Practical Prescribing for Medical Students
Learning to prescribe is an essential part of medical training. Due to various high profile serious prescribing errors, the GMC have introduced stricter prescribing standards which medical students must meet, and a prescribing exam is soon to be compulsory on all medical programmes. This book helps medical students learn the essentials of safe prescribing practice, and is aimed directly at their needs. It covers all the aspects of prescribing required by the GMC, including principles of prescribing, law and ethics, professional responsibilities, patient communication, at-risk groups, avoiding common errors and what to do when things go wrong.
- Front Matter
- Back Matter
- Subject Index
- Introduction: The Challenge of Prescribing
- Chapter 1: Communication and Patient Collaboration
- Chapter 2: Law, Ethics and Professional Responsibilities in Prescribing Practice
- Chapter 3: Evidence-based Practice and Keeping Up To Date
- Chapter 4: Working with Others
- Chapter 5: Medicines Requiring Particular Care
- Chapter 6: Prescribing for Specialist Patient Groups
- Chapter 7: Common Errors
- Chapter 8: Adverse Drug Reactions
- Chapter 9: Drug Interactions
An imprint of SAGE Publications Ltd
1 Oliver's Yard
55 City Road
London EC1Y 1SP
SAGE Publications Inc.
2455 Teller Road
Thousand Oaks, California 91320
SAGE Publications India Pvt Ltd
B 1/I 1 Mohan Cooperative Industrial Area
New Delhi 110 044
SAGE Publications Asia-Pacific Pte Ltd
3 Church Street
#10-04 Samsung Hub
© Helen Bradbury and Barry Strickland-Hodge 2014
First published 2014
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
Library of Congress Control Number: 2013947941
British Library Cataloguing in Publication data
A catalogue record for this book is available from the British Library
ISBN 978-1-4462-5640-4 (pbk)
Editor: Alex Clabburn
Development editor: Richenda Milton-Daws
Production controller: Chris Marke
Project management: Swales & Willis Ltd,
Marketing manager: Tamara Navaratnam
Cover design: Wendy Scott
Typeset by: C&M Digitals (P) Ltd, Chennai, India
Printed by: Henry Ling Limited at The Dorset
Press, Dorchester, DT1 1HD
Foreword from the Series Editors[Page vii]The Learning Maters Medical Education Series
Medical education is currently experiencing yet another a period of change, typified in the UK with the introduction of the revised Tomorrow's Doctors (General Medical Council, 2009) and ongoing work on establishing core curricula for many subject areas. Changes are also occurring at Foundation and postgraduate levels in terms of the introduction of broader non-technical competencies, a wider range of assessments and new revalidation requirements. This new series of textbooks has been developed as a direct response to these changes and the impact on all levels of medical education.
Research indicates that effective medical practitioners combine excellent, up-to-date clinical and scientific knowledge with practical skills and the ability to work with patients, families and other professionals with empathy and understanding; they know when to lead and when to follow and they work collaboratively and professionally to improve health outcomes for individuals and communities. In Tomorrow's Doctors, the General Medical Council defines a series of learning outcomes set out under three headings:
- Doctor as Practitioner;
- Doctor as Scholar and Scientist;
- Doctor as Professional.
The books in this series do not cover practical clinical procedures or knowledge about diseases and conditions, but instead cover the range of non-technical professional skills (plus underpinning knowledge) that students and doctors need to know in order to become effective, safe and competent practitioners.
Aimed specifically at medical students (but also of use for junior doctors, teachers and clinicians), each book relates to specific outcomes of Tomorrow's Doctors and other relevant documents, providing both knowledge and help to improve the skills necessary to be successful at the non-clinical aspects of training as a doctor. One of the aims of the series is to set medical practice within wider social, policy and organisational agendas to help produce future doctors who are socially aware and willing and prepared to engage in broader issues relating to healthcare delivery.
Individual books in the series outline the key theoretical approaches and policy agendas relevant to that subject, and go further by demonstrating through case studies and scenarios how these theories can be used in work settings to achieve best practice. Plenty of activities and self-assessment tools throughout the book will help readers to hone their critical thinking and reflection skills.
Chapters in each of the books follow a standard format. At the beginning a box highlights links to relevant competencies and outcomes from Tomorrow's Doctors and other curricula, if appropriate. This sets the scene and enables readers to see exactly what will be covered. This is extended by a chapter overview which sets out the key topics and learning outcomes.
[Page viii]Each chapter typically includes at least one case study which illustrates how theory can be used in practice from different perspectives. Activities are included which include practical tasks with learning points, critical thinking research tasks and reflective practice/thinking points. Activities can be carried out by readers or with others and are designed to raise awareness, consolidate understanding and enable students to improve their practice by using models, approaches and ideas. Each activity is followed by a brief discussion on issues raised. At the end of each chapter a chapter summary provides an aide-mémoire of what has been covered.
All chapters are evidence-based in that they set out the theories or evidence that underpins practice. In most chapters, one or more ‘What's the evidence?’ boxes provide further information about a particular piece of research or a policy agenda referenced in books, articles, websites or policy papers. A list of additional readings is set out under the ‘Going further’ section, with all references collated at the end of the book.
The series is edited by Professor Judy McKimm and Professor Kirsty Forrest, both of whom are experienced medical educators and writers. Book and chapter authors are drawn from a wide pool of practising clinicians and educators from around the world.
adverse drug event
adverse drug reaction
activated partial thromboplastin time
British National Formulary
BNF for Children
central nervous system
drug analysis print
Faculty of Sexual and Reproductive Healthcare
glomerular filtration rate
General Medical Council
general sales list
ideas, concerns and expectations
international normalised ratio
monoamine oxidase inhibitor
modification of diet in renal disease
Medicines and Healthcare Products Regulatory Agency
National Health Service
NHS Improving Quality
National Institute for Health and Care Excellence
no known drug allergies
number needed to harm
number needed to treat
National Prescribing Centre
National Patient Safety Agency
non-steroidal anti-inflammatory drug
over the counter
Patient Group Direction
Patient Specific Direction
randomised controlled trial
Scottish Intercollegiate Guidelines Network
Summary of Product Characteristics[Page xii]
Drug Calculations[Page 148]
Here are ten typical situations where a dose needs to be calculated. None are too difficult. Think carefully, as it can be easy to make mistakes. The answers follow in Appendix 2 so you can check how you did.
- The dose of tinzaparin for the treatment of pulmonary embolism is 175 units/ kg. You have a patient who weighs 56kg. The tinzaparin preparation is 20,000 units/mL.
- What is the dose?
- What volume should be administered?
- A 25kg child with tuberculosis requires the following oral medicines.
- What doses should be prescribed?
- What volumes should be administered?
- A patient who is nil-by-mouth requires 200 micrograms of digoxin intravenously. You have 0.5mg in 2mL injection available.
- What volume should be administered?
- A 62kg, 80-year-old patient requires a 5mg/kg loading dose of intravenous aminophylline for severe chronic obstructive pulmonary disease. You have 250mg in 10mL ampoules available.
- What is the dose?
- What volume is required?
- A 68.5kg patient with pneumonia requires gentamicin 7mg/kg. You have gentamicin injection 80mg/2mL available.
- What is the dose?
- What volume of gentamicin injection is needed?
- A 70kg patient requires intravenous lorazepam for a severe, acute panic attack at a dose of 30 micrograms/kg. You have lorazepam injection 4mg/mL available.[Page 149]
- What is the dose?
- What volume should be administered?
- A 65kg patient is admitted with a paracetamol overdose and requires an infusion of acetylcysteine at 100mg/kg. You have ampoules of acetylcysteine 2g/10mL available. The infusion needs to be given in 1 litre of glucose 5% over 16 hours.
- What is the dose?
- What volume of acetylcysteine is needed?
- How would you prepare and administer the infusion?
- A 70kg patient requires dopamine 4 micrograms/kg/min. The pharmacy supplies pre-made syringes containing 200mg in 50mL.
- What is the dose?
- What rate in mL/hour needs to be administered?
- A 25kg child with severe hyperkalaemia requires salbutamol 4 micrograms/kg by intravenous injection. You have 500 micrograms/mL injection available. The injection needs to be diluted with glucose 5% to a concentration of 50 micrograms/ mL prior to administration.
- What is the dose?
- How would you prepare the injection?
- A 2.8kg neonate requires meropenem intravenous infusion 20mg/kg for septicaemia. You have meropenem 500mg injection (dry powder) available. You speak to the on-call pharmacist who says to reconstitute the meropenem with Water for Injection to make 10mL and that meropenem has a displacement value of 0.4mL. Then you need to dilute further with sodium chloride 0.9% to obtain a 10mg/mL solution.
- What is the dose?
- How would you prepare the infusion?
- What volume of meropenem 10 mg/mL needs to be administered?
Answers to Drug Calculations[Page 150]
- Dose = 9,800 units
- Volume = 0.49mL (would round up to 0.5mL)
Rifampicin 250mg; 12.5mL of 100mg/5mL Isoniazid 250mg; 25mL of 50mg/5mL Pyrazinamide 875 mg; 8.75mL of 500mg/5ml Ethambutol 375mg; 9.4mL of 200mg/5mL
- Volume = 0.5mg in 2mL = 500 micrograms in 2mL
- 200 micrograms ÷ 500 micrograms × 2mL = 0.8mL
- Dose = 62 kg × 5mg = 310mg
- Volume = 310mg ÷ 250mg × 10mL = 12.4mL
- Dose = 68.5kg × 7mg = 479.5mg (round up to 480mg)
- Volume needed = 480mg ÷ 80mg × 2mL = 12mL
- Dose = 70kg × 30 micrograms = 2100 micrograms, 2100 micrograms÷1000 = 2.1mg
- Volume = 2.1mg÷4mg × 1mL = 0.53mL
- Dose = 65 kg × 100 mg = 6500mg ≡ 6.5g
- Volume of acetylcysteine = 6.5g ÷ 2g × 10ml = 32.5mL
- Preparation/administration = remove 32.5mL from 1L glucose 5% bag and add 32.5mL acetylcysteine 2g/10mL. Run the infusion at 62.5mL/hour (1000mL ÷16).
- Rate = 4 micrograms/kg/min = 4 × 70kg micrograms/min = 280 micrograms/min Want rate per hour so 280 micrograms/min = 280 × 60 micrograms/hour
- = 16800 micrograms/hour
- = 16800 ÷ 1000
- = 16.8 mg/hour
- Have 200mg in 50mL, want 16.8mg/hour so (16.8mg ÷ 200mg) × 50mL = 4.2 ml/hour
- Dose = 100 micrograms (25 kg × 4 micrograms)
- 100 micrograms ÷ 500 micrograms × 1mL = 0.2mL of injection needed
- Dose = 20mg×2.8kg = 56mg
- Infusion preparation = add 9.6mL Water for Injection to the 500mg vial of meropenem. This gives 500mg in 10mL (as displacement value is 0.4mL) i.e. 50mg/mL. Therefore, this needs diluting by a factor of five to obtain a 10mg/mL solution.
- Take 10mL of the 500mg/10mL solution and add to 40mL of sodium chloride 0.9% . This gives 500mg in 50mL i.e. 10mg/mL
- Need 56mg dose, so 56mg ÷10 mg × 1mL = 5.6mL
- Give 5.6 mL over 15-30 minutes. (Could also give over 5 minutes as bolus.)
Reference[Page 151]2008) Medication Errors in Nursing and Residential Care Homes: Prevalence, consequences, causes and solutions. Report to the Patient Safety Research Portfolio. London: Department of Health.et al. (2005) Pregnancy induced changes in pharmacokinetics: A mechanistic-based approach. Clinical Pharmacokinetics, 44: 989–1008.(2009) Medication errors: Definitions and classification. British Journal of Clinical Pharmacology, 67 (6): 599–604.(Audit Office (1994) A Prescription for Improvement: Towards more rational prescribing in general practice. London: HMSO.2006) Recommendations from the British Committee for Standards in Haematology and National Patient Safety Agency. British Journal of Haematology, 136: 26–29.and (1970) Treatment or Diagnosis: A study of repeat prescriptions in general practice. London: Tavistock.et al. (Bandolier (1997) NNTs for Stroke Prevention. Available online at: www.medicine.ox.ac.uk/bandolier/band38/b38-2.html (accessed 24 October 2012).1995) What constitutes good prescribing? British Medical Journal, 310: 923–925.(2009) Care homes’ use of medicines study: Prevalence, causes and potential harm of medication errors in care homes for older people. Quality and Safety in Health Care, 18: 341–346.et al. (1978) Compliance, adherence and therapeutic alliance: Steps in the development of self-care. Social Science and Medicine, 12 (5): 369–376.(2000) Patients’ unvoiced agendas in general practice consultations: Qualitative study. British Medical Journal, 320: 1246.et al. (2010) Stockley's Drug Interactions: A source book of interactions, their mechanisms, clinical importance and management, 9th edn. London: Pharmaceutical Press.[Page 152](ed.) (2012) Stockley's Drug Interactions: Pocket companion. London: Royal Pharmaceutical Society of Great Britain.(2013) Stockley's Drug Interactions: A source book of interactions, their mechanisms, clinical importance and management, 10th edn. London: Pharmaceutical Press.and (eds) (2007) Using the clinical consultation as a learning opportunity. Available online at: http://www.faculty.londondeanery.ac.uk/e-learning/feedback/files/Using_the_clinical_consultation_as_a_learning_opportunity.pdf (accessed August 2013).and (2007) Emotional intelligence and patient-centred care. Journal of the Royal Society of Medicine, 100: 369–374.and (1996) Why we need observational studies to evaluate the effectiveness of health care. British Medical Journal, 312: 1215–1218.(Bombay hospital motto. Adapted from a quotation of Mahatma Gandhi. Available online at: http://dignifiedrevolution.org.uk/about-us/background-information.html (accessed 11 July 2012).2001) Pharmacists and the multidisciplinary health care team. In: and Harding G (eds) Pharmacy Practice. London: Taylor and Francis, pp. 254–255.(British National Formulary (2012) Number 63, Appendix 1: Drug interactions. London: Joint Committee of the Royal Pharmaceutical Society, BMA, Pharmaceutical Press.British National Formulary (2013) London: Joint Committee of the Royal Pharmaceutical Society, BMA, Pharmaceutical Press.2004) The patient's lament: Hidden key to effective communication: How to recognise and transform. Medical Humanities, 30: 63–69.(CAIPE (2002) Definition of IPE. Available online at: www.caipe.org.uk/about-us/defining-ipe (accessed 16 June 2012).Cancer Research UK Smoking Statistics. Available online at: http://info.cancerresearchuk.org/cancerstats/types/lung/smoking2007) Patient involvement in decisions about medicines: GPs’ perceptions of their preferences. British Journal of General Practice, 57: 777–784.and (2009) Context is everything or how could I have been that stupid? Healthcare Quarterly, 12 (special issue):171–176.(2000) What is a prescribing error? Quality in Health Care, 9: 232–237.and (2002) Causes of prescribing errors in hospital inpatients: A prospective study. Lancet, 359 (9315): 1373–1378.and (Department of Health (1998) Review of Prescribing, Supply and Administration of Medicines: A report on the supply and administration of medicines under group protocols. London: Department of Health.[Page 153]Department of Health (1999) Making a Difference: Strengthening the nursing, midwifery and health visitor contribution to health and healthcare. London: Department of Health. Available online at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007599 (accessed August 2013).Department of Health (2000a) The NHS Plan: A plan for investment, a plan for reform. London: Department of Health. Available online at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4002960 (accessed August 2013).Department of Health (2000b) Pharmacy in the Future: Implementing the NHS plan. London: Department of Health. Available online at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/Browsable/DH_4989549 (accessed August 2013).Department of Health (2000c) Patient Group Directions. HSC 2000/026. London: Department of Health.Department of Health (2001) Medicines and Older People: Implementing medicines-related aspects of the NSF for older people. London: Department of Health.Department of Health (2003) Winning Ways: Working together to reduce healthcare associated infections in England. London: HMSO.Department of Health (2004) National Service Framework for Children, Young People and Maternity Services: Medicines for children and young people. London: Department of Health. Available online at: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4090563.pdf (accessed 21 September 2012).Department of Health (2005) The National Service Framework for Renal Services Part Two: Chronic kidney disease, acute renal failure and end of life care. London: Department of Health.Department of Health (2007) Management of Medicines: A resource to support implementation of the wider aspects of medicines management for the National Service Frameworks for Diabetes Renal Services and Long-Term Conditions. London: Department of Health.Department of Health (2010) Access to the NHS by Foreign Nationals: Government response to the consultation. Available online at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/ digitalasset/dh_125285.pdf (accessed 22 November 2012).Department of Health (2011a) Stay Smart Then Focus: Guidance for antimicrobial stewardship in hospitals (England). London: HMSO.Department of Health (2011b) The ‘Never Events’ List 2011/12: Policy framework for use in the NHS. Available online at: www.dh.gov.uk/en/ Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_124552 (accessed 22 December 2011).[Page 154]Department of Health (2012) The ‘Never Events’ List 2012/13: Policy framework for use in the NHS. London: HMSO.Derby Hospitals Foundation Trust (2012) Drug Names That Look and Sound Alike. Available online at: www.derbyhospitals.nhs.uk/primary-care-staff/pharmacy/formulary/drug-names-that-look-sound-alike (accessed 3 January 2012).2004) Consultation in general practice: A standard operating procedure? Patient Education and Counselling, 54 (2): 227–233., van den , and De (DHSS (1986) Neighborhood Nursing: A focus for care (Cumberlege report). London: HMSO.2004) The role of effective communication with children and their families in fostering adherence to pediatric regimens. Patient Education and Counselling, 55: 339–344.(2009) An In Depth Investigation into Causes of Prescribing Errors by Foundation Trainees in Relation to their Medical Education. EQUIP study. Available online at: www.gmc-uk.org/about/research/research_commissioned_4.asp (accessed 22 December 2011).et al.(2002) Fruit juices inhibit organic anion transporting polypeptide-mediated drug uptake to decrease the oral availability of fexofenadine. Clinical Pharmacology and Therapeutics, 71 (1): 11–20.et al.(1989)Antimicrobial misuse in patients with positive blood cultures. American Journal of Medicine, 87 (3): 253–259.et al.(1992) Health and Wellness: A holistic approach, 4th edn. Boston, MA: Jones & Bartlett.and (2000) Adverse drug reactions: Definitions, diagnosis and management. Lancet, 356: 1255–1259.and (1993) Drug-related hospital admissions. Annals of Pharmacotherapy, 27: 832–1259.and (2006) Clarification of terminology in medication errors: Definitions and classification. Drug Safety, 29 (11): 1011–1022.and (2005) The incidence of prescribing errors in hospital inpatients: An overview of the research methods. Drug Safety, 28 (10): 891–900.et al.(1999) The consultation. In: (ed.) Clinical Method: A general practice approach, 3rd edn. Oxford: Butterworth Heinemann, p. 34.(Faculty of Sexual and Reproductive Healthcare (2012) Clinical Effectiveness Unit Clinical Guidance: Emergency contraception. Available online at: http://www.fsrh.org/pdfs/CEUguidanceEmergencyContraception11.pdf (accessed August 2013).[Page 155]2004) Evidence based guidelines or collectively constructed ‘mindlines’? Ethnographic study of knowledge management in primary care. British Medical Journal, 329: 1013–1017.and (2002) ABC of psychological medicine: The consultation. British Medical Journal, 324: 1567–1569.and (General Medical Council (2006) Good Medical Practice. Available online at: www.gmc-uk.org/guidanceGeneral Medical Council (2009) Tomorrow's Doctors: Education outcomes and standards for undergraduate medical education. Available online at: www.gmc-uk.org/guidanceGeneral Medical Council (2012) Investigating the Prevalence and Causes of Prescribing Errors in General Practice: The PRACtICe Study. Available online at: http://www.gmc-uk.org/Investigating_the_prevalence_and_causes_of_prescribing_errors_in_general_practice___The_PRACtICe_study_Reoprt_May_2012_48605085.pdf (accessed 21 November 2012).General Medical Council (2013a) Good Medical Practice. London: General Medical Council. Available online at: www.gmc-uk.org/static/documents/content/GMP_2013.pdf_51447599.pdf (accessed 3 July 2013).General Medical Council (2013b) Good Practice in Prescribing and Managing Medicines and Devices. London: General Medical Council. Available online at: www.gmc-uk.org/Prescribing_guidance_Last_ever_final_update_29_4_13.pdf_51867046.pdf (accessed 8 July 2013).2009) Teaching and assessment of explanation and planning in medical schools in the United Kingdom: Cross sectional questionnaire survey. Medical Teacher, 31 (4): 328–331.and (2009) Interventions for Preventing Falls in Older People Living in the Community. Cochrane Database of Systematic Reviews, Issue 2.Gillespie WJ et al.(2000) Impact of relational co-ordination on quality care, postoperative pain and functioning, and length of stay: A nine hospital study of surgical patients. Medical Care, 38: 807–819.et al.(2000) Introduction to the Symptoms and Signs of Clinical Medicine: A hands-on guide to developing core skills. London: Hodder Arnold.and (eds) (2012) Why do we always end up here? Evidence-based medicine's conceptual cul-de-sacs and some off-road alternative routes. Journal of Primary Health Care, 4: 92–97.(2002) Evidence Based Medicine as a Tool for Quality Improvement. Oxford: Oxford University Press.[Page 156]and (2011) Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): A cluster-randomised trial. Lancet, 378: 156–167.et al.(2009) Being Interprofessional. Cambridge: Polity.and (1996) The scale of repeat prescribing. British Journal of General Practice, 46 (412): 649–653.and (1979) Compliance in Health Care. Baltimore, MD: Johns Hopkins University Press.and (Health Protection Agency (2010) Management of Infection Guidance for Primary Care for Consultation and Local Adaptation. London: HMSO.2000) Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: An overview of epidemiologic studies published in the 1990s. Archives of Internal Medicine, 160 (14): 2093–2099.and (2005) Concordance, Adherence and Compliance in Medicine Taking: Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO). Available online at: http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1412-076_V01.pdf (accessed 28 August 2013).and (1983) A Country Doctor: The Penguin complete short stories of Franz Kafka (Glatzer NN (ed.)). London: Penguin.(2011) Guidelines on oral anticoagulation with warfarin, 4th edn. British Journal of Haematology, 154 (3): 311–324.et al.(2003)Marrying content and process in clinical method teaching: Enhancing the Calgary–Cambridge guides. Academic Medicine, 78: 8.and (1999a)Drugs and falls in older people: A systematic review and meta-analysis, Part I. Psychotropic drugs. Journal of the American Geriatric Society, 47: 30–39.and (1999b)Drugs and falls in older people: A systematic review and meta-analysis, Part II. Cardiac and analgesic drugs. Journal of the American Geriatric Society, 47: 40–50.and (2009)Prevalence, incidence and nature of prescribing errors in hospital inpatients. Drug Safety, 32: 379–389.and (1992) Changes in renal function with aging: Implications for treatment. Drugs and Aging, 2 (5): 423–431.[Page 157](2003) Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. British Journal of Clinical Pharmacology, 57: 6–14.and (1973) Altered absorption of digoxin in patients given propantheline and metoclopramide. Lancet, 301 (7800): 398–400 Available online at: http://www.sciencedirect.com/science/article/pii/S0140673673902523 (accessed 23 July 2012).and (1997) From Compliance to Concordance: Achieving shared goals in medicine taking. London: Royal Pharmaceutical Society of Great Britain.(2011) Supporting patients to make the best decisions. British Medical Journal, 342: d2117.and (2009a) Getting a better grip on research: The comfort of opinion. InnovAiT, 2: 679–686.and (2009b) Getting a better grip on research: A simple system that works. InnovAiT, 2: 739–749.Hutchinson A et al. (2011) Mason & McCall-Smith's Law and Medical Ethics, 8th edn. Oxford: Oxford University Press.and Laurie GT (2006) Systematic review and meta-analysis of ethnic differences in risks of adverse reactions to drugs used in cardiovascular medicine. British Medical Journal, 332 (7551): 1177–1181.and (2009) The pathophysiology of medication errors: How and where they arise. British Journal of Clinical Pharmacology, 67 (6): 605–613.and (Medusa Injectable Medicines Guide. Southern Health NHS Foundation Trust. Available online at: http://www.southernhealth.nhs.uk/knowledge/medicines-management/medusa (accessed August 2013).MHRA (2008) Advice for Healthcare Professionals. Drug Safety Update 1 (11). Available online at: www.mhra.gov.uk/Safetyinformation/index.htmMHRA (2012) Legal Status and Reclassification. Available online at: www.mhra.gov.uk/Howweregulate/Medicines/Licensingofmedicines/Legalstatusandreclassification/index.htm (accessed December 2012).2007) The Naked Consultation: A practical guide to primary care consultation skills. Abingdon: Radcliffe.(2011) Guidelines for the management of inflammatory bowel disease in adults. Gut, 60: 571–607.et al.(2010) Effects of St John's Wort on the pharmacokinetics of levonorgestrel in emergency contraceptive (EC) dosing. Contraception, 83: 191.[Page 158](National Patient Safety Agency (2002) Patient safety alert. Potassium Solutions: Risks to patients from errors occurring during intravenous administration. NPSA/2002/1051. Available online at: www.npsa.nhs.uk[Page 159]National Patient Safety Agency (2006a) Patient safety alert 13. Improving Compliance with Oral Methotrexate Dosing Guidelines. NPSA/2006/13. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2006b) Risk Assessment of Anticoagulation Treatment. Available online at: www.npsa.nhs.uk/health/alertsNational Patient Safety Agency (2007a) Patient safety alert 18. Actions That Can Make Anticoagulant Therapy Safer. NPSA/2007/18. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2007b) Safety in doses. Improving the Use of Medicines in the NHS: Learning from national reporting. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2008a) Rapid response report. Reducing Dosing Errors with Opioid Medicines. Additional supporting information. NPSA/2008/ RRR005. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2008b) Rapid response report. Risks of Incorrect Dosing of Oral Anti-cancer Medicines. NPSA/2008/RRR001. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2009) Safety in doses. Improving the Use of Medicines in the NHS: Learning from national reporting. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2010a) Rapid response report. Reducing Treatment Dose Errors with Low Molecular Weight Heparins. NPSA/2010/ RRR014. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2010b) Rapid response report. Safer Administration of Insulin. NPSA/2010/RRR013. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2010c) Rapid response report. Safer Administration of Insulin. Additional supporting information. NPSA/2010/ RRR013. Available online at: www.npsa.nhs.ukNational Patient Safety Agency (2011) Rapid response report. The Adult Patient's Passport to Safer Use of Insulin. NPSA/2011/PSA003. Available online at: www.npsa.nhs.ukNational Prescribing Centre (2007) A Competency Framework for Shared Decision-making with Patients: Achieving concordance for taking medicines. Available online at: www.npc.co.uk/patients_medicines/adherenceNational Prescribing Centre (2008) Dispensing with Repeats: A practical guide to repeat dispensing, 2nd edn. Available online at: http://www.npc.nhs.uk/repeat_medication/repeat_dispensing/resources/dwr_for_web.pdf (accessed 16 November 2012).National Prescribing Centre (2010) 10 Tips for GPs: Strategies for safer prescribing. Available online at: www.npc.co.uk/evidence/top_10_tips/ top_10_tips_for_GPs.php (accessed 3 January 2012).National Prescribing Centre (2012) A Single Competency Framework for all Prescribers. Available online at: www.npc.co.uk/improving_quality/resources/ single_comp_framework.pdf (accessed 11 October 2012).NHS Information Centre (2012) Prescription Cost Analysis, England 2011. Available online at: www.ic.nhs.uk/statistics-and-data-collections/ primary-care/prescriptions/prescription-cost-analysis-england–2011NICE (2004) Clinical Guideline 21. Falls: The assessment and prevention of falls in older people. London: NICE.NICE (2007) Technical Patient Safety Solutions for Medicines Reconciliation on Admission of Adults to Hospital. PSG001. Available online at: guidance.nice.org.uk/PSG001 (accessed 4 January 2012).NICE (2009) Medicines Adherence: Involving patients in decisions about prescribed medicines and supporting adherence. Available online at: www.nice.org.uk/nicemedia/pdf/CG76FullGuideline2010) Drug induced pancreatitis. Best Practice & Research Clinical Gastroenterology, 24: 143–155.Lerch MM et al. (North- 2008) Drugs and the Liver. London: Pharmaceutical Press.(ed.) (Oxford Dictionary (2012). Available online at: http://oxforddictionaries.com (accessed 1 July 2012).Paediatric Formulary Committee (2013) BNF for Children. London: Pharmaceutical Press. Available online at: http://www.medicinescomplete.com/mc/bnfc/current (accessed August 2013).Palliativedrugs.com. Essential independent drug information for palliative and hospice care. Available online at: http://www.palliativedrugs.com/index.html (accessed August 2013).Patient Safety First (2008) The How-to Guide for Reducing Harm from High Risk of Medicines. Available online at: http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/How-to-guides-2008-09-19/Medicines%201.1_17Sept08.pdf (accessed 28 March 2013).2009) Variation of drug kinetics in pregnancy. Current Drug Metabolism, 10: 520–529.and (2010) Drug Interactions. Available online at: www.cc.nih.gov/training/training/principles/slides/DrugInteractions2010-2011_text.pdf (accessed July 2012).[Page 160](Pharmacia Ltd (2009) Kemicetine Succinate Injection Summary of Product Characteristics. Available online at: www.medicines.org.uk (accessed 21 September 2012).Picker Institute Europe (2007) National Survey of Local Health Services 2006. London: Department of Health.1987) Holistic medicine: New lessons to be learned. Practitioner, 231: 1386–1390.(2004) Adverse drug reactions as a cause of admission to hospital: Prospective analysis of 18,820 patients. British Medical Journal, 329: 15–19.et al. (Police Foundation (1999) Drugs and the Law: Report of the Independent Inquiry into the Misuse of Drugs Act 1971. Available online at: http://www.druglibrary.org/schaffer/library/studies/runciman (accessed 19 August 2013).2005) Pilot study to show the loss of important data in nursing handover. British Journal of Nursing, 14 (20): 1090–1093.and (1998) Working Through Communication. Chapter 12. Listening. Available online at: http://epublications.bond. edu.au/working_through_communication/13 (accessed 12 July 2012).(PSNC and BMA (2009) Guidance for the Implementation of Repeat Dispensing. Available online at: http://www.nhsemployers.org/SiteCollectionDocuments/Repeat_dispensing_guidance_CD_090209.pdf (accessed August 2013).Rabbi Ben Zoma (2nd century) (2006) Pirkei Avot – Ethics of the Fathers, Ch 4 V 1. Authorised Daily Prayer Book of the United Hebrew Congregations of the Commonwealth (Sacks J). London: Collins, p. 545.1977) Pathogenesis of adverse drug reactions. In: Davies DM (ed.) Textbook of Adverse Drug Reactions. Oxford: Oxford University Press, p. 44.and Thompson JW (1990) Human Error. Cambridge: University of Cambridge.(Royal Pharmaceutical Society (2011) Keeping Patients Safe When They Transfer Between Care Providers: Getting the medicines right. Available online at: www.rpharms.com/getting-the-medicines-right/professional-guidance.asp (accessed 3 January 2012).1996) Evidence based medicine: What it is and what it isn't. British Medical Journal, 312: 71–72.et al. (2005) Caution required when relying on a colleague's advice: A comparison between professional advice and evidence from the literature. BMC Health Services Research, 5: 59.et al. (Scottish Intercollegiate Guidelines Network (2008) Diagnosis and Management of Headaches in Adults: A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network. Available online at: http://www.sign.ac.uk/pdf/sign107.pdf (accessed August 2013).[Page 161]2007) Drugs During Pregnancy and Lactation. London: Elsevier.and (eds) (2001) A survey of prescription errors in general practice. The Pharmaceutical Journal, 267: 860–862.and (1999) Are we providing doctors with the training and tools for lifelong learning? British Medical Journal, 319: 1280–1282.and (Shipman Inquiry Fourth Report (2004) The Regulation of Controlled Drugs in the Community. London: The Stationery Office.1997) Obtaining useful information from expert-based sources. British Medical Journal, 314: 947–949.and (1994) Becoming an information master: Feeling good about not knowing everything. Journal of Family Practice, 38: 505–513.and (SPC Brilique 90mg tablets (2011) Summary of Product Characteristics. Available online at: www.medicines.org.uk/EMC/medicine/23935/SPC/Brilique+90+mg+film+coated+tablets (accessed July 2012).1995) Effective physician–patient communication and health outcomes: A review. Canadian Medical Association Journal, 152: 1423–1433.(The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) Trial Investigators (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. New England Journal of Medicine, 345: 494–502.2011) Collaboration and interprofessional working. In: and Forrest K (eds) Professional Practice for Foundation Doctors. Exeter: Learning Matters, pp. 189–203.(2010) Learning outcomes for interprofessional education (IPE): Literature review and synthesis. Journal of Interprofessional Care, 24: 503–513.and (1985) Meetings Between Experts. London: Tavistock Publications.and (2009) The causes of and factors associated with prescribing errors: Systematic review. Drug Safety, 32: 819–836.et al. (2003) Student attitudes to undergraduate interprofessional education. Journal of Interprofessional Care, 17 (2): 61–172.[Page 162]and (UCL Hospitals (2010) Injectable Medicines Administration Guide: Pharmacy Department, 3rd edn. London: University College London Hospitals.UKCCC (2006) UK Council of Clinical Communication in Undergraduate Medical Education. Available online at: www.ukccc.org.ukUKMi (2012) Medicines Q&A 34.5: What Should You Think About When Prescribing to Pregnant Women? National Electronic Library for Medicines. Available online at: www.nelm.nhs.uk (accessed 21 September 2012).2010) Patient Safety. Singapore: Wiley-Blackwell.(WHO/UNICEF (2003) Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization.2002) Adverse drug reactions in hospital patients: A systematic review of the prospective and retrospective studies. Bandolier Extra, June: 1–16.and (1998) Doctor–patient communication and patient satisfaction: A review. Family Practice, 15: 480–492.and (World Health Organization (1970) International drug monitoring: The role of the hospital. A WHO report. Drug Intelligence and Clinical Pharmacy, 4: 101–110.World Health Organization (2010) Framework for Action on Interprofesssional Education and Collaborative Practice. Geneva: WHO.