Carefully consider the following key questions before writing any prescription:

1.1 Does the diagnosed condition require drug treatment?

Not all patients or conditions need a prescription for drugs

Non-drug treatments and/or giving simple advice may be more suitable in certain situations

1.2 Is the prescribed treatment likely to have optimum therapeutic effect?

Good therapeutics depends on:

accurate diagnosis of the condition

knowledge of the relevant available drugs

selection from these of the most appropriate drug and dose-form

correctly and completely prescribing the selected drugs stating clearly for each:

- the dose size

- the dose frequency

- the duration of treatment

ensuring that the patient understands fully how to use each prescribed medicine

1.3 Is the selected dose-form the most appropriate?

For systemic medications, always use the oral route if possible as it is the cheapest and least hazardous route

Always resist patient demands for you to prescribe injections or other expensive dose forms, eg. capsules and oral liquids where these are not clearly indicated or appropriate.

Injections in particular are associated with several major risks including:

- spread of infections, eg. HIV/AIDS, hepatitis, due to problems with re-use of syringes/needles and difficulties in ensuring sterility

- incorrect route of administration

- poor injection technique, eg. using wrong type/size of needle, wrong location, wrong depth of insertion

- difficulty in finding a vein (for IV route)

Always explain that these dose-forms may not represent the best form of treatment

1.4 Am I dealing with a potentially life-threatening situation?

In critical situations, always prescribe the most effective drug available irrespective of cost or limited availability

1.5 Have I used the correct name for each drug?

To avoid any possible confusion and to reduce prescribing costs:

always prescribe drugs by the full generic name and not a brand name, eg.

diazepam (not Valium ®)
paracetamol (not Panadol ®)

avoid using drug name abbreviations unless officially defined and approved

1.6 Can I justify using a combination drug?

Do not prescribe combination drugs unless they have a proven significant therapeutic advantage over corresponding single ingredient preparations

1.7 Have I taken into account all relevant patient criteria?

When prescribing any drug, always take into consideration important patient criteria such as:

age

sex

weight - especially children

presence of renal or hepatic disease

- many drugs may have to be used in reduced doses or avoided completely

any other medicines the patient may be taking

- these may cause unwanted drug interactions or adverse effects

the effect of other diseases present - these may significantly affect the action of particular drugs

pregnancy - only use drugs in pregnancy if the expected benefit to the mother is greater than any risk to the foetus and avoid all drugs if possible during the 3^rd trimester

breastfeeding - only use drugs which are essential for treatment of the mother as for many drugs insufficient information is available to provide guidance

the likely degree of compliance with treatment

- simpler, shorter dosage regimes increase the chance of the patient correctly following prescribed therapy

1.8 Is the prescribed medication likely to clearly benefit the patient?

In all cases consider carefully the expected benefit of a prescribed medication against potential risks

1.9 Am I prescribing unnecessary symptomatic treatment?

Do not overuse symptomatic treatments for treating minor self-limiting conditions for which simple home remedies may often be appropriate and effective

1.10 Do I really need to prescribe more than one drug?

Do not practice multiple prescribing (polypharmacy), especially when the diagnosis is uncertain. It is a tremendous waste of resources and puts the patient at increased risk without corresponding clear benefit