Creating a New Prescription

Purpose

This guide will show you how to create a new prescription for a patient, and will provide guidance to assist you in completing a new prescription form in Medicus.

Creating a new prescription

There are two ways to create a new prescription in Medicus:

1. From a patient's care record.
2. From a consultation.

Creating a new prescription from a patient's care record

To create a new prescription from the care record, select the 'Actions' dropdown menu in the right hand corner of the patient record. Select 'Prescription' from the list.

This will open up the create new prescription form.

Creating a new prescription from a consultation

To create a new prescription whilst completing a new consultation form you can either:

1. Select 'Prescription' from the 'More actions' dropdown list.

2. Use / as a shortcut to open up the actions menu and select 'Prescription'.

This will open up the create new prescription form.

Completing the new prescription form

The create prescription form is split into two halves:

• The left hand side is where will enter required information to issue the prescription
• The right hand side displays information to aid you whilst completing the form, for example any allergies or safety alerts.

The following subsections of this user guide will provide guidance and context on how to complete and submit the new prescription form.

Product search

You must enter the product you are prescribing before you can complete the rest of the form. This is so Medicus can then tailor the form as per the prescription selected.

The product search uses dm+d Primary Care Prescribable Product Search.

Once you select the product you'd like to prescribe from the list, more fields on the form will appear for you to complete.

Selecting the linked product name under 'Product Information' leads to the BNFC website for that product so you can reference additional information as required.

Checks and alerts

Once you've chosen the product to prescribe, Medicus will run a series of safety checks against the selected product and the patient's care record to inform you of any alerts. The following checks are performed:

1. Sensitivity checks - if the product being prescribed contains anything that may cause the patient to have a reaction.
2. Age, sex and condition checks - any contraindications, precautions or warnings directly related to the product and the patient.
3. Pharmacological equivalence checks - the drug is checked against a list of other drugs the patient is already taking to identify whether duplicate products, ingredients or products in the same therapeutic class are being prescribed.
4. Interaction checks - if there are any possible side effects when two medicinal products are concurrently prescribed.
5. High risk messages - if the product is considered high risk.

Note: some medications, such as Methotrexate and Sodium Valproate, have special prescriber warnings to provide additional advice to prescribers.

Indication

To link the prescription to an existing problem tied to the patient's record, select from the dropdown list.

Or, select 'Add new' if the prescription is related to a new problem and you'd like to add it.

To add a new problem, you can search for a new problem code in the box.

If you'd like to switch back to the dropdown to select an existing problem, select 'Link to existing problem'.

Dosage

Selecting certain product will amend the dosage suggestions you can choose for the prescription.

You can also select 'Enter free text' if you don't want to use one of the suggested doses.

Supply

Under the supply section of the form, the first thing you'll need to choose is the type of prescription. There are 4 types to choose from:

• Acute - a one-off prescription, for example, a patient is prescribed a short course of antibiotics for an infection.
• Repeat - a prescription for multiple issues, for example a 28 day supply each month, but the GP must sign off each repeat prescription request.
• Variable repeat - a prescription that is included on the repeat medication list, but are not issued on a regular cadence, for example a patient with mild asthma may only require a new inhaler every few months.
• Repeat dispensing - multiple issues that are signed off by the prescriber at once and sent to the nominated pharmacy.

Selecting 'repeat' or 'repeat dispensing' on the form will add an additional required field of 'number of issues'. You will also need to choose the authorisation method: Issue until medication review date or Fixed Number of Issues.

A maximum of 12 months supply can be prescribed on a repeat dispensing prescription, and the number of issues is limited to a maximum of 99.

The unit of measure will be pre-populated depending on what medication you have selected to prescribe.

If you have selected a pre-defined dosage and entered the expected days supply, the issue quantity will be calculated and populated automatically.

The following prescriber endorsements can be added to prescriptions in Medicus:

• ACBS Indicator
• AF
• SLS
• CC
• FS

Contraceptive (CC) and STI (FS) prescriber endorsements are included on the form constantly. However, ACBS, AF and SLS appear conditionally, depending on what medication has been selected.

The 'additional instructions for dispenser' box is an optional free text box in case the pharmacist should take any additional action or provide advice in relation to the prescribed medication.

Authorisation

• Start date - this is pre-populated with today's date but can be manually edited if required.
• Review date (repeat or repeat dispensing only) - this field is optional, but can be used to indicate if the medication should be reviewed on a specific date. For example, if the you as the prescriber would like to monitor how the patient is getting on in their first few weeks on the medication.
• Authorised by practitioner - this is pre-populated based on what user has created the prescription but can be manually edited if required.
• You can also check boxes the hide from patient facing services or third parties if required.

Once you've completed the form, you can either create another prescription or issue now.

Make sure you check all the information you've entered is correct and taken care to review any allergies, safety alerts and product information displayed on the right hand side of the form before issuing.

Issuing the Prescription

Once you've completed the form, select 'Issue now'. There are four ways to issue a prescription in Medicus:

• Via EPS
• FP10 form
• Handwritten script
• Private handwritten script
• Private printed script

The 'Issue Medication' form defaults to the EPS method.

Note: you must be logged in with your NHS Smartcard to issue a prescription via EPS.

To amend the method of issuing the prescription, select the pencil icon on the 'Issue Medication' form.

This will open up a 'Change Issue Method' form where you can choose your preferred method.

Review the details of the prescription and once you're happy, select 'Issue' to complete the prescription.

EPS prescriptions will send to a patient's nominated pharmacy, but you can send the prescription to a one-off pharmacy if requested.

For EPS prescriptions, a message will be sent by default to the patient to inform them that their prescription has been sent to their nominated pharmacy. You can also add additional text if you need to.