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LEGAL ASPECTS OF PRESCRIPTION WRITING

The following are minimum requirements for a legal prescription:

• Written or printed legibly in indelible ink
• State a valid date
• Signed in ink by the prescriber 
• State the address of the prescriber and an indication of the type of prescriber
• State name and address of the patient
• Specify the age for children under 12 years

A computer-generated prescription is acceptable, however, the prescriber’s signature must be handwritten.  An advanced electronic signature is acceptable where the Electronic Prescription Service (EPS) is used in primary care i.e. the prescription is transmitted electronically to a nominated community pharmacy.  Prescriptions are valid for 6 months from the date stated on the prescription.  Prescriptions for controlled drugs have additional legal requirements and prescriptions are valid for a shorter time period (see later for further information).

The following also needs to be noted on the prescription:

• The approved (or ‘generic’) name of the medicine.  To prevent misinterpretation, the name should be written clearly and unabbreviated e.g. isosorbide mononitrate (not “ISMN”), ferrous sulphate (not “FeSO4”)
• The exception to the above rule is where there is a clinically significant variance in bioavailability of the same preparation between each manufacturer, in which case, the brand name should be written 
  
  • The BNF will specify when this is appropriate e.g. IV ambisome, oral tacrolimus, lithium
  • In practice, insulins and some preparations which contain multi-constituents may need to be prescribed by brand name to help identify the medicine – refer to your local Trust policy
• Specify the form of the medicine and the route 
  
  • Some examples of medication forms are tablets, capsules, oral liquids, modified release (m/r) tablets, solution for injection ampoules, suppositories, eye drops
• Specify the strength of the medicine in the tablet, capsule etc.  For liquid preparations this must be clearly stated (e.g. 250 mg/5 mL)
• Specify the dose and frequency
• For medicines to be taken ‘as required’, the minimum dose interval must be specified along with the maximum daily dose 
  
  • It is also good practice to state the indication
• Treatment courses should specify the duration e.g. course of antibiotics or steroids
• Specify the quantity to be supplied.  This can be stated by indicating the number of days of treatment required in the specified box on a FP10 prescription, otherwise the quantity to be supplied needs to be stated (see FP10 example prescription)

Good Practice Recommendations

• State the age and date of birth of the patient
• State the weight of the patient where it has been used to determine a dose
• The patient’s NHS number should be included
• The contact details of the prescriber e.g. telephone number
• Directions should ideally be in English; although it is generally accepted that some Latin abbreviations can be used instead:

• Write grams as g and milligrams as mg
• Write micrograms and nanograms in full; unclear abbreviations can lead to misinterpreting the dose as milligrams
• Write numbers clearly to avoid misinterpretation, especially the number 1, which can easily be mistaken for the number 2, or the number 4 which can be mistaken for the number 9
• Where a dose is 1 gram or more, it should be written as 1 g, 2 g etc.
• Where a dose or strength is less than 1 g, it should be written in milligrams e.g. amoxicillin 500 mg, not 0.5 g
• Where a dose or strength is less than 1 mg, it should be written in micrograms e.g. write digoxin 125 micrograms, not ‘0.125 mg’
• Use ml or mL e.g. 200 mL.  Do not use cubic centimetre, c.c or cm ³
• Ensure the word ‘units’ is written in full and not ‘U’ or ‘IU’ e.g. for insulin if the dose is written as 10U it can be misinterpreted as ‘100’ and as a consequence can result in a 10-fold overdose.
• Avoid unnecessary use of decimal points e.g. 2 mg, not 2.0 mg
• If a decimal is unavoidable, place a zero in front of the decimal point where there is no other figure e.g. 0.5 mL

Prescription Requirements for Schedule 2 and 3 Controlled Drugs

Prescriptions for schedule 2 and 3 controlled drugs (CDs) are subject to additional prescription requirements and must always state:

• The legal requirements for any prescription
• The name and address of the patient
• The form of the CD e.g. tablets, modified-release tablets
• Strength of the preparation (when more than one strength of a preparation exists) e.g. 60 mg, 10 mg in 5 mL
• The total quantity or dosage units of the preparation in both words and figures:

• For liquids, specify the total volume required in millilitres, in both words and figures e.g. 100 mL (one hundred millilitres)
• For dosage units (ampoules, capsules, tablets), specify the total number of dosage units required in both words and figures e.g. 28 tablets (twenty-eight), 6 ampoules (six)

• The dose, which must be clear
• The words ‘for dental treatment only’ if issued by a dentist
• For NHS prescriptions, the prescriber should include the patient's NHS number on the prescription form

A computer-generated prescription is acceptable, however, the prescriber’s signature must be handwritten.  An advanced electronic signature is acceptable for Schedule 2 and 3 CDs where the Electronic Prescription Service (EPS) is used.  Medicines that are not CDs should not be prescribed on the same form as a Schedule 2 or 3 CD.

Prescriptions for CDs in Schedules 2, 3, or 4 are valid for 28 days from the date on the prescription and Schedule 5 CDs are valid for 6 months from the date on the prescription.  The person collecting a Schedule 2 or 3 CD from the pharmacy must sign the back of the prescription form.

In line with good practice, the Department of Health strongly recommend the maximum quantity of Schedule 2, 3 or 4 CDs prescribed should not exceed 30 days.  Rarely, to cover a justifiable clinical need and after taking into account any risks, a prescription may be issued for longer than 30 days.  However, the reason for this should be clearly recorded in the patient’s notes.