UK-wide medical defence organisation MDDUS is issuing prescribing tips for new graduates embarking on their first hospital jobs next week.
Starting life as a junior doctor is a daunting and exciting challenge, with thousands of graduates taking to the wards on the first Wednesday of August.
MDDUS medical adviser Dr Naeem Nazem offers advice for new foundation year doctors to avoid common pitfalls in prescribing medication. This advice will appear in full as part of an article in the forthcoming issue of MDDUS membership magazine FYi http://bit.ly/1758aZx.
"Prescribing the right drug, in the right dose, to the right patient, is one of the most important responsibilities of any doctor," says Dr Nazem. "It is particularly relevant to hospital trainee doctors, who are often asked to prescribe unfamiliar drugs to unfamiliar patients."
Here, MDDUS offer our top five prescribing tips for new doctors:
1) Write legibly
"Take care to write clearly and legibly, preferably in capital letters using the generic name of the drug," says Dr Nazem. "Many people will need to understand your prescription, from the hospital pharmacist to the nurse on the drug round.
"Some examples we have encountered where patients have received a different drug to the one intended due to an illegible prescription are: carbamazepine vs carbimazole, chlorpromazine vs chlorpropamide and Losec™ vs Lasix™.
"The same cautions apply in hospitals that use electronic prescribing, especially computer systems that use predictive text. MDDUS encountered one case where a patient developed severe toxicity after a patient was prescribed methotrexate instead of metoclopramide. The doctor had typed in 'met' and selected the wrong option from the drop-down menu."
2) Check dosage and frequency
"One source of dosing errors is between 'mg' and 'mcg'," says Dr Nazem. "This often occurs at the time of re-writing a barely legible drug chart, or when instructions to prescribe a drug do not come with the units.
"The consequence is that the patient receives a dose of the drug which is incorrect by a factor of 1,000. Avoid the abbreviation 'µg' which is often misread as 'mg'. You could also try adding a space between each letter to make it clearer, for example writing 'm g' or 'm c g' instead. Remember you are personally responsible for every prescription you write."
Even when the correct drug has been prescribed, patients can come to harm if it is given at an inappropriate dose or frequency. "We have encountered several cases in which a loading dose of digoxin was inadvertently continued as a maintenance dose," says Dr Nazem.
"Errors have also occurred with bisphosphonates being prescribed daily rather than weekly. Such errors are more likely to occur when drug charts are re-written or amended."
3) Confirm route
"Many patients in hospital require complex medical care, which may include the administration of drugs by different routes," says Dr Nazem. "It is important to include a route of administration for every drug you prescribe and ensure the appropriate dosage.
"There have been several cases in which the chemotherapy drug vincristine, which should be administered intravenously, has been incorrectly delivered intrathecally with fatal consequences. Although numerous safeguards have been developed to try and eliminate the risk of this error, it has continued to occur."
4) Consider drug interactions
"Many patients in hospital have complex co-morbidities requiring numerous medications," says Dr Nazem. "It's worth checking a patient's existing medicines before prescribing anything new.
"Consider whether the effects of one drug may be affected by the addition of another, or whether the combination may pose a greater risk of adverse effects to the patient. We have seen cases of patients on warfarin reaching dangerous levels of anticoagulation due to the addition of an interacting antibiotic."
5) Don't be afraid to seek help
"Remember you are not alone," adds Dr Nazem. "As well as the national and local formularies, you should take advantage of the knowledge of those around you. The ward pharmacist will be able to provide valuable advice on dosing regimens and possible drug interactions. You should also ask senior colleagues to clarify any drugs they ask you to prescribe which are unfamiliar."