How to read prescription how to read doctor prescription

In this presentation I have tell that what is doctor prescription
How to read doctor prescription
Types of prescription
History of prescription
Prescription Drugs
Who can write RX
Prescription Format
•Heading
•Body
•Closing
Contents of prescription(RX)
Example of prescription
Selection
List of dangerous abbreviations, acronyms and symbols

1. Principles of Prescription WritingPrinciples of Prescription Writing
Dr Sanjeewani FonsekaDr Sanjeewani Fonseka
Department of PharmacologyDepartment of Pharmacology

2. HistoryHistory

Prescriptions have Prescriptions have
been in use since been in use since
ancient timesancient times

Latin adopted as Latin adopted as
standard standard
languagelanguage

““Rx” = Rx” =
prescriptionprescription

3. Prescription drugPrescription drug

drug that requires a prescription drug that requires a prescription
because it is considered because it is considered
potentially harmful if not used potentially harmful if not used
under the supervision of a under the supervision of a
licensed health care practitionerlicensed health care practitioner

4. DefinitionDefinition
A prescription is a A prescription is a
written, verbal, or written, verbal, or
electronic order electronic order
from a from a practitionerpractitioner
or designated agent or designated agent
to a pharmacistto a pharmacist for for
a a particular particular
medication for a medication for a
specific patientspecific patient. .

5. Writing PrescriptionsWriting Prescriptions
Who can write a Rx?Who can write a Rx?

Practitioners Practitioners

Physicians, veterinarians, dentistsPhysicians, veterinarians, dentists

6. Prescription FormattingPrescription Formatting

HeadingHeading

BodyBody

Closing Closing

7. Current Prescription Current Prescription
FormattingFormatting

HeadingHeading

BodyBody

Closing Closing

8. Current Prescription Current Prescription
FormattingFormatting

HeadingHeading

Name, address, and telephone Name, address, and telephone
number of the prescribernumber of the prescriber

Name, sex and age of the Name, sex and age of the
patientpatient

Date of the prescriptionDate of the prescription
3

9. Contents of the PrescriptionContents of the Prescription

Patient Name and AddressPatient Name and Address

Full first and last nameFull first and last name

Middle initial may be helpfulMiddle initial may be helpful

DOB – not required, but will be helpful in DOB – not required, but will be helpful in
further identifying the correct patient to further identifying the correct patient to
prevent medication errorsprevent medication errors

10. Contents of the PrescriptionContents of the Prescription

Practitioner’s Name, Address, and Phone Practitioner’s Name, Address, and Phone
numbernumber

Validates prescriptionValidates prescription

Provides contact information to clarify Provides contact information to clarify
any questionsany questions

11. Contents of the PrescriptionContents of the Prescription

Date Date

Date the prescription is issued or Date the prescription is issued or
writtenwritten

Allows the determination of the life Allows the determination of the life
of the prescription to validate refillsof the prescription to validate refills

Ensures continual patient Ensures continual patient
supervisionsupervision

Promotes patient follow - upPromotes patient follow - up

13. Current Prescription Current Prescription
FormattingFormatting

HeadingHeading

BodyBody

Closing Closing

14. Current Prescription Current Prescription
FormattingFormatting

BodyBody
The The RR
xx symbol symbol

Name Name

dose size or concentration dose size or concentration
(liquids) of the drug(liquids) of the drug

Amount to be dispensedAmount to be dispensed

Directions to the patientDirections to the patient
4

15. Contents of the PrescriptionContents of the Prescription

Selecting the drugSelecting the drug

Medication AllergiesMedication Allergies

AvailabilityAvailability

CostCost

16. Contents of the PrescriptionContents of the Prescription

Name of the drugName of the drug

Multiple drugs per prescription can add to Multiple drugs per prescription can add to
confusionconfusion

KEEP IT SIMPLEKEEP IT SIMPLE

17. Contents of the PrescriptionContents of the Prescription

Name of the drug -Name of the drug - CAUTION: CAUTION:
Look Alike/Sound Alike drug names Look Alike/Sound Alike drug names

Massive number of new drug releasesMassive number of new drug releases

Massive number of reformulationsMassive number of reformulations

Drug marketing strategy Drug marketing strategy

Build on established namesBuild on established names

New combination drugs – Use converged New combination drugs – Use converged
namesnames

18. Contents of the PrescriptionContents of the Prescription

Name of the drugName of the drug
AVOID THE USE OF:AVOID THE USE OF:

AbbreviationsAbbreviations

Many drugs identified with Many drugs identified with
abbreviationsabbreviations

EX: HCT for hydrochlorothiazide, EX: HCT for hydrochlorothiazide,
MSO4 for morphine sulfateMSO4 for morphine sulfate

Attempts to standardize abbreviations Attempts to standardize abbreviations
have been unsuccessfulhave been unsuccessful

19. AbbreviationAbbreviation Potential ProblemPotential Problem Preferred TermPreferred Term
U (unit)U (unit) Mistaken as zero, fourMistaken as zero, four Write “unit”Write “unit”
IU (international unit)IU (international unit)Mistaken as IV or 10Mistaken as IV or 10 Write “international unit”Write “international unit”
Q.D., Q.O.D.Q.D., Q.O.D. Mistaken for each other. Mistaken for each other.
Period after Q and O after Q Period after Q and O after Q
can be mistaken for “I”can be mistaken for “I”
Write “daily” and “every Write “daily” and “every
other day”other day”
MS, MSO4, MgSO4MS, MSO4, MgSO4 Confused for one anotherConfused for one another Write “morphine sulfate” or Write “morphine sulfate” or
“magnesium sulfate”“magnesium sulfate”
List of dangerous abbreviations, acronyms, and symbols

20. 
Tablets Tablets - tab - tab

CapsuleCapsule– cap – cap

Syrup Syrup – syr – syr

Suspension – susp Suspension – susp

Injection Injection – Inj– Inj

Metered dose inhaler – as such Metered dose inhaler – as such

Lotion – as such Lotion – as such

21. Contents of the PrescriptionContents of the Prescription

Strength of the drugStrength of the drug

Be familiar with drugs and their Be familiar with drugs and their
various dosing strengths and various dosing strengths and
dosage forms dosage forms

When in doubt, use referencesWhen in doubt, use references

22. Dosing cont;Dosing cont;

Weight – based dosing Weight – based dosing

Always convert patient weight to correct units (kg)Always convert patient weight to correct units (kg)

Liquid medicationsLiquid medications

One product may be available in a number of One product may be available in a number of
concentrationsconcentrations

Be familiar with various product concentrationsBe familiar with various product concentrations

Indicate BOTH concentration and dose of Indicate BOTH concentration and dose of
medicationmedication

Example: Cephalexin suspension 125 mg/ 5 ml Example: Cephalexin suspension 125 mg/ 5 ml

1 teaspoon/ every 8 h1 teaspoon/ every 8 h

23. Contents of the PrescriptionContents of the Prescription

Strength of the drugStrength of the drug

Decimal pointsDecimal points

Avoid trailing zeros. Avoid trailing zeros.
EX. 5 mg vs. 5.0 mg; can be mistaken EX. 5 mg vs. 5.0 mg; can be mistaken
for 50 mg for 50 mg

Always use leading zeros.Always use leading zeros.
EX. 0.8 ml vs. .8 ml; can be mistaken EX. 0.8 ml vs. .8 ml; can be mistaken
for 8 mlfor 8 ml

24. Contents of the PrescriptionContents of the Prescription

Quantity of the drugQuantity of the drug

Prescribe only necessary quantityPrescribe only necessary quantity

Write for specific quantities rather than time Write for specific quantities rather than time
period (for example: dispense #30 vs. period (for example: dispense #30 vs.
dispense for 1 month)dispense for 1 month)

Calculate: quantity = frequency per day x Calculate: quantity = frequency per day x
treatment daystreatment days

Writing out “Dispense # X” is helpfulWriting out “Dispense # X” is helpful

25. Rules for writing quantity of Rules for writing quantity of
drug:drug:

Quantities of 1 gram or more should be Quantities of 1 gram or more should be
written in grams. written in grams.

Ex - write 2 g.Ex - write 2 g.

Quantities less than 1 gram but more than Quantities less than 1 gram but more than
1 milligram should be written in Milligrams 1 milligram should be written in Milligrams
For eg, write 100 mg, not 0.1 gFor eg, write 100 mg, not 0.1 g

26. 
Quantities less than 1 milligram Quantities less than 1 milligram should be should be
written in micro / nano gram as appropriate.written in micro / nano gram as appropriate.

DO NOT abbreviate micro/ nanograms; DO NOT abbreviate micro/ nanograms;
since that can lead to Prescribing errors. For since that can lead to Prescribing errors. For
eg. write eg. write 100 micrograms100 micrograms, not 0.1 mg, nor , not 0.1 mg, nor
100 mcg, nor 100 μg100 mcg, nor 100 μg

Use ml or mL for millilitersUse ml or mL for milliliters

27. 
For some drugs, a maximum dose may need to For some drugs, a maximum dose may need to
be stated ( for eg. ergotamine in migraine & be stated ( for eg. ergotamine in migraine &
colchicine in gout).colchicine in gout).


Eg: Eg: Ergotamine 1 mg at onset of attack & repeat Ergotamine 1 mg at onset of attack & repeat
every 30 min if necessary . Do not take more than every 30 min if necessary . Do not take more than
6 mg in one day or more than 12mg in one week6 mg in one day or more than 12mg in one week

28. Contents of the PrescriptionContents of the Prescription

Directions for useDirections for use

Write out in full English or use Latin Write out in full English or use Latin
abbreviations abbreviations

Latin abbreviations – more convenient, more Latin abbreviations – more convenient, more
potential for mistakes potential for mistakes

Avoid Dangerous Abbreviations Avoid Dangerous Abbreviations

Provide clear and specific directionsProvide clear and specific directions

29. 
Should be clearly indicatedShould be clearly indicated
Atenolol 100mg once daily Atenolol 100mg once daily
Amoxicillin 250mg t.d.s.Amoxicillin 250mg t.d.s.

- Tell the patient what you mean be these - Tell the patient what you mean be these
times a day/ four times a day!times a day/ four times a day!

31. Contents of the PrescriptionContents of the Prescription

Determine preference for brand or generic Determine preference for brand or generic
productproduct

Brand vs. genericBrand vs. generic

Is Brand always better? Is Brand always better? NONO

If practitioner prefers brand, must indicate If practitioner prefers brand, must indicate
in print, - in print, - do not substitute do not substitute

32. Sample Prescription-Sample Prescription-

33. Contents of the PrescriptionContents of the Prescription

IndicationIndication

Encouraged, seldom practicedEncouraged, seldom practiced

Helps confirm appropriateness of Helps confirm appropriateness of
medicationmedication

Reminds patient of drug’s purposeReminds patient of drug’s purpose

Facilitates communication between Facilitates communication between
health care providershealth care providers

34. Prescription FormattingPrescription Formatting

HeadingHeading

BodyBody

Closing Closing

35. Current Prescription Current Prescription
FormattingFormatting

ClosingClosing

Prescriber’s signaturePrescriber’s signature

Refill instructionsRefill instructions

Generic substitution Generic substitution
instructionsinstructions
5

36. Contents of the PrescriptionContents of the Prescription

RefillsRefills

To avoid interrupting To avoid interrupting
maintenance therapy, maintenance therapy,
practitioners can authorize refills practitioners can authorize refills
on a written prescriptionon a written prescription

Refills authorized are valid only Refills authorized are valid only
for life of the prescription – 1 yearfor life of the prescription – 1 year

37. Controlled SubstancesControlled Substances

Definition - a prescription drug Definition - a prescription drug
whose use and distribution is whose use and distribution is
tightly controlled because of its tightly controlled because of its
abuse potential or riskabuse potential or risk

Regulation is more strictRegulation is more strict

38. Prescription for controlled drugs must(e.g.morphine)
1.Be completely written in the prescriber’s hand
writing in ink
2. Be signed & dated
3.Carry the prescribers’ address
4.Carry the name & address of the patient
5. State the form of the drug
6.State the total quantity of the drug or the number
of dose units to be disposed in both words &
figures
7.State the exact size of each dose in both words &
figure.

39. CASE #1CASE #1
Poor handwriting contributed to a medication dispensing error
that resulted in a patient with depression receiving the antianxiety
agent Buspar 10 mg instead of Prozac 10 mg

40. CASE #2CASE #2
A hypertensive patient accidentally received Vantin 200 mg
instead of Vasotec 20 mg when a pharmacist misread this
prescription

41. 
SUMMARY SUMMARY

42. MAXIMIZE PATIENT SAFETYMAXIMIZE PATIENT SAFETY

ALWAYS ALWAYS write legibly.write legibly.

ALWAYS ALWAYS space out words and numbers to space out words and numbers to
avoid confusion.avoid confusion.

ALWAYSALWAYS complete medication orders. complete medication orders.

AVOID AVOID abbreviations.abbreviations.

When in doubt, ask to verify.When in doubt, ask to verify.

43. Contents of the PrescriptionContents of the Prescription

Date of the orderDate of the order

Patient Name and AddressPatient Name and Address

Name of the drugName of the drug

Strength of the drugStrength of the drug

Quantity of the drugQuantity of the drug

Directions for useDirections for use

Practitioner Name, Address, Telephone Practitioner Name, Address, Telephone
number number

44. Model Prescription
1)Name: ABC 2) Date: 31.07.07
3) Age: 70yrs. 4) Sex: male
Diagnosis: Idiopathic Parkinsonism
R
x
9) Tab Levodopa 100mg
Tab Carbidopa 25mg
2 tablets by mouth 3 times daily for one month .
Take with food.

Dr. Sathya MD
Assistant Prof. Neurology,
Reg. No. 34523