Grzegorz Chodkowski (MD)Grzegorz Chodkowski (MD)
Riga, Radisson SAS
BNF, PharmacologyBNF, Pharmacology
Prescribing in the NHSPrescribing in the NHS
• Know the medicine well enough to administer safely
• Check and be certain of patient identity
• Know the care plan
• Administer in the context of patient condition
• Check for allergy and
the expiry date before administering
• Know the following so you correct and understand
Key PointsKey Points
• Medication prescribing is:
• The patient must be identifiable
– patient's name
– date of birth
– hospital number
– age if under 12 (legal requirement)
– weight if under 12 (legal requirement)
Prescribing Core KnowledgePrescribing Core Knowledge
(for all clinical staff)(for all clinical staff)
• The Allergy box must not be left empty
• Use approved names (rINN) in black ink and BLOCK CAPITALS
• Metric doses
• Write micrograms and units in full
• Indicate the route and times of administration
• Administration times should be agreed with the nursing team and the 24-
hour clock used. Specify precise times if important.
• Do not alter existing prescriptions. Rewrite if a change is made.
• Only one chart should be active
• Discontinue a treatment by crossing through it and cancelling subsequent
recording panels. Add your initials and the date.
• Antibiotics must be prescribed for a stated time period.
• Place X in administration box to indicate drug not to be given at specific
time & day
• If a drug is to be administered by a pre-prepared protocol or patient
specific direction this must be explicitly referred to on the chart
Prescription Chart StandardsPrescription Chart Standards
Safe prescribing depends upon you putting yourself in the mind of everyone
who might read and act on your script, patient, nurse, pharmacist and fellow
Dangerous errors tend to be:
• Wrong medication in context
• Wrong dose (too much)
• Mistakes, are more likely when tired or distracted or interrupted. Every-one makes
mistakes and every one will make the occassional bad mistake
• Team work and taking responsibility for checking others and then acting appropriately
is the most effective way of reducing patient harm.
• All should accept the correction of potential mistakes in good grace
• Many safety issues are due to culture and can be corrected by system change
• Insulin is the most common cause of administration error
• Anticoagulants are the most common cause of life threatening prescribing error.
• All clinical staff should know the risks with prescribing so they can be detected.
Medicines SafetyMedicines Safety
• Methotrexate given daily instead of weekly
• Writing ug for microgram which might be read as mg and patient given 1000 times
• Allergy box on drug chart left empty
• Three fatal episodes where a prescriber prescribes a penicillin to someone
documented to be allergic penicillin and the penicillin is given despite the allergy
being stated on the wrist band(s) and drug chart
• A study comparing administration error in UK, Germany & France found
– Product not labelled/incorrectly labelled in 43%, 99% and 20% of doses respectively
– Wrong diluent used in 1%, 49% and 18%
– Wrong administration selected for 49%, 21% and 5% of doses observed
– At least one deviation from aseptic technique was observed among 100%, 58% and 19%
– In the UK, no cleaning of preparation area or hand washing was observed for any of the
– Only 1% of cases swabbing the vial top
– In the UK, the most frequent medication errors were related to an incorrect
administration rate (48%).
Thank You!Thank You!
Any Questions?Any Questions?