PRESCRIPTION WRITINGPERFECTO B. SORIANO, MD,DPPS,FPSCEP,MSC

HISTORY

Prescriptions have been in use since ancient times

Latin adopted as standard language

“Rx” = prescription

“Sig.” = directions Federal Food, Drug, and

Cosmetic Act (1938)

Non – prescription

Prescription

Legend drugs

Controlled drugs

Generic Act of 1988 (RA 6675)

DEFINITION

A prescription:

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

PRESCRIPTION WRITING

Rational Prescribing 1. Make a specific diagnosis 2. Consider the pathophysiology of the diagnosis

selected 3. Select the therapeutic objective 4. Select a drug of choice 5. Determine the appropriate dosing regimens 6. Devise a plan for monitoring the drug’s action and

determine an end-point for therapy 7. Plan program of patient education

Writing PrescriptionsWho can write a Rx?

Practitioners Physicians, veterinarians, dentists

PRESCRIPTION WRITING RULES AND REGULATIONS TO IMPLEMENT

PRESCRIBING REQUIREMENTS UNDER GENERIC ACT OF 1988 (R.A. 6675)

Prescription- is the written order and instruction of validly registered physician, dentist, veterinarian for the use of a specific product for a specific patient.

Doctor’s order on the patient’s chart for the use of specific drugs shall be considered a prescription

Generic Name- is the identification of drugs and medicines by their scientifically and internationally recognized active ingredients of their official name as determined by FDA.

Drug- any substance intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man and animals

PRESCRIPTION WRITING

Intended to affect the structure or function of the body of man and animals

Do not include devices or their components, parts or accessories

GUIDELINES ON PRESCRIBING OPD Patient’s Chart

In hospital setting, drugs are prescribed on a particular page of patient’s hospital chart called physician’s order sheet/ chart order.

Elements of Prescription 1. All prescriptions must contain the following:

PRESCRIPTION WRITING Made up of 8 parts:  1. Doctor information Name Qualifications Address Contact Number  2. Patient information Name Gender Age Weight Address Contact Number

PRESCRIPTION WRITING 3. Date 4. Superscription, i.e. Rx Usually said to mean "recipe" meaning "to take"  5. Inscription Body of prescription:

Medication (use generic name) Use criteria of least number of drugs to get the job done Dosage

Avoid use of fractions, e.g. 500mg NOT 0.5g If fractions are absolutely necessary, make it very clear

List medications in order of importance: Basis (i.e. what cures the cause of the disease) Adjuvant

PRESCRIPTION WRITING There are 2 types of prescriptions:

Compounded - i.e. mixed up at the pharmacy according to the doctor's orders

Precompounded - i.e. pre-mixed by the pharmaceutical company  6. Transcription Instructions to patient in their language, written very clearly  7. Subscription Instructions to pharmacist

How many doses required, e.g. 30 tab Note: maximum time prescribed for is 2 months Should not normally exceed 14 days except for chronic diseases Indicate number of refills where appropriate (in this case

prescription is given back to the patient rather than kept by the pharmacist)

 

PRESCRIPTION WRITING

8. Signature Prescription is a legal document. The signature

seals the deal. As with any legal document, this can be used in the

doctor's defense if done right, or used as evidence against him if done incorrectly.

2. Determine the list of dangerous drugs. Special prescription form is required for these drugs. Dangerous drugs Prohibited drugs Regulated drugs

PRESCIPTION WRITING

PRESCRIPTION WRITING

Region I Medical Center

Department of Pediatrics

Dagupan City

_________________________________________________________________________

DOCTOR’S ORDER

_________________________________________________________________________

Date & Time

_________________________________________________________________________

Ampicillin (Ampicin) 250 mg IV q 8 hours ( ) ANST

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Name & Signature

PRESCRIPTION WRITING 3. Generic names shall be used in all prescriptions:

a. For drug with single active ingredient, the generic name of that active ingredient shall be used in prescribing.

b. For drugs with two or more active ingredients, the generic name as determine by BFAD shall be used in prescribing

4. The generic name must be written in full but the salt or chemical form maybe abbreviated.

5. The generic name of the drug ordered must be clearly written on the prescription immediately after the Rx symptom, or on the order chart

a. If written on a prescription pad, the brand name enclosed in parenthesis shall be written below the generic name.

B. If written on a patient’s chart, the brand name enclosed in parenthesis shall be written after generic name.

PRESCRIPTION WRITING 6. In prescribing drugs which needs strict precaution in

their use, the prescriber must comply with the following: the generic name of active ingredients and the specific salt or chemical form, the manufacturer, the brand name if available, the strength or dose using units of the metric system.

Forms of Prescription I. Violative Prescriptions 1. Where generic name is not written. 2. Where the generic name is not legible and a brand

name which is legible is written. 3. Where the generic name is indicated and instructions

added (such as the phrase “no substitution”) which tend to obstruct, hinder or prevent proper generic dispensing

PRESCRIPTION WRITING

II. Erroneous Prescriptions 1. Where the brand name precedes the generic name. 2. Where the generic name is the one in parenthesis. 3. Where the brand name is not in parenthesis. 4. Where more than one drug product is prescribed on one

prescription form.

III. Impossible Prescriptions 1. When only the generic name is written but it is not legible. 2. When the generic name does not correspond to the brand name. 3. When both the generic name and the brand name are not

legible. 4. When the drug product prescribed is not registered with BFAD.

Principles for writing prescription 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

Side Effects of drugs prescribed NEVER abbreviate drug name

PRESCRIPTION WRITING

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.

PRESCRIPTION WRITING

Previous adverse reactions/ 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.

PRESCRIPTION WRITING

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 WRITING

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..

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.

Common Medical Abbreviation Used in Prescription Writing

ac- before meals bid- twice a day cap-capsule DAW-dispense as written D/C-discontinue gm-gram gr-grain gtt-drop hs-at bedtime IM-intramuscular IV-intravenously L-liter mcg-microgram mEq-milliequivalent mL-milliliter

NKA-no known allergy NKDA-no known drug allergy NPO-nothing by mouth pc-after meals po-by mouth prn-as needed q-every qh-every hour q2h-every 2 hours qid-four times a day qs-a sufficient quantity stat-immediately tab-tablet tid-three times daily ud-as directed wk-week

Computerized physician order entry (CPOE):

is a process of electronic entry of physician instructions for treatment 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.

MAXIMIZE PATIENT SAFETY

ALWAYS write legibly. ALWAYS space out words and numbers to

avoid confusion. ALWAYS complete medication orders. AVOID abbreviations. When in doubt, ask to verify.