Table 3.

Marking scheme adapted from the EQUIP classification scheme including examples of drug therapies prescribed by students

Category	Subcategory	Description	Examples (related clinical case)
Appropriate		• A drug therapy is defined as appropriate if the correct drug, dose, dosage, duration, and route is chosen according to the European and/or local guidelines	• amoxicillin 500mg three times a day for 5 days per os (CAPa)
Suboptimal		• The dose of drug therapy is slightly too high (half to two times the normal dose) for the condition being treated	• esomeprazole 40mg once daily (GERDb)
		• The dose of drug therapy is slightly too low for the condition being treated to produce the desired outcome	• paracetamol 1000mg twice daily (osteoarthritisc)
		• The duration of drug therapy is slightly too long for the condition being treated	• amoxicillin 14 days therapy (CAP)
		• The duration of drug therapy is slightly too short for the condition being treated to produce the desired outcome	• omeprazole 3 weeks (GERD)
		• Second or third choice of drug is prescribed instead of first‐choice drug for the condition being treated (according to the local or (inter)national guidelines)	• ranitidine instead of omeprazole (GERD)
		• Symptomatic drug therapy is prescribed without strong scientific benefits for the patient	• acetylcysteine (bronchitisd)
Inappropriate	Not immediately harmful	• The drug dose is too high (three times to four times the normal dose) for the condition being treated	• enalapril 20 mg once daily (hypertensione)
		• The drug dose is too low for the condition being treated to expect a beneficial outcome	• amoxicillin 375mg once daily (CAP)
		• The duration of the drug therapy is too long for the condition being treated resulting in drug overuse	• omeprazole life‐long (GERD)
		• The duration of the drug therapy is too short for the condition being treated to produce the desired outcome	• valsartan 1 week (hypertension)
		• Incorrect drug formulation for route of drug administration	• ceftriaxone per os (CAP)
		• No drug therapy is prescribed although the condition requires initiation of drug therapy	• no additional analgesic prescribed (osteoarthritis)
		• Omission of protective or preventive drug therapy	• NSAID without PPI (osteoarthritis)
		• Unnecessary drug therapy is prescribed for which there is no valid medical indication	• amoxicillin (bronchitis)
		• Duplicate drug therapy is prescribed without benefits for the patient	• two times salbutamol (bronchitis)
		• The prescription lacked drug name, dose, dosage, duration, route, or included inappropriate abbreviations, or drug class instead of generic name, or was illegible	• ‘PPI’ (GERD)
	Potentially harmful	• The drug dose is too high (four to ten times the normal dose) for the condition being treated with increased risk of adverse effects	• tramadol 500 mg once daily (osteoarthritis)
		• Unnecessary drug therapy is prescribed for which there is no valid medical indication and with increased risk of adverse effects	• amitriptyline (osteoarthritis)
		• Intravenous drug therapy is prescribed while not medically necessary	• ceftriaxone intravenous (CAP)
		• Duplicate drug therapy is prescribed with increased risk of adverse effects	• two times ibuprofen (osteoarthritis)
		• Drug therapy could exacerbate the patient's condition including drug‐drug interaction or drug‐disease contraindication	• propranolol and asthma (hypertension)
	Potentially lethal	• Serum drug levels are likely to be toxic based on common dosage guidelines	• naproxen 50 g (osteoarthritis)
		• Errors including decimal points or units resulting in severe toxicity	• salbutamol 200 mg (bronchitis)
		• Drug therapy being administered has a high potential to cause cardiopulmonary arrest in the dose ordered	• amlodipine 300 mg (hypertension)

^aCAP, mild community‐acquired pneumonia (pneumonia severity index I).

^bGERD, gastroesophageal reflux disease (grade A) not sufficiently responding to lifestyle changes.

^cOsteoarthritis not sufficiently responding to treatment with paracetamol.

^dUncomplicated acute bronchitis.

^eEssential hypertension not sufficiently responding to hydrochlorothiazide 12.5 mg daily and lifestyle changes.