Unit 5 – Prescribing in Practice

Prescription Writing


Reading

Reading

British National Formulary (BNF)
www.bnf.org

Prescription writing:
'How to complete a prescription form' section in
Extending Independent Nurse Prescribing within NHS Scotland: A guide for implementation
(2002),
www.scotland.gov.uk/library5/health/einp-07.asp
or
'Annex B. Prescription forms' in Extending Independent Nurse Prescribing within the NHS in England: A guide for implementation (2004),
www.dh.gov.uk/assetRoot/04/07/21/77/04072177.pdf

Make Notes

Use the links below to view and print out a copy of one of the following prescriptions relevant to your work:

Think of a patient for whom you are likely to prescribe. Check all the details of the item you would prescribe in the BNF and, using the guidelines, complete the sample prescription. Use the tick boxes and complete the checklist below: print the checklist and use this as a guide to completing the prescription form.

  • Have you used ink, and is your writing legible?
  • Have you stated the full name and address of the patient, and the patient's age if this is under 12 years?
  • Have you stated clearly the full generic name of the drug, preparation or appliance required?
  • Have you stated the required presentation, strength and size of the medication/appliance, as appropriate?
  • Have you written the units of strength correctly? For example, grams, milligrams or micrograms?
  • Have you indicated the quantity to be supplied?
  • Have you stated the dose and dose frequency, and the minimum dose interval, if necessary?
  • Are your directions written in English (not Latin), and are they unabbreviated?
  • Have you signed and dated the form?

You can practise this with a number of different types of medications, such as oral medication, topical applications, dressings, appliances and so on.

Awareness of fraud and reporting it

It is estimated that theft, forgery and counterfeit of prescription forms costs the NHS about £15m a year (Winyard and Hartley, 1997).

Prescription fraud is usually committed by a person who:

  • Obtains multiple prescriptions from different doctors for the same drug
  • Writes their own prescriptions using a stolen prescription pad
  • Poses as a doctor and requests a prescription for themselves.

By dispensing medication on a forged prescription a pharmacist is committing an offence, whether they are aware that the prescription is a forgery or not. A pharmacist may therefore contact you if they have any doubts about the authenticity of prescription.

It is hoped that the introduction of electronic prescriptions will lead to a decline in such fraud. People will be unable to steal prescription pads and thus pose as a doctor. In addition, because a patient's medical history will be easily accessible, it will be more difficult to obtain the same prescription from different doctors.

Refer Back

Link to 'Electronic patient records and electronic prescribing' of the 'Documentation' section in Unit 4. Prescribing Partnerships.

Security and safe keeping of prescription pads

The following points ensure good practice in the security and safe handling of prescriptions:

  • Hold only minimal stocks of prescription forms
    This reduces the number lost if there is a theft or break-in. Arrangements for the secure storage of prescription forms is the responsibility of both the prescriber and the employing organisation.

  • Do not leave prescriptions unattended

  • Keep prescriptions/prescription pads under lock and key when they are not needed
    They are less likely to be stolen from a locked cupboard than from the back of your car or your bag.

  • Keep records of serial numbers of prescriptions as they are issued
    The first and last serial numbers of the pad should be recorded. This will help to identify any stolen prescriptions.

  • Blank prescription forms should not be pre-signed
    This reduces the risk of misuse should prescription forms fall into the wrong hands.

  • Establish a local policy regarding monitoring the use of prescription forms, to deter the creation of fraudulent prescriptions
Reflection

Consider how you could establish a local policy to ensure effective monitoring of the use of prescription forms.

  • Who would need to be involved?
  • What measures could be taken to monitor the prescriptions written, for example, in one working day?

Ordering and supplying prescription forms

Prescription pads are usually sent to trusts, community health partnerships and employers after the primary care information group of the Information and Statistics Division has received notification of newly qualified nurse prescribers. Managers of hospital-based nurses should order HBPN forms, which will be supplied ready for stamping.

The arrangements for obtaining and supplying prescription order forms for nurse prescribers are detailed in the following documents:

Scotland

Scotland
www.scotland.gov.uk/library5/health/einp-07.asp

England

Wales

England and Wales
www.dh.gov.uk/assetRoot/04/07/21/77/04072177.pdf
Go to Annex B.

Northern Ireland

Northern Ireland

There are two methods of issuing prescription pads in Northern Ireland:

  • Supplementary prescribers make their application through the employing trust
  • Independent extended nurse prescribers apply directly to the Northern Ireland Health and Social Services Board.

Once applications have been made, they are forwarded to the Central Services Agency in Belfast, which then issues the prescription pads.

Loss of prescription forms

Primary care

If a prescription form or pad has been mislaid or lost, the prescriber must report the loss to the primary care manager of their employing trust or NHS board immediately after the disappearance has been confirmed. The prescriber should also inform the GP.

The primary care manager should notify the fraud liaison officer at the primary care trust/board, who should notify the local pharmacists and the Practitioner Services Fraud Investigation Unit. These maintain a database of lost/stolen prescription forms.

Loss of Prescriptions - Primary Care  Model

Secondary care

The loss or theft of a prescription form in the hospital setting should be reported immediately to whoever issued it — usually, the hospital pharmacy — and the local fraud specialist, if applicable.

Loss of Prescriptions - Secondary Care  Model

  • Sometimes after the loss of a prescription form the prescriber will be asked to write and sign all prescriptions in a particular colour of ink for the next two months, to help detect further fraud (fraudulent prescriptions are likely to be written in a different colour)
  • It is the responsibility of the employer to ensure that prescription pads are retrieved from prescribers who leave their employment. The pads must be destroyed by shredding and treated as confidential waste
  • It is good practice to record the first and last serial numbers of the pads destroyed.
Refer Back

Link to the 'Risk assessment and management' section of Unit 4. Prescribing Partnerships.


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