These top-tips from the Royal College of Paediatrics and Child Health (RCPCH) prescribing tool will help you improve your prescribing. We have also added some tips. Prescribing errors sadly remain common, in all grades of doctors. Good prescribing ensures that the right patient gets the right medicine at the right dose at the right time for the right reason. This takes practice. It is not surprising therefore that prescribing is being included in most medical school OSCE practical examinations.
General Points
Use a black pen, write legibly and add name and contact details (bleep and extension if relevant)
Complete patient name, date of birth, hospital number, ward and Consultant
NHS number (in the UK) is used in preference of hospital number
Include ward name, speciality and hospital site
Check weight is appropriate for age of child and is dated
Complete and sign the allergy box whether or not there is an allergy
Use current British National Formulary for Children
Check and use local prescribing guidelines (e.g. antibiotics and sedation)
Prescribe sensible and practical doses of medicine, which can easily be measured. (This will require checking the concentration of some drugs and with the nurses regarding practicality of dose administration)
Always check the suitability of the chosen dosage form for each child
Familiarise yourself with the Trust's Prescription Chart
Always check whether the child is already taking any medications
Concordance; inform the child and/or parents of any prescribing changes you make
Medicines
Names:
Print the drug name clearly and in capitals
Use the approved (generic) rather than brand names. (Some medicines also require the brand name in brackets)
Dosage Units:
Use of 'g', 'mg' and 'ml' is allowed but spell out all other units in full e.g. units, micrograms, nanograms
It is better to not use decimal points where possible (e.g. 500mg is better than 0.5g). However, if you do use a decimal point always ensure you preceed the decimal point with a zero (i.e. 0.5mg rather than .5mg)
Dosage forms must be stated
Do not prescribe liquids in ml unless indicated in the BNFc (e.g. some vitamins may be prescribed by volume). If you do prescribe in fluid volumes then specify the concentration
Route:
Specify the route of administration
Most common routes are INH (inhaled), PO (oral), IV (intravenous), IM (intramuscular), SC (subcutaneous), TOP (topical)
If necessary spell out e.g. intrathecal
Timing:
Write frequency: OD (once a day), BD (twice a day), TDS (three times a day), QDS (four times a day)
Specify times required
Write start and stop dates
Write frequency for "as required" medication, including the clinical indication and maximum daily dose
Paediatric life support and neonatal life support algorithms at back of the BNFc
Emergency treatment of poisoning at front of BNFc including paracetamol overdose chart
Appendices contain information on drug interactions and feeding formulations
Surface area conversion charts at back of BNFc
Drug Conversions
It is important to understand drug conversions to facilitate safe prescribing.
