10 Prescribing Tops Tips
All doctors of all types (hospital and GP), and nurse prescribers, need to be good prescribers.
- Keep within the drugs you know (and know them very well). If outside, look them up in BNF. Ask a pharmacist if still not sure
- Take a long time on drug history (one of key bits of a medical history)
- Take a drug allergy history. Prescribing can be more dangerous than not prescribing
- Compliance wanes after 6 months of a new treatment. We just add stuff, rarely take away. So you have to check, and recheck they are taking them
- Often not prescribing (masterly inactivity) is better than prescribing – i.e. risks outweigh benefits
- Do they really need that drug? Really??
- Most minor illnesses get better in less than two weeks
- They can be a powerful source of suffering. To paraphrase an old saying ‘drugs are poisons with the occasional beneficial side effects’
- For frail elderly ..
- Stop don’t start drugs. Polypharmacy is worse than perfection. Focus on falls prevention, e.g.
- Change your targets, e.g. if 82y with DM2, its OK to have HbA1c 52 mmol/mol with glucose 10 mmol/L, and BP 140/90 etc
- A statin is not much use at 89y old
- If you are worried in this group, ask GP to send paramedic (or you ask community DM or heart failure or other nurse) to visit
- Don’t fiddle with areas that are not your remit (e.g. epilepsy, HIV if not your area of expertise; ask GP/other specialist to lead)
- Give written notes to all patients that you add or change a drug (as well as formal letter) and ask to take to GP
- Use Accurx to insert very important messages into patients phone and GPs EMIS records, e.g. “please stop this drug NOW” (Calcium 3.2 mmol/L and on Vitamin D and calcium supplement)
- Top Top Tip: Be good at communication, communication, and communication
- Most errors are due to poor communication (e.g. NHS App, GP, pharmacy, hospital computers all different). So what are they actually taking?
- If you don’t make the odd small mistake in the early years, you are not prescribing enough.
Summary
Good prescribing is an art/science thing. Part of the art is to follow national and local guidelines but also know when not to. You get better after first 20 years! Then mistakes are rare.
