Alteration of Prescriptions and Verbal Orders

Alteration of Prescriptions

Alterations to existing prescriptions are only permitted by pharmacists who have discussed the requirement for alternation with the prescriber, and the prescription must be annotated PC (prescriber contacted).  This is only applicable where clarification of the prescription is required.

Where the prescriber requires a change to the prescription which is to be dispensed and supplied by HAH e.g. dose change then the existing prescription must be expired/cancelled, and a new prescription issued.

Where the prescriber requires a change to an administration chart the prescriber must rewrite the drug in question with the new dose. Where a drug is cancelled on the administration chart the prescriber must cross out the drug and initial and date the amendment. 

A full audit trail must be made on the patient’s prescription by the pharmacist.

Verbal Orders

Verbal orders are not routinely allowed. All prescribing must be documented on the proforma medication prescription and administration system or electronic prescribing system.

In exceptional circumstances, where a change or addition to the administration details is required and a delay in administering a medicine (other than a Schedule 2 CD) would compromise patient care, verbal orders are used. The process is underpinned by risk assessments and organisational policy and/or procedures. Where appropriate, the prescriber requesting the changes provides a prescription or amends the drug chart or medication administration record containing the new administration details as soon as possible (ideally within 24 hours). If the prescriber is unable to issue a new prescription or amend the drug chart or medication administration record, the changes are communicated by an appropriately secure electronic method. E.g. (NHS.net to NHS.net email). The patient’s records are updated. RPS (2019) An example of when a verbal order is appropriate is during adverse drug reaction management.