Alternatives to transcribing for medicines administration

Tracy Rogers, Director, Medicines Use & Safety, Medicines Use and Safety TeamPublished

Transcribing is not the preferred option for medicines administration and the alternatives should be considered before committing to transcribing.

Consider the need for transcribing

The safety of the patient is paramount, and the use of transcribing should not be used to overcome shortages of prescribers, other poor local processes or inefficiencies within systems or care pathways. Transcribing should only be used when it is in the patient’s best interests to ensure safe and continuous care.

Self-administration

When the patient can self-administer

If it is safe for the patient to continue to self-administer from the medicines already in their possession, as if they were still in their own home, then there is no need for transcribing.

It is necessary to record that the patient has self-administered so that a complete record is maintained.

When the patient is unable to self-administer

Only where there is genuine risk to the patient, or the patient is unable to self-administer should the right of self-administration be removed.  Where this is the case, transcribing may be required to facilitate this process.

Continuity of care and risk/benefit

We need to ensure continuity of care and treatment of patients, especially when they move to a new healthcare setting. Settings which are not medically led may pose specific challenges. The risk created by not administering prescribed medicines whilst waiting for a prescription/administration chart to be written may well outweigh the risk created by administering the medicines from a transcribed chart.

The risks associated with delayed or omitted medicines are well documented and were the subject of an NSPA alert.

Prescribing and Patient Specific Directions (PSD) to administer medicines

Healthcare settings where prescribers are present

Where a prescriber is present, for example on a hospital ward, the prescriber would be expected to write the direction to administer directly onto the prescription/administration chart. The entry should include all information necessary to allow the medicine to be given in accordance with the wishes of the prescriber. Organisations should ensure that their charts are fit for purpose and reflect the typical length of stay in the unit.

Use of EPMA

Electronic Prescribing and Medicines Administration (EPMA) systems may remove the need for transcribing. Integrated Care Systems (ICS) may need to consider whether an area wide IT system would offer the best solution as interface issues may then be addressed.

Healthcare provided in the patient’s own home

The picture is more complex when the patient is receiving care in their own home and ensuring completeness of the information is vital before undertaking any transcribing.

The following points must be considered:

  • There is a greater chance that medicines will have been prescribed by more than one professional (e.g. GP and specialist clinicians).
  • Prescriptions may be dispensed at various pharmacies.
  • MAR charts printed by the community pharmacy are not routinely offered to such patients nor would they include any medicines not dispensed by that pharmacy.
  • Community nurses administering medicines to patients where the label does not specify dose (e.g. insulin, medication administered via a syringe driver or where the dose may have changed since the supply was made) need to ensure that a direction to administer is in place.

Patient Group Directions (PGDs) and transcribing

Where a non-injectable medicine has been supplied to a patient under a PGD then another appropriately trained person can undertake the administration of the medicine and so it is acceptable to transcribe the information about the medicine. However, where an injectable medicine is supplied, the administration of the medicine must not be delegated under a PGD, so transcribing would not be possible in this scenario.

Delegation of supply or administration of medicines using a Patient Group Direction explains this in more detail.