Entrustable Professional Activities

LG 10: Prescribing

Learning Goal 10

Prescribing

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

This activity requires the ability to:

  • collect and interpret medication histories, including the use of complementary and alternative therapies
  • choose appropriate pharmacological and/or non-pharmacological management options based on patients’ preferences, taking into consideration age, benefits, comorbidities, development, potential drug interactions, and risks
  • communicate with patients about the benefits and risks of different therapies
  • communicate instructions about medication administration
  • monitor medicines for efficacy and tolerability, and adjust doses or cease as appropriate
  • identify patients at increased risk from medications in the home, and initiate risk mitigation practices
  • collaborate with other health professionals, including pharmacists and nursing staff

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:

  • consider a range of factors prior to prescribing new medications, including:
    • age
    • allergies
    • illness type and trajectory
    • lifestyle factors
    • patient preference
    • potential drug interactions
  • incorporate a plan for follow-up and medication monitoring when commencing or adjusting medications
  • assess appropriate medications based on the clinical condition, prognosis, and goals of care of patients
  • formulate symptom management plans that include sufficient escalation steps to manage current or potential symptoms, detailing medications’ names, doses, intervals, and routes, using succinct and consistent language
  • incorporate non-pharmacological therapies into care and symptom management plans
  • identify complementary and alternative therapies sought out or used by families, and give advice on the risks and benefits offered by these practices
  • prescribe medications via appropriate routes for administration in the palliative care setting, such as subcutaneous or sublingual in the deteriorating or terminal phase of an illness, or subcutaneous or intravenous in the setting of nausea, vomiting, or bowel obstruction
  • prescribe anticipatory medications to ensure adequate preparation for the terminal phase of illnesses or crisis events across different care settings

direction
Requires some supervision

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

The trainee may:

  • be aware of potential side effects and practical prescription points, including medication compatibility and monitoring in response to therapies
  • select medicines for common conditions safely and accurately
  • demonstrate understanding of the benefits, contraindications, dosage, interactions, rationale, risks, and side effects of prescribed medications
  • 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 and evaluate the benefits, rationale, and risks of treatment options, making decisions in partnership with patients and their families, whānau, and/or carers based on illness stage and goals of care
  • seek guidance from pharmacists and other treating teams to ensure there are no contraindications for medications
  • tailor written instructions about symptom management and medication administration for patients, as well as other health professionals
  • educate patients about the expected outcomes, intended use, and potential side effects for each prescribed medication, addressing the common, rare, and serious effects
  • describe how the medication should and should not be administered

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 to reduce and understand reasons for non‑adherence, and monitor drug interactions, tolerability, and treatment effectiveness, adjusting and ceasing medicines as appropriate
  • access paediatric- and palliative care-specific drug references to ensure best prescribing practice, optimising medication efficacy and minimising risk
  • identify patients at increased risk from medications in the home, such as risk of misuse or diversion, and initiate risk mitigation practices, such as locked boxes for injectable medications
  • contribute to monitoring and evaluation strategies around prescribing, such as clinical audits
  • analyse adverse incidents and sentinel medication prescribing and administration events to identify system failures and contributing factors
  • report suspected adverse medication events to appropriate channels, and record in patients’ medical records

direction
Requires some supervision

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

The trainee may:

  • check the dose 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 clinical practice around prescribing
  • seek feedback from colleagues and learners on their own prescribing practice
  • supervise junior colleagues’ prescribing, and review drafted symptom management plans
  • use, and model the use of, appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new 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 and participate in 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:

  • incorporate cultural and language considerations and factors into conversations and decisions about medication prescription
  • tailor medication advice to the language, education, and health literacy of individual patients
  • provide 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 how these might influence the acceptability of pharmacological 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

direction
Requires some supervision

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

The trainee may:

  • consider the efficacy of medicines in treating illnesses, including the relative merits of different non-pharmacological and pharmacological approaches
  • 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 when selecting treatment options
  • incorporate findings from clinical and psychosocial assessments to formulate and explain choices for starting or continuing medications
  • choose suitable medicines only if medicines are considered necessary and will benefit patients
  • prescribe medicines appropriate to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest 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 and seek help in an appropriate way when required
  • consider the following factors for all medicines:
    • contraindications
    • cost to patients, their families, whānau, and/or carers, 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 other health professionals as appropriate, to ensure safe and effective medicine prescription and administration, including medical staff, pharmacists, and others

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:

  • incorporate considerations about access and availability when prescribing medications in palliative care, such as availability in the community, cost, and PBS listing status
  • advocate within health care organisations and to appropriate stakeholders when safety and availability of medications requires review, such as the cessation of certain medication products that are frequently used in palliative settings and are important for patient care

direction
Requires some supervision

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

The trainee may:

  • prescribe in accordance with the organisational policy