A prescription is a written order from a suitably qualified healthcare professional that authorises the dispensing or administration of a medicine for a patient. Prescribing is an essential skill, central to the practice of medicine, and has many component parts. Deciding what to prescribe requires you to have up-to-date knowledge of diagnosis, pharmacology and therapeutics, backed up by use of appropriate reference material and underpinned by good clinical and consultation skills. Writing the prescription requires you to apply this knowledge, with clear communication and consideration of the implications of the prescription for the patient, healthcare system and society.
The right to prescribe is controlled by legislation. In the UK, prior to 1992, only doctors, dentists and veterinary surgeons could write prescriptions. Prescribing training for these practitioners is therefore included in their undergraduate courses, with supervised prescribing early in postgraduate training required prior to professional registration. Subsequent legislation widened prescribing rights to allow nurses, pharmacists and optometrists, and soon radiographers, podiatrists and chiropodists, to be independent prescribers. These ‘non-medical prescribers’ are required to be experiencedpractitioners, to complete an accredited postgraduate prescribing course and to register this qualification on their professional register.
Whether you are learning prescribing at undergraduate or postgraduate level, you will require considerable practice to attain competence. The aim of this book is to allow you to practise making treatment decisions and writing realistic prescriptions for a wide range of simulated patients, to develop skills that will translate readily into clinical practice. This book is designed around the types and levels of tasks expected of a foundation doctor, but should also be useful for other healthcare professionals training to prescribe.
How to use this book
The book comprises an introductory chapter, which gives an overview of prescribing skills, and 50 simulated patients requiring treatment. For each patient there is a clinical scenario, a prepared chart for you to write the prescription and suggested answers including a model completed chart and an explanation of the prescription. The scenarios, model charts and explanations are presented consecutively in the main book. The prepared charts are provided in a separate workbook in patient order so that you can use them alongside the clinical information and compare them easily with the model answers.
The cases are organised by clinical setting, and have been chosen as situations likely to be encountered by foundation doctors. The three settings are: the acute take; on call in the hospital; and routine or specialty inpatient review. Each case requires you to perform a task at the level expected of a foundation doctor. Within each setting, the cases have been organised by approximate level of complexity, using the scheme shown in Box I.1. This is given as rough guide to allow you to work through more straightforward cases, before tackling more complex patients.