Transcript Slide 1

Gail Feinberg, DO, FACOFP
October, 2009
 Understand
what “makes” a prescription
 Intro to Latin abbreviations
 Intro to DEA
 Practice writing prescriptions
A
prescription order is written for
diagnosis, prevention or treatment of a
specific patient's disease
 Is written by a licensed practitioner
 Is written as part of a proper physicianpatient relationship
 Is a legal document, "prima facie"
evidence in a court of law.
• (side note…A prima-facie case is a lawsuit that
alleges facts adequate to prove the underlying
conduct supporting the cause of action and thereby
prevail.)
 Literally, "Recipe"
means simply
"Take...." and when a medical
practitioner writes a prescription
beginning with "℞", he or she is
completing the command.
 Was probably originally directed at
the pharmacist who needed to take a
certain amount of each ingredient to
compound the medicine (rather than at
the patient who must "take/consume"
it).
The
word "prescription" can be
decomposed into "pre" and "script"
and literally means, "to write
before" a drug can be prepared.
• Another theory exists that the "℞" may
have originally been a "Px", where the
"P" is short for "pre", and the "x" is short
for "script".
 Patient Information
 Superscription
 Inscription
 Subscription
 Signa
 Date
 Signature lines, signature, degree, brand
name indication
 Prescriber information
 DEA# if required
 Refills
 Warnings/label
 Name
 Address
 Age
 Weight
(optional, but useful - esp in
peds)
 Time (used only with inpatient
medication orders)
 RX
 Traditional
symbol for prescription
 Use it to line up the other parts of the Rx
 What
is the pharmacist to take off the
shelf?
• Drug Name
• Dose = Quantity of drug per dose form
• Dose Form = The physical entity needed, i.e.
tablet, suspension, capsule
• Simple vs. Compound Prescriptions
• Manufactured vs. compounded prescriptions
• Clarity of number forms 0.2, 20 not 2.0 (Zeros
lead but do not follow!)
 What
is the pharmacist to do with the
ingredients?
• Quantity to be dispensed (determines amount in
bottle) Dispense # 24
• For controlled substances write in numbers and
letters (like a bank check)
 #24(twenty four)
• Any special compounding instructions
Sig—write, or let it be labeled (Latin terms: signa or
signetur)
 Instructions for the patient

• Route of administration
 Oral, nasally, rectally, etc
 Take by mouth.., Give, Chew, Swallow whole, etc.
• Number of dosage units per dose
 Take one tablet, Give two teaspoonfuls, etc.
• Frequency of dosing
 every six hours, once a day…
• Duration of dosing
 for seven days,... until gone, ...if needed for pain.
• Purpose of medication
 for pain, for asthma, for headache, etc.
 VERY IMPORTANT to include purpose as this reduces errors!
 Do not use “As directed”
• Special instructions (shake well, refrigerate etc.)
• Warnings
 Indicate
either no refills or the number of
refills you want (don’t leave it blank)
• Determines maximum duration of therapy.
 Date the prescription
• All prescriptions expire after one year
• Schedule II drugs can only be dispensed within 7
days of date on RX
 CV-CIII
can be refilled for 5 time in 6 mo.
maximum.
 Automatic Stop Orders (inpatient orders)
• Antibiotics-7 days
• Controlled Substances-3 days
 This
makes the prescription a legal
document
 Include your degree
 You must write “brand necessary,”
“brand medically necessary,” or “DAW”
(Dispense as Written) to get nongenerics.
 All
medical prescribers are required to
request and receive a DEA number,
which contains two letters, six numbers,
and one “check digit” before a single
narcotic prescription can be dispensed.
 This is a precaution taken by the DEA to
ensure that controlled substances are
being prescribed by only qualified
professionals.










A – Deprecated
B –Hospital/Clinic
C – Practitioner
D – Teaching Institution
E – Manufacturer
F – Distributor
G – Researcher
H – Analytical Lab
J – Importer
K – Exporter
L – Reverse Distributor
P- Narcotic Treatment
Program
 R – Narcotic Treatment
Program
 S – Narcotic Treatment
Program
 T- Narcotic Treatment
Program
 U – Narcotic Treatment
Program
 X – Suboxone/Subutex
Prescribing Program


 The
second letter is the initial of the
practitioners last name.
 The third, fourth, fifth, and sixth numbers
are randomly selected by a computer.
The check digit is a calculation of the
following:
• Addition of the first, third and fifth digits
• Addition of the second fourth and sixth digits
times two
• Add the sums of the two numbers
• The sum is the last digit
Abbreviation
Latin
Meaning
bid
Bis in die
Twice daily
tid
Ter in die
Three times daily
qid
Quarter in die
Four times daily
hs (or qhs)
(Quaque) hora somni
At bedtime (each night)
pc
Post cibum
After meals (or not on
an empty stomach
prn
Pro re nata
As circumstances may
require
po
Per os
By mouth (orally)
pr
Per rectum
Rectally (suppository)
ac
Ante cibum
Before meals
gtt (gtts)
Guttae
Drop(s)
 file:///C:/Documents%20and%20Setting
s/Gail%20Feinberg/Desktop/List_of_abb
reviations_used_in_medical_prescription
s.htm
 file:///C:/Documents%20and%20Setting
s/Gail%20Feinberg/Desktop/List_of_me
dical_abbreviations%20_Do-notuse_list.htm
 Prescribing
incorrectly
• Can be due to slips, lapses or lack of knowledge
(mistakes) (Always check dosage
calculations!!!!!!)
 Using
ambiguous symbols
 Poor handwriting

Careful use of decimal points to avoid ambiguity:
• Avoiding unnecessary decimal points: a prescription will be written as
5 mL instead of 5.0 mL .
• Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid
misinterpretation of .5 as 5.
• Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 to avoid
misinterpretation.
• Avoiding decimals altogether by changing the units: 0.5 g is less easily
confused when written as 500 mg.




“mL" is used instead of “cc" or "cm³" even though they are
technically equivalent to avoid misinterpretation of 'c' as '0'
or the common medical abbreviation for "with" (the Latin
"cum"), which is written as a 'c' with a bar above the letter.
Directions written out in full in English
Quantities given directly or implied by the frequency and
duration of the directions.
Where the directions are "as needed", the quantity should
always be specified.
Where possible, usage directions should specify
times (7 am, 3 pm, 11 pm) rather than simply
frequency (3 times a day) and especially relationship
to meals for orally consumed medication.
 The use of permanent ink.
 Avoiding unspecified prn or "as needed"
instructions—instead, specific limits and indicators
are provided e.g. "every 3 hours prn pain."
 For refills, the minimum duration between repeats
and number of repeats should be specified.
 Providing the indication for all prescriptions even
when obvious to the prescriber, so that the
pharmacist may identify possible errors.
 Avoiding units such as "teaspoons" or "tablespoons."

Writing out numbers as words and numerals
("dispense #30 (thirty)“)
 The use of apothecary units and symbols of
measure is discouraged

• pint (O), ounce (℥), drams (ℨ), scruples (℈), grains (gr), and
minims (♏)
• Given the potential for errors, metric equivalents should always
be used.

The use of the degree symbol (°), which is
commonly used as an abbreviation for hours (e.g.,
"q 2-4°" for every 2 - 4 hours), should not be used,
since it can be confused with a '0'.
• In addition, the use of the degree symbol for primary,
secondary, and tertiary (1°, 2°, and 3°) is discouraged, since the
former could be confused with quantities (i.e. 10, 20 and 30,
respectively).
 To
prevent copying of prescription/pad
• Anti-copy Watermark.
 By tipping the paper towards the light, a picture appears
to verify that the prescription is an original. Usually a Rx
appears.
• Anti-Coy Coin Rub.
 By rubbing a penny across the back of the prescription
the words “Secure Prescription Paper” appears.
• Hidden Message Technology.
 The word “Void” appears if a copy is made.
 To
prevent modification of prescription
• Toner Bond Security.
 The paper is treated with a compound that fuses with
any ink used on it (including toner from printers).
• Blue Security Background.
 Prevents erasing of prescription.

Security measures to prevent counterfeiting of
prescription forms
• Unique Production Batch Numbers.
 Unique numbers are assigned to every printed batch by the
manufacturer.
• Security Warning Band.
 Visible warning band provides warning of security measures on paper
to prevent counterfeiting
• UV Fiber Secure.
 Invisible fluorescent fibers and threads that can only be seen under
blacklight

While some physicians use printers and a specific
program to write their prescriptions, the same strict
guidelines are used in the design of the printer paper
used for prescriptions as well.
 Write
a prescription for Amoxil, which
can be given either 125mg/5mL or
250mg/5mL to a child who is 45 lbs
(approx 20kg). The dose is 2040mg/kg/day divided into 3 doses per
day. Child needs to be on the antibiotic
for 10 days
 Amoxil
250/5ml
 Disp: 150mL
 Sig: 5mL tid until gone
Denise
Watermark
Oct. 6, 2009
Amoxil 250/5ml
Disp: 150mL
Sig: 5mL tid until gone (also
acceptable is 5mL tid x 10 days)
Gail Feinberg, DO, FACOFP
none
 Jane
Doe need refill of her digoxin. Her
dose is 1.25mg daily and she takes one
daily. She needs a 30 day prescription to
take to the pharmacy today and another
one for 3 months to mail off…write both
for her.
 Jane
Doe
 Digoxin 1.25 mg
 Disp: #30
 Sig: One p.o. daily (here can also add for
CHF or whatever appropriate)
 No refill
Jane Doe
10/7/09
Digoxin 1.25mg
Disp # 30
Sig: One (1) po daily (can also add for
CHF)
 Jane
Doe
 Digoxin 1.25 mg
 Disp # 90
 Sig: One p.o. daily
 No refill
Jane Doe
10/7/09
Digoxin 1.25mg
Disp # 90
Sig: One (1) po daily (can also add for
CHF)
 Tom
Smith has pulled his back out and
you are going to give him some Flexeril
(Cyclobenzaprine) as a muscle relaxer.
This is given as 10mg up to three times
daily as needed for muscle spasm. You
only want to give him at most a weeks
worth.
 Tom
Smith
 Flexeril 10mg
 # 21 (twenty one)
 i p.o. up to tid prn muscle spasm
• (note the i…represents one ii=2, iii=3, iiii or iv =
4 etc.)
• Can also write one (1) po up to …
Tom Smith
10/7/2009
Flexeril 10mg
DAW
#21 (twenty one)
1 po up to tid prn muscle spasm
Caution: May cause drowsiness
none