THOSE averse to technology prefer to hand-write prescriptions but suffer many disadvantages by doing so. Even using the computer to "top and tail" ^{Note 1} FP10s is a saving of effort to be grateful for, but the promise of the machine is that you only have to type things once, the prescription is automatically entered in the notes legibly, and provided the drug dictionary from which the details are selected is good, it is harder to make mistakes. The number of times you have to flick through the BNF to find doses or pack sizes should fall sharply. The biggest saving is when a patient needs a repeat of a prescription they had before. Providing you know the system, computerised prescribing records are easier to find, easier to read and quicker to record and print than to record and write by hand.

Usually, if a prescription is likely to be needed as a repeat it is worth taking the extra moment to put it on as a repeat. On some systems, this is just a matter of selecting ‘Yes’ rather than ‘No’ when the program asks "Keep for Repeat", or R instead of A. Don’t forget to input how often and for how long the prescription can be repeated. Opinions differ, but a six month period is usually defensible. Most patients return for review more or less as suggested, and, if they are intended to continue their blood pressure tablets, stopping the prescription until they do attend seems contrary. Better to give them a further prescription for a month and write a note on it saying: "Please arrange to see your GP/nurse before you need your next prescription". Different practices have different views on this but don’t leave yourself open to being sued for a failure to monitor repeat prescriptions. If you doubt a practice's repeat prescribing system, don’t set up repeat prescriptions on the computer.

Warning: Prescribing Pitfalls: The Penicillamine Peril
Beware of the standard trap of word-processing which is that anything printed out looks right. Unless you control the computerised repeat prescribing system, check any repeats you are asked to sign as carefully as you check any other prescriptions which someone else has written for you. The BNF advises against making handwritten additions or alterations to computer printed FP10s. This is rather strict but if you find you have to make a lot of changes, it is better to just start again on the computer. Any important changes need to be entered anyway, or you are just putting off the correction for someone else. See the pages on computer issued prescriptions in the BNF for more.

Remember that even if you typed in the drug name yourself, you are signing a prescription someone else (the computer or the programmer) wrote for you. So read the prescription on the FP10 before you hand it over.

The drug dictionaries that the systems use are alphabetical, as well as having ways to search by BNF chapter and various shortcuts. Typing in "Penicill" may bring up Penicillamine before Penicillin V, and giving a child 250 mg QDS will give it a worse sore throat! This is a real, specific peril of computer prescribing and has occurred at least once to a real patient. It has been reduced in different ways by some of the companies. EMIS give Penicillamine a very low velocity ^{Note 2}, so that it appears right at the bottom of the picking list, Micro Solutions provide a formulary which will inevitably have Penicillin in it but will not have Penicillamine in the antibiotic chapter.

Nobody yet has written code to ask "Do you really mean dangerous Penicillamine not safe Penicillin?" when you prescribe it. Don't mistake Quinine and Quinidine either or clomiphene with clonidine etc. etc. You have been warned but don’t let it put you off - illegible handwriting leads to more mistakes!

Adrian Midgley and Shaun O’Connell

Note 1
Print the patient’s and doctor’s name and address and the date on the script

Note 2
Every time you choose an item from a velocity coded list the velocity of that item is increased by 1. Eventually the common items appear at the top of the list and the rare ones at the bottom.