PRESCRIPTION WRITING

PERFECTO 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 medicationfor 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 drugs action and determine an end-point for therapy 7. Plan program of patient education

Writing Prescriptions Who 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. Doctors order on the patients 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

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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 Patients Chart
In hospital setting, drugs are prescribed on a particular page of patients hospital chart called physicians order sheet/ chart order.

Elements of Prescription 1. All prescriptions must contain the following:

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Made up of 8 parts: 1. Doctor information Name

Qualifications
Address Contact Number

2. Patient information
Name Gender

Age
Weight Address Contact Number

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3. Date 4. Superscription, i.e. Rx Usually said to mean "recipe" meaning "to take"

5. Inscription
Medication (use generic name) Use criteria of least number of drugs to get the job done Dosage

Body of prescription:

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

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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 7. Subscription
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

Instructions to patient in their language, written very clearly Instructions to pharmacist

prescription is given back to the patient rather than kept by the pharmacist)

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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

_________________________________________________________________________ DOCTORS ORDER _________________________________________________________________________ Date & Time _________________________________________________________________________ Ampicillin (Ampicin) 250 mg IV q 8 hours ( ) ANST _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Name & Signature

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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 patients chart, the brand name enclosed in parenthesis shall be written after generic name.

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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

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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

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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 'g') 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.

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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.

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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

NKA-no known allergy

NKDA-no known drug allergy NPO-nothing by mouth pc-after meals

D/C-discontinue
gm-gram gr-grain gtt-drop

po-by mouth
prn-as needed q-every qh-every hour

hs-at bedtime
IM-intramuscular IV-intravenously L-liter mcg-microgram mEq-milliequivalent mL-milliliter

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.