Entrustable Professional Activities

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe medications tailored to patients’ needs, prognosis, and goals of care

This activity requires the ability to:

  • collect and interpret medication histories
  • choose appropriate pharmacological and/or non-pharmacological management options based on patients’ preferences, taking into consideration age, comorbidities, potential drug interactions, previous medication use (including alcohol, illicit drug, and nicotine use), benefits, and risks
  • communicate with patients about the benefits and risks of different therapies
  • give instructions about medication administration, taking into account patients’ illness stages
  • monitor medicines for efficacy and tolerability, and adjust doses or cease as appropriate
  • collaborate with other health professionals, including pharmacists and nursing staff
  • comply with regulatory requirements

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • formulate pharmacological management plans in palliative care, incorporating non-pharmacological therapies into care and symptom management plans
  • diagnose and manage side effects
  • consider a range of factors prior to prescribing new medications, including:
    • age
    • allergies
    • comorbidities
    • illness type and trajectory
    • lifestyle factors
    • patient preference
    • potential drug interactions
  • prescribe anticipatory medications to ensure adequate preparation for the terminal phase of illnesses or crisis events across different care settings
  • incorporate plans for follow-up and medication monitoring when commencing or adjusting medications
  • de-prescribe medications, when appropriate, in a timely manner
  • explore use of complementary and alternative medications
  • identify the psychosocial impact of comorbidities on patients, and provide support for these

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • formulate pharmacological management plans for common issues in palliative care
  • formulate plans for titration of medications for common symptoms
  • identify and manage adverse events

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • discuss the benefits, rationale, and risks of medication options
  • provide written instructions and information to patients when appropriate
  • communicate medication changes effectively to other health providers

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • discuss and explain the rationale for treatment options with patients
  • explain the benefits and burdens of therapies, considering patients’ individual circumstances
  • write clearly legible scripts or charts using generic names of required medications in full, including mg / kg / dose information and all legally required information
  • seek further advice from experienced clinicians or pharmacists when appropriate

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • review medicines regularly
  • check that dose conversions are accurate, appropriate, and safe when rotating opioids
  • institute timely follow-ups after medication changes
  • contribute to monitoring and evaluation strategies around prescribing, including clinical audits
  • analyse adverse incidents and sentinel events to identify system failures and contributing factors
  • identify patients at increased risk from medications in the home, such as risk of misuse or diversion, and initiate risk mitigation practices

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • check doses before prescribing
  • monitor side effects of prescribed medicines
  • identify medication errors, and institute appropriate measures
  • use electronic prescribing systems safely
  • rationalise medicines to avoid polypharmacy

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • regularly self-evaluate personal clinical practice around prescribing
  • seek feedback from colleagues and learners on their own clinical practice
  • address gaps in knowledge and skills through self-directed learning and continuing professional development
  • supervise junior colleagues’ prescribing
  • use teaching opportunities arising from prescribing
  • educate patients about their medication management plans
  • use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines
  • train carers, where appropriate, about the indications for administration of medications and when to seek assistance

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • undertake continuing professional development to maintain currency with prescribing guidelines
  • reflect on prescribing, and seek feedback from a supervisor

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • apply relevant research literature and evidence-based guidelines to prescribing practice
  • support clinical research to build the palliative care evidence base in prescribing

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • make therapeutic decisions according to the best evidence
  • recognise where evidence is limited, compromised, or subject to bias or conflict of interest

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • interpret and explain information to patients at the appropriate level of their health literacy
  • use plain-language and culturally appropriate patient education materials

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • appreciate patients’ cultural and religious backgrounds, attitudes, and beliefs, and take into account how these might influence the acceptability of pharmacologic and non-pharmacological management approaches

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • reflect on the ethical implications of pharmaceutical industry-funded research and marketing
  • consider the financial implications of prescribing

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • follow regulatory and legal requirements and limitations regarding prescribing
  • follow organisational policies regarding pharmaceutical representative visits and drug marketing

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use a systematic approach to select treatment options
  • prescribe medicines appropriate to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest cost and risk of potential harm to them
  • evaluate new medicines in relation to their possible efficacy and safety profile for individual patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise personal limitations when prescribing and seek help in an appropriate way when required
  • consider the following factors for all medicines:
    • contraindications
    • cost to patients and the community
    • funding and regulatory considerations
    • generic versus brand medicines
    • interactions
    • risk-benefit analysis

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • collaborate with multidisciplinary teams to ensure safe and effective medicine use

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • work collaboratively with pharmacists
  • participate in medication safety and morbidity and mortality meetings

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • choose medicines in relation to comparative efficacy, safety, and cost-effectiveness against medicines already on the market
  • contribute to the development of and review of prescribing guidelines

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • prescribe in accordance with organisational policy and evidence-based practice