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, potential drug-drug interactions, 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 prescribed/recommended by non-dental health care professionals, 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 that considers the patient's specific and measurable goal(s)	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.

Local Anesthesia Laboratory Prescription