Entrustable Professional Activities

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe medications tailored to patients’ needs and conditions

This activity requires the ability to:

  • take and interpret medication histories
  • choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, benefits, comorbidities, potential drug interactions, and risks
  • communicate with patients, their families, whānau, and/or carers about the benefits and risks of proposed medications
  • provide plans for commencement, up-titration, and weaning of medications
  • provide instructions on medication administration effects and side effects
  • monitor medicines for efficacy and safety
  • review medicines and interactions, and cease where appropriate
  • collaborate with pharmacists and other clinicians

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’ medical issues requiring pharmacotherapy
  • consider non-pharmacologic therapies
  • consider age, allergies, chronic disease status, comorbidities, lifestyle factors, patient preference, and potential drug interactions prior to prescribing new medications
  • plan for follow-up and monitoring
  • administer medication appropriately, taking into consideration any important relationships to food, time of day, and other medicines being taken
  • provide written plans for medication commencement, up-titration, or weaning plans as appropriate

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, mechanism of action, rationale, risks, and side effects
  • 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 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
  • check patients’ understanding by repeating back pertinent information, such as when to return for monitoring and whether therapy continues after a single prescription
  • identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives
  • communicate and collaborate with other clinicians involved in patients’ care
  • interpret and explain information to patients at the appropriate level of their health literacy

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, whānau, 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 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 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
  • participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
  • report suspected adverse events to the relevant governing advisory body on drugs or medications in the jurisdiction, and record it in patients’ medical records
  • use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines
  • make prescribing decisions based on good safety data when the benefits outweigh the risks involved

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

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
  • check 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

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 independent information sources 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:

  • 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
  • anticipate queries to help enhance the likelihood of medicines being taken as advised
  • share appropriate information 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:

  • 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
  • acknowledge and discuss benefits and risks of alternative and complementary therapies that patients may wish to explore

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, families, 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 history, current medicines, allergies, and preferences, ensuring that 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