Entrustable Professional Activities

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

  • adhere to the principles of quality use of medicines, including scheduled medications
  • take and interpret medication histories
  • consider principles of personalised medicine approaches, such as concentration-guided dosing, in order to optimise medicine use
  • choose medicines based on an understanding of pharmacology, taking into consideration age, benefits, comorbidities, potential drug interactions, and risks
  • communicate with patients about the benefits and risks of proposed therapies and appropriate non-drug therapies
  • provide instructions on medication administration effects and side effects
  • monitor medicines for efficacy and safety, and deprescribe 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 the patients’ disorders requiring pharmacotherapy
  • consider non-pharmacologic therapies
  • elicit comprehensive drug histories, including complementary and alternative medicines (CAM)
  • apply principles of pharmacodynamics and pharmacokinetics to drug dosing regimens
  • consider age, allergies, chronic disease status, frailty, lifestyle factors, organ impairments, patient preference, pharmacogenomics, potential drug interactions, and therapeutic objectives prior to prescribing new medications
  • use pharmacokinetic equations to derive basic pharmacokinetic parameters
  • review patients’ drug concentrations, considering clinical condition, dosing history, and other factors that may affect interpretations of drug concentrations, such as age, lactation, pregnancy, and weight
  • predict the pharmacology and possible effects of a drug group from an understanding of its mechanism of action, including possible drug reactions
  • plan for follow-up and monitoring, and interpret the interpatient variability and factors contributing to it
  • consider critically reviewing medicines at each visit, deprescribing where appropriate, in discussion with patients and other relevant stakeholders
  • assess and introduce new medicines

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 accurately, appropriately, and safely
  • demonstrate understanding of the benefits, contraindications, dosage, drug interactions, rationale, risks, and side effects
  • identify and manage adverse events
  • interpret laboratory data

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
  • write complete, clear, legible, and legal prescriptions in plain language, and include specific indications for the anticipated duration of therapy
  • educate patients about the expected outcomes, intended use, and potential side effects for each prescribed medication, addressing the common, rare, and serious side 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, other medicines being taken, and advice to carers administering medication, where appropriate
  • 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
  • advise on off-label and unlicensed medication use
  • explore strategies to improve patient adherence, especially in chronic disease management

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 the required medication in full, including mg / kg / dose information and all legally required information
  • seek further advice from experienced clinicians or pharmacists when appropriate
  • use and advise about adherence aids

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
  • perform complex medication reviews, and provide advice on judicious prescribing
  • review medication charts and make suggestions to reduce inappropriate polypharmacy, drug interactions, and adverse drug reactions
  • 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
  • participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
  • evaluate and act upon drug prescription, dispensing, or administration errors
  • report suspected adverse events to the Therapeutic Goods Administration or Medsafe, and record it in patients’ medical records
  • develop evidence-based prescribing guidelines
  • stay informed and up to date on advances in research and best practice clinical care

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 and/or adverse drug reactions 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 medication management programs
  • use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines
  • ensure patients understand management plans, including adherence issues

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
  • promote safe prescribing for children
  • discuss prescribing errors
  • contribute to formulary maintenance
  • deliver clinical pharmacology teaching materials to undergraduate and postgraduate students

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 than placebo
  • use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines
  • analyse concentration-effect data
  • conduct and evaluate drug utilisation studies

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:

  • 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 prescribed medicines and:
    • how to take the medicine
    • potential side effects
    • what the medicine does
    • what the medicine 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-funded research and marketing
  • explain the legislative and regulatory controls for drugs of abuse
  • adjust prescribing practices to accommodate the growing occurrence of multimorbidity and polypharmacy in ageing populations

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 to select treatment options
  • use medicines safely, judiciously, 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
  • recognise the opposing viewpoints and pressures involved to market and subsidise new drugs
  • assess pharmacodynamic variation over time, and how this impacts clinical decisions

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
  • act as a liaison between laboratory scientists and clinicians on matters related to drug concentrations
  • collaborate with laboratory scientists in matters relating to paediatric drug concentrations

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
  • participate in drug and therapeutics committees

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
  • use electronic clinical decision support
  • support national initiatives around safe and effective use of medicines, including immunisation

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
  • explain the structure of medicine regulatory and health technology assessment bodies