Prescribing-Guidance-updated-English-20210405_pdf-85260533 (2).pdf

You can find the latest version of this guidance on our website at www.gmc-uk.org/guidance Good practice in prescribing and managing medicines and devices You are responsible for the prescriptions that you sign. You must only prescribe medicine when you have adequate knowledge of your patient’s hea...

You can find the latest version of this guidance on our website at www.gmc-uk.org/guidance Good practice in prescribing and managing medicines and devices You are responsible for the prescriptions that you sign. You must only prescribe medicine when you have adequate knowledge of your patient’s health. And you must be satisfied that the medicine serves your patient’s need. Following this guidance will help make sure that you practise safe prescribing. It reminds you that, where possible, you must avoid prescribing for yourself or those close to you. This guidance came into effect on 5 April 2021. Download the guidance You can download this guidance in English or Welsh. n n This guidance covers what you need to consider when prescribing unlicensed medicines, repeat prescribing and when you share responsibility for your patient with a colleague. It also gives important advice on how to work safely when you’re not the patient’s regular prescriber or when you are providing care for patients remotely, including those who are based overseas. Prescribing and managing medicines and devices (English) Presgripsiynu a rheoli meddyginiaethau a dyfeisiau (Cymraeg) This guidance applies equally to all prescribing, in whatever setting your interaction with a patient takes place, including remote consultations. If you can’t meet the standards, it may be appropriate to offer an alternative mode for the consultation to ensure safe care that meets our standards. 01 Good practice in prescribing and managing medicines and devices About this guidance 1 In ‘Good medical practice’ (2013)1 we say: n n n n 12 You must keep up to date with, and follow, the law, our guidance and other regulations relevant to your work. n 14 You must recognise and work within the limits of your competence. 16 In providing clinical care you must: a prescribe medicine or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the medicine or treatment serve the patient’s needs n c the information given to patients d any drugs prescribed or other investigation or treatment e who is making the record and when. This guidance gives more detailed advice on how to comply with these principles when prescribing and managing medicines and medical devices. The guidance applies to all prescribing in whatever setting your interaction takes place, including remote consultations. You are responsible for the prescriptions you sign. You are also accountable for your decisions and actions when supplying or administering medicines and devices, and when authorising or instructing others to do so. 4 ‘Prescribing’ is used to describe many related activities, including: 21 Clinical records should include: b the decisions made and actions agreed, and who is making the decisions and agreeing the actions f check that the care or treatment you provide for each patient is compatible with any other treatments the patient is receiving, including where possible self-prescribed over-the-counter medications. 3 19 Documents you make to formally record your work, including clinical records, must be clear, accurate and legible. You should make records at the same time as the events you are recording or as soon as possible afterwards. a relevant clinical findings b provide effective treatments based on the best available evidence 2 18 You must make good use of the resources available to you. a supplying prescription-only medicines b prescribing medicines, devices, dressings and activities, such as exercise c advising patients on the purchase of over the counter medicines and other remedies. 5 It may also be used to describe any written information (information prescriptions) or advice you give to patients. While some of this guidance is particularly relevant to prescription-only medicines, you should follow it in relation to the other activities you undertake, so far as it is relevant and applicable. 02 Good practice in prescribing and managing medicines and devices 6 7 Prescribing happens in a range of contexts, including face to face and remotely using telephone, online and video-link or other technological platforms. If you can’t meet the standards set out in this guidance through the mode of consultation you are using, you should offer an alternative if possible, or signpost to other services. If you think that systems, policies or procedures are, or may be, placing patients at risk of harm, you must follow the guidance in ‘Raising and acting on concerns about patient safety’.2 You must be prepared to explain and justify your decisions and actions when prescribing, administering and managing medicines and devices. Only serious or persistent failure to follow our guidance that poses a risk to patient safety or public trust in doctors will put your registration at risk. Keeping up to date and prescribing safely 8 As outlined in ‘Good medical practice’, you must recognise and work within the limits of your competence and you must keep your knowledge and skills up to date. You must maintain and develop your knowledge and skills that are relevant to your role and practice in: a pharmacology and therapeutics b prescribing and managing medicines c any technology or processes you use to prescribe, for example via remote consultation. 9 You should make use of electronic and other systems that can improve the safety of your prescribing, for example by highlighting interactions and allergies and by ensuring consistency and compatibility of medicines prescribed, supplied and administered. 10 The Medicines and Healthcare products Regulatory Agency’s (MHRA) Drug Safety Update and Central Alerting System provide information and advice to support the safer use of medicines relevant to your practice and alert you to safety information about medicines you prescribe. 11 The National Institute for Health and Care Excellence (NICE) brings together evidence on the safe, effective and efficient use of medicines from a range of organisations in Evidence Search. It also publishes a range of products to help you improve the safety, as well as the clinical and cost effectiveness, of your prescribing. This includes Patient Decision Aids. The electronic Medicines Compendium contains Summaries of Product Characteristics and Patient Information Leaflets (PILs). 12 If you are unsure about interactions or other aspects of prescribing and managing medicines, you should seek advice from experienced colleagues, including pharmacists, prescribing advisers and clinical pharmacologists. 13 You must be familiar with the guidance in the British National Formulary (BNF) and British National Formulary for Children (BNFC), which contain essential information to help you prescribe, monitor, supply, and administer medicines. 14 You should follow the advice in the BNF on prescription writing and make sure your prescriptions and orders are clear, in accordance with the relevant statutory requirements. You should also make sure you include your name legibly.3 As well, you should consider including clinical indications4 on your prescriptions. 03 Good practice in prescribing and managing medicines and devices 15 You should take account of the clinical guidelines published by: a National Institute for Health and Care Excellence (England) b Department for Health, Social Services and Public Safety (Northern Ireland) c Healthcare Improvement Scotland (including the Scottish Medicines Consortium and Scottish Intercollegiate Guidelines Network) (Scotland) d All-Wales Medicines Strategy Group (Wales) e medical royal colleges and other authoritative sources of specialty specific clinical guidelines. 16 You should be careful about using medical devices for purposes for which they were not intended. 17 You should make sure that anyone you delegate responsibility for dispensing or administering medicines to is competent to do what you ask.5 Advice on training for dispensing support staff can be obtained from the General Pharmaceutical Council and Pharmaceutical Society of Northern Ireland (PSNI). 18 Where relevant, if you don’t wish to prescribe due to a conscientious objection, you should follow our explanatory guidance on ‘Personal beliefs and medical practice’. 19 You should not collude in the unlawful advertising of prescription-only or unlicensed medicines to the public by prescribing via websites that breach advertising regulations.6 Deciding if it is safe to prescribe 20 You should only prescribe medicines if you have adequate knowledge of the patient’s health and you are satisfied that the medicines serve the patient’s needs. You must consider: a the suitability of the mode of consultation you are using, for example face to face or remote, taking account of any need for physical examination or other assessments (see paragraphs 21 to 26) b whether you have sufficient information to prescribe safely, for example if you have access to the patient’s medical records and can verify relevant information (see paragraphs 27 to 33) c whether you can establish two-way dialogue, make an adequate assessment of the patient’s needs and obtain consent (see paragraphs 34 to 38) d whether you can share information appropriately after an episode of care (see paragraphs 53 to 58). Does the mode of consultation meet the individual needs of the patient and support safe prescribing? 21 Patients may prefer to access healthcare services face-to-face or through remote consultations via telephone, video-link or online, depending on their individual needs and circumstances.7 Where different options exist, and when it is within your power, you should agree with the patient which mode of consultation is most suitable for them. 04 Good practice in prescribing and managing medicines and devices 22 Circumstances in which a face-to-face consultation may be more appropriate than a remote consultation include when: a you are unsure of a patient’s capacity to decide about treatment (see paragraphs 41 to 44) b you need to physically examine the patient c you are not the patient’s usual doctor or GP and they have not given you consent to share their information with their regular prescriber; this is particularly important if the treatment needs following up or monitoring, or if you are prescribing medicines where additional safeguards are needed (see paragraphs 59 to 66) d you are concerned that a patient does not have a safe and confidential place to access healthcare remotely, for example due to domestic abuse e you are concerned that a patient may be unable to make a decision freely because they are under pressure from others (see paragraphs 69 to 75 of ‘Decision making and consent’). 23 If you are not the patient’s regular prescriber, such as a GP, you should: a tell the patient your name, role and, if online, your GMC registration number b explain how the consultation is going to work and what they should do if they have any concerns or questions c follow the advice in paragraphs 27 to 33 and 53 to 58 on sharing information. 24 Before you prescribe, you must be satisfied that you can make an adequate assessment, establish a dialogue and obtain the patient’s consent through the mode of consultation you are using (see paragraphs 34 to 44). 25 You must also consider and respond to the patient’s communication needs and make reasonable adjustments to your practice, where necessary, so they can receive care that meets their needs.8 26 You must carry out a physical examination of patients before prescribing non-surgical cosmetic medicines, such as Botox, Dysport, Vistabel or other injectable cosmetic medicines. Therefore, you must not prescribe these medicines remotely. Do you have enough information about the patient to prescribe a treatment that meets their needs? 27 You must only prescribe if it is safe to do so. a It’s not safe to prescribe if you don’t have sufficient information about the patient’s health or if the mode of consultation is unsuitable to meet their needs. b It may be unsafe if relevant information is not shared with other healthcare providers involved in the patient’s care – for example because the patient refuses consent. 28 Before prescribing, you must consider whether the information you have is sufficient and reliable enough to enable you to prescribe safely. For example, whether: a you have access to the patient’s medical records or other reliable information about their health and other treatments they are receiving b you can verify other important information by examination or testing c the patient would be at risk of death or serious harm if they are also obtaining medication from other sources. 05