PRESCRIPTION WRITING

 Trial for medical therapy

Prescription ABBREVIATION: (AVOID!!!)

-an instruction to a pharmacist, written by a doctor to dispense Rx – Recipe = take thou
stated quantity of a particular drug in a specified dose. A ac – ante cibum = before food
prescription also contains instructions to the patient indicating how pc – post cibum = after food
the drug is to be taken, how often and for how long. These are bd – bis in die = twice a day (bid is also used)
usually computer printed on the label by the physician.
PARTS OF A PRESCRIPTION:
THERE ARE 2 TYPES OF PRESCRIPTION: I. Superscription
 Precompounded Prescription: -the symbol Rx from the Latin recipe, meaning “take”
-prescription for already prepared drug (by pharmaceutical II. Inscription
companies) e.g. Cap, Ciprofloxacin (500 mg) etc -specifying the ingredients and their quantities
 Extemporeous/Compounded Prescription III. Subscription
-the pharmacist prepare the medication according to the -which tells the pharmacist how to compound the medicine
drugs and dosages directed by the physician IV. Signature
-is usually preceded by an S to represent the Latin signa,
INTRODUCTION meaning “mark.” The signature is where the healthcare
1. Patient identifiers provider indicates what instructions are to be put on the
2. Drug/medication outside of the package to tell the patient when and how to
3. Strength take the medicine and in what quantities. The pharmacist
4. Amount keeps a file of all the prescriptions filled.
5. Route
6. Frequency SUBSCRIPTION
 This part of the prescription contains directions of the
IMPORTANCE OF PRESCRIPTION prescriber to the pharmacist regarding the type and
 Means of communication between doctor and patient and compounding of dosage form along with the number of
follow-up doses to be dispensed.
 Legal documentation  This is important because dose of drug also depends on the
 Record source type of dosage form.

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 THE COST OF POOR PRESCRIPTION WRITING
SIGNATURA d) Poorly written prescriptions may be one of the main reasons
 This part of the prescription contains directions to the there are so many medication errors today. Lok at some of
patient regarding the administration of the drugs these commonly quoted statistics:
 It is generally represented as ‘Sig’ on the prescription a.) Medication error occur in approximately 1 in every 5
doses given in hospitals
INSCRIPTION b.) One error occurs per patient per day
 Body of the prescription consisting of the official names and c.) Approximately 1.3 million injuries and 7000 deaths
amounts of occur each year in the US from medication-related
a) Basis – chief ingredient errors
b) Adjuvants (if any) – secondary active drugs to assist d.) Drug-related morbidity and mortality are estimated to
the action of the basis cost S177 billion in the US
c) Corrigents/Corrective (if any) – to correct
undesirable quality or action of the basis COMMON ROUTE ABBREVIATIONS FOR PRESCRIPTION WRITING
d) Solvent/Vehicle/Excipient – to give suitable form of o PO (by mouth)
administration o PR (per rectum)
o IM (intramuscular)
DATE o IV (intravenous)
 To know when the medicines were last dispensed o ID (intradermal)
 To prevent the misuse of the drug by the patients o IN (intranasal)
o TOP (topical)
SUPERSCRIPTION o SL (sublingual)
a) Information about the prescriber (name, address and o BUCC (buccal)
telephone number)
o IP (intraperitoneal)
b) Information about the patient (full name, address, gender,
DOB, weight and height if necessary)
c) Rx Symbol
-is an abbreviation of Latin term “recipe”, meaning “to take”
---FOR WRITING
or “take thou”
o Daily (no abbrev)

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 o Every other day (no abbrev) phone number and/or current home address will usually be
o BID/b.i.d (twice a day) included, as well.
o TID/t.i.d (three times a day)  One identifier isn’t enough, even if you use the patient’s full
o QID/q.i.d (four times a day) name. If 2 patients share the same name, it would be
o QHS (every bed time) impossible to know which one of the prescription refers to
o Q4H (every 4 hours) without any other identifier.
o Q4-6h (every 4-6 hours)  Provide your information. As the prescriber your name and
o QWK (every week) contact information must also be listed on the prescription.
Include your full name, the address of your medical
WHY PORTION? practice, and the phone number of your medical practice.
 What physicians and medical students commonly miss with  Note that your United States Drug Enforcement
PRN medications is the “reason.” Administration (DEA)number must also be included
 Why would it be needed? You need to add this to the somewhere on the prescription.
prescription. You should write “PRN Headache” or “PRN  In most cases, this information will already be printed on
Pain” so the patient knows when to take it. the prescription form. If it isn’t, however, you will need to
write it manually.
PRESCRIPTION ERRORS  Note the date of the prescription. Some prescriptions must
 Prescription errors can be costly and dangerous, so when be filed within a certain time period. Even when medication
writing a prescription, you need to include all of the being prescribed does not fall into that category, you should
necessary information and explain everything as clearly as still include the date.
possible. Make sure that you write the required identifying
information, inscription, subscription and patient use TIME SENSITIVE DRUGS
instructions. -rated based on schedule categories (3):
 Include at least two patient identifiers. Patient identifiers  Schedule I Drugs – have a high potential for abuse and
are pieces of information used to clarify the identity of the have no legally accepted medical use within the United
patient. In all settings, you must include at least 2 of these States
identifiers.  Schedule II Drugs – have a high potential for abuse but
 Full name and DOB are the 2 most common identifiers. For do not have some legally accepted medical use
prescriptions fulfilled outside of a hospital, the patient’s  Schedule III Drugs – have some potential for abuse and
can be used for some medical purposes

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  Schedule IV Drugs – have a relatively low potential for o Write the medication. You should typically use the generic,
abuse and are legally permitted for some medical non-proprietary name of the drug instead of the name
purposes brand.
 Schedule V Drugs – have an even lower potential for
abuse and are legally permitted for certain medical o Use the name brand of the drug only when you specifically
purposes wish to prescribe the same brand. Keep in mind that doing
so may make the prescription more expensive for the
patient.
o You will need to sign each prescription before it can be
considered valid. Your signature will usually go at the o If you want to prescribe the name brand, you should also
bottom of the form, regardless of whether or not there is a include a note on the prescription reading “No Generics.”
specific line for it there. On most prescription forms, there will be a “Brand Name
Only” or “No Generics” box you have the option of checking
o It is strongly recommended that you write out the rest of this purpose.
the prescription and sign your name last. Doing so prevents
unfinished or blank prescriptions from falling into the wrong o Include the prescription amount. Tell the pharmacist exactly
hands. how much of the medication should be filled and passed to
the patient.
o Display the “Rx” symbol. “Rx” is the symbol for
“superscription.” Write it just before you write out your o This information should usually be preceded by an
instructions for the medication itself. appropriate heading, such as “dispense,” “disp,” “#,” or
“how much.”
o On most prescription forms, the “Rx” is already printed.
o Include the specific bottle size or number of
o Write the inscription information immediately after this tablets/capsules. Spell the numbers out to avoid possible
symbol. The inscription includes all of the information about miscommunication.
the specific drug you want to prescribe.
o Note the number of permitted refills. For medications that
treat a chronic condition or other similar reasons, you may

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 wish to permit a certain number of refills before another o A medication that must be used “daily” or “every other day”
prescription will be required. must be written out in full. Abbreviations for these
frequencies are prohibited.
o Only allow additional refills when the patient will need the
exact same prescription multiple times. FREQUENCY ABBREVIATIONS
 Twice a day (BID)
o For Example, you might wish to prescribe a year’s worth of  Three times a day (TID)
oral contraceptives, yet each fulfilment of the prescription  Four times a day (QID)
might only provide a month’s worth. On the prescription  Every bedtime (QHS)
form, write “Refills 11” to indicate that eleven refills are  Every four hours (Q4H)
permitted after the first fulfilment. After the final refill runs  Every four to six weeks (Q4-6H)
out, the patient will need a new prescription before any  Every week (QWK)
additional medication can be obtained.
o Write when to discontinue use. Most medications must be
o If you do not wish to permit any refills, write ”Refills 0” or taken until the drugs runs out. In some cases, however, the
“Refills none” to indicate as much. Doing so reduces the risk patient should stop taking medication once his or her
of possible tampering. symptoms disappear. You should specifically write which is
the case on the prescription form.
o Specify the route. The route is the method used to take the
medication prescribed. When writing the route, you can o Mention any other special instructions. Occasionally, there
mention the instructions using either the accepted English might be a special instruction that needs to go on the label.
term or the corresponding Latin abbreviation. Let the pharmacist know to include it by specifically writing
the instruction on the prescription form.
o Indicate the frequency. The frequency describes when and Examples include:
how often the medication should be taken. It is strongly 1. “Take with food”
recommended that you write out the frequency in full 2. “Avoid alcohol”
rather than using abbreviated. 3. “Keep refrigerated”
4. “Do not freeze”
5. “For external use only”
6. “Shake before instillation”

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WARNINGS are not listed on the Preferred Drug List will continue to be
 To reduce the risk of tampering or miscommunication, write covered.
prescriptions in ink or inedible pencil. They may also be
typewritten. THE RATIONAL USE OF DRUGS
 Make sure that all prescriptions are written clearly and  Definition: The rational use of drugs requires that patients
legibly to avoid errors in dosage. Some errors can be deadly, receive medications appropriate to their clinical needs, in
so it is crucial that you do what you can to prevent them. needs, in doses that meet their own individual requirements
 Only write a prescription if you are authorized to do so. In for an adequate period of time, and at the lowest cost to
most cases, this means that you must be registered with the them and their community. WHO conference of experts,
DEA or specially exempted from registration. Nairobi 1985.

PREFERRED DRUG LIST RATIONAL DRUG USE

 The Preferred Drug List (PDL0 is a medication list  Define Rational Drug Use (RDU) and describe specific
recommended to the Bureau for Medical Services by the relevance to ART programs.
Medicaid Pharmaceutical and Therapeutics (P&T)  Describe the different types of irrational drug use.
Committee and approved by the Secretary of the  Identify factors that influence use of ARTs.
Department of Health and Human Resources, as authorized  Discuss strategies and interventions that can improve.
by West Virginia Code 9-15-15. The drugs which are  Improve RDU in ART programs.
indicated as “preferred” have been selected for their clinical
significance and overall efficiencies. PHARMACEUTICAL SUPPLY MANAGEMENT
 All Medicaid-covered drugs noted as “non-preferred” will -is managed through an integrated system that includes:
continue to be available through the prior authorization  Product selection
process. Some select preferred drugs may require prior  Procurement
authorization, as noted. A three-day emergency supply of  Distribution
prior-authorized drugs can be dispersed by a pharmacy until  Rational use
authorization is completed.
 Please note: The PDL only addresses certain drug classes. ASPECTS OF IRRATIONAL DRUG USE
Some classes of drugs will not be reviewed for preferential  Diagnosis
agents because of no or limited cost of savings. Therefore,  Inadequate examination of patient
drugs which have historically been covered by Medicaid and  Incomplete communication between patient and doctor

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  Lack of documented medical history WHAT IS THE SIGNIFICANCE OF RATIONAL DRUG USE IN THE ART
 Inadequate laboratory resources CONTEXT
 Fast development of resistance if adherence <90%
PRESCRIBING  Treatment failure likely if adherence <95%
 Extravagant prescribing  High incidence of toxicities
 Over-prescribing  Waste of financial resources
 Incorrect prescribing
 Under-prescribing METHODS OF MEASURING ADHERENCE
 Multiple prescribing/ers  Self-reports
 Pill counts
DISPENSING  Pharmacy records
 Incorrect interpretation of the prescription  Provider estimate
 Retrieval of wrong ingredients  Pill identification test
 Inaccurate counting, compounding or pouring  Biological markers
 Inadequate labelling  Electronic devices
 Unsanitary procedures  Measuring drug levels

PACKAGING
 Poor-quality packaging materials
 Odd package size, which may require repackaging
 Repacking
 Unappealing package

PATIENT ADHERENCE
 Poor labelling
 Inadequate verbal instructions
 Inadequate counselling to encourage adherence
 Inadequate follow-up/support of patients
 Treatments or instructions that do not consider the
patient’s belief’s, environment or culture