Entrustable Professional Activities

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

  • collect and interpret medication histories
  • choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, comorbidities, potential drug interactions, risks, and benefits
  • prescribe safely, as per treatment schedules of known protocols and clinical trials
  • communicate with patients about the benefits and risks of proposed therapies
  • explain instructions on medication administration effects and side effects
  • monitor medicines for efficacy and safety, including with drug levels, toxicity screening, and pharmacogenomics
  • review medicines and interactions, and cease where appropriate
  • collaborate with pharmacists

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 patients’ disorders requiring pharmacotherapy
  • consider and prescribe non-pharmacologic therapies
  • consider age, chronic diseases, lifestyle factors, allergies, potential drug interactions, and patient preference prior to prescribing new medications
  • plan for follow-up and monitoring
  • maintain up-to-date knowledge of medications and therapies, including their interactions with other therapeutic modalities
  • apply commonly used treatment protocols

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
  • select medicines for common conditions appropriately, safely, and accurately
  • demonstrate understanding of the rationale, risks, benefits, side effects, contraindications, dosage, and drug interactions
  • identify and manage adverse events
  • calculate body surface area for chemotherapy prescribing

Communication

confident
Ready to perform without supervision

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

The trainee will:

  • describe how the medication should and should not be administered, including any important relationships to food, time of day, and other medicines being taken
  • discuss and evaluate the risks, benefits, and rationale of treatment options, making decisions in partnership with patients
  • write clear and legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
  • educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common, rare, and serious effects at the time of prescribing to improve patients’ adherence to pharmacotherapy
  • 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
  • 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
  • provide written / online information when available

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 non-adherence, 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 and poor handwriting
  • prescribe new medicines only when they have been demonstrated to be safer or more effective at improving patient-oriented outcomes than existing medicines
  • identify patients at increased risk from medications in the home (e.g. risk of misuse or diversion), and initiate risk mitigation practices (e.g. locked box for injectable medications)
  • report suspected adverse events to the Advisory Committee on Medicines, and record it in patients’ medical records
  • participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade

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:

  • use continuously updated software for computers and electronic prescribing programs
  • ensure patients understand management plans, including adherence issues
  • use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines

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:

  • critically appraise research material to ensure any new medicine improves patient-oriented outcomes more than older medicines, and not just more a placebo
  • use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines
  • enrol patients in treatments and supportive care clinical trials, understanding the rationales and medications involved

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
  • consider available evidence, guidelines, and clinical trials

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:

  • 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 non-pharmacological and 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:

  • make prescribing decisions based on good safety data when the benefits outweigh the risks involved
  • provide information to patients about:
    • how to take the medicine
    • potential side effects
    • what the medicine is for
    • what the medicine does
    • when it should be stopped
  • make prescribing decisions based on good safety data when the benefits outweigh the risks
  • demonstrate understanding of 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
  • explain the use of orphan medications in children

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 will 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 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 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:

  • 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
  • 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 their history, current medicines, allergies, and preferences, ensuring that health care resources are used wisely for the benefit of patients

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