Good practice in prescribing and managing medicines and devices
In Consent: patients and doctors making decisions together we say:
3. For a relationship between doctor and patient to be effective, it should be a partnership based on openness, trust and good communication. Each person has a role to play in making decisions about treatment or care.
Together with the patient,7 you should make an assessment of their condition before deciding to prescribe a medicine. You must have or take an adequate history, including:
- any previous adverse reactions to medicines
- recent use of other medicines, including non-prescription and herbal medicines, illegal drugs and medicines purchased online, and
- other medical conditions.
or, where appropriate, parents or carers with authority to make decision on behalf of patients. Medicines may be prescribed without consent if it is likely to be of overall benefit to adults who lack capacity, or in accordance with mental health legislation.
You should encourage your patients to be open with you about their use of alternative remedies, illegal substances and medicines obtained online, as well as whether in the past they have taken prescribed medicines as directed.
You should identify the likely cause of the patient’s condition and which treatments are likely to be of overall benefit to them.
You should reach agreement with the patient on the treatment proposed,8 explaining:
- the likely benefits, risks and burdens, including serious and common side effects
- what to do in the event of a side effect or recurrence of the condition
- how and when to take the medicine and how to adjust the dose if necessary, or how to use a medical device
- the likely duration of treatment
- arrangements for monitoring, follow-up and review, including further consultation, blood tests or other investigations, processes for adjusting the type or dose of medicine, and for issuing repeat prescriptions.
A number of patient decision aids are available on the website.
The amount of information you give to each patient will vary according to the nature of their condition, the potential risks and side effects and the patient’s needs and wishes. You should check that the patient has understood the information, and encourage them to ask questions to clarify any concerns or uncertainty. You should consider the benefits of written information, information in other languages and other aids for patients with disabilities to help them understand and consider information at their own speed and to retain the information you give them.
You should also provide patients’ carers with information about the medicines you prescribe, either with the patient’s consent or, if the patient lacks capacity to consent, if it is in their best interests.
It is sometimes difficult, because of time pressures, to give patients as much information as you or they would like. To help with this, you should consider the role that other members of the healthcare team, including pharmacists, might play. Pharmacists can undertake medicines reviews, explain how to take medicines and offer advice on interactions and side effects. You should work with pharmacists in your organisation and/or locality to avoid the risks of overburdening or confusing patients with excessive or inconsistent information.
You should also refer patients to the information in patient information leaflets (PILs) and other reliable sources of relevant information.9 PILs are useful supplements to the information you give patients about their medicines, but they are not a substitute for that information.
and information bearing The Information Standard quality mark, for example.
Some patients do not take medicines prescribed for them, or do not follow the instructions on the dose to take or the time medicines should be taken. You should try to understand the reasons for this and address them by providing reassurance and information, and by negotiating with the patient to reach agreement on an appropriate course of treatment that they are able and willing to adhere to.10
The website includes information, guidance and tools for understanding and improving adherence. See also on medicines adherence.