L07: Prescription and Drug Charts

• Prescriptions


  An instruction written by a medical practitioner that authorises a patient to be issued with a medicine or treatment
• Drug Charts


  Written [or electronic] instructions from a doctor, dentist or non-medical prescriber for a medicine to be supplied or administered to a named patient after the prescriber has assessed the patient on an individual basis
• Prescribers


  • Medical practitioners: Doctors and Dentists
  • Veterinary surgeons
  • Non-medical prescribers (NMPs): Nurses IP/SP, Optometrists IP/SP, Pharmacists IP/SP, Physiotherapists SP/IP, Podiatrist SP/IP, Radiographers IP/SP, Paramedics IP/SP
• Prescribers


  • Electronically generate and/or write legible, unambiguous and complete prescriptions which meet legal requirements
  • Effectively use the systems necessary to prescribe medicines
  • Document accurate, legible and contemporaneous clinical records
• Primary Care


  Pharmacological therapy in the primary care setting in England
• NHS Prescription documentation

  • Standardised to minimise the risk of fraudulency, reduce error, identify elements of accountability, facilitate remuneration for medicines, allow for the collection of data on prescribing patterns and costs
• Legal requirements for a prescription

  • Patient identification: Name and address
  • Age or DOB (if under 12)
  • Signed
  • Dated
  • Name and address of practitioner
  • Written in indelible ink
  • Additional requirements for controlled drugs
• The 5 Rights

  The right drug, at the right dose, by the right route, at the right time, to the right patient

  Considering contraindications, interactions, adverse effects and allergies, and the right to refuse
• NHS FP10 Prescriptions in England

  • GREEN: FP10SS, FP10NC (any medicine on the NHS, including controlled drugs)
  • BLUE: FP10(H)MDA (drugs of misuse, e.g. methadone)
  • YELLOW: FP10D (dental practitioners)
  • LILAC: FP10P (practice nurses)
• Requirements of the FP10 prescription

  • Patient Name
  • Patient address
  • Age or DOB (if under 12)
  • Signature of prescriber
  • Date
  • Particulars of prescriber
  • Address of prescriber
• Electronic Prescription Service (EPS)


  Allows the prescription to be sent electronically from the General Practitioner to a nominated community pharmacy
• The legalities of the prescription remain the same with EPS
• Codes, colours and format of the FP10 used in England differ in Wales, Scotland and NI and the Isle of Man
• NHS FP10 Prescriptions in Wales, Scotland and NI

  • FP10P - Practice Nurses (HS21(N) in NI, GP10(N) in Scotland, WP10CN and WP10PN in Wales)
• NHS Prescription Services

  • England - NHS Business Services Authority
  • Ireland - NI Direct Government Services
  • Scotland - NHS National Services Scotland
  • Wales - NHS Wales Informatics Services
• Secondary Care

  Pharmacological therapy in the hospital setting
• An estimated 500,000 prescriptions are generated in English NHS Hospitals on a daily basis, and in a large acute NHS Hospital, there can be up to 100,000 medicines administrations each week
• Prescriptions are generated for inpatients, patient discharge, outpatients, and account for approximately 55% of the total cost of medicines in the NHS (in England)
• Patient Specific Directions (PSD)


  Written [or electronic] instructions from a doctor, dentist or non-medical prescriber for a medicine to be supplied or administered to a named patient after the prescriber has assessed the patient on an individual basis
• There is no standard documentation for the PSD in English hospitals, hospitals design, maintain, monitor and enforce their own documentation
• All hospitals in Wales use the same PSD inpatient drug chart, and the Single Prescription and Administration Record for Scotland (SPARS) is in draft form
• Inpatient Drug Charts


  • Must allow for the documentation of patient identifiable information, allergy status, and patient information to inform dose calculations
  • Must allow for the instruction of regular medicines, variable regimens, single/one-off doses, when required medicines, and infusions
  • Must allow for the documentation of all administration
• Requirements of the PSD

  • Patient Name
  • Patient Address
  • Age or DOB (if under 12)
  • Hospital number
  • Signature of prescriber
  • Date
  • Name/qualifications of prescriber
  • Address of practitioner
• Outpatients

  Hospital specific outpatient prescriptions can only be dispensed in the Hospital Pharmacy, for medicines intended to treat the condition for which the patient was referred, hospital only medicines, medicines requiring monitoring, or medicines required urgently
• Prescribing for Discharge


  TTO's (To Take Out), TTH (To Take Home) - a direction for pharmacy to supply, stating all drug treatments that are to continue on discharge and any changes in drug treatment during the hospital stay
• PSD documentation, although not standardised, is designed to facilitate the documentation of a complete prescription, reduce the risk of error, minimise the risk of fraudulency, identify elements of accountability, and document a patient's pharmacological history for a single hospital admission
• Private Prescriptions


  Can be issued by any prescribing practitioner, the patient pays for the cost of the medicines and for the pharmacists time, for private healthcare or items that cannot be prescribed on the NHS
• Private Prescription Documentation


  • Must be headed with the name and address of the prescribing practitioner, and state the registration number and qualifications of the practitioner
• Private prescriptions for controlled drugs (e.g. morphine) are on PINK FP10PCD forms in England, to ensure the supply is auditable through the NHS Business Services Authority