Hospital inpatient prescriptions

Sections of the drug chart

• Patient details: hospital number, name, age, DOB, weight, consultant, ward, chart date, chart number, allergies
• Once only drugs: for drugs to be given once only at a certain time/date
• Regular prescriptions
• As required (PRN) medications: for medications only to be given if the patient requests them/complains, e.g. analgesia, antiemetics etc.
• Oxygen
• Fluids

General points

• Review dates for antibiotics should be 48 hours (because this is when culture results should be back). All medications should be reviewed weekly.
• Allergy box must be filled out with all (not just drug) allergies, with details of reactions in brackets. The box should also be signed and dated.
• Times must be written in 24 hour format (00:00)

• When stopping a drug, cross it through neatly, and sign and date
• If a drug needs to be omitted on a certain date, note this in the comments and cross through like this:

• If re-writing a chart, include all of the original start dates

Choosing prescription times

• BD: circle/tick the two intended times (usually latest and earliest times)
• TDS: circle/tick three times throughout the day as spaced out as possible. If there are 4 possible times on the drug chart, it usually does not matter which middle time you choose, unless the medication needs to be taken at mealtimes (e.g. hypoglycaemics).
• 8-HOURLY: must be 8 hours apart, so cross out printed times and write in new ones so they fall 8 hours apart
• QDS: circle/tick four times throughout the day as spaced out as possible
• PRN: in the PRN section of the chart, ‘frequency’ is the maximum frequency (i.e. don’t write ‘PRN,’ write, for example, ‘4-hourly’)
• OD: circle/tick the first dose time of the day (unless it is to be given at night, e.g. statin or sleeping medication)
• ON: circle/tick the last dose time of the day

Tips for Prescribing stations 

• Order of station:
• Fill in patient details
• Check allergies and fill in allergies box
• Prescribe antibiotics (checking for allergies)
  • WARNING: many antibiotics contain penicillin, e.g. amoxicillin, flucloxacillin, ampicillin, co-amoxiclav/Augmentin, Tazocin
• Prescribe other new medications
• Say ‘Normally, I would now check drug interactions. Would you like me to do that now or go on to write up the regular medications?’ (Always check interactions if prescribing any drugs with a narrow therapeutic range, or enzyme-inducers/inhibitors)
• Prescribe regular medications last
• The time is usually short so be as quick as you can
• If you do not know the length of an antibiotic course, say you would call microbiology to confirm while writing the usual duration: IV antibiotics 5 days; oral antibiotics 7 days

Rules for all prescriptions

Pen

Write in black, capital letters

Units

• For doses less than 1 gram, write in milligrams; and for doses less than 1 milligram, write in micrograms
• For volumes, use millilitres (ml), not cubic centimetres or cc
• Do not abbreviate
  • Micrograms
  • Nanograms
  • Units 

Drug names

Use generic drug names (not brand names), except for:

• • Inhalers

• • Insulin

• • Psychiatric drugs

• • Epilepsy drugs

• • Modified release products

• • 5-aminosalicylic acids

• • Narrow therapeutic range drugs (Guys With Large Dongles Totally Make Perfect Internet Connections)

    • • Gentamicin
    • • Warfarin
    • • Lithium
    • • Digoxin
    • • Theophylline/Tacrolimus
    • • Methotrexate
    • • Phenytoin
    • • Insulin
    • • Ciclosporin

In these cases, write the generic name first, then the brand name in brackets afterwards.

Special case prescriptions

• PRN prescriptions
  • Include the minimum dose interval and maximum total daily amount, e.g. ‘DRUG: Tramadol. DOSE: 100mg. FREQUENCY: as required every 6 hours (maximum 400mg in 24 hours)’
• Solutions
  • Write the drug and concentration in the drug box, and how many ml are to be taken in the dose box. e.g. ‘DRUG: Oramorph 5mg/5ml. DOSE: 5ml’
• Inhalers
  • Write the inhaler and puff content in the drug box, and how many puffs are to be taken in the dose box, e.g. ‘DRUG: Salbutamol 100 micrograms. DOSE: 2 Puffs’
• Combined drugs
  • Write the combination specifics in the drug box, and how many tablets are to be taken in the dose box, e.g. DRUG: Co-Codamol 8/500. DOSE: 2 Tablets’
• Complex analgesia
  • You should prescribe background analgesia regularly and breakthrough analgesia PRN (1/6th of the regular dose, repeated up to 4-hourly)
• Oxygen
  • Include the target saturations
• Fluids
  • Include the fluid, volume, additives, and flow rate

Controlled drugs

Outpatient controlled drug prescriptions 

• Must be handwritten in indelible ink
• Include patient’s name and address
• Drug, strength, and formulation (e.g. tablets, capsules, liquid etc.)
• Dose and frequency, e.g. ‘5 mg up to 2-hourly as required for pain’
• Total quantity must be spelled out as well as given in numerals, e.g. ‘supply 20 (twenty) tablets’

Try some prescribing OSCE stations now!

The OSCEstop drug chart can be found here.

1. Pre-operative prescribing
2. Neutropenic sepsis prescribing
3. End of life medication prescribing
4. Asthma exacerbation prescribing
5. COPD exacerbation prescribing
6. And there’s more stations here!