prescription

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parts of prescription, medication errors

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Prescription:

Prescription Pooja Dave Assistant Professor PIPR, Parul University, Vadodara

Objectives:

Objectives Understand what “makes” a prescription Intro to Latin abbreviations Intro to DEA Practice writing prescriptions

The parts of a prescription:

The parts of a prescription

What is a Prescription?:

What is a Prescription? A prescription order is written for diagnosis, prevention or treatment of a specific patient's disease Is written by a licensed practitioner Is written as part of a proper physician-patient relationship Is a legal document, "prima facie" evidence in a court of law. (side note…A prima-facie case is a lawsuit that alleges facts adequate to prove the underlying conduct supporting the cause of action and thereby prevail.)

Definition:

Definition The word "prescription" can be decomposed into "pre" and "script" and literally means, "to write before" a drug can be prepared. Another theory exists that the "℞" may have originally been a " Px ", where the "P" is short for "pre", and the "x" is short for "script".

Parts of the Prescription:

Parts of the Prescription Patient Information Superscription Inscription Subscription Signa Date Signature lines, signature, degree, brand name indication Prescriber information DEA# if required Refills Warnings/label

Patient Information:

Patient Information Name Address Age Weight (optional, but useful - esp in peds ) Time (used only with inpatient medication orders)

Superscription:

Superscription RX Traditional symbol for prescription Use it to line up the other parts of the Rx

Inscription:

Inscription What is the pharmacist to take off the shelf? Drug Name Dose = Quantity of drug per dose form Dose Form = The physical entity needed, i.e. tablet, suspension, capsule Simple vs. Compound Prescriptions Manufactured vs. compounded prescriptions Clarity of number forms 0.2, 20 not 2.0 (Zeros lead but do not follow!)

Subscription:

Subscription What is the pharmacist to do with the ingredients? Quantity to be dispensed (determines amount in bottle) Dispense # 24 For controlled substances write in numbers and letters (like a bank check) #24(twenty four) Any special compounding instructions

Signa, Signatura or Transcription:

Signa, Signatura or Transcription Sig—write, or let it be labeled (Latin terms: signa or signetur) Instructions for the patient Route of administration Oral, nasally, rectally, etc Take by mouth.., Give, Chew, Swallow whole, etc. Number of dosage units per dose Take one tablet, Give two teaspoonfuls, etc. Frequency of dosing every six hours, once a day… Duration of dosing for seven days,... until gone, ...if needed for pain. Purpose of medication for pain, for asthma, for headache, etc. VERY IMPORTANT to include purpose as this reduces errors! Do not use “As directed” Special instructions (shake well, refrigerate etc.) Warnings

Refills and Date Prescribed:

Refills and Date Prescribed Indicate either no refills or the number of refills you want (don’t leave it blank) Determines maximum duration of therapy. Date the prescription All prescriptions expire after one year Schedule II drugs can only be dispensed within 7 days of date on RX CV-CIII can be refilled for 5 time in 6 mo. maximum. Automatic Stop Orders (inpatient orders) Antibiotics-7 days Controlled Substances-3 days

Signature of Prescriber:

Signature of Prescriber This makes the prescription a legal document Include your degree You must write “brand necessary,” “brand medically necessary,” or “DAW” (Dispense as Written) to get non-generics.

Slide 14:

Label directions for use Directions should start with a verb and completely, clearly and accurately describe the administration of the medication. Indicate the route of administration. Use whole word, not abbreviations Use familiar words, especially in measurements.

Slide 15:

Auxiliary Labels Provides additional information and warnings.

Slide 16:

Institutional Labels – Unit Dose Unit dose packaging is used in hospitals and other institutional settings.

Slide 17:

What do the following pharmaceutical symbols refer to?

Latin abbreviations:

Latin abbreviations

Latin Used in Prescription Writing:

Latin Used in Prescription Writing Abbreviation Latin Meaning bid Bis in die Twice daily tid Ter in die Three times daily qid Quarter in die Four times daily hs ( or qhs) (Quaque) hora somni At bedtime (each night) pc Post cibum After meals (or not on an empty stomach prn Pro re nata As circumstances may require po Per os By mouth (orally) pr Per rectum Rectally (suppository) ac Ante cibum Before meals gtt (gtts) Guttae Drop(s)

Slide 20:

Latin Term Common Abbreviation Translation capsula caps a capsule c.c. cubic centimeter chartulae charts powder papers; divided powders cibus cib.; c. food collunarium collun a nose wash collyrium collyr. an eyewash compositus comp. compound congius cong.; C. gallon cum c or c. with cum cibus c.c. with food; with meals dilutus dil. dilute, diluted

Slide 21:

Latin Term Common Abbreviation Translation elix. elixir emulsum emuls. emulsion et et and ex modo prescripto e.m.p. in the manner prescribed; as directed fac, fiat, fiant f.; ft. let it be made; make f.; fl. fluid f.; fl. g.; G.; gm. gram g.; G.; gm. granum gr. grain guttae gtt. a drop hora h at the hour of

Slide 22:

Latin Term Common Abbreviation Translation hora somni h.s. at bedtime injectio inj. injection   i.v.; IV intravenous   i.v.p.; IVP intravenous push IVPB intravenous piggyback i.m. Intramuscular liquor liq. a solution     minimum min; Mx , M minim

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Latin Term Common Abbreviation Translation misce m.; M mix   mcg. microgram   mEq. milliequivalent   mg. milligram   ml. milliliter nocte n. at night naristillae narist. nasal drops nebule neb. a spray non repetatur non.rep. do not repeat    

Slide 24:

Latin Term Common Abbreviation Translation octarius O. pint oculentum occulent. eye ointment oculus o. eye oculus utro o.u . both eyes, each eye omni mane o.m. every morning oculus utro o.u. both eyes, each eye pulvis pulv. powder parti affectae applicandus p.a.a . to be applied to affected part per os   p.o . by mouth post cibum p.c. after meals

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Latin Term Common Abbreviation Translation post cibum p.c. after meals secundum artem s.a. according to the art   S.C.; subc; subq subcutaneously semis ss one-half quater in die q.i.d. four times a day quaque hora q.h. every hour quaque die q.d. every day sine s without quantum sufficiat q.s. a sufficient quantity   quantum sufficiat ad q.s. ad suppositorum supp. suppository

Slide 26:

Latin Term Common Abbreviation Translation signa Sig. write, label sine s without si opus sit s.o.s. if necessary syrupus syr. syrup statim stat. immediately suppositorum supp. suppository tabella tab. tablet ter in die t.i.d. three times a day trochiscus troche lozenge tussis tuss. a cough ungentum ung. an ointment

Slide 27:

HANDALING OF PRESCRIPTION The following procedure should be adopted by the pharmacist while handling the prescription for compounding and dispensing:- 1. Receiving 2. Reading and checking 3. Collecting and weighting the materials 4. Compounding, labeling and packaging

Slide 28:

1.Receiving: - the prescription should be revised from the patient by the pharmacist himself. While receiving a prescription, a pharmacist should not change his facial expression which gives an impression to the patient that he is surprised or confused after seeing the prescription . 2.Reading and checking: - on receiving a prescription, always check it that it is written in proper format. A prescription should always be screened behind the counter. In case of any doubt regarding the prescription ingredients or directions, the pharmacist should consult the other pharmacist or prescriber . 3.Collecting and weighing the material: - before compounding the prescription, all the materials required for it, should be collected on the left hand side of the balance. After weighing the material it should be shifted to right hand side of the balance. This gives a check of ingredients which have been weighed. While compounding the label of every stock bottle should be read at least 3 times in order avoid any error. i . When taken from the shelf or drawer.

Slide 29:

ii. When the contents removed for weighing and measuring. iii. When the containers are returned back to its proper place. 4.Compounding, labeling and packaging: - compounding should be carried out in a neat place. All the equipment etc... Required should be thoroughly cleaned and dried. Only 1 prescription should be compounded at one time. The compounded medicament should be filled in suitable containers depending on its quantity and use. The filled containers are suitable labeled. White plain paper of good quality should be used for labeling the container. The container is polished so as to remove the figure prints. While delivering the prescription to the patient, the pharmacist should explain the mode of administration, direction for use, and storage.

Slide 30:

MODERN METHODS OF PRESCRIBING Nowadays , the majority of the drugs are available in the market as readymade formulation manufacturing by different pharmaceutical companies. The drugs should be prescribed by its official name and not by its proprietary or trade name. There are certain advantages and disadvantages of prescribing the drugs by its proprietary name, which are as under…

Slide 31:

ADVANTAGES It’s easy to remember proprietary because they are very catchy . 2. It is easy to communicate with the patient . The continuity can be maintained by prescribing the same proprietary name every time. The bioavailability of drugs change with the change of adjutants used in drugs formulation manufacture by different

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CARE REQUIRED IN DISPENSING PRESCRIPTION Following precaution should be taken while dispensing a prescription. 1) Always keep the prescription before you. Take the prescription with you while taking out the medicine from the shelf. It will serve as a constant reminder of the name and strength of the preparation required and helps to avoid mistakes.

Slide 33:

2)Always check the dispensing balance before weighing the ingredients which are required and help to avoid mistakes. 3) Replace containers of stock preparation or drugs in their proper position after use. 4) Keep the label in upper position during weighing solid ingredients especially the potent drugs such as morphine hydrochloride to serve as a constant reminder that the correct drug is being used.

Slide 34:

5) When pouring or measuring the liquid ingredients, keep the label upward in order to prevent surplus running down of the bottle and staining the label. 6) Care should be taken to keep the dispensing balance clean . The powder should be transferred from the stock container by using a clean spatula. The scale pan should be cleaned immediately after use.

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7) Medicines which are uses externally such as lotions, liniments , paints, etc ...Should be supplied in vertically fluted or fibbed bottles in order to distinguish it by touch. They must be labeled in red or against a red background.

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ERROR OF PRESCRIPTION 1. Abbreviation:- Abbreviation presents a problem in understanding parts of the prescription order. Extreme care should be taken by a pharmacist in interpreting the Abbreviation. Pharmacists should not guess at the meaning of an ambiguous Abbreviation.

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2. Name of the drug:- There are certain drugs whose name look or sound like those of other drugs. Some of the example of such drugs is as under: - Digitoxin and Digoxin , prednison and pridnisolon 3. Strength of preparation:- The strength of the preparation should be stated by the prescriber. It is essential when various strengths of a product are available in market . 4.Dosage form of the drug prescribed:- Many medicines are available in more than one dosage form like as liquid, tablet, capsule, etc...

Slide 38:

5 . Dose:- Unusually high or low doses should be discussed with the prescriber. Pediatric dosage may present . So pharmacist should consult pediatric posology to avoid an error . Sometime a reasonable dose is administered too frequently . 6 . Instructions for the patient :- The instructions for the patient which are given in the prescription are incomplete or omitted. The quantity of the drug to be taken, the frequent and timing of administration and route of administration should be clearly given in the prescription so as to avoid any confusion.

Slide 39:

7. Incompatibilities:- It is essential to check that there are no pharmaceutical or therapeutic incompatibilities in a prescribed preparation and that different medicines prescribed for the same patient do not interact with each other to produce any harm to patient . Certain antibiotics should not be given with meals since it significantly decrease the absorption of the drug .

Avoiding Medical Errors:

Avoiding Medical Errors Prescribing incorrectly Can be due to slips, lapses or lack of knowledge (mistakes) (Always check dosage calculations!!!!!!) Using ambiguous symbols Poor handwriting

Avoiding Ambiguity:

Avoiding Ambiguity Careful use of decimal points to avoid ambiguity: Avoiding unnecessary decimal points: a prescription will be written as 5 mL instead of 5.0 mL . Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation of .5 as 5. Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 to avoid misinterpretation. Avoiding decimals altogether by changing the units: 0.5 g is less easily confused when written as 500 mg. “mL" is used instead of “cc" or "cm³" even though they are technically equivalent to avoid misinterpretation of 'c' as '0' or the common medical abbreviation for "with" (the Latin " cum "), which is written as a 'c' with a bar above the letter. Directions written out in full in English Quantities given directly or implied by the frequency and duration of the directions. Where the directions are "as needed", the quantity should always be specified.

Avoiding Ambiguity:

Avoiding Ambiguity Where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (3 times a day) and especially relationship to meals for orally consumed medication. The use of permanent ink. Avoiding unspecified prn or "as needed" instructions—instead, specific limits and indicators are provided e.g. "every 3 hours prn pain." For refills, the minimum duration between repeats and number of repeats should be specified. Providing the indication for all prescriptions even when obvious to the prescriber, so that the pharmacist may identify possible errors. Avoiding units such as "teaspoons" or "tablespoons."

Avoiding Ambiguity:

Avoiding Ambiguity Writing out numbers as words and numerals ("dispense #30 (thirty)“) The use of apothecary units and symbols of measure is discouraged pint ( O ), ounce ( ℥ ), drams ( ℨ ), scruples ( ℈ ), grains ( gr ), and minims ( ♏ ) Given the potential for errors, metric equivalents should always be used. The use of the degree symbol (°), which is commonly used as an abbreviation for hours (e.g., "q 2-4°" for every 2 - 4 hours), should not be used, since it can be confused with a '0'. In addition, the use of the degree symbol for primary, secondary, and tertiary (1°, 2°, and 3°) is discouraged, since the former could be confused with quantities (i.e. 10, 20 and 30, respectively).

Prescription Security:

Prescription Security To prevent copying of prescription/pad Anti-copy Watermark. By tipping the paper towards the light, a picture appears to verify that the prescription is an original. Usually a Rx appears. Anti-Coy Coin Rub. By rubbing a penny across the back of the prescription the words “Secure Prescription Paper” appears. Hidden Message Technology. The word “Void” appears if a copy is made.

Prescription Security:

Prescription Security To prevent modification of prescription Toner Bond Security. The paper is treated with a compound that fuses with any ink used on it (including toner from printers). Blue Security Background. Prevents erasing of prescription.

Prescription Security:

Prescription Security Security measures to prevent counterfeiting of prescription forms Unique Production Batch Numbers. Unique numbers are assigned to every printed batch by the manufacturer. Security Warning Band. Visible warning band provides warning of security measures on paper to prevent counterfeiting UV Fiber Secure. Invisible fluorescent fibers and threads that can only be seen under blacklight While some physicians use printers and a specific program to write their prescriptions, the same strict guidelines are used in the design of the printer paper used for prescriptions as well.

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