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

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

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

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!