Prescription & Hadling of Prescription.pptx

Prescription & Hadling of Prescription.pptx

1. Prescription and Prescription Handling D r.Dheeraj D Chechare Assistant Professor PRES's College of Pharmacy ( D&B.Pharm ) Nashik .

2. Prescription is a direct link between physician, pharmacist & patient. Prescription is accompanied by direction for pharmacist and for patient. Prescription is an written order by a physician , dentist or any other medical practitioner to the pharmacist to compound & dispense a specific type of medication for individual patient . Introduction

3. Parts of Prescription Date Name, Age, Sex & Address of the patient Superscription Inscription Subscription Signatura Renewal Instructions Signature, address & registration number of the prescriber.

4. 1) Date: It helps a pharmacist to find out the date of prescribing & date of presentation for filling the prescription. It helps the pharmacist in redispensing a medicine and to guide patient . 2) Name, Age, Sex & Address of the patient: It helps to id e n tify the p r esc r i p t i o n . Especially in case of children Age & sex of the p a t i e n t h e l p s th e pharmac i s t t o check the prescriber dose of medication.

5. 3) Superscription : It is represented by symbol Rx. Rx is the abbreviation of Latin word recipe, meaning ‘You Take’. In olden days, the symbol was considered from the sign of Jupiter, God of healing.

6. 4) Inscription: It is main part of prescription . It contain the name and quantity of prescribed ingredients & It also contain manner in which medicine should be taken. The name of ingredients are generally written in English but common abbreviation can be written in English & Latin languages. Inscription is divided into following parts: Base: The active medicaments which are intended to produce the therapeutic effect. Adjuvant: it is included used to enhance the action of medicaments or to improve the palatability of the prescription. Vehicle: it is inculded for dissolve of solid ingredients or to increase the volume of preparation.

7. 5) Subscription: This part contains the prescriber’s directions to the pharmacist . It includes: Type dosage form to be prepared No of doses to be dispensed 6) Signatura: In that consist of the direction to be given to the patient regarding the administration of the drug. It is usually written as ‘Sig’ on the prescription. The instruction given in the prescription are required to be transferred to the label of the container in which the medicaments is to be dispensed, so that the patient can follow it.

8. 7) Renewal instructions: The prescriber indicate on every prescription, whether it may be renewed & if so, how many times. It is very important for narcotics & other habit forming drugs to prevents its misuse. 8) Signature, address & registration number of the prescriber : Signature, address & registration number of the prescriber is very important for narcotics & other habit forming drugs to prevents its misuse.

9. Example of Prescription

10. Handling of Prescription Receiving Reading & Checking Collecting & Weighing the material Compounding, labeling & Packaging

11. 1) Receiving: Pharmacist should himself receive the Prescription. After receiving the prescription a pharmacist should not change their facial expression. 2) Reading & Checking: on receiving a prescription, always check it that it is written in a proper format i.e on doctors pad & check the signature, name address & date on the prescription. In case of any difficulty in reading or any doubt regarding prescription, the pharmacist should consult other pharmacist or prescriber.

12. 3) Collecting & Weighing the material: Before weighing the required materials for it, should collected on left hand side of the balance. After weighing the material it should be transfer to right hand side of the balance. This gives a check of ingredients which have been weighed. 4) Compounding, labeling & Packaging : Before compounding should be clean all the equipments which are required for it & compounding should be carried out in a neat place. All the ingredients should be compounded according to the direction of the prescriber or pharmaceutical art. Only one prescription should be compounded at one time. After compounding the final preparation should be transfer into suitable container

13. Sources of error in Prescription

14. 1. Abbreviation Abbreviation presents a problem in understanding parts of the prescription order. Extreme care should be taken by a pharmacist in interpreting the abbreviation. Pharmacist should not guess at the meaning of an ambiguous abbreviation. For example- Achro - for Achromycin ; Achrosatin . 2. Name of the drug There are certain drugs whose name look or sound like those of other drugs. Some of the examples of such drugs are as under:- Digitoxin Digoxin Prednisone Prednisolon

15. 3. Strength of the Preparation The strength of the preparation should be state by the prescriber. It is essential when various strength of a product is available in the market. For example- Paracetamol-500 mg. 4. Dosage form of the Drug Prescribed Many medicines are available in more than one dosage form. Prescriber should write prescription with correct and suitable dosage form to the patients in order to avoid ambiguity. For example- liquid, tablet, capsule and suppository .

16. 5. Dose Unusually high or low doses should be discussed with the prescriber. Paediatric dosage may present a problem. So pharmacist should consult paediatric posology to avoid any error. Sometimes a reasonable dose is administered too frequently. For example- a prescription for sustained release formulation to be administered after every four hours should be thoroughly checked because such dosage forms are usually administered only two or three times a day.

17. 6. Instructions for the patient Instructions for the patient which are given in the prescription are incomplete or omitted. Instructions such as quantity of drug to be taken, frequency, timing of administration, route of administration should be clearly given in the prescription so as to avoid any confusion. 7. Incompatibilities It is essential to check that there are no pharmaceutical or therapeutic incompatibilities in a prescribed preparation and that different medicines prescribed for the same patient do not interact with each other to produce any harm to the patient.

18. Following precautions should be taken while dispensing a prescription: 1. Always keep the prescription before you to avoid mistakes. 2. Dispensing balance should be checked before weighing ingredients. 3. Replace containers of stock preparations or drugs in their proper position after use. 4. Keep the label in upper position. 5. In case of liquid ingredients, keep the label upward to prevent staining of label. Care required in Dispensing Prescription

19. 6. Dispensing balance, spatula should be clean. Scale pan should be cleaned immediately after use. 7. Those medicines for external use should be labeled in red or against a red background. FOR EXTERNAL USE / FOR EXTERNAL USE 8. Before handing over the medicine to the patient, again check that the correct preparation, in the correct strength, has been supplied and correct direction has been stated on the label.

20. Labeling of Dispensed Medications Drug labeling, also referred to as prescription labeling, is a written, printed or graphic matter upon any drugs or any of its container, or accompanying such a drug. Drug labels seek to identify drug contents and to state specific instructions or warnings for administration, storage and disposal. Drug labeling plays crucial roles not only in the identification of active ingredients or excipients of a known drug, but also the provision of guidance for patients to ensure safety and appropriate administration of medicine.

21. Main Label Drug labels include instructions, ingredients, and a lot more information like: The Name of Drug Net Content Active Ingredients Manufacturer name & Address Batch Number Manufacturing Lic No. Mfg & Exp.Date Warning Directions

22. Example of Main label

23. Ancillary or Auxiliary label An auxiliary label (also called cautionary and advisory label or prescription drug warning label) is a label added on to a dispensed medication package by a pharmacist in addition to the usual prescription label. These labels are intended to provide supplementary information regarding safe administration, use, and storage of the medication.

24. Pictograms A pictogram also known as a pictograph or picto is a chart or graph which uses pictures to represent data in a simple way. Each picture in the pictogram represents a physical object. They are set out the same way as a bar chart but use pictures instead of bars. Each picture could represent one item or more than one. Pictograms are Images representing proper ways to take or store medications, precautions, or other important information about a medication that a health care provider should provide to his or her patient.

25. Example of Pictograms

26. Brief instructions on medication usage Medicines help patients live longer and healthier. But, taking them in wrong way or mixing certain drugs can be dangerous. Patients need to be careful to keep track of their medicines and use them safely. In fact, safe and accurate medicine administration is an important and potentially challenging patient responsibility. The instructions on medicines tells patients about what amount of medicine to take, how to take it, when to take it, and when not to take it.

27. Instructions: Some important instructions for safe and effective use of medicines are listed below. (1) Medicines for pregnant women or one who planning to become pregnant: (a) The use of any medicines during pregnancy must be carefully considered. (b) For breast feeding woman. ( 2) Medicines administered orally: Tablet, capsule, powder, liquid dosage forms, etc (a) Follow doctor's instructions. (b) Take medicines with full glass of water. (c) Take before/with/after food. (d) For long acting dosage forms: Do not crush, break or chew before swallowing.

28. 3)) Ophthalmic drops a) Avoid touching the tip of the tube to your eye or finger. (b) Hold the tip of the close to your eye with the other hand. (c) First, wash your hands. Then tilt the head back and pull the lower eyelid away from the eye to form a pouch. (d) Drop the medicine into the pouch and gently close the eyes. Try not to blink. (e) Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed. Wash hands after instillation of eye drop.

29. 4) Ophthalmic ointments: (a) Hold the tip of the tube close to your eye with the other hand. (b) Avoid touching the tip of the tube to your eye or finger. (c) Squeeze a small amount (1/4 inch) of ointment into the pocket between your lower lid and eyeball. Close your eyes for 1 to 2 minutes. (d) Wipe the tip with a clean tissue and close the tube tightly.

30. 6) Nasal spray (a) Close the nostril that is not receiving the medication. Do this by gently pressing on that side of your nose. (b) Gently insert the bottle tip into the other nostril Breathe in deeply through that nostril as you squeeze the bottle. (c) If directed, repeat these steps for the other nostril.

31. 7) Mouth inhaler: (a) Shake the inhaler hard 10 to 15 times before each use. (b) Take the cap off. Look inside the mouthpiece and make sure there is nothing in it (c) Breathe out all the way. Try to push out as much air as you can. Hold the inhaler with the mouthpiece down. d) Place your lips around the mouthpiece so that you form a tight seal (e) As you start to slowly breathe in through your mouth, press down on the inhaler one time. Keep breathing in slowly, as deeply as you can. (f) Take the inhaler out of your mouth. If you can, hold your breath as you slowly count to 10. (g) Pucker your lips and breathe out slowly through your mouth. (h) Put the cap back on the mouthpiece and make sure it is firmly closed. (1) After using your inhaler, rinse your mouth with water, gargle, and spit. Do not swallow the water.

32. 8) Ear drops: (a) Warm the ear drop bottle in hands to avoid dizziness when placed in the ear canal. (b) Lie down with affected ear facing up. (c) Gently pull ear back to straighten the ear canal. Hold the dropper over the ear and squeeze out 4 to 5 drops of medicine per dose. (d) Massage the tragus to open the ear canal to force the drops down the ear canal. (e) Continue to lie on one side for a couple minutes to allow the drops to reach the eardrum at the base of the ear canal. (f) Sit up and let any excess drops drain out. Repeat in the other ear, if needed.

33. Dispensing Dispensing is a process of preparing and giving medicine on the basis of prescription. Dispensing Process Dispensing process is ensuring that the medicines are dispensed correctly and any potential errors which may occur during dispensing process are detected and corrected before medicines are delivered to the patient.

34. A) Prescription Processing Checking : Following points should be checked Patients details Drug Information Date Doctors Information 2) Interpreting the Prescription order: a) After receiving the prescription pharmacist should check for drug interaction, medicine duplication, inappropriate drug therapy, contraindication & allergies.

35. 3) Handling prescription which requires clarification : If an incomplete prescription or one which requires further clarification is received, attempts must always be made to contact the prescriber: (a) If the prescriber can be contacted and is available on site, arrange for the incomplete/missing details to be inserted on the prescription by the prescriber. (b) If the prescriber is not available to change the prescription himself/herself, authorization to make the change may be obtained verbally through the phone. (c) The changes to the prescription should be communicated back to the prescriber to ensure accuracy. The changes should be documented on the prescription and written as Prescriber Contacted, dated & initialled by the Pharmacist.

36. B) Preparing the Medicines Filling of medicines Labeling Checking of filled medicines C) Counter Checking: It should be done by a second person other than a staff who previously filled the prescription. D) Recording E) Issuing Medicines to the Patient: It should be done by pharmacist only & ensure 5R while dispensing medicines to patient: 1) Right patient 2) Right medicine 3) Right dose 4) Right route 5) Right time

37. Good Dispensing Practices Pharmacists are the most accessible healthcare professionals in a community, Patients visit Pharmacies more regularly and hence they should maintain highest level of standards of quality and safety. The PCI has prescribed standards that should be met by the Pharmacies PCI has stated that "Any drug from a Pharmacy can be dispensed only by a pharmacist each and every drug has its own specifications on intake and storage methods. It is the pharmacist who is solely responsible for explaining these specifications to the patients. For this the presence of pharmacists should be strictly regulated and all reasonable steps should be taken to minimize the occurrence of errors.

38. To ensure right dispensing and thus avoid contributing to medication errors at large, the stakes of which are high. The elements of GPP guidelines 2015 by IPA are as follows. GPP Guidlines.pdf Structure Guidelines Process Guidelines

39. Dispensing Errors Dispensing errors include any deviations from the prescription order, such as dispensing the incorrect drug, dose, dosage form, wrong quantity or inappropriate, incorrect, or inadequate labeling. Also, confusing or inadequate directions for use, incorrect or inappropriate preparation, packaging or storage of medication prior to dispensing are considered to be errors. Errors occur at a rate of 4 per day in a pharmacy filling 250 prescriptions daily, which amounts to an estimated 51.5 million errors out of 3 billion prescriptions filled annually nationwide.

40. Causes of Errors Wrong prescription evaluation Dispensing wrong medicines. Poor dispensing procedure. Poor understanding of directions for use. Incorrect abbreviation use. Wrong labeling. Incorrect dosage & dosage form. Dispensing of expired medicines.

41. Strategies to minimize Errors Ensure correct entry of the prescription Confirm that the prescription is correct and complete Be careful with zeros and abbreviations Focus on reducing stress and balancing heavy workloads Beware of look-alike, sound alike drugs Store medicines properly Thoroughly check all prescriptions Always provide thorough patient counseling

42. THANK YOU