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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!