Is your prescribing up to standard?

 In Clinical Guidelines, Improving Compliance, Medicines Management Processes, Pharmacy Information

Prescriptions for Controlled Drugs (Schedule 2 and 3) can only be dispensed legally if the prescription contains all the mandatory requirements specified in the Misuse of Drugs Regulations 2001.

The regulations are specific and if the prescription isn’t written correctly, the pharmacist cannot supply the Controlled Drug.

There is no room for discretion for the pharmacist to dispense if the prescription doesn’t meet the required standards, apart from what is permitted in the regulations.

The pharmacist in a typical dispensary will frequently have to deal with perplexed prescribers who don’t like to be interrupted during their busy schedule to be asked to add the word “tablets” or write the quantity “in words, as well as in figures” on a prescription before it can be supplied.

Legal requirements

To be valid, on top of the normal prescription requirements required by the Human Medicines Regulations, Controlled Drug prescriptions must also contain all of the following:

  • The form (e.g. tablet).
  • The strength (e.g. 10mg, or for a liquid 10mg/5ml).
  • The dose (e.g. two tablets or 20mg).
  • The frequency (e.g. TDS).
  • The total quantity in words and figures (e.g. 30 (thirty) or 300 (three hundred) mls for a liquid).

If any of these details are missing or not written correctly, then the prescription will not comply with the regulations and cannot be dispensed legally.

The regulations for writing stock orders for Controlled Drugs also require the above details, apart from the dose and frequency.

Common errors for Controlled Drug prescriptions include:

  • Writing “as directed” or “MDU” as the dosage instruction is not permitted on its own, and nor is “when required” or “PRN” on its own.
  • Writing the dose “as per chart” or “titration dose” or similar wording is not sufficiently specific.
  • Writing a single prescription for two or more strengths is not possible. For example, a dose of 10mg of buprenorphine tablets would require two separate prescriptions (for the 2mg and 8mg strength tablets).
  • The strength and dose must be written separately, even if it is the same number.
  • The dose and frequency must be specified.

Prescribing examples quiz

Try to identify which of the following Controlled Drug prescriptions can be dispensed, and which would require the prescriber to rewrite the prescription:

Tramadol 50mg caps 50mg TDS x 30 (thirty)
Tramadol 50mg caps 1 TDS x 30 (thirty)
Tramadol 50mg caps 1 TDS x 1 (one) box
Tramadol 50mg caps 1 PRN x 30 (thirty)
Tramadol 50mg caps PRN x 30 (thirty)
Tramadol 50mg TDS x 30 (thirty)

(Answers at the bottom of the article)

The BNF has guidance for prescribers on prescription writing and also more details about the regulatory requirements for Controlled Drug prescriptions.

Please ask the Ashtons pharmacist for advice about prescription requirements if you require assistance.

The pharmacist is available until 10pm by calling 0345 222 3550.


 

Answers to quiz

  1. Dispense
  2. Dispense
  3. Amend
  4. Dispense
  5. Amend
  6. Amend
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