Prescribe medications tailored to patients’ needs and conditions
This activity requires the ability to:
- take and interpret medication histories
- choose appropriate medications1
- communicate with patients about the benefits and risks to patients, and provide instruction on medication administration effects and side effects
- produce prescriptions
- monitor medications for efficacy, safety, and concordance
- review medications and interactions, and cease where appropriate
- perform this activity in multiple settings, including inpatient and ambulatory care settings and in emergency departments
Behaviours
Each EPA has lists of behaviours. The behaviours help trainees understand how they can improve, and help supervisors to make decisions about whether trainees can be trusted to do the task with supervision at a distance
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- demonstrates an awareness of potential side-effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
- appropriately, safely, and accurately selects medications, and demonstrates an understanding of the rationale, risk-benefit, side effects, contraindications, dosage, and drug interactions
- appropriately chooses when not to prescribe medication
- prescribes medication therapies within jurisdictional guidelines on medication management
- refers prescriptions for cytotoxic medications, medications requiring consultant prescription, and known teratogenic medications to consultants
- monitors and adjusts medications
- identifies and manages adverse events
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- demonstrate an inadequate understanding of the compatibility of medications with intravenous fluids or the need for medication monitoring
- only complete the basics of an inpatient medication chart such as date, name, and signature
- demonstrate an inadequate understanding of the rationale behind the choice of medication
- be unable to source suitable dosing guidelines or implement dose modifications based on organ function, patient age, or size
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- explains the rationale for and discusses various treatment options with patients
- explains the benefits and burdens of therapies in light of patients’ individual circumstances
- writes clearly legible scripts or charts using generic names of the required medication in full, including mg/kg/dose information and all legally required information for inpatient and outpatient prescribing
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- not adequately discuss appropriate alternatives that may be more acceptable to patients
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- applies knowledge of the importance of careful dosing; particularly the need for weight and body surface area-based prescribing in children, practical dosing, and not exceeding adult maximum dosage2
- always checks the dose before prescribing
- applies information regarding side effects and monitoring requirements of medications
- identifies medication errors and institutes appropriate measures
- uses electronic prescribing systems safely
- rationalises medications to avoid polypharmacy
- demonstrates understanding of the role of therapeutic drug monitoring
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- display inadequate knowledge of the monitoring requirements or potential side-effects of the medications they are prescribing
- prescribe medications outside a therapeutic relationship
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- ensures patients understand the management plan including adherence issues, follow up and monitoring for side-effects, and the practical aspects of administration
- undertakes continuing professional development to maintain currency with prescribing guidelines
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- makes therapeutic decisions according to best evidence, and recognises where evidence is limited, compromised, or subject to bias or conflict of interest
- refers to guidelines to ensure decision making is evidence-based and applies guidelines to individual patients appropriately
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- appreciates patients’ cultural and religious background, attitude and beliefs, and how these might influence the acceptability of pharmacological and non-pharmacological management approaches
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- demonstrates consideration of the utility of medicines in treating illness in their prescribing decisions, including the relative merits of different pharmacological and non-pharmacological approaches
- demonstrates an understanding of the regulatory and legal requirements and limitations regarding prescribing
- reports adverse events related to medications
- demonstrates an understanding of the ethical implications of pharmaceutical industry marketing and funded research
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- takes into account the following factors for all medications:
- contraindications
- cost to patients, families, and the community
- funding and regulatory considerations
- generic versus brand medicines
- interactions
- risk-benefit analysis
- recognises their own limitations and seeks help when required in an appropriate way
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- inadequately consult with senior colleagues
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- works collaboratively with pharmacists
- participates in medication safety meetings and morbidity and mortality meetings
- develops local and national guidelines
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- incorporates the population-based impacts of, and constraints on, decisions about prescribing, including:
- economic costs to community
- antimicrobial resistance
- applies the principles of prescribing using therapeutic guidelines and other resources
- prescribes in accordance with institutional policies
- Includes drugs, fluids, and oxygen.
- This behaviour is particularly relevant to Paediatrics & Child Health.