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Hospital inpatient prescriptions

Sections of the drug chart

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  • 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:
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  • 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
      • 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’ 
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