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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.