Transcript Prescription writing

Prescription writing
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 ! drug’s 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 ! patient’s hospital chart
called ! physician’s 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 'µg')
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 Rationale for category & Rx rules
-al for
abuse
Examples
I
High
abuse
potential
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
H
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
g
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.
4 times a day
q.h.
every hour
q.2h.
every 2 hours
t.i.d.
3 times a day
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.