Prescribing: a personal responsibility
Prescription writing is one of the most powerful tools that a doctor has in their arsenal of care—but that also leaves it open to abuse and errors. Prescription best practice and guidelines are your defence against these issues.
IN THIS FACT SHEET:
- What good prescribing practice looks like.
- Practical advice on avoiding common prescription errors.
Prescribing appropriately is a personal responsibility of medical practitioners. You must resist any pressure applied by anyone else including your employer or your patients to prescribe inappropriately.
The Medical Council’s Guideline “Good Prescribing Practice” dated November 2016 states:
“Make the care of patients your first concern. You should only prescribe medicines or treatment when you have adequately assessed the patient’s condition, and/or have adequate knowledge of the patient’s condition and are therefore satisfied that the medicines or treatment are in the patient’s best interests. Alternatively you may prescribe on the instructions of a senior colleague or a practice colleague who can satisfy the above criteria, as long as you are confident that the medicines or treatment are safe and appropriate for that patient and the patient has given his or her informed consent. Medicines or treatment must not be prescribed for your own convenience or simply because patients demand them.“
We therefore advise:
- Avoid writing prescriptions for yourself or those with whom you have a close personal relationship. It is never appropriate to prescribe or administer medicines with a risk of addiction or misuse, psychotropic medication or controlled drugs to yourself or someone close to you. An independent doctor should be engaged in these circumstances.
- Avoid prescribing for a patient you have not examined except in circumstances where a colleague has done so and you are confident that the medications or treatment are safe and appropriate.
- Keep accurate records of all medicines, including non-prescription medicines, prescribed or taken by patients.
- Never falsify any part of a script. It is a criminal act to falsify a signature on a script, or to enter any patient details which the doctor knows to be incorrect e.g. the intended recipient of the medication.
In short, avoid prescribing for yourself, those you know, or for patients whose diagnoses and course of care you aren’t confident in.
Current as at 6 November 2018
If you are concerned about correct prescribing, or you are worried that one of your prescriptions has gone awry, get in touch with NZMPI’s team of medico-legal advisors now.
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Removal of body parts and informed consent
The rights of patients to decide what happens to their body parts following a surgery does not end at the decision to remove said body part.
Often, there is a significant amount of personal and cultural significance tied to these tissues, and it is a core part of a doctor’s legal responsibilities and duty of care to not only understand the correct procedure for the disposal of body parts, but to ensure the patient also understands the principles of informed consent.
IN THIS FACT SHEET:
- Clarification of what processes require informed consent.
- Reiteration of the HDC code and how it applies to body part removal.
- The hierarchy of consent in the case of deceased persons.
Related content: Informed consent: what doctors need to know.
Under the Code of Health and Disability Services Consumers’ Rights, health professionals must gain informed consent from the patient not only about the procedure involved in removing body parts, but also about the storage, utilisation and disposal of the removed body parts. Processes must also be in place for the safe return of the body part, if requested by the patient.
Right 7(9) of the Code states, “Every consumer has the right to make a decision about the return or disposal of any body parts or bodily substances removed or obtained in the course of a health care procedure”.
Right 7(10) states, “Any body parts or bodily substances removed or obtained in the course of a health care procedure may be stored, preserved, or utilised only with the informed consent of the consumer.”
In relation to a deceased person, the Human Tissue Act 2008 (“the Act”) sets out the consent framework for the collection and use of collection and use of tissue. The Act provides for a hierarchy for other people who may consent (or object) if no one above them in the hierarchy has consented or objected. In order, these parties are the individual, the individual’s nominee, the individual’s immediate family and a close available relative of the individual.
In short, patients and their families have significant rights in regards to the storage, return and disposal of any materials removed from their person during the course of their medical care. It is integral that medical professionals understand this and the hierarchy of decision involved.
Current as at 19 September 2018