Category: EPA-4

EPA 4A.2: Generate Medication Prescription

SCOPE OF WORK: This activity includes writing a prescription that considers at a minimum rationale, medical history, drug selection, dosage, expected outcomes, and side effects.

Domains of Competence
  • Critical Thinking and Decision Making
  • Team Based Care
  • Biomedical Science Application
Knowledge
  • Names and key features of drugs commonly prescribed/recommended by the general dentist and frequently reported in patient medication history.
  • Key features of drugs including mechanism of action, pharmacological/ physiological effects, indication/adverse effects/drug-drug interactions/ contraindications
  • Potential effects of dentist-prescribed and frequently reported medications on dental treatment plans
  • Evidence-based guideline-directed therapy, including indications/ contraindications for opioid and antibiotic use
  • Components of an accurate and legal prescription
  • Dose calculations, including pediatric liquid doses
  • Dose and frequency modifications in patient with varying disease conditions including, but not limited to, chronic kidney and end-stage renal disease, obesity, and geriatric conditions
  • DEA Substance Schedules Prescription Monitoring Program (PDMP)
  • Effective communication with pharmacy
Skills
  • Writes accurate and legal prescriptions with all components
  • Provides appropriate prescription rationale to preceptor
  • Provides instructions for proper use, expected outcomes, and potential medication side effects/interactions of prescribed medications
  • Invites questions and addresses patient’s concerns
  • Properly document prescription in patient record (Epic Wisdom)
Generate Medication Prescription
Meets Expectations of the Graduate
Progressing
Below Expectations
Critical Error
MEDICAL AND MEDICATION HISTORY Accurately explains all of patient’s medical and medication history components1, including medication allergies, history of substance use disorder, and how they affect patient’s oral health and treatment plan Lists all medical and medication history; accurately explains most of the medication history components; may have difficulty explaining how they affect patient’s oral health and treatment plan List of medical and medication history may be incomplete; may not include medication allergies; may have difficulty explaining many of the medication history components; or struggles to relate to patient’s oral health and treatment plan Fails to identify that a medication is potentially contraindicated (including due to medication allergy), given the patient’s medical and medication history
MEDICATION AND DOSAGE Chooses and justifies appropriate medication, dosages, and duration; for antimicrobials, applies knowledge of guideline-directed therapy; applies knowledge of the Drug Enforcement Administration (DEA) Substance Schedules, Prescription Monitoring Program (PDMP) and the opioid recommendations for common surgical procedures4 Chooses appropriate medication and dosage but has difficulty providing full justification and/or lacking evaluation of evidence-based guideline for appropriateness Suggests potential medication(s) with unsubstantiated justifications Chooses inappropriate medication, dosage, and/or duration that may endanger the patient’s health; prescribes an opioid without justification; not exploring history of drug abuse, or fails to use PDMP; indicates incomplete and/ or inaccurate assessment of medication allergies
PRESCRIPTION WRITING Writes accurate/legal prescription with all components2 Prescription contains one error, either omitting a component or having inaccurate information, that does not result in patient harm Prescription contains more than one error, either in omitting components or having inaccurate information, that does not result in patient harm Written prescription may endanger the patient’s health
PATIENT INFORMATION Provides appropriate prescription rationale, instructions for proper use, expected treatment outcomes, and potential medication side effects. Invites questions and addresses patient’s concerns Provides appropriate prescription rationale and instructions, but may fail to discuss treatment outcomes, potential medication side effects, or solicit patient’s questions or fails to address them Insufficient discussion with patients regarding prescription rationale and instructions, treatment outcomes and potential side effects. Did not elicit patient questions/ concerns. Provides prescription with insufficient instructions and possible side effects that can threaten patient’s health outcomes

1 Components include presence and reactions to any drug allergies and medication history, including drug class, use (indication) mechanism of action, pharmacological (physiological) effects, dose, and frequency.
2 Prescription components: drug name/strength/dosing instructions (e.g., number of pills/capsules or volume; route of administration; and frequency/total amount to dispense.
3 Antimicrobial guidelines for treatment and prophylaxis resources:

  1. ADA Antibiotic Stewardship Resources: https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/antibiotic-stewardship (opens in a new tab)
  2. ADA Antibiotic Prophylaxis Prior to Dental Procedures: https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/antibiotic-prophylaxis (opens in a new tab)
  3. AHA Antibiotic Prophylaxis for Infective Endocarditis: https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000969 (opens in a new tab)
  4. Antimicrobial Prescribing in Dentistry – Good Practice Guidelines: /epas/files/Antimicrobial-Prescribing-in-Dentistry-2020-online-version.pdf (opens in a new tab)
4 Six Key Recommendations made by a multidisciplinary panel to establish opioid guidelines for dental surgical procedures:
  1. If patients express desire to avoid opiods, alternative pain medications should be offered when clinically appropriate.
  2. Avoid prescribing opiods post-surgery if pain can be comfortably managed with NSAID/APAP.
  3. Non-pharmacological measures advised — cold and heat therapy, distraction therapy.
  4. Maximize non-narcotic pain medication (NSAIDs/APAP) with scheduled doses before opioids are considered unless contraindicated.
  5. Shared decision-making process with clinicians and patients. Fully informed of risks/benefits including addiction risk.
  6. Consideration of medical contraindications, risks for addiction and aversion to such risks: Farooqi OA, Bruhn WE, Lechelop MK, et al. Opioid guidelines for common dental surgical procedures: a multidisciplinary panel consensus. Int J Oral Maxillofac Surg. 2020;49(3):397-402. doi:10.1016/j.ijom.2019.09.001

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