Principles of effective prescription writing for pharmacist prescribers

Outlining the core elements of safe prescription writing and common pitfalls to avoid.
Man at desk looks at computer screen while holding mouse. On screen is NHS prescription service

Charlotte Gurr

By the end of this article, you should be able to:

  • Recognise the importance of prescription writing as an activity within primary care;
  • Recognise the components of a legally valid prescription; 
  • Understand your professional responsibilities as a registered pharmacist relating to prescription writing; 
  • Identify common barriers to effective prescription writing and evaluate strategies to enhance patient safety and patient-centred care.


RPS competency framework for all prescribers

This article is aimed to support the development of knowledge and skills related to the following areas from the ‘RPS competency framework for prescribers’:

  • Domain 2.3: Assesses the risks and benefits to the patient of taking or not taking a medicine or treatment;
  • Domain 3.1: Actively involves and works with the patient/carer to make informed choices and agree a plan that respects the patient’s/carer’s preferences;
  • Domain 4.9: Electronically generates and/or writes legible, unambiguous and complete prescriptions which meet legal requirements;
  • Domain 8.2: Accepts personal responsibility and accountability for prescribing and clinical decisions, and understands the legal and ethical implications;
  • Domain 8.3: Knows and works within legal and regulatory frameworks affecting prescribing practice.

Introduction  

A prescription is a core component of patient care and central to the safe use of medicines. All pharmacists will recognise the importance of a well-written prescription and its role in ensuring patient safety and legal compliance. For pharmacists, the transition from primarily checking prescriptions written by others to now increasingly writing prescriptions themselves represents a significant shift in professional responsibility. Prescriptions must not only comply with the law, but also be clinically appropriate, clearly written, ethically sound and supported by good documentation.

This article outlines the legal and regulatory frameworks governing prescribing in the UK, the core elements of a well-written prescription and common pitfalls to avoid when writing a prescription. It also explores the ethical and professional responsibilities of pharmacist prescribers, with practical strategies to support safe, effective and accountable prescribing in practice. 

It is recommended that you read this article in conjunction with these resources from The Pharmaceutical Journal:

Prescribing in the UK is governed by a comprehensive legal and regulatory framework designed to protect patient safety and ensure professional accountability. Prescribers must understand the main legislative instruments that underpin their practice and act in accordance with the law, as well as meet the standards set by their professional regulator.  

The Human Medicines Regulations 2012 is the primary piece of legislation that defines who can prescribe and under what conditions​1​. Under these regulations, pharmacists may prescribe as either independent or supplementary prescribers. Independent prescribers work autonomously, undertaking assessments, making diagnoses, and prescribing any medicine for any condition, except diamorphine, dipipanone or cocaine, when used for the treatment of addiction​1​. Supplementary prescribers, in contrast, prescribe in partnership with a doctor or dentist and the patient, working within an agreed clinical management plan that specifies the medicines that may be supplied for that individual​1​. 

Beyond defining who can prescribe, the regulations also specify the exact details that must be included on each prescription to ensure its legal validity. These include details of both the prescriber and the patient, the appropriate date and the prescriber’s signature​1​. Prescriptions are usually valid for six months from the relevant date, although those for Schedule 2, 3 and 4 controlled drugs must be first dispensed within 28 days (see Box 1)​1​. For private prescriptions, the appropriate date must always be the date on which the prescription was issued​1​. While most prescriptions are generated electronically, they remain legally valid only if they are signed in indelible ink or transmitted through an approved electronic prescribing system​1​. 

Box 1: Controlled drug classification in the UK

In the UK, controlled drugs are categorised into five schedules that reflect the medicine’s therapeutic usefulness, risk of misuse and the level of regulatory control applied:

  • Schedule 1 controlled drugs (e.g. LSD, raw opium): Little to no therapeutic value, high potential for abuse and dependence, high levels of restriction, with possession and supply prohibited except under Home Office licence;
  • Schedule 2 controlled drugs (e.g. morphine, oxycodone): These have therapeutic value but also a high potential for misuse and dependence. They are subject to the strictest requirements;
  • Schedule 3 controlled drugs (e.g. buprenorphine, tramadol): These have therapeutic uses but a lower potential for misuse than Schedule 2 drugs. They are subject to special prescription requirements but generally fewer other restrictions;
  • Schedule 4 controlled drugs (e.g. benzodiazepines, z-drugs): Subject to minimal control, primarily to regulate import and export;
  • Schedule 5 controlled drugs (e.g. codeine): Lower strength preparations containing controlled drugs with a lower potential for misuse and therefore are exempt from full control.

Additional legislation applies when prescribing controlled drugs. The Misuse of Drugs Act 1971 introduced the concept of “controlled drugs” and prohibited their possession or supply except in circumstances authorised by law​2​, while the Misuse of Drugs Regulations 2001 set out the conditions under which these substances may be prescribed and administered​3​. Pharmacist prescribers’ authority in this area depends on their qualification, with independent prescribers able to prescribe most Schedule 2–5 medicines, with the exceptions already noted. In contrast, supplementary prescribers may only prescribe controlled drugs if they are explicitly included within a patient’s clinical management plan​1​. 

Alongside statutory requirements, pharmacist prescribers must also meet the standards of the General Pharmaceutical Council (GPhC), whose ‘Standards for pharmacy professionals’ outline the principles of safe, effective and ethical care​4​, while the accompanying ‘In practice: guidance for pharmacist prescribers’ provides detailed expectations around competence, clinical reasoning, consent and accountability​5​. These frameworks emphasise that safe prescribing extends beyond legal validity, requiring professional judgement, reflective practice and a patient-centred approach​4,5​.

Core components of a well-written prescription  

Despite minimum legal requirements for a valid prescription, a well-written prescription goes beyond basic compliance. In essence, a prescription serves as a communication tool, not only between the prescriber and the patient, but also across the broader healthcare team (see Box 2).   

Patient identification  

First and foremost, the prescription must be generated for the appropriate patient and contain sufficient identifying details, such as full name, date of birth and NHS or hospital number. Only prescriptions for individuals aged under 12 years are legally required to state the age, owing to the different dosage requirements for children​1​. However, it is good practice to provide this information for all prescriptions. The provision of the age on a prescription improves safety, accuracy, accountability and communication, all essential components of safe and effective pharmaceutical care. 

Clear directions

Clarity is a fundamental aspect of a well-written prescription. Directions should be explicit, complete and unambiguous to ensure safe and effective treatment. In the UK, while full written directions are legally required only for controlled drug prescriptions, vague phrases such as “as directed” or “when required” should be avoided​3,5​. Prescriptions are often issued at the end of busy consultations, when patients may be overwhelmed by information and unable to recall precise verbal instructions​6​. As a result, patients frequently rely on pharmacists at the point of dispensing to provide advice and instruction on the use of their medicines; however, without complete directions, pharmacists cannot offer adequate counselling. Lack of clarity also affects inpatient care and medicine reconciliation, with around half of hospital medication errors linked to the incomplete or incorrect transfer of information between care settings​7​. 

Legibility  

While handwritten prescribing is increasingly uncommon, legibility remains critical when it is used​8​. Poor handwriting has led to serious medication errors, with devastating consequences.

For example, in one well-known case, a prescription for Amoxil (amoxicillin) to treat a chest infection was misread as Daonil (glibenclamide), resulting in the patient developing a hypoglycaemic coma and sustaining permanent brain injury​9​. Both the prescriber and the pharmacists were subsequently found negligent​9​.

Errors of this nature are preventable and underscore the importance of clear, unambiguous prescribing. Prescribers must be conscious that they have a duty of care not only to their patients but also to other healthcare professionals who rely on the accuracy of their written instructions.   

Clinical appropriateness  

A prescription should reflect an informed clinical decision, ensuring that the selected medication is appropriate for the diagnosis, the severity of the condition and the individual patient context​5​. Evidence-based prescribing is supported by guidelines developed by the National Institute for Health and Care Excellence (NICE), which act as a foundation for good prescribing practice.

However, even when following evidence-based recommendations, prescribers are often left with multiple suitable options. In these situations, local formularies, developed by NHS trusts or health boards, can help streamline decision-making; for example, by prioritising a specific calcium channel blocker based on cost-effectiveness or availability.   

While guidelines and formularies are valuable tools for managing disease, a well-written prescription must be appropriately tailored to the individual patient​10​. This means taking into account not only the clinical indication but also the patient’s age, comorbidities, potential drug interactions, allergies, intolerances and personal beliefs or preferences.  

Box 2: Top tips for prescription writing

  • Include all the legally required elements in your prescription;
  • Write legibly if handwriting your prescription or use electronic prescribing where and when available;
  • Always confirm your patient’s allergy status and check for any past intolerances to medications;
  • Always check for interactions;
  • Make effective use of local formularies and clinical decision support tools;
  • Avoid unsafe and unnecessary abbreviations;
  • Prescribe within your competence;
  • Stop and check before signing; 
  • Document clearly your rationale for prescribing, the patient advice provided and the monitoring plan for your patient if applicable.

Electronic prescribing considerations  

Before the introduction of the Electronic Communications Act 2000​11​, all prescriptions in the UK were required to be printed or handwritten and physically signed, because electronic signatures were not legally valid. This legislation established the legal basis for using electronic signatures and facilitated the development of systems such as the electronic prescription service (EPS) in England. Since then, electronic prescribing has been adopted to varying extents across the UK. In some settings, prescriptions are generated electronically but are still printed and signed manually. In contrast, fully electronic systems allow for prescriptions to be created, signed digitally and transmitted directly to the dispensing pharmacy.  

Benefits of electronic prescribing

Electronic prescribing was introduced with the intention of improving patient safety. A clear advantage of electronic prescribing is the removal of risk associated with illegible handwriting, which reduces the likelihood of medications being dispensed and/or administered incorrectly and, ultimately, patient harm​12​. It is estimated that electronic prescribing systems can reduce the risk of medication errors by 50%​13​. Further advantages include a clear audit trail within patient electronic notes and the time savings that unambiguous prescriptions provide to pharmacy teams, such as reduced need for clarification from a prescriber regarding their prescribing intentions​14​. 

Challenges and considerations

Like all electronic systems, the prescriptions produced by an electronic prescribing system are only as good as the prescriber inputting the information, demonstrating the need for a sound understanding of the foundational principles of safe prescribing. 

Alert fatigue is a recognised barrier within the literature for e-prescribing systems. When clinicians are presented with multiple alerts and warnings about prescribing choices, they become desensitised to their significance, conversely increasing the risk to the patient from a drug interaction or a missed allergy alert, for example​15​. Clinicians can mistakenly believe that because the computer says it is right, it must be right​16​. This highlights the importance of designing alerts appropriately, prioritising clinically significant warnings and providing ongoing training to ensure prescribers remain engaged with safety features rather than dismissing them​17​.

A further disadvantage of these systems is the perceived deskilling of clinicians in their ability to handwrite prescriptions, as evidenced when the clinical system fails and goes offline for an extended period​18​. Clinicians can become accustomed to the automated population of doses and directions and lose the skills necessary to prescribe effectively. 

Effective prescribing in practice  

Effective prescribing goes beyond generating a legal and clearly written prescription. The GPhC guidance outlines three areas that pharmacist prescribers must consider, ensuring that prescribing is safe, appropriate and effective​5​: 

1. Access to the correct information

Prescribers must ensure they have all the necessary information to prescribe safely and effectively. The type and extent of information available may depend upon the practice setting and location within the UK. For instance, prescribers in England may use the summary care record, whereas they would use the emergency care summary in Scotland or the Welsh GP record in Wales. 

Additional sources, such as recent discharge letters or clinic notes, should be reviewed where available. Most importantly, this should be supplemented by a direct conversation with the patient to identify any missing information, including allergies, adherence or any recent changes in the management of their condition.  

2. Prescribing safely

Safe prescribing requires working within the prescriber’s scope of practice and level of competence as a prescriber. Where the clinical situation falls outside this scope, referral to a more appropriate healthcare professional is warranted. As previously discussed, evidence-based guidelines and clinical frameworks can help inform the decision-making process.  

Clear, accurate documentation is essential to support continuity of care. Records should include both the decision to prescribe and the rationale for not prescribing, when relevant.  

3. Follow-up and monitoring

The act of prescribing does not end with the signing of the prescription but is part of a wider clinical process that includes safety-netting, follow-up and ongoing monitoring. It is the prescriber’s responsibility to ensure that arrangements are in place to assess the effectiveness of treatment and identify any potential adverse effects. This may include planned medication reviews, blood tests or referral to another member of the multidisciplinary team. 

These practical steps are not only good practice but also form part of the prescriber’s wider professional accountability. Every prescribing decision carries legal, ethical and professional responsibilities.

Ethical considerations in prescribing

Safe and effective prescribing is not only a matter of clinical skill and legal compliance; it is also underpinned by sound ethical decision-making. Pharmacist prescribers must integrate ethical principles into every prescribing decision​4​. The most effective way to uphold ethical practice is by consistently applying established ethical principles throughout the prescribing process.

The four widely recognised pillars of medical ethics provide a practical framework for guiding decisions in practice (see Figure 1​19​).

Figure 1: The four principles of medical ethics in prescribing

By actively applying these principles, pharmacist prescribers can ensure their practice not only meets clinical and legal standards but also supports professional integrity. Ethical practice ensures that clinical choices are made fairly, safely and in the patient’s best interests. This forms the foundation for the legal, professional and organisational frameworks that hold prescribers accountable in practice. 

Professional accountability 

Professional accountability requires healthcare professionals to adhere to a duty of candour based on openness and transparency​20​. While these principles apply to all pharmacists, the additional responsibility of prescribing introduces a heightened level of accountability that must be recognised and upheld. In this context, accountability refers to a practitioner’s professional and legal responsibility for their decisions and actions​20​. Pharmacist prescribers may be held to account for their prescribing decisions and actions through the following avenues (see Figure 2​21​).

Figure 2: Types of accountabilities in prescribing practice

The most effective way to ensure accountability is through accurate documentation and regular reflective practice. The clinical record should clearly capture the rationale for the chosen treatment, any alternatives considered and there should be demonstrable evidence that the patient was actively involved in the decision-making process. Comprehensive records provide a clear demonstration that decisions were made responsibly and transparently, supporting patient safety, professional standards and the prescriber’s professional integrity​4​. Regular reflective practice enables prescribers to review and learn from their decisions, prevent repeated errors and maintain high standards of practice, reinforcing accountability in everyday clinical work​20​.

Barriers to effective prescription writing and strategies to overcome these

There are well-recognised barriers to effective prescribing (see Table). Knowing their impact is one of the main drivers in improving the overall quality of the prescriptions received by patients. Ultimately, this contributes to improved patient safety and clinician satisfaction. See Box 3 for most common mistakes in prescription writing and how to avoid them.  

Box 3: Top five prescription writing mistakes and how to avoid them 

  • Omission of important information

Always ensure that the prescriptions you write include all the essential details, such as drug strength, dose, frequency and quantity. Failure to do this may result in your prescription being rejected for dispensing by the pharmacy team responsible for supplying the medication to your patient. Alternatively, your patient may inadvertently receive the wrong dose or the incorrect frequency of administration. 

This can be avoided through the use of structured electronic prescribing systems where possible. Stop and check before signing to ensure all elements are present, including the drug name, strength, form, dose, route, frequency, quantity and duration of therapy, as necessary. Always include units such as milligrams and millilitres, for example. 

  • The use of ambiguous or unsafe abbreviations

The use of abbreviations, such as ‘OD’, ‘IU’ or ‘U’, is well-documented in the literature as a contributing factor to errors associated with the prescribing of medications. The use of certain abbreviations is dangerous as they can be misread and misinterpreted by pharmacists or patients. OD can be misread as ‘right eye’ instead of ‘once daily’, and IU can be mistaken for ’10’ or ‘IV’, particularly when handwritten. This can be avoided by writing full and clear instructions, such as ‘once daily’ instead of ‘OD’, which are easily understood by all involved in the prescribing and dispensing process. 

  • Prescribing the wrong drug or dose

While the use of electronic prescribing systems has many advantages from a safety perspective, prescribers must be aware of the potential to inadvertently select the wrong formulation or dosage. Be alert also for look-alike, sound-alike drugs such as amlodipine and amitriptyline. Issues in this context can pose serious harm to patients, especially with high-risk medications such as insulin, opioids and anticoagulants. The stop and check approach, which involves reviewing your prescription before signing, is essential to ensure the appropriateness of your prescription for your patient.

  • Incomplete or incorrect controlled drug prescriptions

The legislation around the writing of a controlled drug prescription is clear. Omissions such as not including the total quantity in words and figures or unclear dosage instructions, such as “use as directed”, result not only in prescriptions having to be rejected by pharmacy teams as they are legally invalid, but importantly, they also cause harm to patients through delays leading to unmanaged pain or withdrawal symptoms. To avoid this common pitfall, ensure adherence to and familiarity with the legal frameworks around the writing of controlled drug prescriptions. 

  • Prescribing without checking allergies or interactions

Failing to check a patient’s documented allergy status or reviewing for drug–drug interactions may lead to serious consequences for your patient. Making effective use of your opportunity to confirm a patient’s medical history, reviewing patient notes and using the available clinical decision support systems.

Case in practice — Clarifying prescription instructions

Mrs Patel, a 74-year-old with type 2 diabetes mellitus and hypertension, receives a prescription for metformin (500mg tablets to be taken one twice a day) and lisinopril (10mg tablets “as directed”).

When the prescription arrives at the pharmacy, the community pharmacist notices that the instructions for lisinopril are unclear.

Reflective questions: 

  • What are the potential risks associated with unclear or ambiguous prescription instructions in this scenario?
  • How could the prescriber and the dispensing pharmacist work together to ensure safe, person-centred care for Mrs Patel?

Case in practice: answers

Risks in Mrs Patel’s case:

  • Incorrect dosing or timing of lisinopril, potentially leading to hypotension, renal complications or uncontrolled hypertension;
  • Patient confusion, poor adherence;
  • Legal and professional accountability issues for the prescriber, if harm occurs.

Possible collaborative approaches:

  • Prescriber clarifies instructions with precise dosage, frequency and timing;
  • Dispensing pharmacist provides patient counselling and double-checks patient understanding;
  • Collaborative communication helps ensure patient safety and person-centred care.

Conclusion

Safe and effective prescription writing is a fundamental responsibility for pharmacist prescribers, combining legal compliance, clinical judgement, ethical decision-making and professional accountability. This article has explored the frameworks, principles and practical strategies that underpin good prescribing practice. 

Prescriptions must be clear, complete, tailored to the individual patient and supported by accurate documentation. Ethical considerations ensure that decisions are patient-centred, fair and minimise harm, while professional accountability frameworks safeguard both the prescriber and the patient. Awareness of common barriers and practical strategies — such as the use of electronic prescribing systems and careful allergy and interaction checks — further enhances the safety and effectiveness of prescribing. 

Safe prescription writing is an ongoing process that requires reflection and continuous learning. Integrating the principles discussed in this article into daily practice can support pharmacist prescribers in meeting their legal and professional obligations, while also contributing to optimal patient outcomes. 


Knowledge check


Expanding your scope of practice

The following resources expand on the information contained in this article:

  1. 1.
    The Human Medicines Regulations 2012, SI 2012/1916. The Stationery Office. 2012. Accessed February 2026. https://www.legislation.gov.uk/uksi/2012/1916/contents/made
  2. 2.
    Misuse of Drugs Act 1971, Chapter 38. The Stationery Office. 1971. Accessed February 2026. https://www.legislation.gov.uk/ukpga/1971/38/contents
  3. 3.
    Misuse of Drugs Regulations 2001, SI 2001/3998. The Stationery Office. 2001. Accessed February 2026. https://www.legislation.gov.uk/uksi/2001/3998/contents
  4. 4.
    Standards for Pharmacy Professionals. General Pharmaceutical Council. 2017. Accessed February 2026. https://www.pharmacyregulation.org/pharmacists/standards-and-guidance-pharmacy-professionals/standards-pharmacy-professionals
  5. 5.
    In Practice: Guidance for Pharmacist Prescribers. General Pharmaceutical Council. 2019. Accessed February 2026. https://assets.pharmacyregulation.org/files/2024-01/in-practice-guidance-for-pharmacist-prescribers-february-2020.pdf
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    Tarn D, Flocke S. New prescriptions: how well do patients remember important information? Fam Med. 2011;43(4):254-259. https://www.ncbi.nlm.nih.gov/pubmed/21499998
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    Rozich J, Resar R. Medication safety: one organisation’s approach to the challenge. J Clin Outcomes Manage. 2001;(8):24-34.
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    Ariaga A, Balzan D, Falzon S, Sultana J. A scoping review of legibility of hand-written prescriptions and drug-orders: the writing on the wall. Expert Review of Clinical Pharmacology. 2023;16(7):617-621. doi:10.1080/17512433.2023.2223972
  9. 9.
    Mullan K. Importance of legible prescriptions. J R Coll Gen Pract. 1989;39(325):347-348. https://www.ncbi.nlm.nih.gov/pubmed/2556570
  10. 10.
    Scott IA, Hilmer SN, Le Couteur DG. Going Beyond the Guidelines in Individualising the Use of Antihypertensive Drugs in Older Patients. Drugs Aging. 2019;36(8):675-685. doi:10.1007/s40266-019-00683-8
  11. 11.
    Electronic Communications Act 2000. Chapter 7. The Stationery Office. 2000. Accessed February 2026. https://www.legislation.gov.uk/ukpga/2000/7/contents
  12. 12.
    Albarrak AI, Al Rashidi EA, Fatani RK, Al Ageel SI, Mohammed R. Assessment of legibility and completeness of handwritten and electronic prescriptions. Saudi Pharmaceutical Journal. 2014;22(6):522-527. doi:10.1016/j.jsps.2014.02.013
  13. 13.
    Bates DW. Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors. JAMA. 1998;280(15):1311. doi:10.1001/jama.280.15.1311
  14. 14.
    Wietholter J, Sitterson S, Allison S. Effects of computerized prescriber order entry on pharmacy order-processing time. American Journal of Health-System Pharmacy. 2009;66(15):1394-1398. doi:10.2146/ajhp080303
  15. 15.
    Carroll AE. Averting Alert Fatigue to Prevent Adverse Drug Reactions. JAMA. 2019;322(7):601. doi:10.1001/jama.2019.11710
  16. 16.
    Caldwell NA, Power B. The pros and cons of electronic prescribing for children. Arch Dis Child. 2011;97(2):124-128. doi:10.1136/adc.2010.204446
  17. 17.
    Gani I, Litchfield I, Shukla D, Delanerolle G, Cockburn N, Pathmanathan A. Understanding “Alert Fatigue” in Primary Care: Qualitative Systematic Review of General Practitioners Attitudes and Experiences of Clinical Alerts, Prompts, and Reminders. J Med Internet Res. 2025;27:e62763. doi:10.2196/62763
  18. 18.
    Hill B, Mitchell A, eds. Independent and Supplementary Prescribing At a Glance. Wiley-Blackwell; 2022. Accessed February 2026. https://www.wiley.com/en-ae/Independent+and+Supplementary+Prescribing+At+a+Glance-p-9781119837916
  19. 19.
    Teays W. Beauchamp and Childress: Principles of Biomedical Ethics. Library of Public Policy and Public Administration. Published online 2025:115-127. doi:10.1007/978-3-031-96566-1_10
  20. 20.
    Nuttal D, Rutt-Howard J, eds. The Textbook of Non-Medical Prescribing. 2nd ed. Wiley-Blackwell; 2015. Accessed February 2026. https://www.wiley.com/en-us/The+Textbook+of+Non-Medical+Prescribing%2C+2nd+Edition-p-9781118861868
  21. 21.
    Armstrong A. Accountability and prescribing. Journal of Prescribing Practice. 2019;1(8):406-410. doi:10.12968/jprp.2019.1.8.406
Last updated
Citation
The Pharmaceutical Journal, PJ January 2026, Vol 316, No 8005;316(8005)::DOI:10.1211/PJ.2026.1.392996

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