Five Prescribing Tips for New Doctors

The top five prescribing tips for new doctors are:

Write legibly: an illegible prescription could result in the patient receiving the wrong medication, for example chlorpromazine in place of chlorpropamide. This also applies in hospitals that use electronic prescribing, especially computer systems that use predictive text. A doctor can type in the first few letters, and then select the wrong option from the drop-down menu.

Check dosage and frequency: dosing errors can often occurs at the time of rewriting a barely legible drug chart, or when instructions to prescribe a drug do not come with the units. The consequence is that the patient may come to harm from an inappropriate dose or frequency. An example is if bisphosphonates are prescribed daily rather than weekly.

Confirm route: Many patients in hospital require complex medical care, which may include the administration of drugs by different routes. It is important to include a route of administration for every drug prescribed and ensure the appropriate dosage. For example, there have been several cases in which the chemotherapy drug vincristine, which should be administered intravenously, has been incorrectly delivered intrathecally, with fatal consequences.

Consider drug interactions: Many patients in hospital have complex comorbidities requiring numerous medications. It is important to check a patient's existing medicines before prescribing anything new. Drug affects may be amplified by the addition of another, or may pose a greater risk of adverse effects to the patient. For example, warfarin may reach dangerous levels of anticoagulation due to the addition of an interacting antibiotic.

Don't be afraid to seek help: As well as accessing national and local formularies, take advantage of the knowledge of co-workers. A ward pharmacist will be able to provide valuable advice on dosing regimens and possible drug interactions. Senior colleagues can clarify any drugs which are unfamiliar.

“Prescribing the right drug, in the right dose, to the right patient, is one of the most important responsibilities of any doctor,” said Naeem Nazem, MD, medical adviser to the MDDUS. “It is particularly relevant to hospital trainee doctors, who are often asked to prescribe unfamiliar drugs to unfamiliar patients.”

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