Prescriptions Medication orders

A prescription is an order for a medicine or medicines usually written as a formula by a physician, a dentist, a veterinarian or some other licensed health science practitioner legally entitled to prescribe. It contains the names and the quantities of the desired substances, with instructions to the pharmacist for the preparation of the medicine and to the patient for the use of the medicine at a particular time. Medication orders:- In hospitals and other institutions

The instructions are written by ink

I. Simple Prescription: It is the prescription in which the inscription consists single component . Not required compounding.

only

II. Compound prescription: The inscription of a typical compound prescription may contain more than single. Required compounding Quantity of each ingredient required The substances in prescription may be: chemical or generic nametrademark name Examples: trade name Lipitor tab---- generic drug Amoxicillin

Parts of the prescriptions

1- prescriber information 2- Patient information 3- The date of prescription must be written. 4- () Symbol (The superscription) meaning take thou, you take, or recipe 5- Medication prescribed (the inscription) including : a- The name of the medication which can be written denoting either the chemical or nonproprietary (generic) name of the substance or the manufacturer's brand or trademark name b- The dosage or strength of the medication. Special Note: the pharmacist is required to dispense exactly what the doctor has written, unless the doctor provides instructions otherwise.

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Dispencing instructions to the pharmacist (The subscription) including the amount or quantity of medication to be dispersed. Directions to the patient (the signa). The abbreviation "Sig" is Latin for "label". The directions for taking the medication are provided here. Those directions may include instructions to take before meals, with food, at bedtime, on an empty stomach, or with plenty of water. Special instructions .The physician will denote the number of times that a prescription can be refilled.

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Special notes

Prescription for infant, child or an elderly person may include the age, weight and or body surface area calculation of the dose For example.
Mary M. Brown, M.D. Pediatric clinic Libertyville, Maryland Phone 456-1234 Patient's Name: Suzie Smith Address: 123 Broad street R/ Age: 5 weight 39 Ib Date: Jan 9, 20yy

Omnicef oral suspension 125 mg/5 ml disp 100 ml Give14 mg/kg/dayx10 days Sig: tsp q 12 h

Refill time Label: yesNo. Generic if avilable: Yes.No 1JM Brown, M.D Dea No. MB 55555555 State licnense No.65432

John M. Brown, M.D. 100 Main Street Libertyville, Maryland Phone 123-4567 Patients Name: ........................... Address: ....................... R/ Date:. Age: .............................

Chloral hydrate 8 g Sodium bromide 10 g Syrup of Raspberry 22.5 ml Water to 60 ml Fiat Mixture Sig.: 4ml. every 4 hours
Refill time Label: yesNo. Generic if avilable: Yes.No 1JM Brown, M.D Dea No. 1234563

To prevent the unauthorized copying, or modification or counterfeiting of prescription Tamper-Resistant prescription Pads has been developed It is used for hand-written prescriptions for outpatient drugs covered by medicaid TRPP security paper, erase-resistant paper, thermochromatic ink (on photocopies appearance of the word VOID)

The use of electronic means for the generation and transmission of prescriptions is used and accepted in some countries. In the inpatient or outpatient setting, a medication order, for a patient is entered into an automated data entry system as a personal computer (PC) or a hand-held device loaded with software and sent to a pharmacy as an e-prescription. When received, a pharmacist immediately reduces the order to a hard copy and/or stores it as a computer file.

Advantages of this system Reduction of the error to the prescription illegibility Induction of the screen soft ware for the drug interaction Reduction the incidence of altered or forged prescription Efficiency for the prescriber and pharmacist Convenience to the patient pick up arrival the pharmacy

Doses: total number of the doses prescribed and the number of days Compliance: the patient compliance in meeting prescribed directions for dosing Drug concentration: the quantity of active ingredient to use to achieve the desired concentration Rate of the drug administration: the quantity of the drug administered per unit time (mg/min, drop/min or ml/hr for intravenous fluid) Compounding: the quantities of active and inactive components to use for the preparation of the a pharmaceutical product Chemical-physical factors: to make isotonic, isoosmotic or buffered solution Pharmacoeconomic: medication cost,

It is responsibility of the pharmacist to ensure that each prescription received is correct in its form and content Patient administration accurately Each medatication should be: Therapeutically appropriate for the patient Correct dose Dispensing in the correct strength and dosage form Labeling with complete instructions Inpatient: medication for correct patient, correct time rate and route of administration

To ensure such accuracy, the pharmacist is obliged to review each prescription and medication order in a step-by-step manner to detect errors of omission and commission. This is termed a search for errors and omissions.
Error: e.g. Drug name incorrect. Omission: e.g. Directions incomplete.

Among the items that the pharmacist should check for the correct reading and interpretation of a prescription or medication order are: 1. prescriber information, including address and telephone number, license number and signature;
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date of the order and its currency to the request for filling; patient information, including dose-relevant information, such as the age and/or weight of the patient if the dose of the drug is so based; drug prescribed, including dose, preparation strength, dosage form, and quantity;

2.

3.

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clarity of any abbreviations, symbols, and/or units of measure; clarity and completeness of directions for use by the patient or caregiver; refill and/or generic substitution authorization; need for special labeling, such as expiration date, conditions for storage, and foods and/or other medications not to take concomitantly; and

3. 4.

5.

a listing of the ingredients and quantities for orders to be compounded; calculations performed should be checked and double-checked.

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2.

3. 4. 5.

Among the specific recommendations to help reduce medication errors arising from poorly written, illegible, or misinterpreted prescriptions and medication orders are the following: A whole number should be shown without a decimal point and without a terminal zero (e.g., express 4 milligrams as 4 mg and not as 4.0 mg). A quantity smaller than one should be shown with a zero preceding the decimal point (e.g., express two tenths of a milligram as 0.2 mg and not as .2 mg). Leave a space between a number and the unit (e.g., 10 mg and not 10mg). Use whole numbers when possible and not equivalent decimal fractions (e.g., use 100 mg and not 0.1 g). Use the full names of drugs and not abbreviations (e.g., use phenobarbital and not PB).

6. Use USP designations for units of measure (e.g., for grams, use g and not Gm or gms; for milligrams, use mg and not mgs or mgm). 7. Spell out units (e.g., use 100 units and not 100 u or 100 U since an illegible U may be misread as a zero, resulting in a 10-fold error, i.e., 1000). The abbreviation I.U., which stands for International Units, should also be spelled out so it is not interpreted as I.V., meaning intravenous. 8- Certain abbreviations that could be mistaken for other abbreviations should be written out (e.g., write right eye or left eye rather than use o.d. or o.l., and spell out right ear and left ear rather than use a.d. or a.l.). 9. Spell out every day rather than use q.d.; every other day, rather than q.o.d; and four times a day, rather than q.i.d to avoid misinterpretation.

10. Avoid using d for day or dose because of the profound difference between terms, as in mg/kg/day versus mg/kg/dose. 11. Integrate capital or tall man letters to distinguish between look alike drug names, such as AggreSTAT and AggreNOX; hydrOXYZINE and hydrALAZINE; and DIGoxin and DESoxyn. 12. Amplify the prescriber's directions on the prescription label when needed for clarity (e.g., use Swallow one (1) capsule with water in the morning rather than one cap in a.m.).

Abbreviations, Acronyms, and Symbols used in prescription

Gtt. ii each eye q. 4 h. p.r.n. Pain Instill 2 drops in each eye every four hours (4) as needed for pain