Prescriptions

Prescription:

An order that is created by a practitioner for a particular drug to be dispensed to a particular patient.

Can be verbal or written

Physician writes prescription on a special pad, and makes a note of order in the patient’s chart

Some physicians prefer to fax prescriptions to the pharmacy so the medication can be ready and waiting for the patient.

Long-term prescriptions should be added to the patient’s medication profile (short-term medications can be listed if desired)

Prescription pads must be kept secure to avoid theft and forgery◦ Pads should be labeled with physician’s name,

address and telephone number◦ Pads may be sequentially numbered to detect loss◦ Pads should be locked up and only 1 in use at a time

(keep in desk drawers, or physician’s pocket)◦ Physicians should never pre-sign blank prescription

forms◦ Prescription pads should never be used as

notepaper◦ To prevent changes:

Use tinted pads so erasures will show up Physician should draw diagonal line through any empty

space

If faxes are used:◦ Fax machines in the physician’s office as well as

the pharmacy should be kept in a secure area

◦ Cover sheet should be prepared to include all physician information (including any identifiers), date and time of transmission, pharmacy address and phone number, etc

1. Heading◦ Physician’s information

(usually preprinted) and patient information (name, address, date, etc)

2. Superscription◦ Represents the order for

the pharmacist to provide the requested medication

◦ Represented by Rx – an abbrevation which means “Take Thou”

3. Inscription◦ Name of the drug, form,

strength

Dr. E. Miller M.D C.F.P.C.

123 Anywhere St.

St. John,NB (567)426-8456

Date ___________ 20__

Name: _______________________________

Address: _____________________________

Micronase 2.5 mg tab

30

sig. 1 tab q.d. a.c.

x3

E. Miller_________ Emily Miller, MD

4.5.6.7.

1.

2.3.

4. Subscription (Mitte)◦ Directions for the

pharmacist (size of dose, amount to dispense)

5. Signa (Signatura)◦ Directions for the patient

to be printed on the label (when and how many to take)

6. Refill◦ Number of times a refill

is allowed on a script 7. Signature

◦ Signature and identifier of the ordering physician

Dr. E. Miller MD C.F.P.C.

123 Anywhere St.

St. John, NB (567)426-8456

Date ___________ 20__

Name: _______________________________

Address: _____________________________

Micronase 2.5 mg tab

30

sig. 1 tab q.d. a.c.

x3

E. Miller_________ Emily Miller, MD

4.5.6.7.

1.

2.3.

a.c. p.c. gtt b.i.d. t.i.d. q.i.d q.d q.4h. q.h. p.r.n. h.s

stat p.o. caps agit SL ad lib. OD OS AS AD Rx

Three systems used:◦ Canada generally uses the metric system

Other areas use imperial system or apothecaries’ measure

◦ SI Units International metric system Drugs measured in milligrams (mg), millilitres (mL),

or cubic centimetres (cc) (mL and cc are the same) May also be measured in micrograms (μg or mcg)

Be aware of decimals when transcribing prescription orders

◦ Household (Imperial) Measurement Teaspoon, tablespoon, cup, drop Often only used when relaying information to

patient. Actual prescription written in SI

◦ Apothecaries’ Measure Minims, fluid drams, fluid ounces for volume Grains, scruples, drams, pounds, ounces for weight

1 gr = 60 mg When encountered, transcribe as given and let

pharmacist perform the conversion

◦ International Units Used for some vitamins and drugs 1 mL = 1000 IŪ

Ontario Drug Benefit Program◦ Covers people 65 or older, residents of long-term

care facilities and people receiving home care, and Trillium Drug Program recipients

◦ Recipients may have to pay a deductible and/or co-pay

Trillium Drug Program◦ Helps people who have high drug costs in relation

to their income◦ Covers only specific drugs

Some drugs are only covered by the Ontario Drug Benefit program in certain circumstances◦ Ex: only for certain ailments, only if other drugs

have been tried first, etc

In these circumstances, the physician must fill in a Limited Use number on the prescription◦ If the limited use number is not present, or the

patient does not meet the requirements for the drug to be covered, the pharmacist will not fill the prescription

Repeat:◦ Continuation of long-term medications

Long-term medications are usually given a limited amount of time the prescription is good for before a new prescription is necessary

Renewal:◦ Extension of a short-term prescription that has

run out

Policies for handling renewals vary with the physician◦ Some will renew over the phone in certain

situations, others require a patient to come in for a renewal If the physician allows telephone renewals, make

sure to take all information about the patient and the medication desired and write it down for the physician to review

Information required:◦ Client’s first and last name◦ Address and phone number◦ Name of medication◦ Prescription number◦ Dose and frequency◦ Date issued◦ Preferred pharmacy (unless the pharmacy is the

party calling)◦ Pharmacy’s location and telephone number

Exposure to:◦ Light◦ Moisture◦ Temperature ◦ Air

Deteriorated and expired drugs should be disposed of properly

What is the proper disposal technique?

Keep all medication in their original containers Check manufacturer’s storage recommendations Keep drugs in dark containers or dark rooms Some drugs need to be refrigerated Do not open bottles unnecessarily Do not return unused drugs to the original

container Keep external use medications away from

internal use medications Store medications away from cleaning supplies Organize drugs on the shelf Discard all unused, expired medication Never leave drugs out in the exam rooms

To check for accuracy, read back any prescription information delivered orally in person or on the phone

Be alert for drugs with similar names when transcribing or entering notes

Ask for interpretation if poor handwriting makes it difficult to read a written prescription

Governed by the Controlled Drugs and Substances Act (CDSA)

Establishes 5 schedules of controlled substances and the regulations to control their use

◦ Drugs are scheduled according to: Potential for abuse Medical usefulness Degree of possible physical or psychological

dependence

Keep a special record of controlled substances dispensed, administered, or prescribed (keep records for two years)

Store all drugs in a safe or locked, immoveable cabinet

Be alert to break-ins

If any loss occurs, report to authorities immediately

Physicians may prescribe only small amounts of drugs with high potential for abuse

Be aware of warning signs:◦ Patient asking for larger quantities or for a drug to

be renewed early◦ Walk-ins looking for narcotics◦ Patient immediately requesting a specific

controlled drug