Prescription writing Dr.Saeed Ahmed 2009

 A prescription: A physician's order to prepare / to dispense a specific Tr -usually medication- for an individual patient. A physician's order to prepare / to dispense a specific Tr -usually medication- for an individual patient.

Rational prescribing: Like any other process in health care, writing a prescription should be based on a series of rational steps: 1- Make a specific diagnosis 2- Consider ! pathophysiologic implications of ! diagnosis 3- Select a specific therapeutic objective 4- Select a drug of choice 5- Determine ! appropriate dosing regimen 6- Devise a plan for monitoring ! drug’s action & determine an end point for therapy 7- Plan a program of patient education.

 In ! hospital setting, drugs are prescribed on a particular page of ! patient’s hospital chart called ! physician’s order sheet/ chart order. There are 3 common types of Rx : 1- Prescription in general practice 2- Hospital prescription for in-patients 3- Hospital prescription for an (external pharmacy).

Parts of prescrition:  Superscription: name, professional degree, contact no. address of ! prescriber, ! date when ! order is written. name, address & age of ! patient; & ! symbol Rx (an abbreviation for "recipe," ! Latin for "take thou." _ name, address & age of ! patient; & ! symbol Rx (an abbreviation for "recipe," ! Latin for "take thou." _  Inscription : ! body of ! Pres. containing ! name, strength of each drug, & dosage form of ! Tr.  Subscription: quantity to be dispensed. ! directions to ! pharmacist, usually consisting of a short sentence: "make a solution," "mix & place into 10 capsules," or "dispense 10 tablets."  Transcription : labeling of instruction to ! Patient,  prescriber's signature.

 When writing ! drug name: -either generic name (nonproprietary name) is used. -OR ! brand name (proprietary name) - ! strength of ! medication should be written in metric units (Not apothecary). 1 gr = 60 mg 15 gr = 1 g 1 ounce (oz) by volume = 30 ml 1 tsp = 5 ml 1 tbsp= 15 ml 20 drops= 1 ml 2.2 ponds (Ib) = 1 kg.

Principles for writing pres. 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 SE  NEVER abbreviate drug names

 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.

 Previous adverse pres./ 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.

 ! 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 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.. because sudden withdrawal may lead to withdrawal symptoms..

Classification of controlled substances. Based on estimated addiction liability Examples Rationale for category & Rx rules Potenti -al for abuse Class Heroin, LSD ( Lysergic Acid Diethylamide), marijuana No accepted medical use, All no research use forbidden, can Not be prescribed lack of accepted safety as drug High abuse potential I Opioids as morphine, amphetamines Current accepted medical use but abuse may lead to severe physical/ psychic dependence HII Weaker opioids such as codeine, some amphetamine-like drugs Current accepted medical use. moderate or low potential for physical & high potential for psychologic dependence, No refills, Rx must be rewritten after 6 months < class II III

Diazepam, phenobarbital, chloral hydrate etc Medical use is accepted. Limited / low potential for dependence < III IV cough syrups e codeine, antidiarrheal e diphenoxylate etc Medical use is accepted. ! least potential for abuse ! least potential for abuse < IV Schedule V

 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. 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.

Rx for controlled drugs:  Should not be typed & written by hand  Written in ink  Signed & dated  Carry ! prescriber's full name, address & registration number  State ! form of ! drug  State ! total quantity of ! drug or ! number of doses units (10.0 mg i.e. ten milligrams) Not be refillable > than 5 times in a 6 months period for schedule III-IV-V Rx;  No refilling for schedule II Rx.

before meals a.c. After meal p.c. Capsulescap gramg hourh. milligrammg Abbreviation \ Meaning

milliliterml Twice daily Bid by mouth, orally p.o. when necessary p.r.n. once a day q.d. 4 times a day q.i.d.

every hour q.h. every 2 hours q.2h. 3 times a day t.i.d. Intra-arterialIA IntramuscularIM intravenousIV HsAt bed time

CapsuleCap suppository Sup, supp suspensionSusp tabletTab StatAt once D/CDiscontinue CD Controlled drugs

Computerized physician order entry (CPOE): is a process of electronic entry of physician instructions for ! tr of patients (particularly hospitalized patients) under his or her care. is a process of electronic entry of physician instructions for ! tr of patients (particularly hospitalized patients) under his or her care.physician hospitalizedphysician hospitalized 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. computer networkpharmacy radiology computer networkpharmacy radiology

 CPOE advantages: -decreases delay in order completion, -reduces errors related to handwriting or transcription,?? transcription - provides error-checking for duplicate or incorrect doses or tests, & - simplifies inventory & posting of charges.