Summary: Back-up prescribing involves the supply of a prescription, with clear instructions to the patient as to when to obtain the medication
Intended Users: GPs
What is back-up (delayed) prescribing?
Back-up (delayed) prescribing involves the supply of a prescription, commonly for antibiotics, with clear instructions to the patient as to when to obtain the medication, for example, if their symptoms don’t improve within the next 48 hours
- The main aim is to reduce unnecessary and inappropriate use of antibiotics when the clinician believes that the condition is most likely self-limiting
- This promotes antimicrobial stewardship by encouraging self-management as an initial step, but providing the patient with specific criteria in which they can start antibiotic therapy without having to make an additional appointment
Prescribing back-up antibiotics
Consider:
- The natural history of the presenting infection
- The evidence of benefit of antibiotic treatment for the condition
- The length of time a patient should wait before using the prescription
- Specific signs and symptoms to look out for which would prompt using the medication
- Specific information about when to re-consult
Process
- Add the code "deferred antibiotic therapy"
- Request a prescription on EPS - enter deferred antibiotic prescription in the pharmacy note
- Explain to the patient why you are prescribing this and the reason to delay starting the antibiotics
- Instruct the patient to only collect the antibiotics if their symptoms haven’t improved after 48 hours
- Send Accurx: ‘Delayed prescribing’
Safety-netting advice
See also Safety Netting
- What you expect the clinical course to be
- What to do if the expected clinical course is not followed
- What signs and symptoms to look out for
- When and how to seek further assessment
Considerations with back-up prescribing for children
- <3 Months: back-up prescribing is never appropriate
- <2 Years: This is a particularly vulnerable group, being less able to communicate symptoms in a meaningful way, and the use of a back-up prescription for these patients would not be considered part of routine practice
- In all children, it is wise to have systems to enable and facilitate further and prompt review. There should be a low threshold for review whether an antibiotic is prescribed or not.
- The safety netting advice, in the form of guidance on when to have concern and seek further assessment, must be tailored to the age of the child, the understanding of the parents and the home circumstances