PRESCRIPTION WRITING

Nathalie K. Zgheib and Joseph Simaan

References:

- Buxton I.L.O. Appendix I. Principles of prescription order writing and patient compliance in the
pharmacological basis of therapeutics, Goodman and Guilman. Eleventh edition 2011.
- Blaschke T.F. Chapter 26. Writing prescription in Clinical Pharmacology, Mellon and Morrelli.
Fourth edition 2000.
- WHO Guide to good prescribing, a practical manual. Chapter 9: step 4: write a prescription:
http://apps.who.int/medicinedocs/en/d/Jwhozip23e/5.4.html#Jwhozip23e.5.4

What does the prescription represent?

1. It is an important therapeutic transaction between the physician and the patient

2. It is a summary of the physician’s diagnosis of the patient’s illness and the treatment provided
3. It embodies the physician’s instructions for drug intake for palliation or cure
4. It is a medico-legal document

In LEBANON, only licensed physicians by the Ministry of Health and the Lebanese Order of Physicians
are allowed to write and sign a drug prescription. In addition, only certified pharmacists by the Ministry
of Health and the Lebanese Order of Pharmacists are allowed to dispense drugs.

The format of sample prescription contains the following minimum elements:

1. Prescriber’s identification. It is important that the physician provides his or her printed name,
address, and phone number, to facilitate communication with the pharmacist.

2. Date. This is important for record-keeping and because prescriptions for certain drugs are not
valid beyond a specified period.

3. Patient identification. The full name and address and the age or, preferably, the birth date of
the patient. These ensure proper handling and labeling of the medication and identification of
the patient. This information also assists in monitoring for possible dosage errors, especially in
the pediatric or geriatric patient.

4. The superscription. On most blank order forms, this is preprinted using the symbol Rx (recipe, or
“take”). If the superscription is absent, the physician should introduce his or her prescribed drug
with this symbol.
5. The inscription. Immediately below the superscription, this area contains the name, unit dose,
and pharmaceutical form of the drug to be dispensed. Only the officially approved generic name
or brand name should be used. Abbreviations should be avoided because many drug names
have similar spellings and sound alike when spoken. The names of drugs should be capitalized.
When a generic product combination, such as triamterene and hydrochlorothiazide, is
prescribed, the name and amount of each component should be written on separate lines
directly underneath one another. Amounts should always be written in the metric system using
Arabic numerals.

6. The subscription. This consists of the instruction to the pharmacist about the quantity of the
medication to dispense. In principle, the quantity of the medication to be dispensed is based on
the duration of a course of treatment, as estimated by the physician. Higher quantities may be
prescribed in the treatment of chronic illnesses. The mental state of the patient and the
pharmacological effect of the drug may limit the quantity of the prescribed drug to avoid
intoxication, as in instances of elderly patients with depression and suicidal tendency.
Availability of unused drugs must be avoided as this can lead to accidental or suicidal
intoxication. Prescribers may request transferring the medications to a container with a regular
stopper instead of a container with a child-proof stopper if the patient is elderly and unable to
open the special container.

7. The transcription or signa. Signa, abbreviated as “Sig.”, is the Latin for “label”. It is the direction
of the prescriber to the pharmacist to write on the medication all the details as to how the
patient should take the drug, including the dose to be taken, frequency of intake, when and how
to take the drug and the duration of intake, all written in language understood by the patient
and not using any abbreviations. In Lebanon, the expression “Take as directed” should be
reserved for intimate and confidential treatment, particularly in the treatment of certain
gynecological problems, provided adequate instructions are given by the physician to the
patient directly.

8. Refill information. Physicians should consider and indicate their instructions on refills for each
prescription written, even when several prescriptions are written at the same time. Refill
instructions must comply with the local laws. Factors such as suicide risk or abuse potential
must be considered in regard to the quantity of prescription filling.

9. Prescriber signature. The order form should be signed with an indelible pen with the physician’s
name followed by the appropriate professional degree (e.g., MD).

Commonly, physicians use prescription blanks on which their name, address, telephone number,
and the Lebanese Order of Physicians (LOP) registration number are preprinted. Keeping an
exact or carbon copy of each prescription is a must for legal reasons and because many
physicians do not transcribe such details into the patient visit note. Preprinted prescriptions and
prewritten orders for hospitalized patients containing proprietary names and containing blanks
to be filled in should not be used; they fundamentally interfere with the thought processes that
should be a part of every therapeutic decision. However, preprinted forms for complicated
orders or prescriptions, such as for parenteral nutrition or cancer chemotherapy, may greatly
improve prescription accuracy and clarity for both inpatients and outpatients. These however
have to be signed by a licensed physician.

What to do and what not to do in writing prescriptions:

1. The physician’s name and address should be printed on the prescription, for legal reasons,
and for the pharmacist to contact the physician for clarification if the need arises.
2. The patient’s name should be written to avoid dispensing a drug for another patient.
3. The sex, age and weight of the patient should be written to enable the pharmacist to check
the prescribed dose especially when the dose is calculated. This is an important professional
responsibility of the pharmacist.
4. Writing should be legible to avoid misreading. About 750 pairs of drugs look and sound
similar. Confusion between drugs can readily happen if the writing is not legible.
5. No abbreviations for measures, drug names or instructions should be used. Numbers should
be written in words if necessary. Do not start a number with a decimal point. Always start
with a zero followed by a decimal point.
6. Write in ink for clarity and also for legal reasons.
7. Do not prescribe a surplus amount of a drug.
8. Never sign a prescription blank to be filled by an assistant.
9. The instructions for drug intake by the patient should be written in detail and explained to
the patient prior to handing over the prescription.
10. The date is important for legal purpose.
11. Authorization for refilling the prescription should have full justification to avoid possible
adverse consequences.