Medical Council of Canada Objectives on Prescribing Practices

Available at: https://www.mcc.ca/objectives/expert/key/125/. Accessed June 14, 2021

PRESCRIBING PRACTICES — 125
Rationale:
Prescribing medications safely is a central component of most physicians’ activities and requires appropriate medical knowledge, skill, professional judgment, and an understanding of the applicable legislation related to prescribing.

Key Objectives:
To safely and effectively manage a patient presenting with a condition that requires prescription medication, the candidate will first undertake a thorough clinical assessment and then apply principles of evidence-based medicine and cost effectiveness in prescribing.

Enabling Objectives:
Given a patient that requires a medication to be prescribed safely and effectively, the candidate will

1. Undertake a thorough clinical assessment, including:
   1. complete medication history, including allergies and intolerances;
   2. a review for adherence and effectiveness of the patient’s current medications;
   3. address polypharmacy and the options for deprescribing; and
2. Apply principles of clinical pharmacology in prescribing medication to:
   1. address the effect of comorbidities, current medications, liver and renal function, genetics, age, and pregnancy on the risks and benefits of prescribing the medication;
   2. apply an evidence-based approach to clinical and cost effectiveness, including prescribing generic medications when appropriate;
   3. anticipate the potential for adverse effects and take steps to mitigate them (e.g., prescribing appropriate routes, strengths, and quantities of medication);
   4. recognize potential medical interactions when prescribing new medications;
   5. recognize barriers to patients access to the medication (e.g., affordability, accessibility, supply) and advocate to resolve these where possible; and
3. Document the prescription appropriately, including:
   1. generating a clear and legible prescription that meets legal requirements;
   2. recognizing common cases of medication errors and how they can be prevented;
   3. creating contemporaneous clinical notes of prescribing decisions;
   4. documenting appropriate follow-up plans for review of the effectiveness of the prescribed medication and any adverse effects encountered; and
4. Communicate with the patient or, if appropriate, their family or caregivers to:
   1. build a therapeutic relationship that encourages adherence but respects the patient’s
   2. values, beliefs, and expectations about medications and their right to refuse treatment;
   3. ensure they understand the rationale for the prescription;
   4. provide them with information about any adverse effects, how to report them, and what they should do if adverse effects occur;
   5. ensure that those involved in sharing care or transfer of prescribing responsibilities are adequately informed about the prescription.