Marc Imhotep Cray, M.D.
Identify required elements of a prescription (noncontrolled substances). Identify dangerous abbreviations that should be avoided. Identify common prescription writing errors. Demonstrate an ability to write a correct hand written prescription.
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Marc Imhotep Cray, M.D.
Historically, writing prescriptions is not well covered in medical school may be one of reasons for so many medication errors in medicine ? Some commonly quoted statistics include: Medication errors occur in approximately 1 in every 5 doses given in hospitals One error occurs per patient per day 1.3 million people are injured and approx. 7,000 deaths occur each year in U.S. from medication-related errors Drug-related morbidity and mortality is estimated to cost $177 billion in U.S. If there are 800,000 physicians in U.S, each physician accounts for $221,250! 1 reason why malpractice insurance is so expensive? Marc Imhotep Cray, M.D.
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A prescription is an order written by you, the physician (or medical student w signature by a physician) to tell pharmacist what medication you want your pt. to take Basic format of a prescription includes patient’s name and another patient identifier, usually date of birth
It also includes meat of Rx Medication and strength, Amount to be taken, Route by which it is to be taken and Frequency For “as needed” medications, there is a symptom included for when it is to be taken o Prescriber also writes how much should be given, and how many refills o o o o o
Marc Imhotep Cray, M.D.
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Certain elements should be included in every Rx, whether a noncontrolled or controlled substance Basic elements include following:
Date the prescription was written Prescriber identification Patient identification The inscription The subscription Signa Indication Refill information Generic substitution Warnings Container information Prescriber’s signature
Marc Imhotep Cray, M.D.
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Following, we will briefly discuss each of the 11 basic elements of the Rx (as per U.S standards ) listed in the previous slide.
Marc Imhotep Cray, M.D.
In many cases, this is preprinted on a standard prescription form Includes name and title of prescriber and address and telephone number of practice or institution When prescriber is a nonphysician some states in U.S. require supervising physician’s name be printed on Rx form as well
Marc Imhotep Cray, M.D.
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This includes patient’s name, address, age or date of birth, and sometimes, weight Recommended (and in some states required) that you use patient’s legal name instead of a nickname o If you are unsure of pt’s legal name, ask to see a driver’s license or an insurance card if available • This helps avoid confusion & correctly identifies pt.
Date of birth (DOB) is more commonly requested than patient’s age b/c it allows more specific identification When a Rx is written for a pediatric patient, you should include patient’s weight so pharmacist can verify medication has been dosed appropriately Marc Imhotep Cray, M.D.
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This includes name and strength of Medication Generic or trade names may be used Avoid abbreviating names of medications to help reduce possibility of error There are exceptions for well-known medications for example, trimethoprimsulfamethoxazole is commonly abbrev. TMP/SMX Strength= amount per dosing unit, such as a 50 mg tablet or 250 mg per 5 mL
Marc Imhotep Cray, M.D.
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Some meds come in many different strengths and forms (i.e., tablets and liquids) If you are unsure which strengths and forms are available you should consult a prescribing guide, pharmacology text, or medication reference formulary
NB: Strength is not same as total amount to be taken by patient over course of prescription Marc Imhotep Cray, M.D.
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This provides information to pharmacist on dosage form and number of units or doses to dispense Instructions about dosage form may be tablets, capsules, or suspension, for example If a liquid or semiliquid is to be dispensed provide quantity, such as how many milliliters of suspension or how many grams in a tube
Marc Imhotep Cray, M.D.
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Amount dispensed should be amt. needed to complete a course of treatment
For example, if a pt. is to take a tablet twice a day for 10 days subscription, or amount to dispense, would be 20 tablets o You will often see #20 or Disp: 20 tabs either is acceptable
Marc Imhotep Cray, M.D.
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This provides instructions to patient on how to take medication and should be as specific as possible It should include: route any special instructions, such as to take on an empty stomach or with food, and how often to take When medication is Rx on a prn basis reason for taking med. should be included NB: Avoid writing vague or ambiguous instructions, such as take as directed or apply in usual manner Marc Imhotep Cray, M.D.
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Numerous studies have documented pts usually do not remember all information they are given during course of a doctor– patient encounter therefore, it is necessary to provide instructions that are as detailed and accurate as possible to reduce chance medication may be taken inappropriately
Marc Imhotep Cray, M.D.
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Frequency is simply how often you want prescription to be taken This can be anywhere from once a day, once a night, twice a day or even once every other week
Many frequencies start with letter “q” Q if from Latin word quaque which means once So it used to be that if you wanted a medication to be taken once daily, you would write QD, for “once daily” (“d” is from “die,” Latin word for day) However, to help reduce medication errors, QD and QOD (every other day) are on the JCAHO* “do not use” list. Instead you need to write “daily” or “every other day.” *Joint Commission on Accreditation of Healthcare Organizations Marc Imhotep Cray, M.D.
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Common Route Abbreviations: PO (by mouth) PR (per rectum) IM (intramuscular) IV (intravenous) ID (intradermal) IN (intranasal) TP (topical) SL (sublingual) BUCC (buccal) IP (intraperitoneal)
Marc Imhotep Cray, M.D.
Common Frequencies Abbreviations: daily (no abbreviation) every other day (no abbreviation) BID/b.i.d. (Twice a Day) TID/t.id. (Three Times a Day) QID/q.i.d. (Four Times a Day) QHS (Every Bedtime) Q4h (Every 4 hours) Q4-6h (Every 4 to 6 hours) QWK (Every Week)
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U or u (unit) – use “unit” IU (International unit) – use “International Unit” Q.D./QD/q.d./qd – use “daily” Q.O.D./QOD/q.o.d./qod – use “every other day” Trailing zeros (#.0 mg) – use # mg Lack of leading zero (.#) – use 0.# mg MS – use “morphine sulfate” or “magnesium sulfate” MS04 and MgSO4 – use “morphine sulfate” or “magnesium sulfate”
http://www.jointcommission.org/assets/1/18/Do_Not_Use_List.pdf
Marc Imhotep Cray, M.D.
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Including indication for prescription is mandatory in some U.S. states Even when states do not require an indication, Institute for Safe Medication Practices (ISMP) recommends including it for two reasons: First, many drugs have names that look and sound alike Second, illegible writing may cause confusion or misinterpretation
Including indication for prescribed medication provides another safety check for the prescriber, the pharmacist, and the patient Marc Imhotep Cray, M.D.
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This should be included on prescription form & can be written as number of times a prescription may be refilled or a period during which Rx may be refilled Most U.S. states impose a 1-year maximal refill period Pts taking medications for chronic conditions should be assessed at least annually so it is not prudent to write medication refills for more than a 1-year period Marc Imhotep Cray, M.D.
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ď ąMost Rx forms will allow you to indicate whether medication should be dispensed as written (DAW) or if substitution of a generic form of medication is permitted ď ąGeneric medications usually offer considerable cost savings to pt., and with few exceptions, it is preferable to allow substitution Marc Imhotep Cray, M.D.
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Prescription should specify what, if any, warning labels should be attached to medication package or vial
In most cases, pharmacist filling Rx will automatically affix appropriate warnings listed in prescribing information but prescriber should include this information on form This provides another safety check between prescriber and pharmacist Marc Imhotep Cray, M.D.
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Item
Description
Date of Prescription Prescriber’s Information
Name and title, office or institution name, address, and phone number, blank line for DEA number
Patient’s Information
Legal name, age or date of birth, address, weight if necessary
Inscription
Name of drug and strength
Subscription
Information for pharmacist regarding dosage form and number of doses to dispense
Signa
Instructions to patients including route of administration, how often to take, special instructions, or indication for medication
Refill information
Number of refills or length of time prescription may be filled
Generic substitution
Indicate if a generic form is permissible or if medication is to be dispensed as written
Warnings
What adverse effects may be caused by medication, such as drowsiness, feeling shaky, etc.
Container information
Use of childproof containers is required unless specifically indicated to use non-childproof container
Provider’s signature and title Marc Imhotep Cray, M.D.
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From http://medicalschoolhq.net/prescription-writing-101/ Marc Imhotep Cray, M.D.
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This example is a common medication prescribed when people are leaving the hospital. It is one 100 mg tablet, taken at bedtime. The Rx is for 30 pills and no refills. Zofran is a anti-nausea medication used after surgery You’ll notice this script is missing “amount” IV medications are a little different in that amt and strength are kind of mixed together an “as needed” or “PRN” medication. When the patient complains of nausea, the nurse can give Marc Imhotep Cray, M.D.
From http://medicalschoolhq.net/prescription-writing-101/ 24
This example shows a common way to write prescriptions for liquids, especially for children • Obviously “liquid” isn’t the med, but you get idea Liquids come in specific strengths per amount of liquid Here, strength is 10 mg per 5 mL We only want to give 5 mg though, so the “amount” that we prescribe is only 2.5 mL per dose It’s given by mouth every 4 hours We are dispensing “1 (one) bottle” You could also just write “1 (one)” as pharmacist would know what you meant
Marc Imhotep Cray, M.D.
From http://medicalschoolhq.net/prescription-writing-101/
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THE END
See next slide for companion learning tools.
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Prescription Writing 101 notes.pdf Medicines Prescription, Prescribing, Dispensing, and Counseling notes.pdf (Specific to Ethiopia) ETHIOPIAN MEDICINES FORMULARY 2nd Ed. 2013. Addis Ababa, Ethiopia. Medicines: Good Prescribing Practices (GPP)� Manual 2012 Edition. The Food, Medicine and Health Care Administration and Control Authority (FMHACA) of Ethiopia.
Marc Imhotep Cray, M.D.
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