We recommend the establishment of an efficient local prescribing policy through an effective practice-based Pharmacy and Therapeutic Committee, training in prescribing to be introduced

in medical schools and the lending of support to continuous education AZD5363 manufacturer programmes targeting prescribing skills. “
“Objective  Large numbers of drugs are prescribed antenatally, many of which are off-label or unlicensed. An off-label medication is one which does have a market authorisation, but for a different indication, dose, route or patient group than that for which it is prescribed. The purpose of this study was to determine how commonly these prescriptions are written at Liverpool Women’s ABT 888 Hospital (LWH), a unit with 8000 deliveries per annum. Methods  All inpatient prescriptions received from antenatal areas at LWH during a 3-month period were analysed. The drugs were divided into categories according to their licence, FDA class

and degree of clinical risk. Key findings  Some 17 694 prescriptions of 235 different drugs were prescribed during this period. Thirty-seven (16%) drugs and 4445 (25%) medications prescribed were licensed for use in pregnancy; 57 (24%) drugs and 3363 (19%) of the total prescriptions were off-label but considered safe by the manufacturers (e.g. erythromycin, prochlorperazine and clotrimazole); 138 (58%) drugs and 9722 (55%) prescriptions were cautioned or contraindicated by the manufacturer in pregnancy (e.g. cefalexin, magnesium sulphate and nifedipine). After further investigation into the safety of the off-label medications from the FDA safety profile and with the opinion of a multidisciplinary team, we were able to draw up a list of high-risk off-label medicines. This consisted of 38 drugs (16% of total) and 1735 (10%) of the total prescriptions (e.g. lisinopril, diazepam and morphine). Conclusions  A significant number of prescriptions

being used in an off-label manner at Clomifene LWH are high risk. Prescribers need to be aware of the risks associated with these drugs and the possible legal consequences of prescribing and administering them. “
“Objective  Thrombolysis decreases the chance of post-stroke dependence, although its use carries significant risk, notably of intra-cerebral haemorrhage. Patients (and families) face an important risk/benefit decision before consenting. We drafted a patient information booklet for this purpose, and applied performance-based readability testing with the aim that the most important information in the booklet could be found and understood. Methods  The booklet was developed with reference to best practice in information writing and design. We User-Tested its performance on 56 people without prior experience of stroke. After reading the booklet they were asked to find and explain 15 pieces of information.