Entrustable Professional Activities

LG10: Prescribing

Learning Goal 10

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

  • take and interpret medication histories, including immunisation history
  • choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, weight, comorbidities, potential drug interactions, risks, and benefits
  • determine appropriate treatment regimens while weighing up risks versus benefits
  • communicate with patients, families, and/or carers about the indications, benefits, and risks of proposed therapies
  • provide instructions on treatment administration effects and side effects
  • monitor medicines for efficacy and safety
  • review medicines and interactions, and cease where appropriate
  • collaborate with pharmacists
  • apply knowledge and competency in prescribing new therapies

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:

  • identify the patients’ disorder requiring pharmacotherapy
  • identify medicines that may cause a high risk of harm to children (including young women at child-bearing age)
  • consider non-pharmacological therapies
  • consider age, gestation, weight, chronic disease status, allergies, and potential drug interactions when prescribing
  • demonstrate an awareness of, and mitigate, calculation errors
  • optimise the use of antimicrobials with involvement with antimicrobial stewardship
  • plan for follow up and monitoring
  • demonstrate awareness of different formulations of common medications, and consider appropriate formulations and/or strengths for individual patients
  • recognise the impacts of age and metabolism on the absorption, distribution, and excretion of medicines
  • apply knowledge and competency in prescribing new drug therapies, changes in line with updates in guidelines and protocols, and rationalising therapies with regular medication reviews

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, such as medication compatibility and monitoring in response to therapies
  • appropriately, safely, and accurately select medicines for common conditions
  • demonstrate an understanding of the rationale, risks and benefits, side effects, contraindications, dosage, and drug interactions
  • 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 risk and benefits of treatment options, making decisions in partnership with patients and their parents and/or carers
  • write clear, legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
  • demonstrate dosing / drug delivery techniques and include written instructions / plans, and ask the parent or carer to demonstrate to confirm knowledge
  • educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common and the rare but serious side effects at the time of prescribing, to improve patients’ adherence to pharmacotherapy
  • outline strategies to assist with children taking unpalatable medicines
  • describe how the medication should and should not be administered, including any important relationships to food, time of day, and other medicines being taken
  • ensure patients’ understanding by repeating back pertinent information, such as when to return for monitoring and whether therapy continues after this single prescription
  • identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives

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, families, and/or carers
  • explain the benefits and burdens of therapies, considering patients’ individual circumstances
  • write clearly legible scripts or charts using generic names of the required medication in full, including mg / kg / dose information and all legally required information
  • seek further advice from experienced clinicians, pharmacists, or physiotherapists (for nebulised therapy) 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 improve compliance, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
  • use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions, miscalculation, and poor handwriting
  • consider available evidence and experience prior to prescribing new medications
  • participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
  • report suspected adverse events to the Advisory Committee on Medicines, and record it in patients’ medical records
  • educate patients and families on nature and type of adverse events, including misconception of allergic reaction

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 medicines prescribed
  • identify medication errors and institute appropriate measures
  • use electronic prescribing systems safely
  • rationalise medicines to avoid polypharmacy and reduce care burden
  • exhibit awareness of potential financial support to assist patient access to medication (e.g., Health Care Card and Close The Gap scheme in Australia)

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:

  • use continuously updated software for computers and electronic prescribing programs
  • role model how to ensure patients understand management plans, including adherence issues
  • use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, and keep up to date on new medicines, changes in the use of existing medications, and updates in guidelines

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 and innovations in drug therapies
  • 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:

  • critically appraise research material to understand the benefits and risks (including financial cost) of new medicines relative to medicines that have been on the market for longer
  • use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines

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:

  • use culturally safe health information resources to facilitate patient understanding of the benefits and risks of specific medications
  • explore patients’ understanding of and preferences for non-pharmacological and pharmacological management
  • offer patients effective choices based on their expectations of treatment, health beliefs, and cost
  • interpret and explain information to patients at the appropriate level of their health literacy
  • anticipate queries to help enhance the likelihood of medicines being taken as advised
  • ensure appropriate information is available at all steps of the medicine management pathway

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:

  • provide information to patients about:
    • how to take the medicine
    • potential side effects
    • what it does
    • what it is for
    • when it should be stopped
  • make prescribing decisions based on good safety data when the benefits outweigh the risks involved
  • demonstrate understanding of the ethical implications of pharmaceutical industry marketing and funded research

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 pharmacological and non-pharmacological options
  • 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
  • use medicines safely and effectively to get the best possible results
  • choose suitable medicines only if medicines are considered necessary and benefit patients
  • prescribe medicines appropriately to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest cost to them
  • evaluate new medicines in relation to their possible efficacy, financial cost, 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:

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

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:

  • interact with medical, pharmacy, and nursing staff 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 and other relevant medical experts (e.g., infectious disease physicians in antibiotic stewardship)
  • 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
  • prescribe for individual patients, considering history, current medicines, allergies, and preferences, ensuring resources are used wisely for the benefit of patients
  • advocate for appropriate immunisations and vaccines while maintaining respect for the views and wishes of individual patients
  • advocate for and support smoking and vaping cessation interventions, including nicotine withdrawal therapies for young people and carers
  • advocate for equitable access to effective treatment available overseas or not currently subsidised by the government for patients in Australia and New Zealand

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