How “Prescribe” came to be

The ‘Prescribe: Clinical pharmacology and prescribing’ e-learning programme has recently been launched for which I am an author and senior editor.

I became involved in healthcare education in my role as consultant pharmacist in academic pharmacy practice at a UK teaching hospital.  In conjunction with a nurse colleague, I developed an accredited course for pharmacist and nurse prescribers for a higher education institution in 2004.  I also contributed to the development of a competence framework for non-medical prescribers and trained as an independent prescriber myself.  Experienced practitioners began to question whether there was an equivalent course and competence framework for medical prescribers since all prescribers should work to the same standards of practice.

I conducted an audit of prescribing quality by doctors within the hospital against the local standards for good prescribing.  This looked at practical aspects of prescribing such as:

  • clear and legible writing of prescriptions;
  • the use of inappropriate abbreviations of drug names and dose units;
  • bioequivalent dosage of drugs prescribed by multiple routes of administration;
  • provision of legible prescriber details including name and contact number;
  • the correct method of cancelling and amending prescriptions.

The outcomes of this audit linked with the investigation of prescribing errors reported to the medication safety committee led to collaboration with the local medical school and the subsequent setting up of a prescribing course for final year medical students.  Students were required to demonstrate practical prescribing by writing a range of ‘student’ drug charts for patients they had encountered (based on real drug charts but altered so they couldn’t be used for drug administration to the patient).  This included the prescribing of high-risk drugs including insulins and treatment anticoagulation.  There was also an open-book summative examination looking at other practical aspects of prescribing such as calculation skills and interpretation of information found in the British National Formulary (BNF).  A formative drug chart assessment continues to this day, although the examination has been replaced by the national Prescribing Skills Assessment (PSA).

In 2012 I was approached about authoring several topics for ‘Prescribe’ in conjunction with Professor Simon Maxwell.  I wrote several sessions on topics such as how to write a hospital drug chart, calculation skills, intravenous fluid therapy and how to use the BNF.  Unforeseen problems delayed publication and launch of the course at that time.  In April 2016 I was approached to see if I was interested in working with the course team again.  This great team of people all collaborated to achieving the goal of launching the course at the British Pharmaceutical Society (BPS) conference in December.   I was able to update my original sessions and contribute to the editing of many more.  It was amazing just how much practice had moved on during the intervening years.  For example, we now have the electronic BNF (e-BNF) and electronic prescribing, both of which impact dramatically on prescribing practice.

‘Prescribe’ should help medical students to prepare for the PSA.  It is a resource that will support both medical students and junior doctors as they prepare for and gain experience in practical prescribing.

I feel very privileged to have had the opportunity to contribute to this initiative.  It has the potential to impact significantly on patient care and reduce the risk of harm arising from prescribing errors.

We will continue to review, update and develop the course.  We would love to hear your feedback – whether you found the course useful, any ideas you may have for new topics and, of course, any suggestions for improving what is already available.

To access the e-learning programme click here.

Alison G Eggleton
Consultant Pharmacist in Academic Pharmacy Practice
alison.g.eggleton@btopenworld.com