Essential Practical Prescribing E-Book

Georgia Woodfield

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: essentials
• Sprache: Englisch

Seitenzahl: 1015

Veröffentlichungsjahr: 2016

Beschreibung

ESSENTIAL PRACTICAL PRESCRIBING

The Essentials are an international, best-selling series of textbooks, all of which are designed to support lecture series or themes on core topics within the health sciences. See www.wileyessential.com for further details.

Essential Practical Prescribing is an important new textbook with a clinical, ward-based focus. It is specifically designed to help new foundation doctors working on the hospital wards and in the community, as well as medical students preparing for the Prescribing Safety Assessment.

Using an accessible format, Essential Practical Prescribing demonstrates how to manage common medical conditions, and explains the logic behind each decision. It also emphasises common pitfalls leading to drug errors, and highlights drugs that could cause harm in certain situations. Organised by hospital department, it outlines the correct management of conditions, as well as highlighting the typical trials of a junior doctor.

Essential Practical Prescribing:

• Contains a range of learning methods within each chapter including: key topics, learning objectives, case studies, DRUGS checklists, ‘Top-Tips’, advice on guidelines and evidence, and key learning points
• Uses patient histories to set the scene and enhance the clinical emphasis
• Offers examples of correctly completed drug charts throughout
• Is an ideal companion for Prescribing Safety Assessment (PSA) preparation

For more information on the complete range of Wiley medical student and junior doctor publishing, please visit: www.wileymedicaleducation.com

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Essential Practical Prescribing

Georgia Woodfield MBChB MRCP Specialist Registrar in Gastrointestinal Medicine, LondonBenedict Lyle Phillips MBChB BSc (Hons) MRCS MScSpecialist Registrar in General Surgery, NE London DeaneryVictoria Taylor MBChB BSc MRCPSpecialist Registrar in Respiratory Medicine, LondonAmy Hawkins BA (Hons) MBChB (Hons) MRCP MScSpecialist Registrar in Palliative Medicine, LondonAndrew Stanton MD FRCPConsultant Respiratory PhysicianThe Great Western Hospital, Swindon;Honorary Senior Clinical Lecturer, University of BristolWith contribution from Marie O'Sullivan MB ChBSpecialist Registrar in Obstetrics & Gynaecology, Severn Deanery

This edition first published 2016 © 2016 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Names: Woodfield, Georgia, author. | Phillips, Benedict Lyle, author. |   Taylor, Victoria, MBChB, author. | Hawkins, Amy, MBChB, author. | Stanton,    Andrew, MD, author. | O'Sullivan, Marie, active 2015, contributor.

Title: Essential practical prescribing / Georgia Woodfield, Benedict Lyle    Phillips, Victoria Taylor, Amy Hawkins, Andrew Stanton ; with contribution from Marie O'Sullivan.

Description: Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons, Inc.,    2016. | Includes bibliographical references and index.

Identifiers: LCCN 2015046044 (print) | LCCN 2015048186 (ebook) |    ISBN 9781118837733 (pbk.) | ISBN 9781118837702 (pdf) | ISBN 9781118837696 (epub)

Subjects: | MESH: Drug Prescriptions

Classification: LCC RM139 (print) | LCC RM139 (ebook) | NLM QV 748 | DDC    615.1/4-dc23

LC record available at http://lccn.loc.gov/2015046044

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

CONTENTS

Preface

Acknowledgements

How to use your textbook

About the Companion website

Chapter 1 Trials of a Junior Doctor

Prescribing

Being a medical student

Being a junior doctor

Common pitfalls

The ‘DRUGS’ safety check

References

Chapter 2 Emergency Department

Cardiac arrest

Anaphylaxis

Overdose

Acute alcohol withdrawal

References

Chapter 3 Cardiology

Acute coronary syndrome

Acute left ventricular failure

Chronic heart failure

Atrial fibrillation

Tachycardia

Bradycardia

Hypertension

References

Chapter 4 Respiratory

Acute asthma

Chronic asthma

Acute exacerbation of COPD

COPD – long-term management

Community-acquired pneumonia

Prescribing in other respiratory infections

References

Chapter 5 Gastroenterology

Upper gastrointestinal haemorrhage

Acute inflammatory bowel disease

Acute infective diarrhoea

Acute hepatitis

Constipation

References

Chapter 6 Neurology

Stroke

Thrombolysis

Prescribing for strokes not amenable to thrombolysis

Bacterial meningitis

Seizures and epilepsy

Parkinson’s disease

Levodopa (L-DOPA): rational and evidence

Dopamine agonists: essential pharmacology

Other aspects of Parkinson’s disease

Case outcome and discharge

References

Chapter 7 Surgery

Fluid management

Maintenance electrolytes

Resuscitation fluids

Blood products

Postoperative pain

Constipation

References

Chapter 8 Care of the Elderly

Bone protection

Delirium

Polypharmacy

Hyponatraemia

References

Chapter 9 Anticipatory Prescribing at the End of Life

Pain

Breathlessness and excess secretions

Nausea and vomiting

Agitation

References

Chapter 10 Renal

Acute kidney injury

Hyperkalaemia

References

Chapter 11 Microbiology

Sepsis and antibiotics

Infections related to antibiotic use

Prescribing for

Clostridium difficile

infection

Antibiotics in

Clostridium difficile

infection: rationale and evidence

Neutropenic sepsis

References

Chapter 12 Rheumatology

Osteoarthritis

Gout

Rheumatoid arthritis

Giant cell arteritis and polymyalgia rheumatica

References

Chapter 13 Dermatology

Eczema

Psoriasis

Allergic rashes

Cellulitis

Fungal infections

Acne

References

Chapter 14 Obstetrics and Gynaecology

Introduction

Pain in pregnancy

Nausea and vomiting in pregnancy

Hypertensive disease in pregnancy

Diabetic disease in pregnancy

Labour

Gynaecology – contraception

Gynaecology – pain and bleeding in early pregnancy

References

Chapter 15 Diabetes

Diabetic ketoacidosis

Hyperosmolar hyperglycaemic state

Hypoglycaemia

Other aspects of prescribing in diabetes

References

Chapter 16 Anticoagulation

Venous thromboembolism

Anticoagulation in atrial fibrillation

Anticoagulation reversal

References

Index

Eula

List of Tables

Chapter 1

Table 1.1

Chapter 2

Table 2.1

Chapter 3

Table 3.1

Table 3.2

Table 3.3

Table 3.4

Chapter 4

Table 4.1

Table 4.2

Table 4.3

Table 4.4

Chapter 5

Table 5.1

Table 5.2

Chapter 6

Table 6.1

Table 6.2

Table 6.3

Table 6.4

Table 6.5

Table 6.6

Chapter 7

Table 7.1

Table 7.2

Table 7.3

Chapter 9

Table 9.1

Chapter 10

Table 10.1

Table 10.2

Table 10.2

Table 10.4

Chapter 12

Table 12.1

Chapter 14

Table 14.1

Table 14.2

Table 14.3

Chapter 15

Table 15.1

Table 15.2

Table 15.3

Chapter 16

Table 16.1

Table 16.2

Table 16.3

Table 16.4

Table 16.5

List of Illustrations

Chapter 1

Figure 1.1

A blank drug chart showing typical sections for regular, once-only, as-required and infusion medications.

Chapter 2

Figure 2.1

Cardiac arrest case study rhythm strip.

Figure 2.2

Medications from the cardiac arrest trolley.

Figure 2.3

Paracetamol nomogram.

Chapter 3

Figure 3.1

SVT cardioverting to sinus rhythm with administration of adenosine.

Figure 3.2

Rhythm strip showing non-sustained ventricular tachycardia.

Chapter 4

Figure 4.1

Venturi masks; note also the different size apertures in 60% mask compared with 24%.

Figure 4.2

Strategy for the pharmacological management of chronic COPD. SABA, short-acting beta agonist; SAMA, short-acting muscarinic antagonist; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; ICS, inhaled corticosteroid. * SABA (as required) may continue at all stages. Source: National Institute for Health and Care Excellence (2010) CG101. Chronic obstructive pulmonary disease. London: NICE. Available at: www.nice.org.uk/guidance/CG101. Reproduced with permission.

Chapter 7

Figure 7.1

The distribution of fluid in the body, with one-third being extracellular and two-thirds being intracellular.The extracellular space includes the intravascular space, where IV fluid enters directly, and the interstitial space.

Figure 7.2

Effective and safe combinations of antiemetic classes.

Chapter 9

Figure 9.1

The WHO analgesic ladder. Source: Reproduced with permission of WHO.

Chapter 10

Figure 10.1

STOP' AKI checklist of the important causes of AKI. The checklist acts as an aide memoire to junior doctors. Source: London AKI Network, 2015.

Figure 10.2

Electrocardiogram showing tall tented T waves in leads I, II, V

2

–V­

5

. This is suggestive of dangerous hyperkalaemia.

Chapter 11

Figure 11.1

The Hartford nomogram. Source: Ross S(2014) Prescribing at a Glance. Reproduced with permission of Wiley.

Chapter 14

Figure 14.1

Section of cardiotocograph (CTG) to assess fetal wellbeing (normal CTG).

Guide

Cover

Contents

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Preface

This textbook was inspired by the need for a practical prescribing textbook for medical students and junior doctors. In a 2009 General Medical Council (GMC) report, 9% of hospital prescriptions contained errors, where 18.7% of these were made by junior doctors (Dornan et al., 2009). A 2008 GMC report of newly qualified UK doctors showed that prescribing was the ‘main area of practice in which errors were reported by respondents, indicating a significant potential risk’ (Illing et al., 2008). Aside from these figures, the initial inspiration for the book came from my own and others' personal experiences of being a doctor training in busy UK hospitals. Starting as a doctor is daunting, particularly due to the sudden weight of responsibility, much of which lies in prescribing medications. A National Patient Safety Agency study in 2007 found that 32% of the most serious UK drug error incidents were caused by prescribing (NPSA, 2009). When I (GW) started I would have certainly found a practical prescribing book beneficial, as common prescriptions do not become embedded in your memory until you have had the experience to draw back on.

Later on, whilst teaching medical students in the Great Western Hospital Swindon, it became clear that many were worried about becoming junior doctors, where prescribing was a major theme. I and the co-authors (working as clinical teaching fellows or with regular teaching roles) therefore ran prescribing tutorials for medical students, and received hugely positive feedback from them. This encouraged us to publish the data from the tutorials, present at conferences and ultimately write this textbook.

We believe our textbook fills a gap in a critical subject area by relating to medical students and junior doctors in a practical and accessible way. We have tried to ensure this by basing it on our own experiences as junior doctors. It is concise enough to be used as a ward guide, particularly as the DRUGS Checklists provide a quick summary of how to write prescriptions. The book also contains MCQs on a companion website (see the link at the end of each chapter) for those revising for the Prescribing Skills Assessment or wanting to test their knowledge. The website also has easily accessible DRUGS Checklist boxes, where important information is condensed for ease of reference.

We hope this book helps you to avoid mistakes, learn tips from doctors who have gone before you and be the best doctor you can be. Good Luck!

Georgia WoodfieldBenedict Lyle PhillipsVictoria TaylorAmy HawkinsAndrew Stanton

Reference

Dornan T, Ashcroft D, Heathfield H et al. (2009). Final report. An in Depth Investigation into Causes of Prescribing Errors by Foundation Trainees in Relation to their Medical Education. Equip Study. Available at: www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf (accessed Dec. 2015).

Illing J, Morrow G, Kergon C et al. (2008). How Prepared are Medical Graduates to Begin Practice? A Comparison of Three Diverse UK Medical Schools. Available at: www.gmc-uk.org/FINAL_How_prepared_are_medical_graduates_to_begin_practice_September_08.pdf_29697834.pdf (accessed Dec. 2015).

NHS National Patient Safety Agency (NPSA) (2009). National Reporting and Learning Service. Safety in Doses Improving the Use of Medicines in the NHS. Learning from National Reporting 2007. Available at: www.nrls.npsa.nhs.uk/resources/?entryid45=61625 (accessed Dec. 2015).

Acknowledgements

We are most grateful to a number of our colleagues from the Great Western Hospital, the University of Bristol and London for their time and expertise in reviewing and providing valuable comments and suggestions to improve sections of the book.

Chapter 2 Emergency Department: Dr Clare Taylor, Emergency Medicine Consultant at the Royal United Hospitals, Bath

Chapter 3 Cardiology: Dr Andrianos Kontogeorgis, Senior Clinical Fellow in Cardiology and Electrophysiology at the Royal Brompton Hospital, London

Chapter 5 Gastroenterology: Dr Ajeya Shetty, Gastroenterology Consultant at the Great Western Hospital, Swindon

Chapter 6 Neurology: Dr Stephan Hinze, Neurology Consultant at the Great Western Hospital, Swindon

Chapter 7 Surgery: Dr Tony Pickworth, Consultant Anaesthetist at the Great Western Hospital Swindon

Chapter 8 Care of the Elderly: Dr Sameer Maini, Care of the Elderly Consultant at the Great Western Hospital, Swindon

Chapter 9 Anticipatory Prescribing at the End of Life: Professor Karen Forbes, Palliative Medicine Consultant at the University Hospitals, Bristol

Chapter 10 Renal: Dr Gavin Dreyer, Specialist Registrar in Nephrology in the NE London Deanery, Dr Rhys Evans, Specialist Registrar in Nephrology in the NE London Deanery and Dr Ulla Hemmilä, Specialist Registrar in Nephrology in the NE London Deanery

Chapter 11 Microbiology: Dr Robert Baker, Microbiology Consultant at the Musgrove Park Hospital, Taunton

Chapter 12 Rheumatology: Dr Lyn Williamson, Rheumatology Consultant at the Great Western Hospital, Swindon

Chapter 13 Dermatology: Dr Sam Gibbs, Dermatology Consultant at the Great Western Hospital, Swindon

Chapter 14 Obstetrics and Gynaecology: Mr Kevin Jones, Obstetrics and Gynaecology Consultant at the Great Western Hospital, Swindon

Chapter 15 Diabetes: Professor Andy Levy, Consultant Endocrinologist, University Hospitals, Bristol

Thank you also to Dr Stanton for believing in us and supporting us every step of the way.

About the Companion website

Don't forget to visit the companion website for this book:

www.wileyessential.com/prescribing

There you will find valuable material designed to enhance your learning, including:

MCQs

Downloadable DRUGS checklists

Scan this QR code to visit the companion website

CHAPTER 1Trials of a Junior Doctor

Georgia Woodfield

Key topics:

Prescribing 2

Being a medical student 5

Being a junior doctor 6

Common pitfalls 7

Learning objectives

By the end of this chapter you should…

…understand the general principles of prescribing and its importance in providing good patient care.

…be able to consider the appropriateness and safety of a medication in the context of the individual patient’s age, comorbidities, allergies and preferences.

…be aware of some of the common pitfalls of prescribing, where doses may need adjusting.

…be aware of which medications

not

to prescribe. Sometimes this is as important as knowing which medications to prescribe, and can prevent much harm.

Prescribing

Introduction

Prescribing is a daunting task as a junior doctor. No pharmacology textbook can prepare you for the responsibility of signing your name to a drug and giving it to your patient. The best preparation is practice but there are a few key principles that will prevent major errors being made. It is well recognised that drug errors are a major cause of patient morbidity and mortality, hence prescribing was a key area targeted by the National Patient Safety Agency (NPSA, 2007). In a 2009 GMC report, 9% of hospital prescriptions contained errors, with FY1 doctors making 8.4% of prescription errors and FY2 doctors making 10.3% of errors (highest error rate) in 19 UK hospitals on 7 days. In addition, a 2008 GMC report of medical students moving to FY1 showed prescribing was the ‘main area of practice in which errors were reported, indicating a significant potential risk’ (GMC, 2008). One conclusion for the 2012 review of Tomorrow’s Doctors guidance (GMC, 2009a) was that development of ward-based teaching of prescribing should be supported.

General prescribing principles

A few basic rules go a long way with regards to writing a drug on a drug chart. With every prescription, all of the following need to be clearly specified; then there can be no mistake with the prescription side of things:

Correctly identify the patient with at least three identifiers on the drug chart: full name, date of birth, NHS number (these three are the legal minimum) and hospital number.

Write the date and time.

All allergies must be written clearly at the front of the drug chart.

Write the drug in the correct section of the chart: once-only drugs, regular, as required, variable prescriptions, infusions and fluids section; some charts have a dedicated thromboprophylaxis section, insulin section and antibiotic section.

Write the drug name clearly, with its formulation if required (e.g. insulin is not enough, the formulation has to be specified, e.g. NovoRapid insulin) and ideally in capital letters for clarity.