Principles of Good Prescribing

Prescribing medications is one of the main strategies to the prevention and treatment of disease in modern healthcare. Per capita utilization of prescription drugs, predicated on the top 200 drugs dispensed by U.S. community pharmacies, is about 12 prescriptions per person per year.26-28 Adults over 50 years of age consume the largest number of prescription medications and account for 64% of the total number of prescriptions dispensed.

While drugs have the capacity to enhance health, they all have the potential to cause harm if prescribed inappropriately. For this reasons it is recommended that healthcare professionals who prescribe medications exercise critical thinking skills to ensure the safe and effective use of therapeutic agents. The following ten steps, along with ongoing self-directed learning, reflect an efficient and practical approach to prescription writing and avoiding errors (Box C).29,30

Box C. Principles of good prescribing.29,30
  1. Be clear about the reasons for prescribing
    • Establish an accurate diagnosis whenever possible (although this may at times be difficult)
    • Specify a clear therapeutic objective

  2. Consider the patient’s drug history before prescribing
    • Obtain an accurate list of current and recent medications (including over-the-counter and alternative medicines) and a history of prior adverse drug reactions and drug allergies

  3. Identify other factors that might alter the benefits and risks of treatment
    • Consider individual risk factors that might influence the prescription (e.g., physiological changes with age and pregnancy, or impaired kidney or liver function)

  4. Take into consideration the patient’s expectations
    • Seek to form a partnership with the patients when selecting treatments, making sure that they understand and agree with the reasons for taking the medication

  5. Select efficacious, safe, and cost-effective drugs appropriate for the patient
    • The likely beneficial effects of a drug should outweigh any potential harms and, whenever possible, this decision should be based on published evidence
    • Choose the best formulation, dose, frequency, route of administration, and duration of treatment

  6. Adhere to guidelines
    • Be aware of evidence-based recommendations developed by respected professional organizations
    • Balance specific drug selection considering the needs of the patient and cost
    • Identify, access, and use reliable and validated sources of information

  7. Write unambiguous legal prescriptions using the correct documentation
    • Be aware of common factors that cause medication errors and know how to avoid them

  8. Monitor the beneficial and adverse effects of therapeutic agents
    • Understand how to alter the therapeutic regimen as a result of this information
    • Know how to report adverse drug reactions

  9. Communicate the reasons for and document prescribing decisions
    • Communicate clearly with the patient as well as the pharmacist
    • Give patients information about how to take the medicine, what benefits might arise, adverse effects (especially those that will require urgent attention), and any monitoring that is required
    • Document prescribing decisions in the health record accurately

  10. Prescribe within limitations of knowledge, skills and experience
    • Always keep relevant knowledge and skills up to date
    • Be prepared to seek the advice and support of qualified professional colleagues
    • Verify all information on prescriptions