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Ambulance Service
For ambulance service staff
Acute Coronary Syndrome and Cardiac Arrest
Prescribing in Medical Emergencies (Primary Care Focus)
In this module, we will focus on the drugs and therapeutic procedures to manage a presentation of Acute Coronary Syndrome (ACS), including a Cardiopulmonary Resuscitation (CPR) event.
As a minimum, it is expected that all general practitioners in the UK hold a valid CPR and Automated External Defibrillation (AED) qualification. This is normally achieved through completion of a Basic Life Support (BLS) course.
The module summarises guidance from the European Resuscitation Council 2015 and the Resuscitation Council UK, but will be pitched at the level of the Basic Life Support (BLS) provider, rather than that of an Advanced Life Saver certificate holder.
Adherence
The Principles of Prescribing
In this module we will explore medicines adherence and other related terminology. It will consider levels of and reasons for non-adherence. The module will also explore methods to promote shared decision-making and interventions to increase adherence to, and persistence with, prescribed medication regimens.
Adverse Drug Reactions
Managing the Risks of Prescribing (Secondary Care Focus)
This module will explore the identification and prediction of adverse drug reactions (ADRs) in patients. It will also consider the public health burden of adverse drug reactions, and pharmacovigilance systems in the UK. The module will highlight the importance of reporting ADRs.
Anaphylaxis
Prescribing in Medical Emergencies (Primary Care Focus)
In this module, we will discuss the stepwise management of anaphylaxis in the general practice setting. We will list the signs and symptoms of an anaphylactic reaction and describe how to assess severity. We will discuss the pharmacological management and any follow-up required for patients who required hospitalisation.
It is important you remain up-to-date with the most recent evidence-based guidance to manage an anaphylactic reaction in the community setting.
Anticoagulation: DOACs and Parenteral Anticoagulants
Therapeutic Groups (Secondary Care Focus)
In the ‘Anticoagulation: Vitamin K Antagonists’ module, we provided an overview of anticoagulation and discussed vitamin K antagonists (VKAs) such as warfarin, phenindione and acenocoumarol.
In this module, we will focus on Direct Oral Anticoagulants (DOACs) and parenteral anticoagulation.
We will consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements of DOACs.
Anticoagulation: Vitamin K Antagonists
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide an overview of anticoagulation therapy.
We will discuss Vitamin K Antagonists (VKAs) and consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements.
The SCRIPT 'Anticoagulation: DOACs and Parenteral Anticoagulants' module supports the content within this module.
Asthma and Croup
Prescribing in Medical Emergencies (Primary Care Focus)
In this module, we will discuss the pharmacological management of an acute exacerbation of asthma or croup in general practice, or during a home visit in the community. Acute management of asthma will be discussed for both adults and children while, for croup we will concentrate on management in children (i.e. the patient group most affected).
We will also describe any follow-up required for patients who experience one of these medical emergencies.
Bipolar Affective Disorders
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide you with an introduction to the treatment and management of Bipolar Affective Disorder (BPAD).
We will briefly describe the aetiology and symptoms of BPAD. We will discuss the medicines commonly used in the management of acute mania and prophylaxis of BPAD. We will then discuss in further detail, the role of lithium and the risks of toxicity.
Note: we will not discuss the management of bipolar depression in this module, as this will be discussed in our ‘Depression’ module. The SCRIPT ‘Introduction to Psychiatry’ and ‘Affective Disorders’ modules provide additional content to support your overall learning in relation to psychiatry.
Throughout this module, we will refer to ‘patients’, as this is consistent with the terminology used by the Royal College of Psychiatrists. However, many guidelines refer to people with mental health problems as ‘service users’ or ‘clients’.
Breastfeeding
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will explore the use of drugs in patients who are breastfeeding.
The module includes the general principles of prescribing in breastfeeding patients, the effects of drugs on lactation, the possible effects that a drug may have on the breastfed infant and introduces some useful resources for establishing the safety of drug use during lactation.
Cardiac arrest
Prescribing in Medical Emergencies (Secondary Care Focus)
This module will focus on the drugs and therapeutics used during and immediately following cardio-pulmonary resuscitation (CPR) in an adult. It is based on the latest Resuscitation Council guidelines (2010). This module will help you to revise the guidelines for resuscitation of patients in cardiac arrest and management of reversible causes, but does not replace formal Advanced Life Support (ALS) training.
Cardiac Arrhythmias
Therapeutic Groups (Secondary Care Focus)
In this module we will discuss the management of cardiac dysrhythmias in the secondary care setting. Pharmacological treatment options will be discussed for both the acute and long-term management of arrhythmias, and the importance of stroke risk stratification in patients with Atrial Fibrillation (AF).
Clinical Kinetics
The Principles of Prescribing
You must choose the right drug at the correct dose to manage your patient optimally. In this module we will discuss the factors that govern the rate and extent of a drug's action, from when it is administered until it leaves the body.
Understanding clinical kinetics will help you make better therapeutic choices and can be applied to your day-to-day prescribing.
Clinical Pharmacology
The Principles of Prescribing
This module serves as a reminder of the fundamental topics in pharmacology you will have learnt as a medical student, and aims to help you to appreciate the relevance of this knowledge to your early clinical practice.
The module will focus on pharmacodynamics (the interactions between drugs and receptors) and discuss the range of chemically sensitive sites, which mainly exist on proteins. Pharmacokinetics is considered in a separate module.
COVID-19
Prescribing in Medical Emergencies (Secondary Care Focus)
In this module, we will provide a high-level overview of the care of medical inpatients with suspected or confirmed COVID-19.
We will discuss some basic facts about the disease, summarise the managment principles for ward-based patients, and present and outline approach to the escalation or palliation of patients.
We will concentrate the learning on adult inpatients in the non critical care setting.
Dealing with Error
Clinical Governance
There are thousands of cases of avoidable significant harm in the NHS each year. More than half of these harms are avoidable.
In this module, we will discuss how the principles of Root Cause Analysis (RCA), a tool used locally and nationally in healthcare to identify the causes of incidents, can guide quality improvement through implementing change and sharing learning.
Dementia
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will discuss the different types of dementia, their diagnosis and management. As a prescribing practitioner completing this module, you will have the knowledge and skills needed to safely assess, manage and refer any patient with dementia seen in a secondary care setting.
Dementia
Prescribing in Special Circumstances (Primary Care Focus)
In this module, we will discuss the different types of dementia, their diagnosis and management. This module is designed to emphasise the knowledge, skills, and attitudes needed to safely assess, manage and refer patients with dementia who present in the primary care setting.
Depression, Anxiety & Insomnia: Psychiatric Symptom Management in General Hospital Settings
Therapeutic Groups (Secondary Care Focus)
This is one of two SCRIPT modules that discusses psychiatric symptom management in general hospital settings. We aim to provide the knowledge required to manage common mental illnesses and understand how the Mental Health and Mental Capacity Acts impact on the prescribing and administration of medicines.
In this module, we will consider the use of medicines in the management of depression, anxiety, and insomnia occurring in conjunction with a physical illness or presenting with physical symptoms. The second SCRIPT module, ‘Rapid Tranquillisation & Antipsychotics - Psychiatric Symptom Management in General Hospital Settings’ discusses rapid tranquillisation, severe mental illness, and the use of clozapine in general hospital settings.
Note that some medicines are considered under more than one indication in this module. To avoid repetition, it is important to be aware that adverse effects, discontinuation symptoms, interactions and suicide risk apply regardless of what the medicine is prescribed for.
Some medicines are considered under more than one indication in this module. To avoid repetition it is important to be aware that side-effects, discontinuation symptoms, interactions and suicide risk apply regardless of what the medicine is prescribed for.
Designated Prescribing Practitioner Training
The Principles of Prescribing
This module has been designed for qualified healthcare professionals who will be taking on the role of Designated Prescribing Practitioner (DPP) for a trainee independent prescriber.
In this module, we will develop your underpinning knowledge of the legal and ethical responsibilities of being a DPP. We will enhance your pedagogical knowledge to guide high-quality and effective teaching and learning, and build your confidence to assess competence and professionalism of the trainee independent prescriber.
Diabetes: Insulin Part 1
Therapeutic Groups (Secondary Care Focus)
In this module we will focus on the management of diabetes mellitus in adults using insulin.
We will describe how to safely prescribe insulin, which is considered a ‘high-risk’ medicine. We will discuss the different insulin profiles available and the different insulin regimens that may be used to manage diabetes mellitus.
The SCRIPT ‘Diabetes: Insulin Part 2’ module, ‘Diabetes: Antihyperglycaemic Medicines (excluding insulin)’ module and the ‘Medical Emergencies in Diabetes’ module provides additional content to support your overall learning in relation to diabetes mellitus.
Diabetes: Insulin Part 2
Therapeutic Groups (Secondary Care Focus)
In this module we will focus on the management of diabetes mellitus in adults using insulin.
We will describe the key principles of prescribing a Variable Rate Intravenous Insulin Infusion (VRIII). We will discuss how to safely stop a VRIII and restart a patient’s usual antihyperglycaemic regimen, or initiate insulin in insulin-naïve patients. Finally, we will discuss the Think Glucose initiative and when it is appropriate to refer patients to the diabetes specialist team.
The SCRIPT ‘Diabetes: Insulin Part 1’ module, ‘Diabetes: Antihyperglycaemic Medicines (excluding insulin)’ module and the ‘Medical Emergencies in Diabetes’ module provides additional content to support your overall learning in relation to diabetes mellitus.
Disorders of Psychosis
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide you with an introduction to the treatment and management of psychosis and schizophrenia.
We will briefly describe the clinical features of schizophrenia and the factors that may contribute to a patient's prognosis. We will also discuss the medicines used in the management of common psychotic disorders, and how to ensure that these are prescribed and monitored safely and effectively.
Dosing and Calculation
The Principles of Prescribing
In this module we will develop the underpinning knowledge and numeracy skills required for you to perform dose calculations competently and accurately in clinical practice. It will expand on your existing knowledge of drug dosages and calculations needed to ensure safe practice.
Drug Allergy and Anaphylaxis
Prescribing in Medical Emergencies (Secondary Care Focus)
This module will give an overview of drug allergy, concentrating on anaphylaxis. It will describe the signs and symptoms of Type I (immediate) reactions, so you can rapidly assess and treat patients; and know how to reduce the risk of such reactions. Finally the follow up of severe reactions is described.
Drug Interactions
Managing the Risks of Prescribing (Secondary Care Focus)
In this module, we will explore the potential risks and possible harm caused by pharmacodynamic and pharmacokinetic interactions within patients during multiple drug therapy.
We will describe the different types of drug interactions that can occur, their mechanisms and any potential clinical implications.
Knowledge of both the mechanisms of drug interactions and reliable information sources for drug interactions, can allow you to reduce the opportunity of drug interactions that could harm your patients.
Drugs of Misuse
Therapeutic Groups (Secondary Care Focus)
In this module we will explore the main issues surrounding the misuse of drugs, both legal and illegal. We will discuss both the acute presentation with toxicity or withdrawal, as well as chronic problems associated with drug and alcohol dependence.
Epilepsy
Therapeutic Groups (Secondary Care Focus)
In this module we will explore the pharmacological management of both epilepsy and status epilepticus. The factors affecting the choice of antiepileptic drug (AED) treatment will be considered along with how the risk of harm from such treatments can be minimised.
Fluids: Practical Prescribing for Adults
Prescribing in Medical Emergencies (Secondary Care Focus)
In this module, we will describe the indications for intravenous fluid and the common types of intravenous fluid prescribed.
We will discuss some common clinical situations where intravenous fluids are required. We will also describe which fluid types are most appropriate in a variety of situations.
The information contained within this module is only for adult intravenous fluid prescribing. See the ‘Paediatric Prescribing’ module for guidance on prescribing fluids in paediatric patients.
Fluids: The Principles
Prescribing in Medical Emergencies (Secondary Care Focus)
In this module we will discuss the basic principles of fluid management.
We will describe the different fluid compartments and the sources of fluid loss and fluid gain. We will also briefly discuss how to calculate resuscitation and maintenance fluid requirements.
The SCRIPT ‘Fluids: Practical Prescribing in Adults’ module provides additional content and case vignettes to support your overall learning in relation to fluid management. Information relating to blood transfusion is beyond the scope of this module.
Formulation: An Overview for Prescribers
The Principles of Prescribing
In this module, we will discuss the availability of different drug formulations and the issues this may raise in your clinical practice.
We will provide a brief reminder of pharmacokinetics specifically focusing on absorption. We will describe how different formulations of a drug can have different pharmacokinetic properties and how this can affect dosing.
Finally, we will briefly discuss off-label and unlicensed medicines and the additional prescribing considerations you should think about when prescribing these.
Heart Failure
Therapeutic Groups (Secondary Care Focus)
In this module, we will discuss the pharmacological management of acute and chronic heart failure. With reference to national guidelines, we will consider the cautions and contraindications of treatment, the adverse effects of treatments and how you can minimise the risk of harm to your patients.
Hepatic Dysfunction
Prescribing in Special Circumstances (Secondary Care Focus)
This module will explore the use of drugs in patients with liver disease, the effects of drugs on the liver, and the effect of the liver on drugs.
It will examine how to assess liver function, what drugs can cause harm to the liver, the metabolism of drugs by the liver and which drugs to avoid in chronic liver disease.
It will be of use throughout your career as a prescriber.
High-Risk Injectable Medicines
Managing the Risks of Prescribing (Secondary Care Focus)
In this module, we will discuss three commonly encountered high-risk medicines that are administered via the intravenous route.
We will discuss and focus on intravenous potassium chloride, gentamicin and vancomycin. We will describe why these medicines have the potential for harm and how to prescribe them safely. We will also discuss the monitoring requirements for these medicines.
The SCRIPT ‘Infection in Secondary Care’ module provides additional content to support your overall learning in relation to gentamicin and vancomycin.
High-Risk Oral Medicines
Managing the Risks of Prescribing (Secondary Care Focus)
In this module, we will introduce the important aspects surrounding the prescribing, supply, administration, and monitoring of so called ‘high-risk medicines’ that are administered via the oral route.
We will discuss some of the oral medicines encountered in general medicine that pose a significant risk to patients. These medicines have the potential for harm due to the risks of toxicity, significant drug interactions and adverse effects. They require close clinical monitoring and care when prescribing.
Although we will focus on the oral route of administration, where applicable much of this theory can be applied to alternative routes of administration.
Infection in Secondary Care
Therapeutic Groups (Secondary Care Focus)
In this module we will show you how to prescribe safely and appropriately for commonly encountered infections in secondary care. We will discuss how to assess the severity of infection so you can initiate appropriate management.
Introduction to Psychiatry
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide you with some background knowledge of mental health, mental illness and mental health problems. We will briefly outline the organisation of mental health services and discuss the main principles of UK mental health legislation, including the implications of this legislation for prescribing and administration of medicines. Finally, we will explore the management of acute behavioural disturbance.
Managing Complications of Anticancer Therapy
Advanced Prescribing (Secondary Care Focus)
In this module, we will highlight the basic principles of Systemic Anticancer Therapy (SACT), the appropriate management of patients presenting with complications of treatment, as well as those caused by the underlying malignancy.
We will explore modern systemic anticancer therapy and the importance of safe, rational prescribing.
This module will be of particular value to doctors currently in or about to undertake their haematology/oncology rotation. It may also supplement the training of non-medical prescribers who will be working in this field, or for prescribers working in areas that deal with the emergency treatment of chemotherapy-induced toxicity.
Medical Emergencies in Diabetes
Prescribing in Medical Emergencies (Secondary Care Focus)
In this module, we will discuss the signs and symptoms of diabetic emergencies, including hypoglycaemia, diabetic ketoacidosis, and hyperosmolar hyperglycaemic state.For each, we will describe the immediate step-by-step management and continuing care in adults.
The Joint British Societies Inpatient Care Group provide comprehensive guidance on all the diabetic emergencies discussed here, all of which are available online.
Note that hospital Trusts are likely to have their own guidelines or protocols on the management of these emergencies. These should be used as the primary guidance alongside the general principles what we provide here.
Medication Errors
Managing the Risks of Prescribing (Secondary Care Focus)
This module describes the nature and frequency of medication errors and examines the theory underlying general human error.
It will introduce you to tips on reducing medication errors, and how you can identify and correct them. The session also describes how you, as healthcare professionals, should respond when you discover a medication error, and how it should be reported.
Finally, the role of electronic prescribing in preventing errors will be discussed.
Meningococcal Disease
Prescribing in Medical Emergencies (Primary Care Focus)
In this module, we will focus on the presentation and pre-hospital emergency management of a patient with suspected meningococcal disease.
The content of this module is based on the NICE Guidance: 'Meningitis (bacterial) and meningococcal septicaemia in under 16s'
Monitoring Medicines
Managing the Risks of Prescribing (Secondary Care Focus)
In this module, we will provide an overview of the importance of monitoring medicines. We will describe how effective monitoring can reduce the incidence of adverse drug reactions and improve therapeutic outcomes. We will also briefly discuss the principles of Therapeutic Drug Monitoring (TDM).
Note: this module is designed to provide a wider overview of monitoring medicines rather than specific examples (although we will provide a few examples throughout the module). We hope that the principles discussed in the module will help you in your practice. If you are unsure of the monitoring requirements of a particular medicine, always seek specialist advice."
Older People
Prescribing in Special Circumstances (Secondary Care Focus)
This module will help you understand the way in which older adult patients handle administered drugs (pharmacokinetics) and how they react to these drugs (pharmacodynamics) once they have been absorbed. This will help you to prescribe medicines safely in this patient group.
Paediatric Dermatology
Therapeutic Groups (Primary Care Focus)
In this module, we will discuss prescribing for skin conditions.
We will look at a number of important areas in management, including topical therapy for skin disease, safe prescribing of topical corticosteroids and an overview of the use of systemic treatments.
We will consider special circumstances relevant to prescribing, including in adolescence and in those with suspected or proven multisystem disease.
Note that some therapeutics will be discussed that are only prescribed under the supervision of paediatric dermatologists or general practitioners with a special interest and experience in dermatology.
Paediatric Pharmacokinetics
The Principles of Prescribing
In this module, we will explore the differences in drug handling across various age groups. We will briefly describe how the changes in body composition and organ function as children grow can affect the pharmacokinetics of a medicine.
Please note there is no pre- or post-test for this module. The SCRIPT ‘Paediatric Practical Prescribing’ module provides additional content to support your overall learning in relation to paediatrics.
Paediatric Practical Prescribing
Prescribing in Special Circumstances (Secondary Care Focus)
In this module we will explore the practicalities of dosing medicines for different ages of children. We will discuss the basic principles of fluid management and how to reduce the risk of medication errors. We will also describe the additional factors to consider in the paediatric population, such as the use of unlicensed and ‘off-label’ preparations.
Towards the end of the module, we will use case-based examples to work through selected prescribing scenarios.
Pain: Neuropathic and Complex Analgesia
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide an overview of the management of neuropathic pain and the use of complex pain management techniques such as epidurals, patient-controlled analgesia, and local anaesthetics. We will also consider alternative, non-pharmacological, approaches to pain relief.
Pain: Non-Opioids and Opioids
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide an overview of the management of pain using non-opioid and opioid analgesics. We will consider the properties of the different medicines available and how they can be prescribed safely to minimise harm.
The SCRIPT ’Pain Management – Neuropathic and Complex Analgesia’ and 'Palliative and End-of-Life Care' modules provide content to support this module. You may find these useful in underpinning your knowledge and understanding of pain management.
Palliative and End-of-Life Care
Advanced Prescribing (Secondary Care Focus)
In this module we will explore the prescribing issues in caring for patients with advanced disease and those that are dying.
We will discuss the management of pain in providing palliative care to patients so you can prescribe opioids safely and effectively. The management of nausea and vomiting, and those symptoms that commonly arise in the last days of a patient's life will also be discussed. We will also focus on the importance of shared decision-making with the patient and their family and within the multidisciplinary team.
Perioperative Prescribing
Prescribing in Special Circumstances (Secondary Care Focus)
This module will explore the use of drugs in the perioperative period-specifically looking at issues of therapy immediately before and after operative surgery. It will consider issues such as decisions about stopping/omitting medicines prior to surgery and managing essential drug therapy.
This module is of particular value to prescribers who are currently in or about to begin surgical rotations.
Poisoning
Prescribing in Medical Emergencies (Secondary Care Focus)
In this module we will consider poisoning as a result of drug overdose.
The module will explore the clinical toxicology of commonly prescribed drugs and the management required to alleviate their effects. It will provide practical advice on where to look for information should poisoning be suspected.
Pregnancy
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will explore the use of drugs in patients who are pregnant or who may become pregnant.
The module includes the general principles of prescribing in pregnancy, the effects of drugs on the fetus, the effects of pregnancy on drug handling and introduces some key resources for determining whether a drug is safe to use. Some common conditions encountered during pregnancy are also covered.
Pregnancy and Breastfeeding
Prescribing in Special Circumstances (Primary Care Focus)
In this module we will explore the use of drugs in patients who are both planning to start a family, are already pregnant and who are breastfeeding.
We will discuss the general principles of prescribing in pregnancy, the effects of drugs on the fetus and the effects of pregnancy on drug handling. We will also discuss the general principles of prescribing in breastfeeding mothers, including the effects of drugs on lactation and the possible effects that a drug may have on the breastfed infant.
We will introduce some key resources for determining whether a drug is safe to use during both pregnancy and breastfeeding.
Prescribing at the Interface & Team Prescribing
Advanced Prescribing (Secondary Care Focus)
In this module, we will discuss the importance of communication within the healthcare sector, and how this contributes to the effective management and monitoring of patient care. In an ever changing healthcare system, we will discuss the role of Non-Medical Prescribers (NMPs) and Effective Shared Care Agreements (ESCAs).
Prescribing in Infection
The Principles of Prescribing
In this module we will discuss the safe and appropriate prescribing of antibacterial drugs in patients with known or suspected infections.
It will review the different classes of antibacterial available, when they should be prescribed empirically, and why careful use of antibacterials is important for both patient and public health.
This module will be relevant to your practice throughout your medical career.
Prescription Documentation
The Principles of Prescribing
In this module we will discuss the underpinning knowledge required to prescribe legally, safely and unambiguously. Key areas of good prescribing practice will be emphasised along with a more in-depth discussion for the rationale behind each of the highlighted points.
Rational Drug Choice
Clinical Governance
In this module we will discuss evidence-based medicine and how it should be used help you make rational therapeutic decisions.
Evidence-based medicine is about how information-for example, from clinical trials-is interpreted and used to ensure your patients receive the most appropriate and effective treatment.
Evidence-based medicine can improve patient outcomes, reduce variations in care and ensure NHS resources are managed effectively.
Renal Dysfunction
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will explore the use of drugs in patients with renal impairment - including both Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).
This module is built around three case vignettes. It discusses the changes in drug handling in kidney disease, and the way this can require changes to dose regimens.
Respiratory Medicine: Asthma and COPD
Therapeutic Groups (Secondary Care Focus)
In this module, we will consider the management of asthma and Chronic Obstructive Pulmonary Disease (COPD). We will provide a summary of how to manage acute and chronic asthma in patients of different ages. We will also briefly discuss the pharmacological treatment options for managing stable COPD and acute exacerbations. We will not discuss the diagnosis of either of these conditions. The SCRIPT ‘Respiratory Medicine: Oxygen, Smoking Cessation and Inhalers’ module provides additional content to support your overall learning in relation to Respiratory Medicine.
Respiratory Medicine: Oxygen, Smoking Cessation and Inhalers
Therapeutic Groups (Secondary Care Focus)
In this module, we will discuss prescribing oxygen in acute and long-term settings. We will describe nicotine replacement products and how these can support smoking cessation. We will provide a summary of the different devices available to deliver inhaled drug therapy and how to select an appropriate device for your patient. Finally, we will briefly discuss the management of pneumonia in secondary care. The SCRIPT ‘Respiratory Medicine: Asthma and COPD’ module provides additional content to support your overall learning in relation to Respiratory Medicine.
Rheumatology
Therapeutic Groups (Primary Care Focus)
In this module, we will briefly discuss the presentation of early rheumatoid arthritis in primary care. We will review the classification criteria, how disease activity is measured, and how this is used to guide therapy.
We will discuss the various 'non-biologic' and 'biologic' therapies prescribed in the management of rheumatoid arthritis, and how these are optimised to "treat to target" whilst minimising the risk of adverse effects. We will consider how treatment regimens are modified in women of child-bearing potential and for breastfeeding mothers.
Finally, we will we will describe common problem areas in rheumatology prescribing, considering both inpatient and outpatient settings.
Rheumatology
Therapeutic Groups (Secondary Care Focus)
In this module we will revise the classification criteria for rheumatoid arthritis, how to measure disease activity and how this can be used to guide therapy.
We will discuss the various 'non-biologic' and 'biologic' therapies prescribed in the management of rheumatoid arthritis, and how these are optimised to "treat to target" whilst minimising the risk of adverse effects. We will consider how to modify treatment regimens in women of child-bearing potential and for breastfeeding mothers.
Finally, we will we will describe common problem areas in rheumatology prescribing, considering both inpatient and outpatient settings.
Seizures
Prescribing in Medical Emergencies (Primary Care Focus)
In this module, we will discuss the pharmacological management of a seizure in the practice, or during a home visit in the community. We will also discuss the prescription of anti epileptic medicines, and the potential emergency situations that can arise from their use.
Sepsis in Hospital
Prescribing in Medical Emergencies (Secondary Care Focus)
In this module we will discuss the diagnosis and management of sepsis. We will list the common indicators that suggest a diagnosis of sepsis and the importance of source control in addition to appropriate antimicrobial prescribing. Finally, we will discuss the factors to consider when prescribing for patients with sepsis, and their ongoing management.
Taking a Safe & Effective Medication History
The Principles of Prescribing
In this module we will discuss the importance of an accurate and complete drug history, and what can go wrong when this information is not gathered or used correctly.
We will describe the different sources of information available to confirm the drug history, and their limitations. Problem drugs will be identified, including those which are often omitted from the history. We will give practical advice on how to obtain a safe and effective drug history.
Finally, we will discuss the importance of reconciling and documenting information about a patient's medicines on admission to, transfer in, and discharge from hospital, as outlined in the NICE Medicines Reconciliation guidance.
Utilising the BNF(C)
The Principles of Prescribing
In this module, you will be provided with the basic knowledge required to utilise the British National Formulary (BNF) and British National Formulary for Children (BNFC) accurately and effectively when prescribing and/or administering medicines.
We will discuss how the BNF and BNFC are constructed, as well as how best to find and use the information contained within them.
Dentistry
For undergraduates, foundation trainees and qualified dentists
Adverse Drug Reactions
Safe Prescribing in Dentistry
In this module, we will explore the identification and prediction of Adverse Drug Reactions (ADRs) in patients, consider the public health burden of ADRs, and describe pharmacovigilance systems in the UK.
Dental Infections
Management of Infection
In this module we will explore the management of dental infections, how they should be treated and when pharmacological therapy is indicated. Evidence and guidelines will be discussed along with appropriate prescribing advice for adult patients.
This module will be of interest to both newly qualified dentists working in general practice and hospital, but also as revision in the process of revalidation and continuing professional development.
Medical Emergencies
Prescribing in Medical Emergencies
In this module, we will discuss the management of medical emergencies in the dental setting. This includes the management of anaphylaxis, asthma, cardiac emergencies, seizures and hypoglycaemia.
It is essential that all members of staff who might be involved in dealing with a medical emergency are appropriately trained. This includes remaining up-to-date with recent evidence-based guidance for their management.
Medication Errors
Safe Prescribing in Dentistry
In this module, we will describe the nature and frequency of medication errors and examine the theory underlying general human error. We will discuss ways in which medication errors can be reduced, and how you can identify and correct them. The session also describes how you, as a healthcare professional, should respond when you discover a medication error, and how it should be reported.
We will also explore the identification and prediction of Adverse Drug Reactions (ADRs) in patients, consider the public health burden of ADRs, and describe pharmacovigilance systems in the UK.
Odontogenic Pain
Pain, Ulceration and Inflammation
This module provides information on the diagnosis of commonly occurring presentations of pain seen in primary care dental settings. We will mainly focus on odontogenic / dento-alveolar pain and basic management for each condition.
Other causes of pain that may present in the dental clinic (e.g. pain of inflammatory, infective, and neurological origin) are covered in the SCRIPT module titled “Dental Pain, Inflammation and Ulceration”.
Pain, Ulceration and Inflammation
Pain, Ulceration and Inflammation
In this module we will explore the management of both dental and non-odontogenic pain, oral ulceration and inflammation. In each case, we will discuss the pharmacological management options available in the Dental Practitioner's Formulary (DPF), the indications for their use, and advice on when patients should be referred.
The associated adverse effects of the medicines will be considered, and the cautions and contraindications in special patient groups.
This module is of particular interest to newly qualified dentists working both in practice and hospital situations, and as revision in the process of revalidation or continuing professional development.
Periprocedural Prescribing
Periprocedural Prescribing
In this module we will explore the use of drugs in the periprocedural period. We will discuss when medicines need stopping or omitting prior to surgery and how essential drug therapy should be managed during the periprocedural period.
We will look at the pharmacology of drugs available to dentists for sedation and those used in general anaesthesia.
This module will be particularly useful for Dental Foundation trainees involved in conscious sedation or in Hospital posts where general anaesthesia is performed.
Prescription Documentation and the Medication History
Safe Prescribing in Dentistry
In this module, we will discuss the main aspects of prescription documentation so you will understand the importance of prescribing medication legally, safely and unambiguously to minimise the risk to patients. In addition, we will discuss the process of taking a safe and effective drug history.
Special Patient Groups
Safe Prescribing in Dentistry
In this module, we will explore the use of drugs in special patient groups, including those with renal and hepatic dysfunction, older adults and during pregnancy and breastfeeding.
You will learn the principles of safe prescribing for each patient group and where to access reputable, evidence-based information to guide your decision making.
Utilising the BNF(C)
Safe Prescribing in Dentistry
In this module, you will be provided with the basic knowledge required to utilise the British National Formulary (BNF) and British National Formulary for Children (BNFC) accurately and effectively when prescribing and/or administering medicines.
We will discuss how the BNF and BNFC are constructed, as well as how best to find and use the information contained within them.
Medicine and Surgery
For undergraduates, foundation trainees, doctors and non-medical professionals in hospitals
Adherence
The Principles of Prescribing
In this module we will explore medicines adherence and other related terminology. It will consider levels of and reasons for non-adherence. The module will also explore methods to promote shared decision-making and interventions to increase adherence to, and persistence with, prescribed medication regimens.
Adverse Drug Reactions
Managing the Risks of Prescribing
This module will explore the identification and prediction of adverse drug reactions (ADRs) in patients. It will also consider the public health burden of adverse drug reactions, and pharmacovigilance systems in the UK. The module will highlight the importance of reporting ADRs.
Anticoagulation: DOACs and Parenteral Anticoagulants
Therapeutic Groups
In the ‘Anticoagulation: Vitamin K Antagonists’ module, we provided an overview of anticoagulation and discussed vitamin K antagonists (VKAs) such as warfarin, phenindione and acenocoumarol.
In this module, we will focus on Direct Oral Anticoagulants (DOACs) and parenteral anticoagulation.
We will consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements of DOACs.
Anticoagulation: Vitamin K Antagonists
Therapeutic Groups
In this module, we will provide an overview of anticoagulation therapy.
We will discuss Vitamin K Antagonists (VKAs) and consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements.
The SCRIPT 'Anticoagulation: DOACs and Parenteral Anticoagulants' module supports the content within this module.
Bipolar Affective Disorders
Therapeutic Groups
In this module, we will provide you with an introduction to the treatment and management of Bipolar Affective Disorder (BPAD).
We will briefly describe the aetiology and symptoms of BPAD. We will discuss the medicines commonly used in the management of acute mania and prophylaxis of BPAD. We will then discuss in further detail, the role of lithium and the risks of toxicity.
Note: we will not discuss the management of bipolar depression in this module, as this will be discussed in our ‘Depression’ module. The SCRIPT ‘Introduction to Psychiatry’ and ‘Affective Disorders’ modules provide additional content to support your overall learning in relation to psychiatry.
Throughout this module, we will refer to ‘patients’, as this is consistent with the terminology used by the Royal College of Psychiatrists. However, many guidelines refer to people with mental health problems as ‘service users’ or ‘clients’.
Breastfeeding
Prescribing in Special Circumstances
In this module, we will explore the use of drugs in patients who are breastfeeding.
The module includes the general principles of prescribing in breastfeeding patients, the effects of drugs on lactation, the possible effects that a drug may have on the breastfed infant and introduces some useful resources for establishing the safety of drug use during lactation.
Cannabis-Based Products for Medicinal Use
Therapeutic Groups
In this module, we will discuss the legislative changes that have enabled cannabis-based products for medicinal use (CBPMs) to be prescribed for patients. We will also discuss why unlicenced CPBMs can only be supplied under the prescription or direction of specialist doctors on the GMC Specialist Register (in specific circumstances) where there is an unmet clinical need.
We will outline the guidelines and recommendations available to support healthcare professionals in the UK.
Cardiac arrest
Prescribing in Medical Emergencies
This module will focus on the drugs and therapeutics used during and immediately following cardio-pulmonary resuscitation (CPR) in an adult. It is based on the latest Resuscitation Council guidelines (2010). This module will help you to revise the guidelines for resuscitation of patients in cardiac arrest and management of reversible causes, but does not replace formal Advanced Life Support (ALS) training.
Cardiac Arrhythmias
Therapeutic Groups
In this module we will discuss the management of cardiac dysrhythmias in the secondary care setting. Pharmacological treatment options will be discussed for both the acute and long-term management of arrhythmias, and the importance of stroke risk stratification in patients with Atrial Fibrillation (AF).
Clinical Kinetics
The Principles of Prescribing
You must choose the right drug at the correct dose to manage your patient optimally. In this module we will discuss the factors that govern the rate and extent of a drug's action, from when it is administered until it leaves the body.
Understanding clinical kinetics will help you make better therapeutic choices and can be applied to your day-to-day prescribing.
Clinical Pharmacology
The Principles of Prescribing
This module serves as a reminder of the fundamental topics in pharmacology you will have learnt as a medical student, and aims to help you to appreciate the relevance of this knowledge to your early clinical practice.
The module will focus on pharmacodynamics (the interactions between drugs and receptors) and discuss the range of chemically sensitive sites, which mainly exist on proteins. Pharmacokinetics is considered in a separate module.
COVID-19
Prescribing in Medical Emergencies
In this module, we will provide a high-level overview of the care of medical inpatients with suspected or confirmed COVID-19.
We will discuss some basic facts about the disease, summarise the managment principles for ward-based patients, and present and outline approach to the escalation or palliation of patients.
We will concentrate the learning on adult inpatients in the non critical care setting.
Dealing with Error
Clinical Governance
There are thousands of cases of avoidable significant harm in the NHS each year. More than half of these harms are avoidable.
In this module, we will discuss how the principles of Root Cause Analysis (RCA), a tool used locally and nationally in healthcare to identify the causes of incidents, can guide quality improvement through implementing change and sharing learning.
Dementia
Prescribing in Special Circumstances
In this module, we will discuss the different types of dementia, their diagnosis and management. As a prescribing practitioner completing this module, you will have the knowledge and skills needed to safely assess, manage and refer any patient with dementia seen in a secondary care setting.
Depression, Anxiety & Insomnia: Psychiatric Symptom Management in General Hospital Settings
Therapeutic Groups
This is one of two SCRIPT modules that discusses psychiatric symptom management in general hospital settings. We aim to provide the knowledge required to manage common mental illnesses and understand how the Mental Health and Mental Capacity Acts impact on the prescribing and administration of medicines.
In this module, we will consider the use of medicines in the management of depression, anxiety, and insomnia occurring in conjunction with a physical illness or presenting with physical symptoms. The second SCRIPT module, ‘Rapid Tranquillisation & Antipsychotics - Psychiatric Symptom Management in General Hospital Settings’ discusses rapid tranquillisation, severe mental illness, and the use of clozapine in general hospital settings.
Note that some medicines are considered under more than one indication in this module. To avoid repetition, it is important to be aware that adverse effects, discontinuation symptoms, interactions and suicide risk apply regardless of what the medicine is prescribed for.
Some medicines are considered under more than one indication in this module. To avoid repetition it is important to be aware that side-effects, discontinuation symptoms, interactions and suicide risk apply regardless of what the medicine is prescribed for.
Designated Prescribing Practitioner Training
The Principles of Prescribing
This module has been designed for qualified healthcare professionals who will be taking on the role of Designated Prescribing Practitioner (DPP) for a trainee independent prescriber.
In this module, we will develop your underpinning knowledge of the legal and ethical responsibilities of being a DPP. We will enhance your pedagogical knowledge to guide high-quality and effective teaching and learning, and build your confidence to assess competence and professionalism of the trainee independent prescriber.
Diabetes: Insulin Part 1
Therapeutic Groups
In this module we will focus on the management of diabetes mellitus in adults using insulin.
We will describe how to safely prescribe insulin, which is considered a ‘high-risk’ medicine. We will discuss the different insulin profiles available and the different insulin regimens that may be used to manage diabetes mellitus.
The SCRIPT ‘Diabetes: Insulin Part 2’ module, ‘Diabetes: Antihyperglycaemic Medicines (excluding insulin)’ module and the ‘Medical Emergencies in Diabetes’ module provides additional content to support your overall learning in relation to diabetes mellitus.
Diabetes: Insulin Part 2
Therapeutic Groups
In this module we will focus on the management of diabetes mellitus in adults using insulin.
We will describe the key principles of prescribing a Variable Rate Intravenous Insulin Infusion (VRIII). We will discuss how to safely stop a VRIII and restart a patient’s usual antihyperglycaemic regimen, or initiate insulin in insulin-naïve patients. Finally, we will discuss the Think Glucose initiative and when it is appropriate to refer patients to the diabetes specialist team.
The SCRIPT ‘Diabetes: Insulin Part 1’ module, ‘Diabetes: Antihyperglycaemic Medicines (excluding insulin)’ module and the ‘Medical Emergencies in Diabetes’ module provides additional content to support your overall learning in relation to diabetes mellitus.
Disorders of Psychosis
Therapeutic Groups
In this module, we will provide you with an introduction to the treatment and management of psychosis and schizophrenia.
We will briefly describe the clinical features of schizophrenia and the factors that may contribute to a patient's prognosis. We will also discuss the medicines used in the management of common psychotic disorders, and how to ensure that these are prescribed and monitored safely and effectively.
Dosing and Calculation
The Principles of Prescribing
In this module we will develop the underpinning knowledge and numeracy skills required for you to perform dose calculations competently and accurately in clinical practice. It will expand on your existing knowledge of drug dosages and calculations needed to ensure safe practice.
Drug Allergy and Anaphylaxis
Prescribing in Medical Emergencies
This module will give an overview of drug allergy, concentrating on anaphylaxis. It will describe the signs and symptoms of Type I (immediate) reactions, so you can rapidly assess and treat patients; and know how to reduce the risk of such reactions. Finally the follow up of severe reactions is described.
Drug Interactions
Managing the Risks of Prescribing
In this module, we will explore the potential risks and possible harm caused by pharmacodynamic and pharmacokinetic interactions within patients during multiple drug therapy.
We will describe the different types of drug interactions that can occur, their mechanisms and any potential clinical implications.
Knowledge of both the mechanisms of drug interactions and reliable information sources for drug interactions, can allow you to reduce the opportunity of drug interactions that could harm your patients.
Drugs of Misuse
Therapeutic Groups
In this module we will explore the main issues surrounding the misuse of drugs, both legal and illegal. We will discuss both the acute presentation with toxicity or withdrawal, as well as chronic problems associated with drug and alcohol dependence.
Epilepsy
Therapeutic Groups
In this module we will explore the pharmacological management of both epilepsy and status epilepticus. The factors affecting the choice of antiepileptic drug (AED) treatment will be considered along with how the risk of harm from such treatments can be minimised.
Fluids: Practical Prescribing for Adults
Prescribing in Medical Emergencies
In this module, we will describe the indications for intravenous fluid and the common types of intravenous fluid prescribed.
We will discuss some common clinical situations where intravenous fluids are required. We will also describe which fluid types are most appropriate in a variety of situations.
The information contained within this module is only for adult intravenous fluid prescribing. See the ‘Paediatric Prescribing’ module for guidance on prescribing fluids in paediatric patients.
Fluids: The Principles
Prescribing in Medical Emergencies
In this module we will discuss the basic principles of fluid management.
We will describe the different fluid compartments and the sources of fluid loss and fluid gain. We will also briefly discuss how to calculate resuscitation and maintenance fluid requirements.
The SCRIPT ‘Fluids: Practical Prescribing in Adults’ module provides additional content and case vignettes to support your overall learning in relation to fluid management. Information relating to blood transfusion is beyond the scope of this module.
Formulation: An Overview for Prescribers
The Principles of Prescribing
In this module, we will discuss the availability of different drug formulations and the issues this may raise in your clinical practice.
We will provide a brief reminder of pharmacokinetics specifically focusing on absorption. We will describe how different formulations of a drug can have different pharmacokinetic properties and how this can affect dosing.
Finally, we will briefly discuss off-label and unlicensed medicines and the additional prescribing considerations you should think about when prescribing these.
Heart Failure
Therapeutic Groups
In this module, we will discuss the pharmacological management of acute and chronic heart failure. With reference to national guidelines, we will consider the cautions and contraindications of treatment, the adverse effects of treatments and how you can minimise the risk of harm to your patients.
Hepatic Dysfunction
Prescribing in Special Circumstances
This module will explore the use of drugs in patients with liver disease, the effects of drugs on the liver, and the effect of the liver on drugs.
It will examine how to assess liver function, what drugs can cause harm to the liver, the metabolism of drugs by the liver and which drugs to avoid in chronic liver disease.
It will be of use throughout your career as a prescriber.
High-Risk Injectable Medicines
Managing the Risks of Prescribing
In this module, we will discuss three commonly encountered high-risk medicines that are administered via the intravenous route.
We will discuss and focus on intravenous potassium chloride, gentamicin and vancomycin. We will describe why these medicines have the potential for harm and how to prescribe them safely. We will also discuss the monitoring requirements for these medicines.
The SCRIPT ‘Infection in Secondary Care’ module provides additional content to support your overall learning in relation to gentamicin and vancomycin.
High-Risk Oral Medicines
Managing the Risks of Prescribing
In this module, we will introduce the important aspects surrounding the prescribing, supply, administration, and monitoring of so called ‘high-risk medicines’ that are administered via the oral route.
We will discuss some of the oral medicines encountered in general medicine that pose a significant risk to patients. These medicines have the potential for harm due to the risks of toxicity, significant drug interactions and adverse effects. They require close clinical monitoring and care when prescribing.
Although we will focus on the oral route of administration, where applicable much of this theory can be applied to alternative routes of administration.
Infection in Secondary Care
Therapeutic Groups
In this module we will show you how to prescribe safely and appropriately for commonly encountered infections in secondary care. We will discuss how to assess the severity of infection so you can initiate appropriate management.
Introduction to Psychiatry
Therapeutic Groups
In this module, we will provide you with some background knowledge of mental health, mental illness and mental health problems. We will briefly outline the organisation of mental health services and discuss the main principles of UK mental health legislation, including the implications of this legislation for prescribing and administration of medicines. Finally, we will explore the management of acute behavioural disturbance.
Managing Complications of Anticancer Therapy
Advanced Prescribing
In this module, we will highlight the basic principles of Systemic Anticancer Therapy (SACT), the appropriate management of patients presenting with complications of treatment, as well as those caused by the underlying malignancy.
We will explore modern systemic anticancer therapy and the importance of safe, rational prescribing.
This module will be of particular value to doctors currently in or about to undertake their haematology/oncology rotation. It may also supplement the training of non-medical prescribers who will be working in this field, or for prescribers working in areas that deal with the emergency treatment of chemotherapy-induced toxicity.
Medical Emergencies in Diabetes
Prescribing in Medical Emergencies
In this module, we will discuss the signs and symptoms of diabetic emergencies, including hypoglycaemia, diabetic ketoacidosis, and hyperosmolar hyperglycaemic state.For each, we will describe the immediate step-by-step management and continuing care in adults.
The Joint British Societies Inpatient Care Group provide comprehensive guidance on all the diabetic emergencies discussed here, all of which are available online.
Note that hospital Trusts are likely to have their own guidelines or protocols on the management of these emergencies. These should be used as the primary guidance alongside the general principles what we provide here.
Medication Errors
Managing the Risks of Prescribing
This module describes the nature and frequency of medication errors and examines the theory underlying general human error.
It will introduce you to tips on reducing medication errors, and how you can identify and correct them. The session also describes how you, as healthcare professionals, should respond when you discover a medication error, and how it should be reported.
Finally, the role of electronic prescribing in preventing errors will be discussed.
Monitoring Medicines
Managing the Risks of Prescribing
In this module, we will provide an overview of the importance of monitoring medicines. We will describe how effective monitoring can reduce the incidence of adverse drug reactions and improve therapeutic outcomes. We will also briefly discuss the principles of Therapeutic Drug Monitoring (TDM).
Note: this module is designed to provide a wider overview of monitoring medicines rather than specific examples (although we will provide a few examples throughout the module). We hope that the principles discussed in the module will help you in your practice. If you are unsure of the monitoring requirements of a particular medicine, always seek specialist advice."
Older People
Prescribing in Special Circumstances
This module will help you understand the way in which older adult patients handle administered drugs (pharmacokinetics) and how they react to these drugs (pharmacodynamics) once they have been absorbed. This will help you to prescribe medicines safely in this patient group.
Paediatric Pharmacokinetics
The Principles of Prescribing
In this module, we will explore the differences in drug handling across various age groups. We will briefly describe how the changes in body composition and organ function as children grow can affect the pharmacokinetics of a medicine.
Please note there is no pre- or post-test for this module. The SCRIPT ‘Paediatric Practical Prescribing’ module provides additional content to support your overall learning in relation to paediatrics.
Paediatric Practical Prescribing
Prescribing in Special Circumstances
In this module we will explore the practicalities of dosing medicines for different ages of children. We will discuss the basic principles of fluid management and how to reduce the risk of medication errors. We will also describe the additional factors to consider in the paediatric population, such as the use of unlicensed and ‘off-label’ preparations.
Towards the end of the module, we will use case-based examples to work through selected prescribing scenarios.
Pain: Neuropathic and Complex Analgesia
Therapeutic Groups
In this module, we will provide an overview of the management of neuropathic pain and the use of complex pain management techniques such as epidurals, patient-controlled analgesia, and local anaesthetics. We will also consider alternative, non-pharmacological, approaches to pain relief.
Pain: Non-Opioids and Opioids
Therapeutic Groups
In this module, we will provide an overview of the management of pain using non-opioid and opioid analgesics. We will consider the properties of the different medicines available and how they can be prescribed safely to minimise harm.
The SCRIPT ’Pain Management – Neuropathic and Complex Analgesia’ and 'Palliative and End-of-Life Care' modules provide content to support this module. You may find these useful in underpinning your knowledge and understanding of pain management.
Palliative and End-of-Life Care
Advanced Prescribing
In this module we will explore the prescribing issues in caring for patients with advanced disease and those that are dying.
We will discuss the management of pain in providing palliative care to patients so you can prescribe opioids safely and effectively. The management of nausea and vomiting, and those symptoms that commonly arise in the last days of a patient's life will also be discussed. We will also focus on the importance of shared decision-making with the patient and their family and within the multidisciplinary team.
Perioperative Prescribing
Prescribing in Special Circumstances
This module will explore the use of drugs in the perioperative period-specifically looking at issues of therapy immediately before and after operative surgery. It will consider issues such as decisions about stopping/omitting medicines prior to surgery and managing essential drug therapy.
This module is of particular value to prescribers who are currently in or about to begin surgical rotations.
Poisoning
Prescribing in Medical Emergencies
In this module we will consider poisoning as a result of drug overdose.
The module will explore the clinical toxicology of commonly prescribed drugs and the management required to alleviate their effects. It will provide practical advice on where to look for information should poisoning be suspected.
Pregnancy
Prescribing in Special Circumstances
In this module, we will explore the use of drugs in patients who are pregnant or who may become pregnant.
The module includes the general principles of prescribing in pregnancy, the effects of drugs on the fetus, the effects of pregnancy on drug handling and introduces some key resources for determining whether a drug is safe to use. Some common conditions encountered during pregnancy are also covered.
Prescribing and Therapeutics in Medical Foundation Training
The Principles of Prescribing
The primary target audience for this module is Foundation trainee doctors.
In this module, we will explain your responsibilities in relation to prescribing and therapeutics during medical Foundation training. We will discuss how you can develop your knowledge skills, and attitudes to improve prescribing competency.
Prescribing at the Interface & Team Prescribing
Advanced Prescribing
In this module, we will discuss the importance of communication within the healthcare sector, and how this contributes to the effective management and monitoring of patient care. In an ever changing healthcare system, we will discuss the role of Non-Medical Prescribers (NMPs) and Effective Shared Care Agreements (ESCAs).
Prescribing in Infection
The Principles of Prescribing
In this module we will discuss the safe and appropriate prescribing of antibacterial drugs in patients with known or suspected infections.
It will review the different classes of antibacterial available, when they should be prescribed empirically, and why careful use of antibacterials is important for both patient and public health.
This module will be relevant to your practice throughout your medical career.
Prescription Documentation
The Principles of Prescribing
In this module we will discuss the underpinning knowledge required to prescribe legally, safely and unambiguously. Key areas of good prescribing practice will be emphasised along with a more in-depth discussion for the rationale behind each of the highlighted points.
Rational Drug Choice
Clinical Governance
In this module we will discuss evidence-based medicine and how it should be used help you make rational therapeutic decisions.
Evidence-based medicine is about how information-for example, from clinical trials-is interpreted and used to ensure your patients receive the most appropriate and effective treatment.
Evidence-based medicine can improve patient outcomes, reduce variations in care and ensure NHS resources are managed effectively.
Renal Dysfunction
Prescribing in Special Circumstances
In this module, we will explore the use of drugs in patients with renal impairment - including both Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).
This module is built around three case vignettes. It discusses the changes in drug handling in kidney disease, and the way this can require changes to dose regimens.
Respiratory Medicine: Asthma and COPD
Therapeutic Groups
In this module, we will consider the management of asthma and Chronic Obstructive Pulmonary Disease (COPD). We will provide a summary of how to manage acute and chronic asthma in patients of different ages. We will also briefly discuss the pharmacological treatment options for managing stable COPD and acute exacerbations. We will not discuss the diagnosis of either of these conditions. The SCRIPT ‘Respiratory Medicine: Oxygen, Smoking Cessation and Inhalers’ module provides additional content to support your overall learning in relation to Respiratory Medicine.
Respiratory Medicine: Oxygen, Smoking Cessation and Inhalers
Therapeutic Groups
In this module, we will discuss prescribing oxygen in acute and long-term settings. We will describe nicotine replacement products and how these can support smoking cessation. We will provide a summary of the different devices available to deliver inhaled drug therapy and how to select an appropriate device for your patient. Finally, we will briefly discuss the management of pneumonia in secondary care. The SCRIPT ‘Respiratory Medicine: Asthma and COPD’ module provides additional content to support your overall learning in relation to Respiratory Medicine.
Rheumatology
Therapeutic Groups
In this module we will revise the classification criteria for rheumatoid arthritis, how to measure disease activity and how this can be used to guide therapy.
We will discuss the various 'non-biologic' and 'biologic' therapies prescribed in the management of rheumatoid arthritis, and how these are optimised to "treat to target" whilst minimising the risk of adverse effects. We will consider how to modify treatment regimens in women of child-bearing potential and for breastfeeding mothers.
Finally, we will we will describe common problem areas in rheumatology prescribing, considering both inpatient and outpatient settings.
Sepsis in Hospital
Prescribing in Medical Emergencies
In this module we will discuss the diagnosis and management of sepsis. We will list the common indicators that suggest a diagnosis of sepsis and the importance of source control in addition to appropriate antimicrobial prescribing. Finally, we will discuss the factors to consider when prescribing for patients with sepsis, and their ongoing management.
Taking a Safe & Effective Medication History
The Principles of Prescribing
In this module we will discuss the importance of an accurate and complete drug history, and what can go wrong when this information is not gathered or used correctly.
We will describe the different sources of information available to confirm the drug history, and their limitations. Problem drugs will be identified, including those which are often omitted from the history. We will give practical advice on how to obtain a safe and effective drug history.
Finally, we will discuss the importance of reconciling and documenting information about a patient's medicines on admission to, transfer in, and discharge from hospital, as outlined in the NICE Medicines Reconciliation guidance.
Utilising the BNF(C)
The Principles of Prescribing
In this module, you will be provided with the basic knowledge required to utilise the British National Formulary (BNF) and British National Formulary for Children (BNFC) accurately and effectively when prescribing and/or administering medicines.
We will discuss how the BNF and BNFC are constructed, as well as how best to find and use the information contained within them.
Nursing
For undergraduate and qualified nurses
Advanced Pain Management
Therapeutic Groups
In this module, we will discuss primarily the pharmacological management of severe pain. We will describe the issues surrounding the prescribing and administrations of strong opioid analgesics so that you have the knowledge to administer these safely and effectively.
We will also briefly discuss dose equivalents of the various opioids and administration of analgesics via a continuous subcutaneous syringe driver.
The SCRIPT 'Introduction to Pain Management' and 'Pharmacological Pain Management' modules provide content to support this module.
Dealing with Error
Principles of Medicines Management
There are thousands of cases of avoidable significant harm in the NHS each year. More than half of these harms are avoidable.
In this module, we will discuss how the principles of Root Cause Analysis (RCA), a tool used locally and nationally in healthcare to identify the causes of incidennts, can guide quality improvement through implementing change and sharing learning.
Designated Prescribing Practitioner Training
Managing the Risks
This module has been designed for qualified healthcare professionals who will be taking on the role of Designated Prescribing Practitioner (DPP) for a trainee independent prescriber.
In this module, we will develop your underpinning knowledge of the legal and ethical responsibilities of being a DPP. We will enhance your pedagogical knowledge to guide high-quality and effective teaching and learning, and build your confidence to assess competence and professionalism of the trainee independent prescriber.
Dose Calculations for Nurses
Principles of Medicines Management
In this module we will take you step-by-step through the process of performing various dose calculations and associated conversions. We will provide examples and then test your knowledge throughout using in-module activities. We will highlight some of the common pitfalls when calculating doses and explain how you can avoid them. Finally we will direct you to some resources for further reading and practice.
Evidence Based Practise
Principles of Medicines Management
In this module, we will discuss how evidence-based medicine should be used to help inform your approach to clinical practice. We will describe how this can improve patient and healthcare outcomes, reduce variations in care, and ensure NHS resources are managed effectively.
Formulation and Administration
Principles of Medicines Management
In this module, we will discuss the availability of different drug formulations and the issues this may raise in your clinical practice. We will describe the Nursing and Midwifery Council's (NMC) Standards for Medicines Management relating to the safe administration of medicines. We will also briefly discuss the preparation and/or manipulation of medicines.
Fundamentals of Pharmacology
Principles of Medicines Management
In this module we will discuss the basic principles of the effects a drug can have on the body (i.e pharmacodynamics). We will also describe whats the body does to the drug (i.e. pharmacokinetics) from when it is administered until it leaves the body, and the factors that can influence this.
We will explore these basic concepts in the context of your clinical practice.
Introduction to Pain Management
Therapeutic Groups
In this module, we will describe acute, chronic and breakthrough pain. We will highlight the importance of undertaking a well conducted pain assessment and discuss the non-pharmacological approaches to pain management.
The Script 'Pharmacological Pain Management’ and ‘Advanced Pain Management’ modules provide content to support this module.
Introduction to Psychiatry
Therapeutic Groups
In this module, we will provide you with some background knowledge of mental health, mental illness and mental health problems. We will briefly outline the organisation of mental health services and discuss the main principles of UK mental health legislation, including the implications of this legislation for prescribing and administration of medicines. Finally, we will explore the management of acute behavioural disturbance.
Medication Interruptions
Managing the Risks
In this module, we will discuss the epidemiology of medication interruptions, both in the UK and internationally. The consequences of medication interruptions will be discussed, and the protective behaviours you can engage in to reduce medication interruptions.
To help consolidate your learning this eLearning module should be completed around 2 weeks after the zoom education session.
Medicines Management in Care Homes
Principles of Medicines Management
In this module, we will discuss the national guidelines and local policies and procedures that exist to ensure the safe and effective management of medicines in care homes. We will describe some of the problems encountered at the interface of care, such as the sharing of information and effective communication.
This module will be particularly relevant for nurses and staff working in the care home setting.
Medicines Policy for Nurses
Principles of Medicines Management
In this module, we will discuss the national regulations and local policies and procedures that exist to ensure the safe and legal use of medicines within both the hospital and community setting.
Pregnancy and the Puerperium
Therapeutic Groups
In this module, we will discuss the medicines used to manage conditions in the antenatal, intrapartum and postpartum period.
This module aims to provide you with a broad overview of some scenarios that you may encounter in women who are pregnant and those in the puerperium period. We will not be able to discuss every eventuality and therefore recommend seeking specialist advice as needed. The content in this module is supported by the Pregnancy and Breastfeeding sections of the SCRIPT ‘Special Patient Groups’ module, and the ‘Therapeutics of the Newborn’ module.
Respiratory for Nurses: Asthma and COPD
Therapeutic Groups
In this module, we will consider the management of asthma and Chronic Obstructive Pulmonary Disease (COPD).
We will provide a summary of how acute and chronic asthma in patients of different ages should be managed. We will also briefly discuss the pharmacological treatment options for managing stable COPD and acute exacerbations.
The SCRIPT ‘Respiratory Medicine: Oxygen, Smoking Cessation and Inhalers’ module provides additional content to support your overall learning in relation to respiratory conditions.
Respiratory for Nurses: Oxygen, Smoking Cessation and Inhalers
Therapeutic Groups
In this module, we will discuss the issues surrounding the prescribing and administration of oxygen in acute and long-term settings. We will describe nicotine replacement products and how these can support smoking cessation.
We will provide a summary of the different devices available to deliver inhaled drug therapy and highlight the importance of an appropriate device being selected for your patient.
The SCRIPT ‘Respiratory Medicine: Asthma and COPD’ module provides additional content to support your overall learning in relation to respiratory conditions.
Sepsis
Managing the Risks
In this module, we will describe the common indicators that suggest a diagnosis of sepsis and the subsequent management of the patient with sepsis. We will discuss the factors to consider when treatment is to be initiated and the ongoing management of the patient.
In February 2016, the Sepsis International Consensus Definitions Task Force announced a revised set of evidence-based definitions. In July 2016, NICE issued a clinical guideline on the recognition, diagnosis and early management of sepsis [NG51, 2016]. The UK Sepsis Trust provides up-to-date evidence-based clinical toolkits, supported by NICE, to guide healthcare professionals through the recognition, diagnosis and management of sepsis for a range of age groups, both in the community and hospital.
NICE recommended the use of the UK Sepsis Trust's Red Flag Sepsis approach in their high risk criteria, and introduced a second set of lower acuity moderate risk criteria. During this module, we shall refer to NICE high risk and moderate risk criteria as Red Flags and Amber Flags respectively according the UK Sepsis Trust's clinical toolkits.
Special Patient Groups
Managing the Risks
In this module, we will explore the use of drugs in special patient groups, including those with renal and hepatic dysfunction, older adults and during pregnancy and breastfeeding.
You will learn the principles of safe prescribing in each patient group and where to access reputable, evidence-based information to guide your decision making.
Treatment of Infection
Therapeutic Groups
In this module, we will discuss the management of asthma and COPD. We will describe the issues surrounding the prescribing and administration of oxygen and devices for inhaled drug therapy.
It will be of particular value to nurses working in general medicine, general practice or Emergency Departments.
Utilising the BNF(C)
Principles of Medicines Management
In this module, you will be provided with the basic knowledge required to utilise the British National Formulary (BNF) and British National Formulary for Children (BNFC) accurately and effectively when prescribing and/or administering medicines.
We will discuss how the BNF and BNFC are constructed, as well as how best to find and use the information contained within them.
Paediatric
For specialist trainees, doctors and non-medical professionals working in a paediatric setting
Cannabis-Based Products for Medicinal Use
General Therapeutics
In this module, we will discuss the legislative changes that have enabled cannabis-based products for medicinal use (CBPMs) to be prescribed for patients. We will also discuss why unlicensed CBPMs can only be supplied under the prescription or direction of specialist doctors on the GMC Specialist Register (in specific circumstances) where there is an unmet clinical need.
We will outline the guidelines and recommendations available to support healthcare professionals in the UK.
This module has been commissioned by NHS England to provide a basic overview for all healthcare professionals and not specifically for a prescriber audience. We advise that you refer to your local policies for guidance on the practicalities of prescribing and obtaining CBPMs in your organisation.
Cardiology
Advanced Therapeutics
In this module we will describe the mechanism of action of the different classes of diuretics, and list the monitoring requirements to minimise the risk of adverse effects. Describe the role of diuretics in the management of ventricular septal defect. Describe the role of prostaglandin, anti-platelet and anticoagulant therapies in the management of duct dependent circulation.
We will list the medicines that should be initiated in a patient with dilated cardiomyopathy. Categorise antiarrhythmics medicines according to the Vaughan-Williams classification based on their mechanism of action.
We will list the adverse effects of antiarrhythmics and describe the monitoring requirements to minimise the risk of these occurring. List the signs and symptoms digoxin toxicity and describe how this is managed. Initiate immunoglobulins for the management of Kawasaki disease. Describe the aims of treatment in the management of Teratology of Fallot.
Dermatology
General Therapeutics
In this module, we will discuss prescribing for skin conditions.
We will look at a number of important areas in management, including topical therapy for skin disease, safe prescribing of topical corticosteroids and an overview of the use of systemic treatments.
We will consider special circumstances relevant to prescribing, including in adolescence and in those with suspected or proven multisystem disease.
Developmental Pharmacology
The Principles of Prescribing in Paediatrics
In this module we will explore the differences in drug handling across various age groups. We will briefly discuss the identification and prediction of drug interactions and adverse drug reactions in the paediatric population.
Diabetes
General Therapeutics
In this module we will describe the onset and duration of action of different insulins available in the UK. Calculate a patient's insulin: carbohydrate ratio and insulin sensitivity factor. Manage diabetes during an episode of acute illness (i.e. 'sick day rules'). Discuss the initial management of hypoglycaemia in a conscious or unconscious patient. List the diabetes-related complications and associated conditions that should be monitored and managed. Counsel children and/or their relatives/carers on the importance of self-management.
Ear, Nose and Throat
Surgical Specialties
In this module we will identify when antimicrobials are indicated for the management of commonly encountered ENT conditions, and select the most appropriate drug, dose, route and duration of treatment. Discuss the management of epistaxis. List the pharmacological treatment options available for the management of allergic rhinitis. Describe the management of acute uncomplicated sinusitis. Discuss the medical management of post-tonsillectomy bleeding. Describe appropriate treatment(s) for the management of airway oedema.
Endocrine 1
General Therapeutics
In this module we will discuss the role of screening in the identification of congenital hypothyroidism. Initiate levothyroxine for the management of congenital hypothyroidism and know how often the patient's thyroid function should be monitored. List the pharmacological treatment options available for the management of hyperthyroidism. Describe the potential neonatal complications of maternal thyrotoxicosis and the management of newborn babies at risk of neonatal thyrotoxicosis. Describe the pharmacological management of Congenital Adrenal Hyperplasia (CAH). Counsel children and/or their relatives/carers on managing corticosteroids during an acute illness (i.e. 'sick day rules'). Discuss the role of glucocorticoid and mineralocorticoid replacement in the pharmacological management of Addison's disease. Discuss the diagnosis and management of Cushing's syndrome.
Endocrine 2
General Therapeutics
In this module we will describe the role of somatropin (growth hormone) in the management of children with growth failure. List the medicines used for pubertal suppression in precocious puberty. Describe the medicines used in the induction of puberty in boys and girls. List the cautions associated with prescribing desmopressin for the management of diabetes insipidus. Initiate intravenous calcium gluconate 10% for the emergency management of acute severe hypocalcaemia. Discuss the prevention and management of vitamin D-deficiency rickets.
Gastroenterology and Hepatology
General Therapeutics
In this module we will Initiate pharmacological treatment for the management of constipation in line with NICE guidance. Select an appropriate milk replacement when managing cows' milk protein and/or lactose intolerance. Initiate therapy and effectively manage Gastro-Oesophageal Reflux Disease (GORD). Discuss the role of exclusive enteral feeding in inducing remission in patients with Crohn's disease. List the pharmacological treatment options available for the management of IBD and the factors affecting drug selection. List the factors that affect hepatic drug clearance. Initiate appropriate treatment(s) for the management of cholestasis. Discuss the management of bleeding in acute hepatic failure.
Counsel children and/or their relatives/carers on the adverse effects associated with tacrolimus.
General Surgery and Burns
Surgical Specialties
In this module, we will explore the use of medicines in the perioperative period and in the management of burns.
Using case-based examples, we will discuss the general principles of prescribing medicines in the perioperative period, such as when to stop or omit medicines, management of postoperative nausea and vomiting, venous thromboembolism prophylaxis, and indications for preoperative prophylactic antimicrobials.
Finally, we will provide a brief overview of some of the pharmacological interventions required in the management of burns, such as prescribing resuscitation fluids.
This module is one of a two-part module. The SCRIPT 'Surgical Prescribing Scenarios' module will discuss some common surgical interventions (e.g. appendicitis) and how to manage certain co-morbidities (e.g. diabetes mellitus, epilepsy) in the perioperative period.
Inflammatory Disease
General Therapeutics
In this module we will initiate pharmacological treatment for the management of pain associated with inflammatory disease considering all the patient’s comorbidities (e.g. renal impairment). Discuss how Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are used in the management of inflammation and pain. Initiate corticosteroids for management of inflammatory disease, and understand how to wean them appropriately.
We will list the commonly prescribed systemic medicines used in the management of inflammatory disease (i.e. non-biologic and biologic disease modifying drugs). List the medicines that can cause immunosuppression, and know when to seek specialist advice when managing infections in an immunocompromised patient. Discuss the importance of shared decision-making in the management of inflammatory disease. Counsel children and/or their relatives/carers on the administration and adverse effects of medicines used in the management of inflammatory disease.
Malignancy and Haematology
Advanced Therapeutics
In this module we will describe some of the oncology and haematology conditions encountered in paediatrics, including brain tumour, lymphoma, newly diagnosed leukaemia, Immune Thrombocytopenic Purpura (ITP), and sickle cell crises. Know the restrictions relating to the prescribing, dispensing, checking and administration of intrathecal therapy. List the baseline monitoring requirements and adverse effects of some systemic anticancer therapies (SACT).
We will initiate appropriate treatment for the management of some of the adverse effects associated with SACT, including neutropenic sepsis, chemotherapy-induced nausea and vomiting, mucositis and tumour lysis syndrome. Discuss the management of deep vein thrombosis. Initiate appropriate treatment for the management of an acute painful episode of sickle cell disease. Know when to escalate concerns and seek specialist advice where necessary.
Neonates
General Paediatrics
In this module, we will discuss the medicines most commonly used in the neonatal intensive care unit and when they may be considered for use. We will approach this in a systematic way by working through three clinical cases.
Neurology
General Therapeutics
In this module, we will explore the pharmacological management of common neurological conditions such as epilepsy, headaches and sleep disorders. We will use case-based examples to discuss common prescribing scenarios in paediatric neurology, such as how to initiate and wean antiepileptic treatment regimens.
We will also briefly discuss the medicines most commonly used in the management of dystonia and spasticity.
Opthalmology
Surgical Specialties
In this module we will administer ocular medicines safely and effectively to children of all ages. Select appropriate ocular medicines to administer during the examination of a child. Initiate appropriate pharmacological treatment for the management of periorbital and orbital cellulitis. Select the most appropriate treatment option for the management of conjunctivitis in different age groups. Describe the pharmacological management of pain associated with ocular conditions. Discuss the potential ophthalmic adverse effects associated with some prescribed medicines. Counsel patients and/or relatives/carers on the safe administration of ocular medicines.
Paediatric Emergencies
General Paediatrics
In this module we will list the six elements of the Paediatric Sepsis Six® Care bundle (from birth -11-years-old) and discuss the role of blood products and components in the management of sepsis. Know where to find reputable, reliable and up-to-date information on the management of poisoning and toxicity. Discuss the initial management of a patient presenting with suspected poisoning due to a drug overdose. Know where to find reputable, reliable and up-to-date information on the management of inherited metabolic diseases. Initiate pharmacological treatment for the management of a cardiac arrest. Describe the process of organising an inter-hospital transfer.
Paediatric Intensive Care Unit
Advanced Therapeutics
In this module we will describe how critically ill children handle medicines differently from ‘healthy children’ and how this influences prescribing. Know where to find information on the compatibility of medicines. List the medicines recommended in the management of intubation and sedation. Discuss the use of vasoactive medicines to maintain cardiovascular stability.
We will describe the principles of managing a traumatic brain injury, including raised intracranial pressure.
Pharmaceutical Management of the Critically Ill Child: Use of the FLATCHUG TOOL
General Therapeutics
In this module, we will discuss the pharmaceutical management of patients on the Paediatric Intensive Care Unit (PICU). We will describe the key aspects of pharmaceutical care that should be considered during each patient encounter. We will introduce a systematic method (FLATCHUG) for undertaking a pharmaceutical review of a critically ill child and
managing medicine-related problems in a critical care setting.
This module will be particularly helpful for pharmacists working in PICU, however the content will be useful for any healthcare professional working in this environment.
Practical Prescribing
The Principles of Prescribing in Paediatrics
In this module we will discuss why children are more vulnerable to medication errors, and how to avoid them.
We will demonstrate the different ways a dose may need to be calculated, including those based on body weight and Body Surface Area (BSA). We will calculate maintenance and rehydration fluid requirements for children of all weights and ages. Explain what is meant by unlicensed and off-label prescribing, and provide example of this in paediatrics. We will recognise that age appropriate medicines are not always readily available to children, and understand how this is managed in practice.
Renal Disease
General Therapeutics
In this module we describe how to assess and accurately calculate renal function in children. Explain how impaired renal function affects the pharmacokinetics of medicines. Identify common medicines that need dose adjustment and/or additional monitoring in renal impairment.
We will also describe (a) intravenous fluid therapy; (b) management of hyperkalaemia; and (c) management of hypertension in renal impairment. Discuss the management options for nephrotic syndrome. Describe the pharmacological management of nocturnal enuresis and Urinary Tract Infections (UTIs). Know where to find information to guide prescribing in renal impairment.
Respiratory
General Therapeutics
In this module we will discuss the pharmacological management of chronic asthma. Describe the different devices available for delivering inhaled therapy, and be able to select the most suitable device for your patient. Discuss the management of cystic fibrosis with a particular focus on the antimicrobials used in the prevention and treatment of infection.
We will list the vitamins and Pancreatic Enzyme Replacement Therapy (PERT) that may be required in children with cystic fibrosis. Describe the evolving role of personalised medicine in the management of cystic fibrosis. List the common causative organisms of pneumonia. Initiate appropriate antibacterial(s) therapy for the management of pneumonia.
We will discuss the role of long-term oxygen therapy. Know where to find evidence-based information to guide prescribing in respiratory disorders.
The Acutely Unwell Child
General Paediatrics
In this module we will initiate treatment to manage Convulsive Status Epilepticus (CSE)and escalate management according to response. Accurately prescribe adrenaline and affiliated medicines for a child presenting with anaphylaxis. Explain to a child and their carer how to administer an adrenaline auto-injector (e.g. EpiPen®) and the steps to take after a dose has been administered. Manage an acute exacerbation of asthma in children. Initiate appropriate fluid management and medicines to treat hypoglycaemia outside the neonatal period. Initiate fluid management, insulin and medicines to manage Diabetic Ketoacidosis (DKA) in children. Manage an acute episode of psychosis.
Utilising the BNF(C)
The Principles of Prescribing in Paediatrics
In this module, you will be provided with the basic knowledge required to utilise the British National Formulary (BNF) and British National Formulary for Children (BNFC) accurately and effectively when prescribing and/or administering medicines.
We will discuss how the BNF and BNFC are constructed, as well as how best to find and use the information contained within them.
Pharmacy
For undergraduate, Foundation and newly qualified pharmacists, NHS and community pharmacists
Acute Coronary Syndrome and Cardiac Arrest
Prescribing In Medical Emergencies (Primary Care Focus)
In this module, we will focus on the drugs and therapeutic procedures to manage a presentation of Acute Coronary Syndrome (ACS), including a Cardiopulmonary Resuscitation (CPR) event.
As a minimum, it is expected that all general practitioners in the UK hold a valid CPR and Automated External Defibrillation (AED) qualification. This is normally achieved through completion of a Basic Life Support (BLS) course.
The module summarises guidance from the European Resuscitation Council 2015 and the Resuscitation Council UK, but will be pitched at the level of the Basic Life Support (BLS) provider, rather than that of an Advanced Life Saver certificate holder.
Adherence
The Principles of Prescribing
In this module we will explore medicines adherence and other related terminology. It will consider levels of and reasons for non-adherence. The module will also explore methods to promote shared decision-making and interventions to increase adherence to, and persistence with, prescribed medication regimens.
Adverse Drug Reactions
Managing The Risks of Prescribing (Secondary Care Focus)
This module will explore the identification and prediction of adverse drug reactions (ADRs) in patients. It will also consider the public health burden of adverse drug reactions, and pharmacovigilance systems in the UK. The module will highlight the importance of reporting ADRs.
Anaphylaxis
Prescribing In Medical Emergencies (Primary Care Focus)
In this module, we will discuss the stepwise management of anaphylaxis in the general practice setting. We will list the signs and symptoms of an anaphylactic reaction and describe how to assess severity. We will discuss the pharmacological management and any follow-up required for patients who required hospitalisation.
It is important you remain up-to-date with the most recent evidence-based guidance to manage an anaphylactic reaction in the community setting.
Anticoagulation: DOACs and Parenteral Anticoagulants
Therapeutic Groups (Secondary Care Focus)
In the ‘Anticoagulation: Vitamin K Antagonists’ module, we provided an overview of anticoagulation and discussed vitamin K antagonists (VKAs) such as warfarin, phenindione and acenocoumarol.
In this module, we will focus on Direct Oral Anticoagulants (DOACs) and parenteral anticoagulation.
We will consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements of DOACs.
Anticoagulation: Vitamin K Antagonists
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide an overview of anticoagulation therapy.
We will discuss Vitamin K Antagonists (VKAs) and consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements.
The SCRIPT 'Anticoagulation: DOACs and Parenteral Anticoagulants' module supports the content within this module.
Asthma and Croup
Prescribing In Medical Emergencies (Primary Care Focus)
In this module, we will discuss the pharmacological management of an acute exacerbation of asthma or croup in general practice, or during a home visit in the community. Acute management of asthma will be discussed for both adults and children while, for croup we will concentrate on management in children (i.e. the patient group most affected).
We will also describe any follow-up required for patients who experience one of these medical emergencies.
Bipolar Affective Disorders
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide you with an introduction to the treatment and management of Bipolar Affective Disorder (BPAD).
We will briefly describe the aetiology and symptoms of BPAD. We will discuss the medicines commonly used in the management of acute mania and prophylaxis of BPAD. We will then discuss in further detail, the role of lithium and the risks of toxicity.
Note: we will not discuss the management of bipolar depression in this module, as this will be discussed in our ‘Depression’ module. The SCRIPT ‘Introduction to Psychiatry’ and ‘Affective Disorders’ modules provide additional content to support your overall learning in relation to psychiatry.
Throughout this module, we will refer to ‘patients’, as this is consistent with the terminology used by the Royal College of Psychiatrists. However, many guidelines refer to people with mental health problems as ‘service users’ or ‘clients’.
Breastfeeding
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will explore the use of drugs in patients who are breastfeeding.
The module includes the general principles of prescribing in breastfeeding patients, the effects of drugs on lactation, the possible effects that a drug may have on the breastfed infant and introduces some useful resources for establishing the safety of drug use during lactation.
Cardiac arrest
Prescribing In Medical Emergencies (Secondary Care Focus)
This module will focus on the drugs and therapeutics used during and immediately following cardio-pulmonary resuscitation (CPR) in an adult. It is based on the latest Resuscitation Council guidelines (2010). This module will help you to revise the guidelines for resuscitation of patients in cardiac arrest and management of reversible causes, but does not replace formal Advanced Life Support (ALS) training.
Cardiac Arrhythmias
Therapeutic Groups (Secondary Care Focus)
In this module we will discuss the management of cardiac dysrhythmias in the secondary care setting. Pharmacological treatment options will be discussed for both the acute and long-term management of arrhythmias, and the importance of stroke risk stratification in patients with Atrial Fibrillation (AF).
Clinical Kinetics
The Principles of Prescribing
You must choose the right drug at the correct dose to manage your patient optimally. In this module we will discuss the factors that govern the rate and extent of a drug's action, from when it is administered until it leaves the body.
Understanding clinical kinetics will help you make better therapeutic choices and can be applied to your day-to-day prescribing.
Clinical Pharmacology
The Principles of Prescribing
This module serves as a reminder of the fundamental topics in pharmacology you will have learnt as a medical student, and aims to help you to appreciate the relevance of this knowledge to your early clinical practice.
The module will focus on pharmacodynamics (the interactions between drugs and receptors) and discuss the range of chemically sensitive sites, which mainly exist on proteins. Pharmacokinetics is considered in a separate module.
COVID-19
Prescribing In Medical Emergencies (Secondary Care Focus)
In this module, we will provide a high-level overview of the care of medical inpatients with suspected or confirmed COVID-19.
We will discuss some basic facts about the disease, summarise the managment principles for ward-based patients, and present and outline approach to the escalation or palliation of patients.
We will concentrate the learning on adult inpatients in the non critical care setting.
Dealing with Error
Clinical Governance
There are thousands of cases of avoidable significant harm in the NHS each year. More than half of these harms are avoidable.
In this module, we will discuss how the principles of Root Cause Analysis (RCA), a tool used locally and nationally in healthcare to identify the causes of incidents, can guide quality improvement through implementing change and sharing learning.
Dementia
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will discuss the different types of dementia, their diagnosis and management. As a prescribing practitioner completing this module, you will have the knowledge and skills needed to safely assess, manage and refer any patient with dementia seen in a secondary care setting.
Dementia
Prescribing In Special Circumstances (Primary Care Focus)
In this module, we will discuss the different types of dementia, their diagnosis and management. This module is designed to emphasise the knowledge, skills, and attitudes needed to safely assess, manage and refer patients with dementia who present in the primary care setting.
Depression, Anxiety & Insomnia: Psychiatric Symptom Management in General Hospital Settings
Therapeutic Groups (Secondary Care Focus)
This is one of two SCRIPT modules that discusses psychiatric symptom management in general hospital settings. We aim to provide the knowledge required to manage common mental illnesses and understand how the Mental Health and Mental Capacity Acts impact on the prescribing and administration of medicines.
In this module, we will consider the use of medicines in the management of depression, anxiety, and insomnia occurring in conjunction with a physical illness or presenting with physical symptoms. The second SCRIPT module, ‘Rapid Tranquillisation & Antipsychotics - Psychiatric Symptom Management in General Hospital Settings’ discusses rapid tranquillisation, severe mental illness, and the use of clozapine in general hospital settings.
Note that some medicines are considered under more than one indication in this module. To avoid repetition, it is important to be aware that adverse effects, discontinuation symptoms, interactions and suicide risk apply regardless of what the medicine is prescribed for.
Some medicines are considered under more than one indication in this module. To avoid repetition it is important to be aware that side-effects, discontinuation symptoms, interactions and suicide risk apply regardless of what the medicine is prescribed for.
Designated Prescribing Practitioner Training
The Principles of Prescribing
This module has been designed for qualified healthcare professionals who will be taking on the role of Designated Prescribing Practitioner (DPP) for a trainee independent prescriber.
In this module, we will develop your underpinning knowledge of the legal and ethical responsibilities of being a DPP. We will enhance your pedagogical knowledge to guide high-quality and effective teaching and learning, and build your confidence to assess competence and professionalism of the trainee independent prescriber.
Diabetes: Insulin Part 1
Therapeutic Groups (Secondary Care Focus)
In this module we will focus on the management of diabetes mellitus in adults using insulin.
We will describe how to safely prescribe insulin, which is considered a ‘high-risk’ medicine. We will discuss the different insulin profiles available and the different insulin regimens that may be used to manage diabetes mellitus.
The SCRIPT ‘Diabetes: Insulin Part 2’ module, ‘Diabetes: Antihyperglycaemic Medicines (excluding insulin)’ module and the ‘Medical Emergencies in Diabetes’ module provides additional content to support your overall learning in relation to diabetes mellitus.
Diabetes: Insulin Part 2
Therapeutic Groups (Secondary Care Focus)
In this module we will focus on the management of diabetes mellitus in adults using insulin.
We will describe the key principles of prescribing a Variable Rate Intravenous Insulin Infusion (VRIII). We will discuss how to safely stop a VRIII and restart a patient’s usual antihyperglycaemic regimen, or initiate insulin in insulin-naïve patients. Finally, we will discuss the Think Glucose initiative and when it is appropriate to refer patients to the diabetes specialist team.
The SCRIPT ‘Diabetes: Insulin Part 1’ module, ‘Diabetes: Antihyperglycaemic Medicines (excluding insulin)’ module and the ‘Medical Emergencies in Diabetes’ module provides additional content to support your overall learning in relation to diabetes mellitus.
Disorders of Psychosis
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide you with an introduction to the treatment and management of psychosis and schizophrenia.
We will briefly describe the clinical features of schizophrenia and the factors that may contribute to a patient's prognosis. We will also discuss the medicines used in the management of common psychotic disorders, and how to ensure that these are prescribed and monitored safely and effectively.
Dosing and Calculation
The Principles of Prescribing
In this module we will develop the underpinning knowledge and numeracy skills required for you to perform dose calculations competently and accurately in clinical practice. It will expand on your existing knowledge of drug dosages and calculations needed to ensure safe practice.
Drug Allergy and Anaphylaxis
Prescribing In Medical Emergencies (Secondary Care Focus)
This module will give an overview of drug allergy, concentrating on anaphylaxis. It will describe the signs and symptoms of Type I (immediate) reactions, so you can rapidly assess and treat patients; and know how to reduce the risk of such reactions. Finally the follow up of severe reactions is described.
Drug Interactions
Managing The Risks of Prescribing (Secondary Care Focus)
In this module, we will explore the potential risks and possible harm caused by pharmacodynamic and pharmacokinetic interactions within patients during multiple drug therapy.
We will describe the different types of drug interactions that can occur, their mechanisms and any potential clinical implications.
Knowledge of both the mechanisms of drug interactions and reliable information sources for drug interactions, can allow you to reduce the opportunity of drug interactions that could harm your patients.
Drugs of Misuse
Therapeutic Groups (Secondary Care Focus)
In this module we will explore the main issues surrounding the misuse of drugs, both legal and illegal. We will discuss both the acute presentation with toxicity or withdrawal, as well as chronic problems associated with drug and alcohol dependence.
Epilepsy
Therapeutic Groups (Secondary Care Focus)
In this module we will explore the pharmacological management of both epilepsy and status epilepticus. The factors affecting the choice of antiepileptic drug (AED) treatment will be considered along with how the risk of harm from such treatments can be minimised.
Fluids: Practical Prescribing for Adults
Prescribing In Medical Emergencies (Secondary Care Focus)
In this module, we will describe the indications for intravenous fluid and the common types of intravenous fluid prescribed.
We will discuss some common clinical situations where intravenous fluids are required. We will also describe which fluid types are most appropriate in a variety of situations.
The information contained within this module is only for adult intravenous fluid prescribing. See the ‘Paediatric Prescribing’ module for guidance on prescribing fluids in paediatric patients.
Fluids: The Principles
Prescribing In Medical Emergencies (Secondary Care Focus)
In this module we will discuss the basic principles of fluid management.
We will describe the different fluid compartments and the sources of fluid loss and fluid gain. We will also briefly discuss how to calculate resuscitation and maintenance fluid requirements.
The SCRIPT ‘Fluids: Practical Prescribing in Adults’ module provides additional content and case vignettes to support your overall learning in relation to fluid management. Information relating to blood transfusion is beyond the scope of this module.
Formulation: An Overview for Prescribers
The Principles of Prescribing
In this module, we will discuss the availability of different drug formulations and the issues this may raise in your clinical practice.
We will provide a brief reminder of pharmacokinetics specifically focusing on absorption. We will describe how different formulations of a drug can have different pharmacokinetic properties and how this can affect dosing.
Finally, we will briefly discuss off-label and unlicensed medicines and the additional prescribing considerations you should think about when prescribing these.
Heart Failure
Therapeutic Groups (Secondary Care Focus)
In this module, we will discuss the pharmacological management of acute and chronic heart failure. With reference to national guidelines, we will consider the cautions and contraindications of treatment, the adverse effects of treatments and how you can minimise the risk of harm to your patients.
Hepatic Dysfunction
Prescribing in Special Circumstances (Secondary Care Focus)
This module will explore the use of drugs in patients with liver disease, the effects of drugs on the liver, and the effect of the liver on drugs.
It will examine how to assess liver function, what drugs can cause harm to the liver, the metabolism of drugs by the liver and which drugs to avoid in chronic liver disease.
It will be of use throughout your career as a prescriber.
High-Risk Injectable Medicines
Managing The Risks of Prescribing (Secondary Care Focus)
In this module, we will discuss three commonly encountered high-risk medicines that are administered via the intravenous route.
We will discuss and focus on intravenous potassium chloride, gentamicin and vancomycin. We will describe why these medicines have the potential for harm and how to prescribe them safely. We will also discuss the monitoring requirements for these medicines.
The SCRIPT ‘Infection in Secondary Care’ module provides additional content to support your overall learning in relation to gentamicin and vancomycin.
High-Risk Oral Medicines
Managing The Risks of Prescribing (Secondary Care Focus)
In this module, we will introduce the important aspects surrounding the prescribing, supply, administration, and monitoring of so called ‘high-risk medicines’ that are administered via the oral route.
We will discuss some of the oral medicines encountered in general medicine that pose a significant risk to patients. These medicines have the potential for harm due to the risks of toxicity, significant drug interactions and adverse effects. They require close clinical monitoring and care when prescribing.
Although we will focus on the oral route of administration, where applicable much of this theory can be applied to alternative routes of administration.
Infection in Secondary Care
Therapeutic Groups (Secondary Care Focus)
In this module we will show you how to prescribe safely and appropriately for commonly encountered infections in secondary care. We will discuss how to assess the severity of infection so you can initiate appropriate management.
Introduction to Psychiatry
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide you with some background knowledge of mental health, mental illness and mental health problems. We will briefly outline the organisation of mental health services and discuss the main principles of UK mental health legislation, including the implications of this legislation for prescribing and administration of medicines. Finally, we will explore the management of acute behavioural disturbance.
Managing Complications of Anticancer Therapy
Advanced Prescribing (Secondary Care Focus)
In this module, we will highlight the basic principles of Systemic Anticancer Therapy (SACT), the appropriate management of patients presenting with complications of treatment, as well as those caused by the underlying malignancy.
We will explore modern systemic anticancer therapy and the importance of safe, rational prescribing.
This module will be of particular value to doctors currently in or about to undertake their haematology/oncology rotation. It may also supplement the training of non-medical prescribers who will be working in this field, or for prescribers working in areas that deal with the emergency treatment of chemotherapy-induced toxicity.
Medical Emergencies in Diabetes
Prescribing In Medical Emergencies (Secondary Care Focus)
In this module, we will discuss the signs and symptoms of diabetic emergencies, including hypoglycaemia, diabetic ketoacidosis, and hyperosmolar hyperglycaemic state.For each, we will describe the immediate step-by-step management and continuing care in adults.
The Joint British Societies Inpatient Care Group provide comprehensive guidance on all the diabetic emergencies discussed here, all of which are available online.
Note that hospital Trusts are likely to have their own guidelines or protocols on the management of these emergencies. These should be used as the primary guidance alongside the general principles what we provide here.
Medication Errors
Managing The Risks of Prescribing (Secondary Care Focus)
This module describes the nature and frequency of medication errors and examines the theory underlying general human error.
It will introduce you to tips on reducing medication errors, and how you can identify and correct them. The session also describes how you, as healthcare professionals, should respond when you discover a medication error, and how it should be reported.
Finally, the role of electronic prescribing in preventing errors will be discussed.
Meningococcal Disease
Prescribing In Medical Emergencies (Primary Care Focus)
In this module, we will focus on the presentation and pre-hospital emergency management of a patient with suspected meningococcal disease.
The content of this module is based on the NICE Guidance: 'Meningitis (bacterial) and meningococcal septicaemia in under 16s'
Monitoring Medicines
Managing The Risks of Prescribing (Secondary Care Focus)
In this module, we will provide an overview of the importance of monitoring medicines. We will describe how effective monitoring can reduce the incidence of adverse drug reactions and improve therapeutic outcomes. We will also briefly discuss the principles of Therapeutic Drug Monitoring (TDM).
Note: this module is designed to provide a wider overview of monitoring medicines rather than specific examples (although we will provide a few examples throughout the module). We hope that the principles discussed in the module will help you in your practice. If you are unsure of the monitoring requirements of a particular medicine, always seek specialist advice."
Older People
Prescribing in Special Circumstances (Secondary Care Focus)
This module will help you understand the way in which older adult patients handle administered drugs (pharmacokinetics) and how they react to these drugs (pharmacodynamics) once they have been absorbed. This will help you to prescribe medicines safely in this patient group.
Paediatric Dermatology
Therapeutic Groups (Primary Care Focus)
In this module, we will discuss prescribing for skin conditions.
We will look at a number of important areas in management, including topical therapy for skin disease, safe prescribing of topical corticosteroids and an overview of the use of systemic treatments.
We will consider special circumstances relevant to prescribing, including in adolescence and in those with suspected or proven multisystem disease.
Note that some therapeutics will be discussed that are only prescribed under the supervision of paediatric dermatologists or general practitioners with a special interest and experience in dermatology.
Paediatric Pharmacokinetics
The Principles of Prescribing
In this module, we will explore the differences in drug handling across various age groups. We will briefly describe how the changes in body composition and organ function as children grow can affect the pharmacokinetics of a medicine.
Please note there is no pre- or post-test for this module. The SCRIPT ‘Paediatric Practical Prescribing’ module provides additional content to support your overall learning in relation to paediatrics.
Paediatric Practical Prescribing
Prescribing in Special Circumstances (Secondary Care Focus)
In this module we will explore the practicalities of dosing medicines for different ages of children. We will discuss the basic principles of fluid management and how to reduce the risk of medication errors. We will also describe the additional factors to consider in the paediatric population, such as the use of unlicensed and ‘off-label’ preparations.
Towards the end of the module, we will use case-based examples to work through selected prescribing scenarios.
Pain: Neuropathic and Complex Analgesia
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide an overview of the management of neuropathic pain and the use of complex pain management techniques such as epidurals, patient-controlled analgesia, and local anaesthetics. We will also consider alternative, non-pharmacological, approaches to pain relief.
Pain: Non-Opioids and Opioids
Therapeutic Groups (Secondary Care Focus)
In this module, we will provide an overview of the management of pain using non-opioid and opioid analgesics. We will consider the properties of the different medicines available and how they can be prescribed safely to minimise harm.
The SCRIPT ’Pain Management – Neuropathic and Complex Analgesia’ and 'Palliative and End-of-Life Care' modules provide content to support this module. You may find these useful in underpinning your knowledge and understanding of pain management.
Palliative and End-of-Life Care
Advanced Prescribing (Secondary Care Focus)
In this module we will explore the prescribing issues in caring for patients with advanced disease and those that are dying.
We will discuss the management of pain in providing palliative care to patients so you can prescribe opioids safely and effectively. The management of nausea and vomiting, and those symptoms that commonly arise in the last days of a patient's life will also be discussed. We will also focus on the importance of shared decision-making with the patient and their family and within the multidisciplinary team.
Perioperative Prescribing
Prescribing in Special Circumstances (Secondary Care Focus)
This module will explore the use of drugs in the perioperative period-specifically looking at issues of therapy immediately before and after operative surgery. It will consider issues such as decisions about stopping/omitting medicines prior to surgery and managing essential drug therapy.
This module is of particular value to prescribers who are currently in or about to begin surgical rotations.
Poisoning
Prescribing In Medical Emergencies (Primary Care Focus)
In this module we will consider poisoning as a result of drug overdose.
The module will explore the clinical toxicology of commonly prescribed drugs and the management required to alleviate their effects. It will provide practical advice on where to look for information should poisoning be suspected.
Pregnancy
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will explore the use of drugs in patients who are pregnant or who may become pregnant.
The module includes the general principles of prescribing in pregnancy, the effects of drugs on the fetus, the effects of pregnancy on drug handling and introduces some key resources for determining whether a drug is safe to use. Some common conditions encountered during pregnancy are also covered.
Pregnancy and Breastfeeding
Prescribing In Special Circumstances (Primary Care Focus)
In this module we will explore the use of drugs in patients who are both planning to start a family, are already pregnant and who are breastfeeding.
We will discuss the general principles of prescribing in pregnancy, the effects of drugs on the fetus and the effects of pregnancy on drug handling. We will also discuss the general principles of prescribing in breastfeeding mothers, including the effects of drugs on lactation and the possible effects that a drug may have on the breastfed infant.
We will introduce some key resources for determining whether a drug is safe to use during both pregnancy and breastfeeding.
Prescribing at the Interface & Team Prescribing
Advanced Prescribing (Secondary Care Focus)
In this module, we will discuss the importance of communication within the healthcare sector, and how this contributes to the effective management and monitoring of patient care. In an ever changing healthcare system, we will discuss the role of Non-Medical Prescribers (NMPs) and Effective Shared Care Agreements (ESCAs).
Prescribing in Infection
The Principles of Prescribing
In this module we will discuss the safe and appropriate prescribing of antibacterial drugs in patients with known or suspected infections.
It will review the different classes of antibacterial available, when they should be prescribed empirically, and why careful use of antibacterials is important for both patient and public health.
This module will be relevant to your practice throughout your medical career.
Prescription Documentation
The Principles of Prescribing
In this module we will discuss the underpinning knowledge required to prescribe legally, safely and unambiguously. Key areas of good prescribing practice will be emphasised along with a more in-depth discussion for the rationale behind each of the highlighted points.
Rational Drug Choice
Clinical Governance
In this module we will discuss evidence-based medicine and how it should be used help you make rational therapeutic decisions.
Evidence-based medicine is about how information-for example, from clinical trials-is interpreted and used to ensure your patients receive the most appropriate and effective treatment.
Evidence-based medicine can improve patient outcomes, reduce variations in care and ensure NHS resources are managed effectively.
Renal Dysfunction
Prescribing in Special Circumstances (Secondary Care Focus)
In this module, we will explore the use of drugs in patients with renal impairment - including both Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).
This module is built around three case vignettes. It discusses the changes in drug handling in kidney disease, and the way this can require changes to dose regimens.
Respiratory Medicine: Asthma and COPD
Therapeutic Groups (Secondary Care Focus)
In this module, we will consider the management of asthma and Chronic Obstructive Pulmonary Disease (COPD). We will provide a summary of how to manage acute and chronic asthma in patients of different ages. We will also briefly discuss the pharmacological treatment options for managing stable COPD and acute exacerbations. We will not discuss the diagnosis of either of these conditions. The SCRIPT ‘Respiratory Medicine: Oxygen, Smoking Cessation and Inhalers’ module provides additional content to support your overall learning in relation to Respiratory Medicine.
Respiratory Medicine: Oxygen, Smoking Cessation and Inhalers
Therapeutic Groups (Secondary Care Focus)
In this module, we will discuss prescribing oxygen in acute and long-term settings. We will describe nicotine replacement products and how these can support smoking cessation. We will provide a summary of the different devices available to deliver inhaled drug therapy and how to select an appropriate device for your patient. Finally, we will briefly discuss the management of pneumonia in secondary care. The SCRIPT ‘Respiratory Medicine: Asthma and COPD’ module provides additional content to support your overall learning in relation to Respiratory Medicine.
Rheumatology
Therapeutic Groups (Primary Care Focus)
In this module, we will briefly discuss the presentation of early rheumatoid arthritis in primary care. We will review the classification criteria, how disease activity is measured, and how this is used to guide therapy.
We will discuss the various 'non-biologic' and 'biologic' therapies prescribed in the management of rheumatoid arthritis, and how these are optimised to "treat to target" whilst minimising the risk of adverse effects. We will consider how treatment regimens are modified in women of child-bearing potential and for breastfeeding mothers.
Finally, we will we will describe common problem areas in rheumatology prescribing, considering both inpatient and outpatient settings.
Rheumatology
Therapeutic Groups (Secondary Care Focus)
In this module we will revise the classification criteria for rheumatoid arthritis, how to measure disease activity and how this can be used to guide therapy.
We will discuss the various 'non-biologic' and 'biologic' therapies prescribed in the management of rheumatoid arthritis, and how these are optimised to "treat to target" whilst minimising the risk of adverse effects. We will consider how to modify treatment regimens in women of child-bearing potential and for breastfeeding mothers.
Finally, we will we will describe common problem areas in rheumatology prescribing, considering both inpatient and outpatient settings.
Seizures
Prescribing In Medical Emergencies (Primary Care Focus)
In this module, we will discuss the pharmacological management of a seizure in the practice, or during a home visit in the community. We will also discuss the prescription of anti epileptic medicines, and the potential emergency situations that can arise from their use.
Sepsis in Hospital
Prescribing In Medical Emergencies (Secondary Care Focus)
In this module we will discuss the diagnosis and management of sepsis. We will list the common indicators that suggest a diagnosis of sepsis and the importance of source control in addition to appropriate antimicrobial prescribing. Finally, we will discuss the factors to consider when prescribing for patients with sepsis, and their ongoing management.
Taking a Safe & Effective Medication History
The Principles of Prescribing
In this module we will discuss the importance of an accurate and complete drug history, and what can go wrong when this information is not gathered or used correctly.
We will describe the different sources of information available to confirm the drug history, and their limitations. Problem drugs will be identified, including those which are often omitted from the history. We will give practical advice on how to obtain a safe and effective drug history.
Finally, we will discuss the importance of reconciling and documenting information about a patient's medicines on admission to, transfer in, and discharge from hospital, as outlined in the NICE Medicines Reconciliation guidance.
Utilising the BNF(C)
The Principles of Prescribing
In this module, you will be provided with the basic knowledge required to utilise the British National Formulary (BNF) and British National Formulary for Children (BNFC) accurately and effectively when prescribing and/or administering medicines.
We will discuss how the BNF and BNFC are constructed, as well as how best to find and use the information contained within them.
Primary Care
For GP trainees, qualified GPs and other prescribing staff working in the primary care setting
Acute Coronary Syndrome and Cardiac Arrest
Prescribing in Medical Emergencies
In this module, we will focus on the drugs and therapeutic procedures to manage a presentation of Acute Coronary Syndrome (ACS), including a Cardiopulmonary Resuscitation (CPR) event.
As a minimum, it is expected that all general practitioners in the UK hold a valid CPR and Automated External Defibrillation (AED) qualification. This is normally achieved through completion of a Basic Life Support (BLS) course.
The module summarises guidance from the European Resuscitation Council 2015 and the Resuscitation Council UK, but will be pitched at the level of the Basic Life Support (BLS) provider, rather than that of an Advanced Life Saver certificate holder.
Adherence
The Principles of Prescribing
In this module we will explore medicines adherence and other related terminology. We will consider levels of and reasons for non-adherence.
We will also discuss methods to promote shared decision-making and interventions to increase adherence to, and persistence with, prescribed medication regimens.
Anaphylaxis
Prescribing in Medical Emergencies
In this module, we will discuss the stepwise management of anaphylaxis in the general practice setting. We will list the signs and symptoms of an anaphylactic reaction and describe how to assess severity. We will discuss the pharmacological management and any follow-up required for patients who required hospitalisation.
It is important you remain up-to-date with the most recent evidence-based guidance to manage an anaphylactic reaction in the community setting.
Antidepressant Deprescribing (Part 1): The Principles
Therapeutic Groups
Many patients take antidepressants for long period of time. For some patients, the harms may outweigh the benefits, and therefore they would benefit from stopping them.
Recent guidance on how to stop antidepressants from NICE aims to make stopping easier for patients and more likely to succeed. This process involves stopping antidepressants much more slowly than has been advised in the past and doing so in a specific pattern down to low doses before stopping. This module discusses the principles and theory which have led to these changes in guidance. The module content has been written so that it is focused towards prescribers working in primary care, however the principles discussed may be useful for prescribers working in other settings.
Please note there is no pre- or post-test for this module. The learning outcomes associated with this module will be assessed in the pre/post-test of the ‘Antidepressant Deprescribing (Part 2): The Practicalities’ module.
Antidepressant Deprescribing (Part 2): The Practicalities
Therapeutic Groups
In this module (part 2), we will outline when and how to safely stop antidepressants. We will provide some practical tips, examples, and tools for prescribers to help make stopping antidepressants easier for patients.
This module follows on from the ‘Antidepressant Deprescribing (Part 1)’ module, where we discussed the principles and theory behind safely stopping antidepressants. Both modules should be completed to support your overall learning in relation to stopping antidepressants.
The module content has been written so that it is focused towards prescribers working in primary care, however the principles discussed may be useful for prescribers working in other settings.
Please note the pre- or post-test for this module covers the content of this module and the ‘Antidepressant Deprescribing (Part 1): The Principles’ module.
Asthma and Croup
Prescribing in Medical Emergencies
In this module, we will discuss the pharmacological management of an acute exacerbation of asthma or croup in general practice, or during a home visit in the community. Acute management of asthma will be discussed for both adults and children while, for croup we will concentrate on management in children (i.e. the patient group most affected).
We will also describe any follow-up required for patients who experience one of these medical emergencies.
Dementia
Prescribing in Special Circumstances
In this module, we will discuss the different types of dementia, their diagnosis and management. This module is designed to emphasise the knowledge, skills, and attitudes needed to safely assess, manage and refer patients with dementia who present in the primary care setting.
Developmental Pharmacology in Paediatrics
Prescribing in Special Circumstances
In this module, we will explore the differences in drug handling across various paediatric age groups. We will also briefly discuss the identification and prediction of drug interactions and adverse drug reactions in the paediatric population.
Hypoglycaemia
Prescribing in Medical Emergencies
In this module, we will discuss the pharmacological management of hypoglycaemia in general practice, or during a home visit in the community.
We will revise the signs and symptoms of hypoglycaemia and discuss the associated risk factors. We will describe how pharmacological management of hypoglycaemia needs to be adjusted depending on severity.
Medicines Use In Competitive Sport
Therapeutic Groups
In this module, we will provide information to support you when prescribing or making recommendations for the management of asthma, hay fever and glucocorticoid medicines to any of your patients involved in, or who may become involved in competitive sports and are subject to the World Anti-Doping Code.
The topics illustrate key principles to consider and apply across other medical conditions when prescribing or providing advice for athletes.
Meningococcal Disease
Prescribing in Medical Emergencies
In this module, we will focus on the presentation and pre-hospital emergency management of a patient with suspected meningococcal disease.
The content of this module is based on the NICE Guidance: 'Meningitis (bacterial) and meningococcal septicaemia in under 16s'
Older People
Prescribing in Special Circumstances
In this module, we will revisit the principles of safe prescribing in older adults and where to access reputable, evidence-based information to guide your decision making.
We will discuss how age-dependent changes in composition and function of the body can alter the pharmacokinetics and pharmacodynamics of a drug. We will also describe how to optimise the use of medicines in this patient group through identification of problematic and appropriate polypharmacy.
Paediatric Dermatology
Therapeutic Groups
In this module, we will discuss prescribing for skin conditions.
We will look at a number of important areas in management, including topical therapy for skin disease, safe prescribing of topical corticosteroids and an overview of the use of systemic treatments.
We will consider special circumstances relevant to prescribing, including in adolescence and in those with suspected or proven multisystem disease.
Note that some therapeutics will be discussed that are only prescribed under the supervision of paediatric dermatologists or general practitioners with a special interest and experience in dermatology.
Practical Prescribing in Paediatrics
Prescribing in Special Circumstances
In this module, we will explore the practicalities of prescribing, supplying and administering medicines safely to children. We will discuss calculating paediatric drug doses based on age and body weight, and describe the principles of oral fluid management. We will also discuss the additional factors to consider in the paediatric population, such as the use of unlicensed and off-label preparations.
Pregnancy and Breastfeeding
Prescribing in Special Circumstances
In this module we will explore the use of drugs in patients who are both planning to start a family, are already pregnant and who are breastfeeding.
We will discuss the general principles of prescribing in pregnancy, the effects of drugs on the fetus and the effects of pregnancy on drug handling. We will also discuss the general principles of prescribing in breastfeeding mothers, including the effects of drugs on lactation and the possible effects that a drug may have on the breastfed infant.
We will introduce some key resources for determining whether a drug is safe to use during both pregnancy and breastfeeding.
Prescribing in Infection
The Principles of Prescribing
In this module, we will discuss the safe and appropriate prescribing of antibacterials in patients with known or suspected infections.
We will describe the different classes of antibacterial treatments available, when they should be prescribed based on empirical evidence, and why careful use of antibacterials is important for both patient and public health.
We will refer to Public Health England's Antimicrobial Prescribing and Stewardship Competencies and the Royal College of General Practitioners (RCGP) TARGET Antibiotic Toolkit throughout.
Prescribing in Renal and Hepatic Dysfunction
Prescribing in Special Circumstances
In this module, we will explore the use of drugs in patients with hepatic and renal dysfunction.
We will revisit the principles of safe prescribing for each patient group and where to access reputable, evidence-based information to guide your decision making.
Prescription Documentation and Shared Care
The Principles of Prescribing
In this module we will discuss the underpinning knowledge required to prescribe legally, safely and unambiguously. We will also summarise the concepts of the Non-Medical Prescribers (NMPs) and Shared Care Agreements (SCAs).
Rheumatology
Therapeutic Groups
In this module, we will briefly discuss the presentation of early rheumatoid arthritis in primary care. We will review the classification criteria, how disease activity is measured, and how this is used to guide therapy.
We will discuss the various 'non-biologic' and 'biologic' therapies prescribed in the management of rheumatoid arthritis, and how these are optimised to "treat to target" whilst minimising the risk of adverse effects. We will consider how treatment regimens are modified in women of child-bearing potential and for breastfeeding mothers.
Finally, we will we will describe common problem areas in rheumatology prescribing, considering both inpatient and outpatient settings.
Seizures
Prescribing in Medical Emergencies
In this module, we will discuss the pharmacological management of a seizure in the practice, or during a home visit in the community. We will also discuss the prescription of anti epileptic medicines, and the potential emergency situations that can arise from their use.
Sepsis in Primary Care
Prescribing in Medical Emergencies
In this module, we will discuss that sepsis may be easier to identify than previously recognised, and help you to actively assess patients for their risk of sepsis when presenting with infection.
This module describes the common indicators that may suggest a diagnosis of sepsis and the use of early warning score tools to guide escalation of care and aid diagnosis. We will discuss how the patient can be managed pre- and post-hospital admission. We will also discuss the need for a change in clinical behaviours and the importance of 'sepsis aware' practices and communities.
Utilising the BNF(C)
The Principles of Prescribing
In this module, you will be provided with the basic knowledge required to utilise the British National Formulary (BNF) and British National Formulary for Children (BNFC) accurately and effectively when prescribing and/or administering medicines.
We will discuss how the BNF and BNFC are constructed, as well as how best to find and use the information contained within them.
SCRIPT Safety
For healthcare professionals
Adverse Drug Reactions
High-Risk Part of the Medicines Use Process
This module will explore the identification and prediction of adverse drug reactions (ADRs) in patients. It will also consider the public health burden of adverse drug reactions, and pharmacovigilance systems in the UK. The module will highlight the importance of reporting ADRs.
Anticoagulation: DOACs and Parenteral Anticoagulants
High-Risk Drugs
In the ‘Anticoagulation: Vitamin K Antagonists’ module, we provided an overview of anticoagulation and discussed vitamin K antagonists (VKAs) such as warfarin, phenindione and acenocoumarol.
In this module, we will focus on Direct Oral Anticoagulants (DOACs) and parenteral anticoagulation.
We will consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements of DOACs.
Anticoagulation: Vitamin K Antagonists
High-Risk Drugs
In this module, we will provide an overview of anticoagulation therapy.
We will discuss Vitamin K Antagonists (VKAs) and consider the indications and contraindications to treatment, the recommended dosing regimens, adverse effects, and monitoring requirements.
The SCRIPT 'Anticoagulation: DOACs and Parenteral Anticoagulants' module supports the content within this module.
Dose Calculations for Nurses
High-Risk Part of the Medicines Use Process
In this module we will take you step-by-step through the process of performing various dose calculations and associated conversions. We will provide examples and then test your knowledge throughout using in-module activities. We will highlight some of the common pitfalls when calculating doses and explain how you can avoid them. Finally we will direct you to some resources for further reading and practice.
Dosing and Calculation
High-Risk Part of the Medicines Use Process
In this module we will develop the underpinning knowledge and numeracy skills required for you to perform dose calculations competently and accurately in clinical practice. It will expand on your existing knowledge of drug dosages and calculations needed to ensure safe practice.
Formulation: An Overview for Prescribers
High-Risk Part of the Medicines Use Process
In this module, we will discuss the availability of different drug formulations and the issues this may raise in your clinical practice.
We will provide a brief reminder of pharmacokinetics specifically focusing on absorption. We will describe how different formulations of a drug can have different pharmacokinetic properties and how this can affect dosing.
Finally, we will briefly discuss off-label and unlicensed medicines and the additional prescribing considerations you should think about when prescribing these.
High-Risk Injectable Medicines
High-Risk Drugs
In this module, we will discuss three commonly encountered high-risk medicines that are administered via the intravenous route.
We will discuss and focus on intravenous potassium chloride, gentamicin and vancomycin. We will describe why these medicines have the potential for harm and how to prescribe them safely. We will also discuss the monitoring requirements for these medicines.
The SCRIPT ‘Infection in Secondary Care’ module provides additional content to support your overall learning in relation to gentamicin and vancomycin.
High-Risk Oral Medicines
High-Risk Drugs
In this module, we will introduce the important aspects surrounding the prescribing, supply, administration, and monitoring of so called ‘high-risk medicines’ that are administered via the oral route.
We will discuss some of the oral medicines encountered in general medicine that pose a significant risk to patients. These medicines have the potential for harm due to the risks of toxicity, significant drug interactions and adverse effects. They require close clinical monitoring and care when prescribing.
Although we will focus on the oral route of administration, where applicable much of this theory can be applied to alternative routes of administration.
Medication Errors
High-Risk Part of the Medicines Use Process
This module describes the nature and frequency of medication errors and examines the theory underlying general human error.
It will introduce you to tips on reducing medication errors, and how you can identify and correct them. The session also describes how you, as healthcare professionals, should respond when you discover a medication error, and how it should be reported.
Finally, the role of electronic prescribing in preventing errors will be discussed.
Medication Interruptions
High-Risk Part of the Medicines Use Process
In this module, we will discuss the epidemiology of medication interruptions, both in the UK and internationally. The consequences of medication interruptions will be discussed, and the protective behaviours you can engage in to reduce medication interruptions.
To help consolidate your learning this eLearning module should be completed around 2 weeks after the zoom education session.
Medicines Management in Care Homes
Patients with the Highest Vulnerabilities
In this module, we will discuss the national guidelines and local policies and procedures that exist to ensure the safe and effective management of medicines in care homes. We will describe some of the problems encountered at the interface of care, such as the sharing of information and effective communication.
This module will be particularly relevant for nurses and staff working in the care home setting.
Medicines Policy for Nurses
High-Risk Part of the Medicines Use Process
In this module, we will discuss the national regulations and local policies and procedures that exist to ensure the safe and legal use of medicines within both the hospital and community setting.
Older People
Patients with the Highest Vulnerabilities
This module will help you understand the way in which older adult patients handle administered drugs (pharmacokinetics) and how they react to these drugs (pharmacodynamics) once they have been absorbed. This will help you to prescribe medicines safely in this patient group.
Paediatric Practical Prescribing
Patients with the Highest Vulnerabilities
In this module we will explore the practicalities of dosing medicines for different ages of children. We will discuss the basic principles of fluid management and how to reduce the risk of medication errors. We will also describe the additional factors to consider in the paediatric population, such as the use of unlicensed and ‘off-label’ preparations.
Towards the end of the module, we will use case-based examples to work through selected prescribing scenarios.
Pain: Neuropathic and Complex Analgesia
High-Risk Drugs
In this module, we will provide an overview of the management of neuropathic pain and the use of complex pain management techniques such as epidurals, patient-controlled analgesia, and local anaesthetics. We will also consider alternative, non-pharmacological, approaches to pain relief.
Pain: Non-Opioids and Opioids
High-Risk Drugs
In this module, we will provide an overview of the management of pain using non-opioid and opioid analgesics. We will consider the properties of the different medicines available and how they can be prescribed safely to minimise harm.
The SCRIPT ’Pain Management – Neuropathic and Complex Analgesia’ and 'Palliative and End-of-Life Care' modules provide content to support this module. You may find these useful in underpinning your knowledge and understanding of pain management.
Palliative and End-of-Life Care
High-Risk Drugs
In this module we will explore the prescribing issues in caring for patients with advanced disease and those that are dying.
We will discuss the management of pain in providing palliative care to patients so you can prescribe opioids safely and effectively. The management of nausea and vomiting, and those symptoms that commonly arise in the last days of a patient's life will also be discussed. We will also focus on the importance of shared decision-making with the patient and their family and within the multidisciplinary team.
Sepsis in Hospital
Patients with the Highest Vulnerabilities
In this module we will discuss the diagnosis and management of sepsis. We will list the common indicators that suggest a diagnosis of sepsis and the importance of source control in addition to appropriate antimicrobial prescribing. Finally, we will discuss the factors to consider when prescribing for patients with sepsis, and their ongoing management.
Sepsis in Primary Care
Patients with the Highest Vulnerabilities
In this module, we will discuss that sepsis may be easier to identify than previously recognised, and help you to actively assess patients for their risk of sepsis when presenting with infection.
This module describes the common indicators that may suggest a diagnosis of sepsis and the use of early warning score tools to guide escalation of care and aid diagnosis. We will discuss how the patient can be managed pre- and post-hospital admission. We will also discuss the need for a change in clinical behaviours and the importance of 'sepsis aware' practices and communities.
Taking a Safe & Effective Medication History
High-Risk Part of the Medicines Use Process
In this module we will discuss the importance of an accurate and complete drug history, and what can go wrong when this information is not gathered or used correctly.
We will describe the different sources of information available to confirm the drug history, and their limitations. Problem drugs will be identified, including those which are often omitted from the history. We will give practical advice on how to obtain a safe and effective drug history.
Finally, we will discuss the importance of reconciling and documenting information about a patient's medicines on admission to, transfer in, and discharge from hospital, as outlined in the NICE Medicines Reconciliation guidance.
Prescriber Ready
For healthcare professionals
Antibacterials
In this module, we will describe the basic pharmacology of the main classes of antibacterials.
The module will explain how antibacterials work to fight infection and how the body processes them. We will outline the adverse effects caused by antibacterials and how these might be managed or prevented.
We will also describe the monitoring requirements associated with antibacterials to ensure their appropriateness, effectiveness, and safety. Finally, we will discuss the counselling that should be provided to patients and/or their relatives/carers prior to and during use to ensure safe, appropriate management of antibacterials.
Antidepressants
In this module, we will describe the basic pharmacology of antidepressants.
The module will explain how antidepressants work (i.e., mechanism of action) and the pharmacokinetics and pharmacodynamics of commonly used antidepressants. We will outline the main contraindications, cautions, potential adverse effects, and drug interactions and how these might be managed or prevented.
We will also discuss the important of developing a person-centred care plan and monitoring the effectiveness of treatment. Finally, we will describe the counselling and education that should be provided to patients and their relatives/carers to help enable safe and effective use of antidepressants.
Throughout this module, we will refer to ‘patients’, as this is consistent with the terminology used by the Royal College of Psychiatrists. However, many guidelines refer to people with mental health problems as ‘service users’ or ‘clients’.
Antiseizures
In this module you will explore the pharmacological actions of antiseizure medications (ASMs). There will be an overview of various medications utilised within this field, and the multiple modes of action by which ASMs provide therapeutic benefit.
You will consider a holistic approach to ASMs covering their pharmacology, how to initiate and monitor treatment, their interactions and adverse effects, drug monitoring and finally, patient/carer education.
Basics of Pharmacology
In this module, we will discuss the general principles of the effects that a medicine can have on the body (known as pharmacodynamics). We will also describe what the body does to medicines (known as pharmacokinetics) from when it is administered until it leaves the body, and the factors that can influence this.
We will explore these concepts in the context of your clinical practice.
This module is a pre-requisite to the other modules in the Prescriber Ready portfolio. Therefore, it is advised that you complete this module before completing other modules in the portfolio.
Diuretics
In this module, we will describe the basic pharmacology of diuretics that are commonly used in practice.
The module will explain how each of the three commonly used groups of diuretics exert their action to cause diuresis, and how the body processes them. We will outline the adverse effects that can be caused by diuretic therapy and how these can be managed or prevented.
We will also outline the interactions and contraindications to diuretic therapy, and describe their monitoring requirements to ensure their appropriateness, effectiveness, and safety.
Finally, we will discuss the counselling that should be provided to patients and/or carers to ensure the safe and appropriate use of diuretic medicines.
Opioids
In this module, we will explore the pharmacodynamics and pharmacokinetics of opioid medicines. In other words, how they work to control pain and how the body processes them. We will also outline the adverse effects caused by opioid medications and how these can be managed or prevented. This module also provides information which should be discussed with patients prior to and during opioid use to ensure safe, appropriate, and effective pain management.