To discontinue a medicine, the prescriber must draw a clear Z through the prescription section and a clear diagonal line through every section of the record of administration areas with a vertical line right through the last recorded date of being given, enter the date in the ‘stop date’ box and initial it.
  • When an amendment to a medicine currently being prescribed is needed, eg dosage change, a new entry must be made on the Kardex* and the original entry discontinued.
 8. PRESCRIPTION SHEETS  
  • Avoid using more than one Drug Kardex* for each patient if at all possible. Old Kardexes* must be cancelled by drawing two parallel diagonal lines across the front page and writing ‘cancelled’. It should be authorised by the prescriber’s signature and date of cancellation.
  • A new Kardex* should be used for each hospital admission.
 9. REWRITING If it is necessary to rewrite a Drug Kardex* the original start date for each item must be used.
10. SPECIAL SHEETS When special sheets (eg oral anticoagulants, insulin and continuous infusions) are in use, items must also be prescribed on the Drug Kardex* with the dose stated as charted.
11. PATIENT TRANSFER The Kardex* should be signed and dated when a patient is transferred from one place to another and the same Kardex* continued.
12. ALLERGY SECTION 
  • An entry must always be made in the Allergy/Drug Sensitivity section.
  • Write either drug name or ‘nil known’.

*refers to any form of (direction to administer) documentation.

PRIMARY CARE/HOSPITAL OUTPATIENT PRESCRIPTIONS (additional advice)
1.  PATIENT’S DETAILS

The prescription should include as a minimum:

  • name
  • home address
  • hospital number (and/or CHI number). 
2.  PRESCRIBER’S DETAILS 

Prescriptions written by non-medical prescribers should state:

  • the type of prescriber, eg Nurse Supplementary/Independent Prescriber
  • the prescriber’s professional registration number, eg NMC PIN number
  • the prescriber’s contact details including telephone number where this is not pre-printed on the form.
For prescriptions to be dispensed by a community pharmacy/dispensing GP practice, the prescription should state the reference number of the GP practice with which the patient is registered to allow correct allocation of prescribing costs. 
3.  CAPITALS  All handwritten prescribing information on prescriptions must be in capitals. 
4.  NAME, PRESCRIBED ITEM, FORMULATION, STRENGTH, DOSE/FREQUENCY and QUANTITY 
  • For prescribing in primary care and for patients whose prescriptions will be dispensed in the community, the prescription must contain the name of the prescribed item, formulation, strength (if appropriate), dosage and frequency, and quantity to be dispensed. The quantity should be appropriate to the patient’s treatment needs, bearing in mind the frequency of review and need to avoid waste.
  • Some medicines are only available in patient packs (or multiples thereof) and special containers. In such cases complete packs (or multiple packs) should be prescribed, provided this is clinically and economically appropriate.
  • Specify the quantity for solid preparations as number of dose units (number of tablets, patches, etc.), for liquid measures in millilitres (mL), for topical preparations by mass (grams, g), or volume (millilitres, mL).
  • Do not use terms such as ‘1 pack’ or ‘1 OP’.
  • Alternatively, for preparations to be given at a fixed dose and interval, the duration of treatment can be used in place of the quantity to be dispensed. 
5.  NUMBER OF DAYS   
  • The quantity to be supplied may be stated by indicating the number of days’ treatment required in the box provided on the NHS forms. In most cases, the exact amount will be supplied.
  • This cannot apply to items directed to be used ‘as required’ – if the exact dose and frequency are not given the quantity needs to be stated.
  • When several items are ordered on one form, the box can be marked with the number of days’ treatment, provided the quantity is added for any item for which the amount cannot be calculated.
6.  UNUSED SPACE  Block out unused space on the prescription form with, for example, a diagonal line (to prevent subsequent fraudulent addition of extra items). 
7.  MORE THAN ONE/           MAXIMUM NUMBER  Where there is more than one item on a form, insert a line between each item for clarity. A maximum of three items is allowed on one prescription form. 
8. SIGNATURE  Prescriptions must be signed in the signature space, in black ink, before they are issued. 
COMPUTER GENERATED PRESCRIPTIONS (additional advice)
1.  PRINT OUT  The computer must print out the date, the patient’s surname, one forename, other initials, address and CHI number and may also print out the patient’s title and date of birth. The age of children under 12 years and of adults over 60 years must be printed in the box available; print the age of children under 5 years in years and months. A facility must also exist to print out the age of patients between 12 and 60 years. 
2.  PRESCRIBER’S DETAILS  The prescriber's name must be printed on the prescription (who will normally sign it). The surgery address, reference number, and Health Board are also necessary. In addition, print the surgery telephone number. Computer generated prescriptions issued by non-medical prescribers should also indicate the type of prescriber, eg Nurse Supplementary/Independent Prescriber, and their professional registration number, eg NMC PIN number. 
3.  RESPONSIBLE PRINCIPAL  When prescriptions are to be signed by general practitioner registrars, assistants, locums or deputising doctors, the name of the doctor printed on the form must still be that of the responsible principal. 
4.  COMPUTER MEMORY  Names of medicines must come from a dictionary held in the computer memory to provide a check on the spelling and to ensure that the name is written in full. The computer can be programmed to recognise both the non-proprietary and the proprietary name of a particular drug and to print out the preferred choice, but must not print out both names. For medicines not in the dictionary, separate checks are required – the user must be warned that no check was possible and the entire prescription must be entered in the lexicon. 
5. THE DICTIONARY  The dictionary may contain information on usual doses, formulations and pack sizes to produce standard pre-determined prescriptions for common preparations and provide a check on individual prescription validity on entry. 
6.  DISPENSING  Checks may be incorporated to ensure that all the information required for dispensing a particular drug has been filled in. For instructions such as ‘as directed’ and ‘when required’, the maximum daily dose should normally be specified. 
7.  NUMBERS/CODES  Numbers and codes used in the system for organising and retrieving data must never appear on the form. 
8.  SUPPLEMENTARY WARNINGS/ADVICE  Write all supplementary warnings and advice in full. They should not interfere with the clarity of the prescription itself and should be in line with any warnings or advice in the Highland Formulary or BNF. Avoid numerical codes. 
9.  UNUSED SPACE  A mechanism (such as printing a series of non-specific characters) should be incorporated to cancel out unused space, or wording such as ‘no more items on this prescription’ may be added after the last item. Otherwise, the prescriber should delete the space manually. 
10.  AVOID FORGERY  To avoid forgery, the computer may print on the form the number of items to be dispensed (somewhere separate from the box for the pharmacist). There should be no more than three items on a prescription form. 
11. HANDWRITTEN   ALTERATIONS Handwritten alterations should only be made in exceptional circumstances – it is preferable to print out a new prescription. Any alterations must be made in the prescriber’s own handwriting and countersigned; update all computer records to fully reflect any alteration. Prescriptions for drugs used for contraceptive purposes (but which are not promoted as contraceptives) may need to be marked in handwriting with the symbol (or endorsed in another way to indicate that the item is prescribed for contraceptive purposes).
12. THE PRESCRIPTION The right hand side of the prescription is normally used as an ordering form for repeat prescriptions, but take care to avoid including confidential information. It may be advisable for the patient’s name to appear at the top, but this should be preceded by ‘confidential’.
13. REPRINTING/DUPLICATE

Prescription forms that are reprinted or issued as a duplicate should be labelled clearly as such.

Editorial Information

Last reviewed: 31 October 2016

Next review: 31 October 2018

Approved By: TAM subgroup of ADTC