Example 3 - Prescribing for pain | Medical Appraisal Scotlan

Resources Toolkit Scottish Medical Appraisal & Revalidation Toolkit Role specific additional considerations Sessional GPs Supporting Information

Example 3 - Prescribing for pain (5 or 8 criterion audit)

As a sessional doctor you will often see a high proportion of patients presenting for unscheduled care with painful conditions. Your prescribing will reflect this.

For ten surgeries, note your use of analgesic prescribing against your chosen set of criteria and standards. You need to consider setting criteria such as:

Patients prescribed analgesics should have a condition or reason clearly recorded in their records
Analgesics should be used which are in line with local formulary recommendations for first line use, unless clinically contraindicated
If a non steroidal anti-inflammatory is used, gastric protection should be considered where appropriate (for example elderly, debilitated patients)
Non steroidal anti-inflammatory drugs should generally be avoided in patients with a past history of GORD, ulcer disease or upper G-I haemorrhage
Strong analgesics should be prescribed in relatively small quantities on first presentation (a week?)
Patients with chronic pain should have a clear record of any adjustment to their regime
Patients who are prescribed opiates often experience constipation: for elderly patients a laxative should be prescribed or a warning of the risk given to the patient and recorded
All analgesic prescribing should be accompanied by a check for known past history of hypersensitivity
All analgesic prescribing should be accompanied by a check for potential drug interactions
If a second line analgesic is used, the reason for its use should be documented

As an alternative you could audit your personal handling of controlled drugs:

Your controlled drug register should contain details of all controlled drugs that you hold (Class A)
Your injectable Class A drugs must be in a locked case or bag
You have details of how to contact the appointed officer responsible for disposal of expired or redundant Class A drugs
Your prescriptions for controlled drugs all meet the regulations (you will need to log these prescriptions or take copies prospectively for this criterion)
No prescriptions for controlled drugs should exceed one month's supply

These are only examples of criteria which you might choose from. You are recommended to use criteria which you can justify, and you will then need to justify the standards that you set for your performance.

You might want to consider repeating the exercise for another 10 surgeries at a later date, to complete the "audit cycle".

If you are unable to undertake these preferred options, you could use the tools below for reflective learning with your appraiser.

Example 3 - Prescribing for pain (5 or 8 criterion audit)

Example 3 - Prescribing for pain (5 or 8 criterion audit)

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