Creating a new prescription

What is a dose sentence?

Dose sentences are pre-configured prescriptions with varying degrees of flexibility. The dose sentence might have:

Pre-populated values
Questions that present you with a small number of options

Adding a prescription by searching

From your patient list, select a patient.
Select Chart > +.
Enter medication in the search box.
Select required medication.
Answer dose sentence questions.

Read about prescribing with a dose sentence

Adding a prescription by scanning

From your patient list, select a patient.
Select Chart > +.
Select Scan then scan the medication barcode.

Select Toggle Torch to switch the camera torch on and off.
Select required medication.
Answer dose sentence questions.

Read about prescribing with a dose sentence

Adding a prescription from a group

From your patient list, select a patient.
Select Chart > +.
Select GROUPS from the list or enter a group name in the search box.
Select required medication.
Answer dose sentence questions.

Read about prescribing with a dose sentence

Adding a prescription from previous prescriptions

From your patient list, select a patient.
Select Chart > +.
Select from the list of previous prescriptions.
Select required medication.
Answer dose sentence questions.

Read about prescribing with a dose sentence

Prescribing with a dose sentence

You can prescribe medications and fluids with a dose sentence. Dose sentences available depend on your organisation.

Some dose sentences include questions and fields where you can enter additional information.

From your patient list, select a patient.
Select Chart > +.
Add the medication or fluid by typing, scanning, adding from groups or adding from previous prescriptions.

Read more about adding a prescription
Select options to specify the method and frequency.
Answer dose sentence questions.
- Dose sentence questions depend on your organisation. Mandatory fields are marked . You cannot prescribe until all mandatory fields are completed.
- Some fields might be automatically populated. Select a field to edit the information.
- You might see results from investigations at this stage. Results are included to provide clinical decision support.
- To prescribe fluids sequentially, for each fluid except the first in the sequence, select the previous fluid from OR, START AFTER.
Select DOSE QUANTITY, select the required dose, and then select Done.
Select START TIME, and select a start time from the list, or enter a custom time.
1. To enter a custom time, select Enter date/time.
  
  You are returned to the previous screen. ENTER START TIME is populated with the next available start time.
2. From ENTER START TIME, select the date and then select a new start date from the calendar.
3. Select outside the calendar.
4. Select the time and then select a new start time.
5. Select outside the time picker.
Select COURSE DURATION, enter a duration, select units, and then select Done.
Select INSTRUCTIONS, enter instructions, and select Back.

Select Clear to remove all the writing. Select Cancel to return to the previous screen without making any changes.

Select Submit to continue to signing page.
Acknowledge alerts and sign the prescription.

Read about alerts

Read about signing a prescription

Prescribing without a dose sentence

When you prescribe without a dose sentence, you receive only limited clinical decision support. You prescribe by answering a set of mandatory questions, for example, the route and licenced form of the medication.

From your patient list, select a patient.
Select Chart > +.
Add the medication by typing, scanning, adding from groups or adding from previous prescriptions.

Read more about adding a prescription
Select Prescribe without using dose sentences.
Answer questions for route, form, and product, then enter the frequency. All questions are mandatory. You cannot prescribe until all fields are completed.
Select DOSE QUANTITY, enter the required dose, and then select Done.
Select START TIME and select a start time from the list, or enter a custom time.
1. To enter a custom time, select Enter date/time.
  
  You are returned to the previous screen.
2. Select ENTER START TIME. The field is populated by the current time and date.
3. Select the date and select a new start date from the calendar.
4. Select outside the calendar.
5. Select the time and then select a new start time.
6. Select outside the time picker.
Select COURSE DURATION > enter a duration, select units, and then select Done.
Continue to select fields and enter or select information until you see Submit.

Select Submit to continue to signing page.
Acknowledge alerts and sign the prescription.

Read about alerts

Read about signing a prescription

About dose range warnings

Your organisation can specify dose ranges for dose sentences and add dose range warnings.

When you prescribe a medication, if you enter a dose quantity that is outside the specified dose range, a message might appear in a dialogue box. This message is a dose range warning and you can continue to prescribe.

About alerts

There are four levels of alert that can appear when you sign a prescription. Alerts capture all clinical decision support, except interactions between drugs or drug classes. Stockley Drug-Drug Interactions shows interactions between drugs or drug classes.

Organisations can configure their own alerts and choose whether alert levels 1 to 3 are pre-acknowledged or need acknowledgement.

Level 4 alerts need acknowledgement and justification. You must enter a reason before you proceed. This is fully auditable.

When you prescribe duplicate order sets, an alert appears.
When you prescribe an order set containing duplicate medications, no alert appears.
If estimated or reported height and weight are used to calculate a dose quantity, a level 4 alert appears. Your organisation decides if estimated height and weight can be used to calculate a dose.

Signing a prescription

From your patient list, select a patient.
Select Chart > +.
Add the medication by typing, scanning, adding from groups, or adding from previous prescriptions.
Enter and select information to complete the prescription.
Select Submit. This shows alerts and clinical decision support.
Acknowledge any alerts.
- Select  to acknowledge alerts.
- Select the alert to view more detail.
  - Select Acknowledge to acknowledge the alert and return to the previous screen.
  - Select Ack & Next to acknowledge the alert and move on to the next alert.
  - Select  Sign Prescription to return to the previous screen without acknowledging the alert.

To enter a note:
1. Select Additional Notes
2. Enter a note
3. Select  Sign Prescription.
NOTES are mandatory if there is a level 4 alert.
Select Sign.

The prescription is now added to the patient’s medication chart and can be administered.

Prescribing a syringe driver

From your patient list, select a patient.
Select Chart > +.
From GROUPS, select Syringe Driver.
Select New syringe driver.
Complete the needed fields, then select Submit.
To add a medication to the syringe driver:
1. Select a medication.
2. Complete the fields.
3. Select Done > Submit.
You are prompted to sign the prescription.
- To sign the prescription, select Yes.
  
  Or
- If you want to add any more medications to the prescription, select No.
  
  Then repeat step 6 until you’ve finished adding medications.
Acknowledge any alerts and select Sign.

Read about alerts

The syringe driver now appears on the medication chart and can be administered.

About order sets

Your organisation can configure sets of medications which you can prescribe in one step. When you prescribe order sets, you do not have to add each medication individually.

Order sets belong to groups. To find an order set, type to search for a group, or select a group from GROUPS. Any order sets that belong to the group appear under ORDER SETS.

Select an order set to see the medications included.

	(no icon)	This medication is not selected.
		This medication is selected by default, or you selected this medication.
		This medication is a mandatory part of the order set. You can’t clear this.
		This medication is part of an OR group. You can select one item from an OR group. This medication is not selected.
		This medication is part of an OR group. You can select one item from an OR group. This medication is selected by default, or you selected this medication. Depending on your organisation, a medication in an OR group can be mandatory. A medication is selected by default. You can change the selection to another medication in the OR group, but you can’t clear the OR group entirely.

Prescribing order sets

From your patient list, select a patient.
Select Chart > +.
Start typing the name of a group to search, or select a group from GROUPS.
Select sub-groups until you reach the order set, then select the order set.
Select or deselect medications, then select Next.
Review the list of medications and any alerts.

For any alerts, select  and acknowledge the alert.

Select Ack & Next to move to the next alert.

Read about alerts
Optional: add any notes.
Select Sign.

Prescribing and administering medication in a single step

In some situations, a clinical user might need to prescribe and administer medications at the same time. For example, an anaesthetist working in surgery might prescribe and administer antibiotics or pain relief.

Medications that you can prescribe and administer as a single step are configured by your organisation and are limited to medications configured as stat (once off) dose sentences.

These medications are not marked in Nervecentre for mobile. However, your organisation might organise them into a single group or include STAT in the name of the dose sentence.

From your patient list, select a patient.
Select Chart > +.
Start typing the name of a medication to search, or select a group from GROUPS.
Select sub-groups until you see the medication, then select the medication.
Select a dose sentence.
Enter and select information to complete the dose sentence. Mandatory fields are marked  .
Select Submit.
For any alerts, select  and acknowledge the alert.

Select Ack & Next to move to the next alert

Read about alerts
Optional: add any notes.
Select Sign & record as given.
Check the time and date are correct for when you administered the dose. You can select the day or the time to change it.
Select Confirm given at (hh:mm DD/MM).

Prescribing exemptions, or Patient Group Directions (PGDs)

PGD Patient Group Directions. These provide a legal framework that allows some registered health professionals to supply and administer specified medicines to a pre-defined group of patients, without having to see a prescriber, such as a doctor or nurse prescriber. PGDs vary depending on your organisation.s, also called exemptions, allow groups of health care professionals specified by your organisation to supply or administer a medication directly to a patient with an identified clinical condition, without the need for a prescription or an instruction from a prescriber.

Each ward area or specialty has a designated set of PGDs. All PGDs are once-only doses.

From your patient list, select a patient.
Select Chart > +.
Select the needed exemption group. In this example, Core PGDs.
Select the required medication.
Enter and select any additional information to complete the prescription.

Read about prescribing with a dose sentence
Acknowledge any alerts and enter notes as needed.

You can select Sign to prescribe the PGD, or select Sign & record as given to prescribe and administer the PGD.

Read about signing a prescription

Read more about prescribing and administering in a single step
If you signed the prescription, the PGD is added to the patient’s medication chart and can be administered.

Read more about administering medications

Viewing a dose calculation

You can view information about how Nervecentre calculated the dose of medication needed using the patient's weight.

From your patient list, select a patient.
Select Chart.
Select the medication name to view information about a dose calculation.

Finding the prescribing page

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  >  to start a new prescription.

Depending on your permissions,  is shown.

Searching for a medication using the search field

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  > .
Type the first few letters of a medication name in Search or scan and press Enter.
Select the medicine in the next column to see dose sentences.

Formulary VTM Virtual Therapeutic Moiety. A representation of active medicinal ingredient. Information on indication, strength, dose or administration route are not included.s (Virtual Therapeutic Moieties) are listed based on the configuration of the formulary.

Searching for a medication using a scanner

You can scan a barcode with a USB handheld scanner connected to the computer.

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  > .
Select inside Search or scan.
Scan the barcode on the medication packaging.

The dm+d Dictionary of Medicines and Devices. A dictionary of descriptions and codes that represent medicines and devices in use across the NHS. code is displayed in Search or scan. Matching results appear.
Select a medication.

Searching for a medication using groups and folders

You can select items from Groups to move through groups of medications, treatment pathways, and order sets. The groups and folders you see depend on your organisation. Groups and folders allow you to move through clinically configured choices, providing appropriate dose sentences.

Depending on your organisation, some medications might only be available from groups and so do not appear in text searches.

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  > .
Select a group from Groups.

In this example, the group labelled Commonly used contains the washes and creams.
Continue to select groups until you reach dose sentences.
Select a medication.

Searching for a medication from a previous prescription

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  > .
Select one of the following options:
- To prescribe medications a patient arrived on, select Add from arrival meds, and select a medication.
- To prescribe medications a patient received as TTO To Take Out. Often used to describe the medicines added to the discharge letter, and, informally, the letter itself. medication in a previous episode, select Add from previous episodes, select an episode, and select a medication.
- To prescribe a planned medication, select Add from plan, and select a medication.
  
  Read about adding planned medications

Prescribing with a dose sentence

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  > .
Find a medication. You can:
- Search the name of the medication or fluid.
- Scan a barcode from a pack of medication.
- Select an option from Groups.
- Select an option from Previous prescriptions.
Select an option from Formulary VTMs for medications, or Fluids for fluids.
Select a dose sentence.
Depending on the dose sentence, select or enter information to complete the prescription.
- This might include the route, dose quantity, or total fluid volume. Mandatory fields are marked  .
- You might see results from investigations at this stage. Results are included to provide clinical decision support.
- To prescribe fluids sequentially, for each fluid except the first in the sequence, select the previous fluid from or, Start after.
Optional: select  to view attached policies.
Select Prescribe and  appears next to the medication.
You can either select more medications to prescribe, or sign the prescription.

Read more about signing the prescription

Prescribing without a dose sentence

Some medications might not have a dose sentence attached. In that instance, you can select Prescribe without using dose sentences.

This method of prescribing does not provide full clinical decision support, such as dosing guidance. It does provide allergies, interaction, and duplication checking.

Depending on your organisation, prescribing without a dose sentence might be prohibited for some medications, such as high-risk medications.

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  > .
Find a medication. You can:
- Search the name of the medication or fluid.
- Scan a barcode from a pack of medication.
- Select an option from Groups.
- Select an option from Previous prescriptions.
Select an option from Formulary VTMs.
Select Prescribe without using dose sentences.
Select parameters for the prescription.
Depending on the dose sentence, select or enter information to complete the prescription. Mandatory fields are marked  .
Optional: select  to view attached policies.
Select Prescribe and  appears next to the medication.
You can either select more medications to prescribe, or sign the prescription.

Read more about signing the prescription

Prescribing reducing or increasing doses

Some medications need the dose to be reduced or increased throughout the course duration. Below are three examples showing you can prescribe an increasing or reducing dose.

Exact duration and amount specified in the dose sentence.

You can prescribe a dose sentence that specifies the exact duration and amount of each reducing or increasing dose.

For example, you prescribe a medication that has the dose sentence “Oral, 20 mg once a day during the morning for 7 days THEN 10 mg once a day during the morning for 7 days”.
Duration specified in the dose sentence.

You can prescribe a dose sentence that specifies the duration of each dose, but you can enter the dose needed.

For example, you prescribe a medication that has the dose sentence is “Oral ‘morning dose 1’ once a day during the morning for 3 days THEN ‘morning dose 2’ once a day during the morning for 3 days”. When prescribing the medication, you can enter the dose needed for ‘morning dose 1’ and ‘morning dose 2’.
Increasing or decreasing without a dose sentence.

If your organisation allows it, you can prescribe a reducing or increasing course of medication by prescribing without a dose sentence.

For example, you prescribe a medication without a dose sentence. When prescribing the medication, you select the frequency Reducing/Increasing Dose. You can then enter any dose, at any frequency, for any number of days, for the full duration of the course. You can also enter asymmetric doses.

The dose sentences you see depend on your organisation.

On the MAR Medicines Administration Record. Also known as drug chart. A list of all medication prescribed and administered (given)., in addition to the detail given in the prescription, daily dose amounts are shown in grey.

Prescribing sequential fluids

From Nervecentre version 7.1, fluids can now be prescribed with dose sentences.

Read about prescribing with dose sentences

If one bag of fluid has been prescribed you have the option to prescribe sequential fluids.

Select or, Start after to view a list of prescribed fluids.
Select the required fluid and then select Prescribe.

You can prescribe multiple sequences as needed.

The starting fluid must be stopped early or marked as completed on the MAR, for the sequential fluid to become due.

Prescribing syringe drivers

Syringe drivers are multiple drugs in a singe syringe used, for example, for end of life care.

You must prescribe a new syringe before you can add the required medications.

From  Inpatients > Patient List > double-click on a patient's name > Patient Detail, select Meds.
Select  > .
From Groups, select Syringe Driver > New syringe driver.
Select or enter the required details, and then select Prescribe.
Select a medication for the syringe driver, select or enter the required details, and then select Prescribe.

Selected medications show .
Continue to select and prescribe medications until you are finished. Select Sign now.
Sign the prescription. See below for details of signing and alerts.

If you select Sign now in error, you will need to delete the draft prescription and start the process again.

Prescribing order sets

Your organisation can configure sets of medications that you can prescribe in one step. When you prescribe order sets, you do not have to add each medication individually.

Order sets belong to groups. To find an order set, select a group. Any order sets that belong to the group appear under Order sets.

Select an order set to see the medications included.

	This medication is not selected.
	This medication is selected by default, or you selected this medication.
	This medication is a mandatory part of the order set. You can’t clear the selection.
	This medication is part of an OR group. You can select only one item from an OR group. This medication is not selected.
	This medication is part of an OR group. You can select only one item from an OR group. This medication is selected, either by default or because you selected it. Depending on your organisation, it can be mandatory to select a medication in an OR group. If so, a medication is selected by default. You can change the selection to another medication in the OR group, but you can’t clear the OR group entirely.

Select Next, acknowledge any alerts, and sign the prescription as normal.

Read about signing prescriptions

Creating a new prescription

Creating a new prescription on a mobile

Creating a new prescription on a desktop

Alerts	Shows all clinical decision support, except interactions between drugs or drug classes
Stockley Drug-Drug Interactions	Shows interactions between drugs or drug classes.
	Shown next to pre-acknowledged alerts.
	Shown next to alerts that need acknowledgement. Select  to acknowledge the alert. Selecting  makes Notes mandatory. You must enter a reason before you proceed. This is fully auditable.