Prescribing | Medical Appraisal Scotland

Scottish Medical Appraisal Toolkit Domain 2 QIA Prescribing

QIA - Prescribing review

You are required to provide evidence that your prescribing is effective and efficient, that you reflect on the different types of information available to you concerning prescribing, and make appropriate changes.

Good prescribing practice has been defined as:

Safe (avoidance of high risk unless clearly justified)
Effective (is there evidence that the drug works?)
Necessary (is the condition likely to benefit from treatment?)
Most cost effective choice (all other factors being equal, choose the cheapest)
Following recognised peer guidance (formularies or other consensus statements)

You may choose to submit evidence of one or more of the following types:

Analyse your PRISMS data, with description of changes resulting from the analysis.
Analyse other prescribing data, with description of changes resulting from the analysis.
Describe a significant event that has occurred in your practice, involving a prescribing issue. Describe changes resulting from the analysis. This could be development of a practice protocol / policy / guideline / management plan.
Write up an audit, involving a prescribing issue, with description of changes resulting from the analysis. This could be development of a practice protocol / policy / guideline / management plan.

Your analysis needs to clearly demonstrate that you have considered current prescribing practice, and taken steps to change it if necessary.

Care should be taken to ensure that all aspects of the situation are considered. For instance, it would not be sufficient to present a significant event in which a drug was not available when needed, and conclude that you now keep it. You could, however, revise or develop a system for ensuring that all emergency drug requirements are reviewed, and all required drugs are available and in-date, in your situation.

The following pages will take you through some suggestions for gathering supporting information in this category.

Examples of "Prescribing" QIA

Prescribing - Frequently Asked Questions:

I have identified a problem and plan to address it. Is it essential to analyse prescribing data to support the need for change?

No, you need to demonstrate that you are aware of a prescribing issue and address it. For instance, if a new guideline is issued suggesting that the management of condition X should change, there is little point analysing past prescribing to demonstrate that you did not comply with the new guidance. You do need to demonstrate that you have considered how the new guidance should be implemented, and plan to do so. However, if you look at a prescribing error, it might be worth assessing the current practice to determine how significant a problem you have uncovered. This could help you to plan change.

As a sessional or out-of-hours doctor, how many prescriptions do I need to collect to demonstrate my current prescribing habits?

There is no definite answer to this question. Enough for you to be clear about any trends. Naturally this will depend upon how commonly the group of drugs you are interested in are prescribed.

If I am basing my review on an audit, does it need to be an audit that I have done?

No, provided it gives you an indication that you need to consider prescribing in this area. A regional or even national audit may do this; alternatively an audit by a member of your team could be the stimulus. You need to be clear what current practice is, and consider the need for change.

Can I submit one piece of evidence in two categories?

Yes, an audit or significant event analysis can provide evidence in more than one category. Consider carefully the requirements for each category.

Where can I find help?

We have included examples of prescribing reviews (as well as other Quality Improvement Activities examples) in the QIA examples section of the website. This should give you ideas on what supporting information you can provide for your appraisal.

This page was last updated on: 08/03/2022