Essential prescribing tips for GP Associates-in-Training

Prescribing is an essential role in general practice but it is also, at times, a high risk activity. GP Associates-in-Training (GP AiTs) have been highlighted as needing further support to reduce the risk of prescribing errors. This article highlights some common prescribing errors to help GP AiTs to review their prescribing and develop prescribing habits to avoid errors. The general practice workforce is changing and there are more pharmacists working in general practice. This article describes the role of clinical pharmacists in prescribing safety and in supporting GP AiTs

The evaluation of an e-learning prescribing course for general practice

Prescribed medication may lead to significant morbidity or mortality as a result of these medications causing adverse events, or because of a prescribing error. E-learning is a common tool used in supporting training in prescribing. This paper describes the development of an e-learning course and the subsequent evaluation undertaken by the users with the aim of obtaining an effective e-learning course for prescribing. The e-learning course was developed by general practitioners and pharmacists and focussed on the principles of good prescribing, examined the common reasons for prescribing errors, and was evaluated using self-reported quantitative and qualitative measures. Scores significantly increased on an assessment given before and after the course. The majority of respondents reported that the e-learning course had a positive impact on prescribing knowledge, skills and attitudes, with medication reviews the top area where a change in prescribing practice was reported. Over 90% of the respondents agreed that the e-learning course was easy to use and a useful part of their continuing professional education. This study shows that clinicians recognise the on-going need for training in prescribing, but the lack of training is one of the factors contributing to errors, which suggests that more education is needed, not just for GPs in training, but for qualified GPs as well

Avoiding hazardous prescribing

Around one in 13 of the prescribing errors detected in the General Medical Council-funded PRACtICe study involved either contraindications or hazardous drug-drug combinations In this article we focus on these issues and also cover the problem of selecting the wrong drug, or drug strength, from computer-based drop-down menus. The article gives the reader opportunities to reflect upon different scenarios involving hazardous prescribing, and there are also suggestions for additional continuing professional development activities

Providing the right medication monitoring

In order for medication to be prescribed effectively and safely, many medications require monitoring. Medication monitoring may involve blood tests but can also include other monitoring such as blood pressure, weight or electrocardiograms. Monitoring can be required before initiating medication, soon after starting, or regularly over the course of treatment. Ensuring that this monitoring has been undertaken is an important part of medication review involving repeat prescribing. The General Medical Council-funded PRACtICe study looked at prescribing and monitoring errors in primary care. Out of the 302 errors identified, 55 (18%) were monitoring errors. Of those drugs that required blood test monitoring, 7% of prescriptions contained a monitoring error. This article gives the reader opportunities to reflect upon different scenarios that involve medication that requires monitoring decisions and how monitoring could be managed in primary care. There are also suggestions for additional continuing professional development activities

Providing the right dose instructions

The General Medical Council -funded PRACtICe study investigated the prevalence and causes of prescribing errors in general practices. The results showed that around one in three of the prescribing errors detected were associated with incomplete information on the prescription whilst around one in 10 involved giving a medicine at the wrong time. In this article we focus on achieving clear and unambiguous dosing instructions including how clinical computer systems can help to alleviate the problem. We also look at the cautionary and advisory labels added during the dispensing process. The article gives the reader opportunities to reflect upon different scenarios, and there are also suggestions for additional continuing professional development activities

Selecting the right dose

Around one in six of the prescribing errors detected in the General Medical Council-funded PRACtICe study involved either the wrong dose or the wrong strength of medication. Around one in 10 of the prescribing errors involved giving a medicine at the wrong time. In this article we focus on the factors that need to be taken into consideration when selecting the right dose for an individual patient. We also highlight the importance of selecting the right timing for particular medicines. The article gives the reader opportunities to reflect upon different scenarios, and there are also suggestions for additional continuing professional development activities

Identification of an updated set of prescribing-safety indicators for GPs

Background Medication error is an important contributor to patient morbidity and mortality and is associated with inadequate patient safety measures. However, prescribing-safety tools specifically designed for use in general practice are lacking. Aim To identify and update a set of prescribing-safety indicators for assessing the safety of prescribing in general practice, and to estimate the risk of harm to patients associated with each indicator. Design and setting RAND/UCLA consensus development of indicators in UK general practice. Method Prescribing indicators were identified from a systematic review and previous consensus exercise. The RAND Appropriateness Method was used to further identify and develop the indicators with an electronic-Delphi method used to rate the risk associated with them. Twelve GPs from all the countries of the UK participated in the RAND exercise, with 11 GPs rating risk using the electronic-Delphi approach. Results Fifty-six prescribing-safety indicators were considered appropriate for inclusion (overall panel median rating of 7–9, with agreement). These indicators cover hazardous prescribing across a range of therapeutic indications, hazardous drug–drug combinations and inadequate laboratory test monitoring. Twenty-three (41%) of these indicators were considered high risk or extreme risk by 80% or more of the participants. Conclusion This study identified a set of 56 indicators that were considered, by a panel of GPs, to be appropriate for assessing the safety of GP prescribing. Twenty-three of these indicators were considered to be associated with high or extreme risk to patients and should be the focus of efforts to improve patient safety

Selecting the right drug

Around 1 in 10 of the prescribing errors detected in the General Medical Council-funded PRACtICe study involved incorrect drug selection or unnecessary prescriptions. In this article we focus on the principles involved in selecting the right drug for individual patients. We also highlight the usefulness of prescribing formularies and explain when it is appropriate to prescribe generically and when it is necessary to prescribe by brand. The article gives the reader opportunities to reflect upon different scenarios involving prescribing decisions, and there are also suggestions for additional continuing professional development activities. </jats:p

Undertaking effective medication reviews

In the General Medical Council-funded PRACtICe study around half the prescribing and monitoring errors identified involved repeat prescriptions. This suggests a need to improve the effectiveness of medication reviews in order to ensure that any errors are detected and corrected. In this article we focus on identifying the elements of an effective medication review; providing examples of medication reviews, and identifying and tackling adherence issues. The article gives the reader opportunities to reflect upon different scenarios, and there are also suggestions for additional continuing professional development activities