Prescription writing

BNF 57 Prescription writing

The Act and Regulations do not set any limitations upon

7. The BNF recommendations should be followed as the number and variety of substances which the dental

in (a), (b), (c), (d), and (e) above. surgeon may administer to patients in the surgery or may order by private prescription—provided the rele-

8. Checks may be incorporated to ensure that all the vant legal requirements are observed the dental surgeon

information required for dispensing a particular may use or order whatever is required for the clinical

drug has been filled in. For instructions such as situation. There is no statutory requirement for the

‘as directed’ and ‘when required’, the maximum dental surgeon to communicate with a patient’s medical

daily dose should normally be specified. practitioner when prescribing for dental use. There are,

9. Numbers and codes used in the system for organis- however, occasions when this would be in the patient’s

ing and retrieving data must never appear on the interest and such communication is to be encouraged.

form.

For legal requirements relating to prescriptions for

10. Supplementary warnings or advice should be writ- Controlled Drugs, see p. 7.

ten in full, should not interfere with the clarity of the prescription itself, and should be in line with any warnings or advice in the BNF; numerical codes should not be used.

11. A mechanism (such as printing a series of non-

specific characters) should be incorporated to can- For computer-issued prescriptions the following advice,

Computer-issued prescriptions

cel out unused space, or wording such as ‘no more based on the recommendations of the Joint GP Infor-

items on this prescription’ may be added after the mation Technology Committee, should also be noted:

last item. Otherwise the doctor should delete the

1. The computer must print out the date, the patient’s

space manually.

surname, one forename, other initials, and address,

12. To avoid forgery the computer may print on the and may also print out the patient’s title and date of

form the number of items to be dispensed (some- birth. The age of children under 12 years and of

where separate from the box for the pharmacist).

Pre

adults over 60 years must be printed in the box The number of items per form need be limited only by the ability of the printer to produce clear and

scription

available; the age of children under 5 years should

be printed in years and months. A facility may also well-demarcated instructions with sufficient space exist to print out the age of patients between 12 and

for each item and a spacer line before each fresh

60 years.

item.

writing

2. The doctor’s name must be printed at the bottom of

13. Handwritten alterations should only be made in the prescription form; this will be the name of the

exceptional circumstances—it is preferable to doctor responsible for the prescription (who will

print out a new prescription. Any alterations must normally sign it). The doctor’s surgery address,

be made in the doctor’s own handwriting and coun-

tersigned; computer records should be updated to are also necessary. In addition, the surgery tele-

reference number, and Primary Care Trust (PCT 1 )

fully reflect any alteration. Prescriptions for drugs phone number should be printed.

used for contraceptive purposes (but which are not promoted as contraceptives) may need to be

3. When prescriptions are to be signed by general marked in handwriting with the symbol , (or practitioner registrars, assistants, locums, or depu-

endorsed in another way to indicate that the item tising doctors, the name of the doctor printed at the

is prescribed for contraceptive purposes). bottom of the form must still be that of the respon-

sible principal.

14. Prescriptions for controlled drugs can be printed

4. Names of medicines must come from a dictionary from the computer, but the prescriber’s signature held in the computer memory, to provide a check

must be handwritten 2 . on the spelling and to ensure that the name is

15. The strip of paper on the side of the FP10SS 3 may written in full. The computer can be programmed

be used for various purposes but care should be to recognise both the non-proprietary and the pro-

taken to avoid including confidential information. It prietary name of a particular drug and to print out

may be advisable for the patient’s name to appear at the preferred choice, but must not print out both

the top, but this should be preceded by ‘confiden- names. For medicines not in the dictionary, separate

tial’.

checks are required—the user must be warned that

16. In rural dispensing practices prescription requests no check was possible and the entire prescription

(or details of medicines dispensed) will normally be must be entered in the lexicon.

entered in one surgery. The prescriptions (or dis-

5. The dictionary may contain information on the pensed medicines) may then need to be delivered to usual doses, formulations, and pack sizes to pro-

another surgery or location; if possible the compu- duce standard predetermined prescriptions for

ter should hold up to 10 alternatives. common preparations, and to provide a check on

17. Prescription forms that are reprinted or issued as a the validity of an individual prescription on entry.

duplicate should be labelled clearly as such.

6. The prescription must be printed in English without abbreviation; information may be entered or stored in abbreviated form. The dose must be in numbers, the frequency in words, and the quantity in numbers in brackets, thus: 40 mg four times daily (112). It must also be possible to prescribe by indicating the length of treatment required, see (h) above.

2. See Controlled Drugs and Drug Dependence p. 7; the prescriber may use a date stamp.

1. Health Board in Scotland, Local Health Board in Wales. 3. GP10SS in Scotland, WP10SS in Wales.

6 Emergency supply of medicines

BNF 57

Emergency supply of medicines

Emergency supply requested by

(e) that the prescription-only medicine is not a sub-

member of the public

stance specifically excluded from the emergency Pharmacists are sometimes called upon by members of

supply provision, and does not contain a Controlled the public to make an emergency supply of medicines.

Drug specified in Schedules 1, 2, or 3 to the Misuse The Prescription Only Medicines (Human Use) Order

of Drugs Regulations 2001 except for phenobarbital 1997 allows exemptions from the Prescription Only

or phenobarbital sodium for the treatment of epi- requirements for emergency supply to be made by a

lepsy: for details see Medicines, Ethics and Practice, person lawfully conducting a retail pharmacy business

No. 32, London, Pharmaceutical Press, 2008 (and medicines subsequent editions as available). provided:

of (a) that the pharmacist has interviewed the person requesting the prescription-only medicine and is

Emergency supply requested by

satisfied:

prescriber

supply

(i) that there is immediate need for the prescrip- Emergency supply of a prescription-only medicine may tion-only medicine and that it is impracticable

also be made at the request of a doctor, a supplementary in the circumstances to obtain a prescription

prescriber, a community practitioner nurse prescriber

gency

without undue delay; (formerly a district nurse or health visitor prescriber), a nurse independent prescriber, or a pharmacist indepen-

Emer

(ii) that treatment with the prescription-only med- dent prescriber provided: icine has on a previous occasion been pre- scribed by a doctor, a supplementary prescri-

(a) that the pharmacist is satisfied that the prescriber by ber, a community practitioner nurse prescriber

reason of some emergency is unable to furnish a (formerly a district nurse or health visitor pre-

prescription immediately; scriber), a nurse independent prescriber, or a

(b) that the prescriber has undertaken to furnish a pharmacist independent prescriber, for the per-

prescription within 72 hours; son requesting it;

(c) that the medicine is supplied in accordance with the (iii) as to the dose that it would be appropriate for

directions of the prescriber requesting it; the person to take;

(d) that the medicine is not a substance specifically (b) that no greater quantity shall be supplied than will

excluded from the emergency supply provision, provide 5 days’ treatment except when the prescrip-

and does not contain a Controlled Drug specified tion-only medicine is:

in Schedules 1, 2, or 3 to the Misuse of Drugs Regulations 2001 except for phenobarbital or phe-

(i) insulin, an ointment or cream, or a preparation nobarbital sodium for the treatment of epilepsy: for for the relief of asthma in an aerosol dispenser

details see Medicines, Ethics and Practice, No. 32, when the smallest pack can be supplied;

London, Pharmaceutical Press, 2008 (and subse- (ii) an oral contraceptive when a full cycle may be

quent editions as available); supplied;

(e) that an entry shall be made in the prescription book (iii) an antibiotic in liquid form for oral administra-

stating:

tion when the smallest quantity that will (i) the date of supply; provide a full course of treatment can be sup- plied;

(ii) the name, quantity and, where appropriate, the pharmaceutical form and strength; (c) that an entry shall be made by the pharmacist in the prescription book stating:

(iii) the name and address of the practitioner requesting the emergency supply; (i) the date of supply;

(iv) the name and address of the patient; (ii) the name, quantity and, where appropriate, the pharmaceutical form and strength;

(v) the date on the prescription; (iii) the name and address of the patient;

(vi) when the prescription is received the entry should be amended to include the date on (iv) the nature of the emergency;

which it is received. (d) that the container or package must be labelled to

show:

Royal Pharmaceutical Society’s

(i) the date of supply;

Guidelines

(ii) the name, quantity and, where appropriate, the

1. The pharmacist should consider the medical con- pharmaceutical form and strength;

sequences of not supplying a medicine in an emer- (iii) the name of the patient;

gency.

2. If the pharmacist is unable to make an emergency (iv) the name and address of the pharmacy;

supply of a medicine the pharmacist should advise (v) the words ‘Emergency supply’;

the patient how to obtain essential medical care. (vi) the words ‘Keep out of the reach of children’ (or

For conditions that apply to supplies made at the similar warning);

request of a patient see Medicines, Ethics and Practice, No. 32, London Pharmaceutical Press, 2008 (and sub- sequent editions).