Understanding Prescriptions

For BNS 1st YearDr. Pravin Prasad

1st year Resident, MD Clinical PharmacologyMaharajgunj Medical Campus

10th December, 2015 (Mangsir 24, 2072), Thursday

Defining a Prescription…• A prescription is a written order by a registered physician directing the

pharmacist to prepare or dispense pharmacological agents for the diagnosis, prevention or treatment of a disease.

• Broadly has 4 components:• Superscription• Inscription• Subscription• Signature

Types of Classification• According to the Health Facility• Outpatient Prescription• Inpatient Prescription (Patient

Order Chart, Chart Order, Cardex)

• According to the Formulations being prescribed• Pre-compounding prescription

• Extemporaneous prescription• According to the Prescriber• Medical Prescriber (Hand-written

or Computer Generated)• Nurse Prescriber (Hand-written or

Computer Generated)• Pharmacist Prescriber• Optometrist Prescriber• Dental Prescriber

Elements of A PrescriptionA. Prescriber related:

1. Name2. Licence Classification

(Professional Degree)3. Address4. Contact Number(s)

• Prescriber’s credential should be verifiable• Should be available if any

queries arises

Elements of A Prescription5. Date• Signifies when was prescription

written• Too old prescription should not be

refilled

B. Patient related:6. Name7. Address

• Proper identification

Elements of A PrescriptionC. Body of Prescription:

8. Medication name (Brand/generic)9. Medication strength (metric units/apothecary)10. Dispensing quantity, dosage (appropriate to duration of

therapy, the cost, need for continued contact with the clinic or physician, the potential of abuse, potential for toxicity/abuse)

11. Direction for use (Patient-specific and drug specific; simpler and few drugs/dosages)

• Instructions should include:• How and when to take medications, duration of therapy,

purpose of medication• Must be clear ad conscise• Latin abbreviation apothecary not preferred, but still in use.

Elements of A PrescriptionD. Others:

12. Refill information13. Requirement of childproof containers14. Additional warnings

E. Prescriber’s identification:15. Prescriber’s name16. Prescriber’s signature17. Prescriber’s registration number

Outpatient Prescriptions… Any Lackings??

Mr. XXX XXXX (##Y/M)

Mr. XXX XXXX

Outpatient Prescriptions… Any Lackings??

Outpatient Prescription.. What’s Missing?

Mr. XXX XXXX

Inaptient Prescription… What are the elements?• Contents are specified in the medical staff

rules by the Hospital’s Pharmacy and Therapeutics Committee• Patient’s name: typed or written on the

form• Order’s include:• Name and strength of medication• Dose, route and frequency of administration• Date and Time• Signature of the prescriber• Duration: usually not mentioned

Types of PrescriptionPre-compounding prescription Extemporaneous (Impromptu) prescription

It is the prescription that contain drugs available in pre-compounded form and is dispensed as it is.

A working definition of extemporaneous dispensing or compounding is the mixing together of the ingredients of a prescription or drug formula and generally refers to a manual process performed for individual orders by a dispenser or pharmacist.

Pharmacists or Nursing Staff dispense the drugs as directed by the physician

Pharmacists or Nursing Staff prepare the medication according to the drugs and dosages as directed by the physician

More common these days Seen in limited scenario, e.g. Ayurvedic prescriptions, ICU prescriptions

Comparatively safer as the dosage forms are not modified. Higher risk: The ‘peppermint water case’ of UK: wrong strength of chloroform water leading to the death of a child

Extemporaneous Prescription

Abbreviations used in Prescriptions

Abbreviations used in

Prescriptions

Types of PrescriptionPrescriber Issued to Remarks

Medical PrescriberHospital Bed Nurse PrescriberSupplementary Prescribers

General Practice PatientsHospital OutpatientsDrug Addict Patients

Prescription from Medical prescriber common in Nepal

Dental Prescribers Dental patients Common in Nepal

NursesSupplementary Prescribers

General Practice Patients

Independent Medical Services Service Personnel

Private prescribing of Controlled Drugs

Private Patients

Ref: Practitioner Services – Pharmacy, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB

Prescribing Errors• Omission of Information• “Resume pre-op medication”• “Continue present iv fluids”• “Continue eye drops”• “prn” authorization without clear

instructions on what conditions will justify the use

• Poor prescription writing• Illegible handwriting• Ambigious decimal point, using “0”

properly, using “/”

• Using “U” for units• Prescribing doses in micrograms• One ampoule of a drug when more

than 1 size ampoules are available• Confusing abbreviations

• Inappropriate drug prescription• Failure to recognise contraindications

imposed by co-morbidities• Failure to ilicit drug history of the

patient• Failure to realise Drug-drug interaction

To Conclude:• Prescription should be legible, unambiguous, dated, signed properly• Contain sufficient information so that any possible errors could be

discovered easily

• Thank you!