Entrustable Professional Activities

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

  • take and interpret medication histories
  • choose appropriate medicines and doses based on an understanding of pharmacology, taking into consideration age, allergies, benefits, comorbidities, potential drug interactions, pregnancy or breastfeeding, and risks
  • communicate with patients, families, and/or carers about the benefits and risks of proposed therapies
  • provide instructions on medication administration effects and side effects
  • monitor medicines for efficacy and safety
  • review medicines and interactions, and cease, switch, or adjust dose 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’ needs requiring pharmacotherapy
  • consider non-pharmacologic therapies
  • consider age, allergies, chronic disease status, lifestyle factors, patient preference, potential drug interactions, and pregnancy prior to prescribing a new medication
  • consider past treatment history and resistance profile (if relevant) prior to commencing or changing medication
  • demonstrate awareness of the special access scheme
  • plan for follow-ups and monitoring
  • recognise up- and down-titration regimen in terms of dosages and rate of change

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 awareness of 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:

  • discuss and evaluate the risks, benefits, and rationale of treatment options, making decisions in partnership with patients
  • 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 regarding dosage regimens, 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
  • provide clear and legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy

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, 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 optimise therapy, provide adherence support when required, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing medicines that are no longer indicated
  • use continuously updated software for computers and electronic prescribing programs, where available
  • use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions and poor handwriting
  • 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 (Australia) or the Centre for Adverse Reactions Monitoring (NZ) and record it in patients’ medical records

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • check the dose and drug-drug interaction 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:

  • maintain up-to-date knowledge with new medications, their indication, safety profile, and efficacy
  • 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 than placebo
  • 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:

  • 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 the medicine 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, including sponsored educational events

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 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, nursing staff, and general practitioners 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

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
  • be aware of stigma, and advocate on behalf of their patients if needed

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