Prescription

Asma Ghulam Mustafa

 Prescription
• Prescription is an order written by a physician, dentist or any other registered medical practitioner to
a pharmacist to compound and dispense a specific medication for the patient. The order is
accompanied by directions for the pharmacist that what type of preparation is to be prepared and
how much is to be prepared. It is also accompanied with the directions for the patient that how much
medicament is to be taken, how many times it is to be taken or at what time and how it is to be taken.
• The prescription provides a common link of mutual interest between the physician, the pharmacist
and the parient. It is the duty of the pharmacist to serve the medication needs of the patient
according to the intention of the prescriber. It is not sufficient that the pharmacist should only
compound the specific medication but he should make the patient understand about the proper
administration of the drug and ensure that the patient sticks to these instructions. At the same time
the pharmacist must maintain and respect the confidentiality of both the physician regarding the
treatment given as well as that of the patient regarding the nature of his illness and the medication
taken by him.
• The prescriptions are generally written in the language of the area in which they originate but Latin
words are frequently used in the prescription writing because in the olden days the medicines were
written in Latin language which was understood all over the world. Still the use of Latin
abbreviations in the prescription writing is very common specially in dosage instructions.
 Parts of Prescription
A complete prescription should have the following parts:
• Date
• Name, age, sex and address of the patient
• Superscription
• Inscription
• Subscription
• Signatura
• Signature, address and registration number of prescriber.
 Date
• Date must be written on the prescription by the prescriber at the
same time when it is written. The date on the prescription helps a
pharmacist to find out the cases where prescription is brought for
dispensing long time after its issue.
• Prescriptions containing narcotics or other habit-forming drugs
must bear the date. The prescriptions should be filled within a
reasonable time after it is written.
• If the prescription is brought for filling after two or three days
from the date when it was written than the pharmacist must
question if the intention of the prescriber and the needs of the
patient can still be met.
Name, Age, Sex, and Address of
the Patient
• Name, age, sex, and address of the patient must be written on the
prescription. If it is not written then the pharmacist himself should ask the
patient about these particulars and put down at the top of the prescription.
This avoids the possibility of giving the finished product to a person other
than the one it is meant for. Patient’s full name must be written instead of
surname or the family name.
• Age and sex of the patient specially in the case of children helps the
pharmacist in checking the medication and the dose. Therefore there will
be less danger of its being administered to the wrong member of the
family or the hospital ward having similar names.
• The address of the patient is recorded to help for any reference at a later
stage, to contact the patient or to deliver the medication personally.
 Superscription
• The superscription is represented by a
symbol “Rx” which is always written at
the beginning of the prescription.
• In the days of mythology and superstition
the symbol was considered as a prayer to
Jupiter, the God of healing, for quick
recovery of the patient but now this
symbol is understood as an abbreviation
of the Latin word recipe, meaning “take
thou” or “you take”.
 Inscription
• This is the main part of the prescription. It contains the names and quantities
of the prescribed ingredients. The names of the ingredients are written each
on a separate line, followed by the quantity ordered and the last item written
is generally the vehicle or diluent.
• In complex prescriptions containing several ingredients, the inscription is
divided into three parts:-
1. the base or the active medicament which is intended to produce the
therapeutic effect;
2. the adjuvant which is included either to enhance the action of the
medicament to make the product more palatable
3. the Vehicle which is either used to dissolve the solid substances and/or to
Increase the volume of the preparation for ease of administration.
 Inscription
Nowadays only a few prescriptions are compounded by
pharmacists. A majority of adjuvant prescriptions are
written for medications already prepared into dosage forms
by industrial manufacturers. The pharmacists are only
required to dispense the ready-made dosage form of drugs
which has eliminated the compounding of prescriptions.
 Subscription
This part of the prescription contains prescriber’s directions
to the pharmacist regarding the dosage form to be prepared
and number of doses to be dispensed. Since now-a-days only
a few prescriptions are compounded therefore such
directions are less frequent.
 Signatura
• It is usually abbreviated as “Sig” on the prescriptions and
consists of the directions to be given to the patient
regarding the administration of the drug.
• It usually indicates the quantity of medicament or number
or dosage units to be taken, how many times in a day or at
what time it should be taken and the manner in which it is
to be administered or applied.
• These instructions must be transferred to the label of the
container in which the medicament is to be dispensed and
ensure that the patient follows these instructions
carefully.
Signature, Address and Registration
Number of the Prescriber
• All other parts of the prescription may be printed or type-
written but the prescriber’s name must be hand-written
and should be signed with ink.
• This eliminates the danger of dispensing medicament on a
spurious order and it authenticates the prescription.
• The prescriptions containing narcotic or other habit-
forming drugs must bear the address and registration
number of the prescriber. This identifies the special
license which a prescriber must have to prescribe the
narcotic and other habit-forming drugs.
 Understanding the
prescription or
medication order and
evaluating its
appropriateness
 Understanding the order
A complete understanding of all information in a prescription or medication
order is required. Each piece of information should be appropriate and
consistent with the remaining information (i.e., the instructions for use should
be appropriate for the medication being ordered). The pharmacist should
determine the prescriber’s intent by interpreting the following information:
1. The name and address of both the patient and the prescriber
2. The patient’s disease or condition requiring treatment
3. The reason the order is indicated, relative to the medical need of the
patient (e.g., an antibacterial for an infection)
4. The name of the product, the quantity prescribed, and instructions for use
5. All terminology, including units of measure and Latin abbreviations.
 Evaluating the
appropriateness
Complete information is required on the prescription or medication order to allow
the pharmacist to evaluate the appropriateness. When the order is incomplete,
the pharmacist must obtain the required information from either the patient or
the prescriber. The following should be considered during an evaluation:
1. The patient’s disease or condition requiring treatment
2. The patient’s allergies or hypersensitivities
3. The pharmacological or biological action of the prescribed product
4. The prescribed route of administration
5. Whether the prescribed product might result in a drug–drug, drug–disease, or
drug–food interaction
 Evaluating the
appropriateness
6. Whether the dose, dosage form, and dosage regimen are safe and likely
to meet the needs of the patient
7. Whether the patient will have any difficulties adhering to the regimen
and the potential impact on the therapeutic outcome desired
8. Whether the total quantity of medication prescribed is sufficient to allow
proper completion of a course of therapy
9. Whether a physical or chemical incompatibility might result (i.e., if the
product requires extemporaneous compounding)
10.Whether a licensed practitioner, acting in the course and scope of
practice, issued the prescription in good faith, for a legitimate medical
purpose
 Discovering inappropriate
prescriptions or medication orders
Pharmacists are required to review medication profiles to ensure the
appropriateness of prescribed medications. This is commonly called drug utilization
review (DUR). Pharmacists should not fill or process prescriptions or medication
orders that they have concerns with or that are considered inappropriate but,
rather, should contact the prescriber. The process of calling a prescriber to discuss
concerns identified during a DUR is commonly called therapeutic intervention.
1. When performing a therapeutic intervention, the following information should
be provided:
a) A brief description of the problem
b) A reference source that documents the problem
c) A description of the clinical significance of the problem
d) A suggestion of a solution to the problem
 Discovering inappropriate
prescriptions or medication orders
2. Documentation of the results of a therapeutic intervention is required
if the prescription or medication order is changed. The name of the
prescriber, date of communication, issues discussed, and resolution
should be included in the documentation. This information should be
kept for the same period as the prescription or medication order.
3. If the pharmacist feels that, in his or her professional judgment, an
order is inappropriate and could harm the patient, the pharmacist
should not process the order. The pharmacist may also be required to
explain the situation to the patient. If, after a therapeutic intervention,
the pharmacist believes the order is still inappropriate, the guidelines
of the institution and professional judgment should be followed.
 Processing
prescriptions and
medication orders
 Processing prescriptions and
medication orders
An environment that limits distractions and disruptions will assist in
increasing the accuracy of this process. Automation and the use of
pharmacy technicians allow the pharmacist to oversee these
functions. The time saved allows the pharmacist greater time for
patient-focused activities, such as counseling and patient education.
1. The following information should be recorded on the prescription:
a) The prescription number (for initial filling)
b) The original date of filling
c) The product and quantity dispensed
d) The pharmacist’s initials
 Processing prescriptions and
medication orders
2. Product selection. Generic substitution statutes, as well as
formulary and therapeutic substitution policies, might provide
direction in product selection.
3. Product preparation for use by the patient. The following might
be necessary:
a) Obtaining the proper amount of medication to be dispensed
b) Reconstitution (the addition of liquid to make a solution or suspension)
c) Extemporaneous compounding
4. Assembly of the medication delivery unit. Selection of the proper
package or container is required to ensure product stability, to
promote patient compliance, and to comply with legal requirements.
 Processing prescriptions and
medication orders
5. Labeling the prescribed product. The prescription label typically contains the following information:
a) Name and address of the pharmacy
b) Patient’s name
c) Original date of filling
d) Prescription number
e) Directions for use
f) Product’s brand name or generic name and manufacturer
g) Product strength (if available in more than one strength)
h) Quantity of medication dispensed
i) Prescriber’s name
j) Expiration date of the medication
6. Unit-dose packages contain one dose or one unit of medication. For a medication order that is dispensed in
unit-dose packages, the label should identify the product’s brand or generic name, strength, lot number, and
expiration date.
7. Auxiliary and cautionary labels ensure proper medication use, storage, and compliance and reinforce
information provided during counseling.
 Record keeping and
confidentiality
The pharmacist is required to maintain prescription files and records in accordance with standards of sound
practice and statutory requirements. The implementation of the Healthcare Insurance Portability and
Accountability Act (HIPAA) has put additional requirements on all health professionals who have access to health
information. State prescription monitoring programs may require pharmacists to collect and provide information
regarding the use of controlled substances. A patient profile contains patient demographic information and a
complete chronological record of all medication use and services provided in the delivery of pharmaceutical care.
1. The patient profile should contain the following patient information:
a) Patient’s name
b) Patient’s address (or room number in institutional settings)
c) Any known allergies, sensitivities, or history of idiosyncratic reactions to previous medications
d) Birth date (i.e., to assess the appropriateness of the dose)
e) Clinical condition(s) (to help assess the appropriateness of the medication and to prevent drug–disease
interactions)
f) Weight (to assess the appropriateness of the dose)
g) Nonprescription medication use (to prevent drug interactions, to assess medication effectiveness, and to detect
possible adverse effects)
 Record keeping and
confidentiality
2. In addition, the patient profile should contain the following information from
each prescription or medication order:
a) Name of the medication
b) Medication strength
c) Dosage form
d) Quantity dispensed
e) Directions for use
f) Prescription number
g) Dispensing date
h) Number of refills authorized and remaining
i) Prescriber’s name
j) Pharmacist’s initials
 Dispensing medication and
counseling
• The dispensing of medication requires that the pharmacist verify that patients
have the necessary knowledge and ability to adhere to the prescribed
treatment. This will increase the likelihood of obtaining the desired outcomes.
• Counseling patients. The pharmacist should evaluate the patient’s
understanding of each medication and supply additional information when the
patient’s information is incorrect or insufficient. The pharmacist may need to
advise patients regarding the proper dosage, appearance, and name of the
medication. Information about the route of administration, instructions for
use, duration of use, and the reason the product was prescribed may also be
needed. In addition, the following topics might also be appropriate:
 Dispensing medication and
counseling
• Special procedures. As appropriate, the pharmacist should advise patients how to
take the medication (e.g., on an empty stomach, with plenty of water) and on foods
to avoid while taking the medication (e.g., alcoholic beverages, dairy products)
• Potential side effects. The pharmacist should ensure that patients are aware of
the possible side effects associated with a medication. Patients should understand
the following:
a) The frequency of side effect. This will help patients recognize common side
effects and not be overly concerned with those that are rare.
b) The severity of side effect. This will help patients focus on those side effects
that are severe and not those that are inconsequential.
c) What action should be taken to manage or minimize the side effect. This
will help patients deal with possible side effects in the appropriate manner
 Dispensing medication and
counseling
• Proper storage. The pharmacist should counsel patients
on how to store medications properly to ensure stability
and potency.
• Over-the-counter (OTC) products. The pharmacist
should instruct patients about the use of OTC products
that may not be appropriate when taking a prescribed
product.