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
  • choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, allergies, benefits, comorbidities, potential drug interactions, and risks
  • communicate with patients about the benefits and risks of proposed therapies
  • provide instructions on medication administration effects and side effects
  • monitor medicines for efficacy, safety, and therapeutic levels, where appropriate
  • 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:

  • consider non-pharmacologic therapies
  • consider age, allergies, chronic disease status, immune compromise, lifestyle factors, patients’ preferences, and potential drug interactions prior to prescribing new medications
  • select appropriate route and duration of antibiotic therapy, rationalising their use and modifying where necessary, including when new microbial data becomes available
  • select appropriate antimicrobials for medical-, surgical-, and travel-related prophylaxis
  • implement appropriate immunisation, such as:
    • adult, with or without adequate childhood immunisation
    • routine childhood immunisation
    • those with special requirements
    • travellers
  • plan for follow-up and monitoring, including therapeutic drug monitoring where appropriate
  • monitor patients for indicators of response to therapy, and for adverse drug reactions

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
  • recognise the benefits, contraindications, dosage, drug interactions, 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:

  • counsel regarding efficacy, potential adverse events, and management for medications, including immunisations
  • discuss and evaluate the benefits, rationale, and risks of treatment options, including immunisations, making decisions in partnership with patients
  • write clear and legible prescriptions in plain language, including specific indications for the anticipated duration of therapy
  • educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication
  • describe optimal medication administration, including timing in relation to food, and concomitant medications

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 medications in full, including mg / kg / dose information and all legally required information
  • seek further advice from experienced clinicians or pharmacists when appropriate
  • address patients’ concerns and expectations

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:

  • undertake regular medication reviews to optimise adherence and efficacy, and identify adverse effects and drug interactions, de-prescribing when possible
  • use electronic prescribing tools, where available, and access electronic drug references to check for drug-drug interactions
  • 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
  • report suspected adverse events to the relevant pharmacovigilance authority, and document in patients’ medical records
  • consider local resistance patterns when prescribing antimicrobial therapy empirically

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:

  • ensure patients understand management plans, including adherence optimisation
  • use appropriate guidelines and evidence-based medicine resources

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:

  • use the available resources to ensure medicines prescribed are up to date
  • use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines
  • access information resources on the use and safety of antimicrobial agents during pregnancy and breastfeeding, particularly high-risk patients
  • consult pharmacists, Australia and Aotearoa New Zealand antibiotic guidelines, and other databases to obtain prescribing information
  • review evidence for antimicrobial drug resistance, cross-resistance, and, in the setting of antibiotic misuse, its consequences locally and globally

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 appropriate for their level of health literacy
  • 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 the medicine should be stopped
  • provide written consumer information sheets when available
  • make prescribing decisions based on good safety data when the benefits outweigh the risks involved
  • recognise 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 medicines safely and effectively to optimise patient outcomes
  • use a systematic approach to select treatment options
  • use medicines safely and effectively to optimise patient outcomes
  • 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
  • access decision support tools and guidelines to assist with antimicrobial prescribing

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 when required
  • consider the following factors for all medicines:
    • contraindications
    • funding (individual and community) 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 medical, pharmacy, and nursing staff to ensure safe and effective use of medicines

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 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 allergies, current medicines, history, and preferences, ensuring that resources are used wisely for the benefit of patients
  • advocate in favour of immunisation as a public health strategy, where appropriate

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