Good prescription writing guidelines

• Please use/refer to the Highland Formulary or other relevant Highland formulary when choosing appropriate prescription.
• Prescribers must be aware of the Formulary and license status of any medicine prescribed and must comply with all policies relating to the supply of non-Formulary medicines, see Formulary Introduction.

• legible
• in black ink
• dated
• include the full name and address of the patient and community health index (CHI) number
• signed in black ink by the prescriber.

• These must always be stated. In the case of prescription-only medicines, it is a legal requirement to state the age for children under 12 years of age.
• For outpatient prescriptions, the PMS (Patient Management System) label should be used.

• The dose must be stated in the International System of Units (SI units).
• Abbreviations for grams (g); milligrams (mg), millilitres (mL) and litres (L) may be used.
• ‘Micrograms’, ‘nanograms’ and ‘units’ must be written in full.
• State the dosage form, dose, route, timing and frequency.
• ‘As required’ prescriptions should also specify the maximum dose per specified time period (eg day) and indication.

• These should be written in full.
• When an amendment to a medicine currently being prescribed is needed, eg frequency or dose change, a new entry must be made on the Kardex* and the original entry discontinued.

• Avoid unnecessary zeros, however always precede a decimal point with a zero where there is no other figure.
• When unavoidable, decimal points should always have a number covering in front eg 0·5mL and not ·5mL.
• Decimal points should be clear and, ideally, centred.
• Whole numbers should be kept whole, eg 5mg and not 5·0 mg.
• Quantities of 1 gram or more should be written as gram/grams.
• Quantities less than 1 gram should be written as milligrams, eg 500mg.
• Quantities less than 1mg should be written as micrograms, eg 100 micrograms, not 100mg or 0·1mg. 

• name
• hospital number (and/or Community Health Index (CHI) number)
• date of birth and weight must be recorded on the front of the Kardex*, also surface area if a dosage requires it.

• These must be dated and written legibly, typed or electronically produced in indelible black ink specifying the dosage form, dose, route, timing and frequency with the prescriber’s signature and printed name for each item prescribed.
• Take care to ensure correct section of form is used, eg ‘once only’ and ’pre-med regular therapy’ or ‘as required therapy’.
• Specify time using the 24-hour clock, eg 22:00 rather than 10pm.

• For medicines prescribed on an ‘as required’ basis, abbreviations must not be used and dose, dosage interval and indication for the medicine should be clearly stated, eg 500mg every four hours for a headache when required.
• Indicate the maximum dose in a given time period, if appropriate.

• To discontinue a medicine, the prescriber must draw a clear Z through the prescription section and a clear diagonal line through every section of the record of administration areas with a vertical line right through the last recorded date of being given, enter the date in the ‘stop date’ box and initial it.
• When an amendment to a medicine currently being prescribed is needed, eg dosage change, a new entry must be made on the Kardex* and the original entry discontinued.

• Avoid using more than one Drug Kardex* for each patient if at all possible. Old Kardexes* must be cancelled by drawing two parallel diagonal lines across the front page and writing ‘cancelled’. It should be authorised by the prescriber’s signature and date of cancellation.
• A new Kardex* should be used for each hospital admission.

• An entry must always be made in the Allergy/Drug Sensitivity section.
• Write either drug name or ‘nil known’.

The prescription should include as a minimum:

• name
• home address
• hospital number (and/or CHI number). 

Prescriptions written by non-medical prescribers should state:

• the type of prescriber, eg Nurse Supplementary/Independent Prescriber
• the prescriber’s professional registration number, eg NMC PIN number
• the prescriber’s contact details including telephone number where this is not pre-printed on the form.

• For prescribing in primary care and for patients whose prescriptions will be dispensed in the community, the prescription must contain the name of the prescribed item, formulation, strength (if appropriate), dosage and frequency, and quantity to be dispensed. The quantity should be appropriate to the patient’s treatment needs, bearing in mind the frequency of review and need to avoid waste.
• Some medicines are only available in patient packs (or multiples thereof) and special containers. In such cases complete packs (or multiple packs) should be prescribed, provided this is clinically and economically appropriate.
• Specify the quantity for solid preparations as number of dose units (number of tablets, patches, etc.), for liquid measures in millilitres (mL), for topical preparations by mass (grams, g), or volume (millilitres, mL).
• Do not use terms such as ‘1 pack’ or ‘1 OP’.
• Alternatively, for preparations to be given at a fixed dose and interval, the duration of treatment can be used in place of the quantity to be dispensed. 

• The quantity to be supplied may be stated by indicating the number of days’ treatment required in the box provided on the NHS forms. In most cases, the exact amount will be supplied.
• This cannot apply to items directed to be used ‘as required’ – if the exact dose and frequency are not given the quantity needs to be stated.
• When several items are ordered on one form, the box can be marked with the number of days’ treatment, provided the quantity is added for any item for which the amount cannot be calculated.

Prescription forms that are reprinted or issued as a duplicate should be labelled clearly as such.