Prescription writing

200
9

Dr.Saeed Ahmed

 A prescription:
A physician's order to prepare / to dispense a
specific Tr -usually medication- for an
individual patient.

Rational prescribing:
Like any other process in health care, writing a
prescription should be based on a series of
rational steps:
1- Make a specific diagnosis
2- Consider ! pathophysiologic implications of !
diagnosis
3- Select a specific therapeutic objective
4- Select a drug of choice
5- Determine ! appropriate dosing regimen
6- Devise a plan for monitoring ! drugs action &
determine an end point for therapy
7- Plan a program of patient education.

 In ! hospital setting, drugs are prescribed on a

particular page of ! patients hospital chart
called ! physicians order sheet/ chart order.
There are 3 common types of Rx :
1- Prescription in general practice
2- Hospital prescription for in-patients
3- Hospital prescription for an (external
pharmacy).

Parts of prescrition:
Superscription: name, professional degree,
contact no. address of ! prescriber,
! date when ! order is written.
name, address & age of ! patient; & ! symbol Rx (an
abbreviation for "recipe," ! Latin for "take thou." _
Inscription : ! body of ! Pres. containing ! name,
strength of each drug, & dosage form of ! Tr.
Subscription: quantity to be dispensed. !
directions to ! pharmacist, usually consisting of a
short sentence: "make a solution," "mix & place
into 10 capsules," or "dispense 10 tablets."
Transcription : labeling of instruction to ! Patient,
prescriber's signature.

When writing ! drug name:

either generic name (nonproprietary name) is used.
OR ! brand name (proprietary name)
- ! strength of ! medication should be written in metric
units (Not apothecary).
1 gr = 60 mg
15 gr = 1 g
1 ounce (oz) by volume = 30 ml
1 tsp = 5 ml
1 tbsp= 15 ml
20 drops= 1 ml
2.2 ponds (Ib) = 1 kg.

Principles for writing pres. for both

controlled & uncontrolled drugs
Prescribers should:
ALWAYS write legibly in ink (clear writing)
Use metric system (g, L)
ALWAYS sign & date ! the prescription
Precise
Accurate
Use precautions to remind patients about SE
NEVER abbreviate drug names

 When writing ! INDIVIDUAL DOSE:

for STRENGTHS >1g use grams
for STRENGTHS <1g use milligrams e.g.100mg
for STRENGTHS <1mg use micrograms e.g. 100
microgram (NEVER use 'g')
AVOID unnecessary decimal points e.g. use 300 mg
NOT 0.3 g.

 Previous adverse pres./ allergies; ask for drug

history or medical record
Check other medication charts
(anticoagulants, insulin)
Specify time course; if ! drug is taken for a
number of days/ continuously (course of
antibiotic, antihypertensive/ antiparkinson
drugs.
As required medications
Indication, frequency, minimal time interval
btw doses & maximum dose in 24 hr period.

 ! instructions should be sufficient for a nurse

to administer a drug accurately in ! hospital,
or for a pharmacist to provide a patient e
both ! correct drug & ! instructions on how to
take it.

Medication error is ! most common

medical mistake.

Prescription for uncontrolled drugs include:

- date
- identification of patient: name, hospital
number, age, sex
- name of ! drug
- dose of ! drug
- frequency of administration
- route & method of administration
- amount to be supplied
- ! prescriber's signature.

 Controlled drugs: Substance, which may

produce physical, psychological dependence /
both
Prescribed for not > than 2 weeks
because sudden withdrawal may lead to
withdrawal symptoms..

Classification of controlled
substances . Based on estimated
addiction liability

Class Potenti
-al for
abuse
I
High
abuse
potential

Rationale for category & Rx rules

Examples

No accepted medical use, All no research

use forbidden, can Not be prescribed
lack of accepted safety as drug

Heroin, LSD (Lysergic

Acid Diethylamide),
marijuana

II

Current accepted medical use but abuse

may lead to severe physical/ psychic
dependence

Opioids as morphine,
amphetamines

III

< class II Current accepted medical use. moderate

or low potential for physical & high
potential for psychologic dependence, No
refills, Rx must be rewritten after 6 months

Weaker opioids such

as codeine, some
amphetamine-like
drugs

IV

< III

Medical use is
accepted. Limited /
low potential for
dependence

Diazepam,
phenobarbital,
chloral hydrate etc

Schedule V

< IV

Medical use is
accepted.
! least potential
for abuse

cough syrups e
codeine ,
antidiarrheal e
diphenoxylate etc

Schedules of Controlled Drugs: ! drugs are divided into 5 schedules:

Schedule I
Drugs in this schedule have no accepted medical use & have a high abuse potential.
Ex. heroin, marijuana, LSD, etc.
Schedule II
Drugs in this schedule have a high abuse potential e severe psychic or physical
dependence liability. Included are certain narcotic analgesics, stimulants, &
depressant drugs. Ex. opium, morphine, codeine, methadone, cocaine,
amphetamine.
Schedule III
Drugs in this schedule have an abuse potential < than those in Schedules I & II &
include compounds containing limited quantities of certain narcotic analgesic drugs,
& other drugs such as barbiturates. pentobarbital.
Schedule IV
Drugs in this schedule have an abuse potential < than those listed in Schedule III &
include such drugs as barbital, phenobarbital, chloral hydrate, chlordizepoxide,
diazepam, oxazepam etc.
Schedule V
Drugs in this schedule have an abuse potential < than those listed in Schedule IV &
consist primarily of preparations containing limited quantities of certain narcotic
analgesic drugs used for antitussive & antidiarrheal purposes.

Rx for controlled drugs:

Should not be typed & written by hand
Written in ink
Signed & dated
Carry ! prescriber's full name, address &
registration number
State ! form of ! drug
State ! total quantity of ! drug or ! number of
doses units (10.0 mg i.e. ten milligrams)
Not be refillable > than 5 times in a 6 months
period for schedule III-IV-V Rx;
No refilling for schedule II Rx.

Abbreviation \

Meaning

. a. c

before meals

.p.c

After meal

cap

Capsules

gram

.h

hour

mg

milligram

ml

milliliter

Bid

Twice daily

. p. o

by mouth, orally

. p. r . n

when necessary

. q. d

once a day

. q.i.d

times a day 4

. q. h

every hour

. q.2h

every 2 hours

. t.i.d

times a day 3

IA

Intra-arterial

IM

Intramuscular

IV

intravenous

Hs

At bed time

Cap

Capsule

Sup, supp

suppository

Susp

suspension

Tab

tablet

Stat
D/C
CD

At once
Discontinue
Controlled drugs

Computerized physician order entry (CPOE):

is a process of electronic entry of physician
instructions for ! tr of patients (particularly
hospitalized patients) under his or her care.
These orders are communicated over a
computer network to ! medical staff (nurses,
therapists, pharmacists, or other physicians)
or to ! departments (pharmacy, laboratory or
radiology) responsible for fulfilling ! order.

 CPOE advantages:
- decreases delay in order completion,
- reduces errors related to handwriting or
transcription,??
- provides error-checking for duplicate or
incorrect doses or tests, &
- simplifies inventory & posting of charges.