Managerial C: Prescribing Safely

MC

Domain: Professionalism

Competency:

C. Able to prescribe drugs / therapeutics for patients safely and with knowledge of potential drug interactions

Recommended for assessment by Deanery:

Copy of practice drug prescribing protocols

Included for assessment :

Reflective commentary on prescribing protocols

An example of prescribing from the clinical records (anonymised)

Practice protocols for prescribing. (practice protocols for emergency drug prescription can be found in Section MK)

Prescribing protocols.

The practice and myself use the Dental Practitioners Formulary within the British National Formulary and Adult Antimicrobial Prescribing in Primary Dental care for General Dental Practitioners by the Faculty of General Dental Practice as the protocols for prescribing in practice. The protocols for emergency drug prescribing can be found within section MK.

Prescription Writing

Evidence A shows patient notes of a new patient who presented and was diagnosed with angular cheilitis and denture stomatitis. The patient was taking no medication and was prescribed a topical antifungal to apply the gel to the affected areas for a minimum of 5 days.

The prescription is annotated to show the necessary information that a prescription requires. Even a technically perfectly filled out prescription form for a drug that is neither needed or indicated is unprofessional and could cause serious harm. The following points give a summary of how drugs should be prescribed: (Adapted from FGDP guidelines)

Never prescribe a drug unless there is a good clinical indication.

Make prescriptions clear.

Use approved names.

Always make the source of prescription clear.

Always record prescription details in the clinical notes.

Avoid prescribing during pregnancy whenever possible.

Avoid abbreviations- give the name of drug in full.

Antimicrobials:

the resistance of to antimicrobials is a serious issue and can lead to resistant strains of micro-organisms, reducing the efficacy of traditional microbial treatments. Drug interactions can also occur e.g. Miconazole and Warfarin. The FGDP guidelines give examples of inappropriate use of antimicrobials:

• Unwarranted clinical situations
• Incorrect dosages and duration of antimicrobials
• Wrong choice of antimicrobials (e.g. Pathogen not susceptible to chosen microbial)

Indications:

As an adjunct to the management of acute or chronic infection

For the definitive management of active infectious disease.

The prevention of metastatic infection.

Evidence B shows copies from the FGDP guidelines on common dental diseases and their management (practice policy on prescribing)

Evidence A: An example of prescribing protocols.

Prescibing protocols could be photocopied from FGDPs prescribing or BNF.