Medicines requiring dosage adjustments
Some medicines, such as insulin, anticoagulants, or diuretics, may require dosages to be titrated or adjusted according to the individual’s response without further changes to the prescription.
The requirement to adjust the dosage needs to be explicit in the prescription for the medicine.
Local mechanisms for adjusting medication dosages
Written protocols
Dosage adjustments for prescribed medications may be managed by appropriately trained and competent healthcare professionals, using locally produced and approved written protocols. The relevant protocol should be used to advise the individual to adjust the dosage of their medication, if required to maintain optimum treatment. Written protocols have no legal standing in respect of medicines legislation and are subject to local agreements between healthcare professionals and their organisations .
Template protocols should be produced for each medicine by the appropriate specialist team, including prescribers and clinicians with a specialist knowledge of the medicine. The protocol should be personally tailored for each individual by the prescriber, or a specialist clinician who knows that individual under the direction of the prescriber.
The protocol should include all necessary parameters, including where relevant, maximum dose(s), time scales for titration and monitoring requirements.
Considerations for training, governance and authorisation
The training required, clinical governance and local authorisation of such protocols must be considered. This is to ensure that they comply with the organisation’s governance processes and support the safe and effective management of medicines.
Written protocols covering advice on dosage adjustment should reflect many of the principles governing other medicines frameworks, such as Patient Group Directions, in terms of their development, organisational approval and review.
Considerations for labelling and record keeping
Medicines that may need dosage adjustments under a written protocol require clear labelling to ensure individuals and carers are fully aware of dosage changes.
Advised dosage adjustments need to be communicated and recorded. Consider how this should be done for all clinical records, including medication administration record (MAR) charts.
Independent or supplementary prescribing
Organisations may need to consider the role of independent or supplementary prescribers within pathways where medication dose adjustments are routinely required. Consider if independent or supplementary prescribing would allow more individualised care.
Further SPS advice
Patient Specific Directions (PSD) and Understanding why PGDs cannot be used for dose adjustments.