Prescribing practices

Rationale

Prescribing medications safely is a central component of most physicians’ activities and requires appropriate medical knowledge, skill, professional judgment, and an understanding of the applicable legislation related to prescribing.

Key Objectives

To safely and effectively manage a patient presenting with a condition that requires prescription medication, the candidate will first undertake a thorough clinical assessment and then apply principles of evidence-based medicine and cost effectiveness in prescribing.

Enabling Objectives

Given a patient that requires a medication to be prescribed safely and effectively, the candidate will

1. undertake a thorough clinical assessment, including:
   1. a complete medication history, including allergies and intolerances;
   2. a review for adherence and effectiveness of the patient’s current medications;
   3. address polypharmacy and the options for deprescribing; and
2. apply principles of clinical pharmacology in prescribing medication to
   1. address the effect of comorbidities, current medications, liver and renal function, genetics, age, and pregnancy on the risks and benefits of prescribing the medication;
   2. apply an evidence-based approach to clinical and cost effectiveness, including prescribing generic medications when appropriate;
   3. anticipate the potential for adverse effects and take steps to mitigate them (e.g., prescribing appropriate routes, strengths, and quantities of medication);
   4. recognize potential medical interactions when prescribing new medications;
   5. recognize barriers to patients access to the medication (e.g., affordability, accessibility, supply) and advocate to resolve these where possible; and
3. document the prescription appropriately, including:
   1. generating a clear and legible prescription that meets legal requirements;
   2. recognizing common cases of medication errors and how they can be prevented;
   3. creating contemporaneous clinical notes of prescribing decisions;
   4. documenting appropriate follow-up plans for review of the effectiveness of the prescribed medication and any adverse effects encountered; and
4. communicate with the patient or, if appropriate, their family or caregivers to
   1. build a therapeutic relationship that encourages adherence but respects the patient’s values, beliefs, and expectations about medications and their right to refuse treatment;
   2. ensure they understand the rationale for the prescription;
   3. provide them with information about any adverse effects, how to report them, and what they should do if adverse effects occur;
   4. ensure that those involved in sharing care or transfer of prescribing responsibilities are adequately informed about the prescription.