Prescription

Dr. Murtaza
CONTENTS
At the end of the lecture the students will be able to:
 Define prescription.
 Explain the different parts of prescription.
 Error in prescription
 Handling of prescription
 Interpret the information on the prescription.
 Process the prescription order / Handle the prescription.
 Define the different types of prescription.
 Define Electronic prescribing and how it works.
 Compare the advantages and disadvantages of Electronic prescribing.
DEFINITION

Prescription is a written order (handwritten or electronic) from a registered

physician, dentist or any other registered medical practitioner to a pharmacist

for the dispense (supply/prepare) of medicine, dressing or appliance to the

patient for the diagnosis, prevention or treatment of a disease.

History
 The concept of prescriptions dates back to the beginning of
history. So long as there were medications and a writing system
to capture directions for preparation and usage, there were
prescriptions.
 Modern prescriptions are actually "extemporaneous
prescriptions" from the Latin (ex tempore) for "at/from
time"."Extemporaneous" means the prescription is written on the
spot for a specific patient with a specific ailment. This is
distinguished from a non-extemporaneous prescription which is
a generic recipe for a general ailment.
Types of prescription
 NHS (National Health Service) prescription/ A prescription
recommended by a doctor working in govt hospitals.
 Private
prescription/ Non-NHS prescription/ A prescription
recommended by a private doctor.
 Prescription for hospital inpatients
 Prescription for hospital outpatients
 Prescription for patients discharged from the hospital.
Types of Prescription
There are mainly two types of prescription:
1) Pre compounding prescription:
Prescription for already prepared drug (by pharmaceutical
companies) e.g. Cap. Ciprofloxacin (500 mg) etc.

2) Extemporaneous prescription:
The pharmacists prepare the medication according to
the drugs and dosages directed by the physician.
Difference between Pre-compounding and Extemporaneous Prescription
Parts of Prescription
 Prescriber’s office information
 Patient information
 Date
 Rx symbol or Superscription
 Medication prescribed or Inscription
 Dispensing directions to the pharmacist or Subscription
 Direction for patient or Signatura
 Refill, special labeling ,and /or other instructions
 Signature and registration number of prescriber
Sample
Prescription
Cont….
Date:
 Written on the prescription by prescriber.
 To know when the medicines were last dispensed
 To prevent the misuse of the drug by the patients
 The prescription which prescribe narcotic or other habit-forming drug, must bear the date, so
as to avoid the misuse of prescription if it is presented by the patient, a number of times for
dispensing.

Superscription:
 Information about the prescriber (name, address and telephone number)
 Information about the patient (full name, address, gender, DOB, weight & height if
necessary)
 Rx symbol - It is an abbreviation of Latin term “Recipe”, meaning “to take” or “take thou”
 Inscription
Main part of the prescription.
It gives the information about the name of the drug (generic
or trade name), its formulation and unit dosage.
 Subscription
Subscription provides information to the pharmacists about
the quantity and dosage form of the drug to be dispensed.
 Transcription
Transcription is the prescriber’s direction to the patient
contains instruction about the amount of drug, time and
frequency of doses to be taken.
Signature & Instructions
 Prescription should be signed by the prescriber.
 Refill instructions (if needed)
 Special instructions (if any)

Renewal instruction
The prescriber indicates on every prescription, whether it may be renewed and if so how
many times. It is particularly important for the prescriptions containing the narcotic and
other habit forming drugs to prevent its misuse.

A Prescription should be:

 Kept simple
 Abbreviations free (if necessary Latin abbreviations should be used)
 Trailing zeros should be avoided, Leading zeros must be added
 It should provide clear and specific directions
Processing/Handling the prescription order
 Receiving
 Reading and checking
 Numbering and dating
 Collecting the materials
 Dispense the medicine
 Counsel the patient
 Endorse the prescription
 Collect fee, if any / Pricing
 Dispose of the prescription
 Make the appropriate records and filing
 Pricing
Receiving
 The prescription should be received by
pharmacist himself/herself.
 It includes
 Reading the prescription
 Checking the prescription
 While receiving a prescription, a pharmacist
should not change his facial expression which
gives an impression to the patient that he is
surprised or confused after seeing the
prescription.
Reading & Checking
 Prescription should be completely and carefully read from top to
bottom.
 Nature of dosage form and time required for preparing.
 If long time is needed for compounding must tell the patient to wait.
 Careful examination of the prescription should be made only behind
the counter.
 Any doubt or direction or any error in writing, patient should not
come to know about it and should consult the other pharmacist or
prescriber.
 Every word and abbreviation must be interpreted correctly.
 Never guess about the meaning of illegible or confusing word.
 Prescription should be checked for any incompatibility.
Incompatibility
Rx
Acetylsalicylic Acid ................................xxx gm
Codeine ...............................................vi gm
Amodopyrinae ......................................xxx gm

M. ft. chart. No. vi

Acetylsalicylic acid intensifies the narcotic action of codeine. This combination

is questionable.
Numbering and Dating

To maintain record
Dosage calculation
A child dosage form is calculated by:

Young’s rule
Child dose = (Age × adult dose) / (Age + 12)

Fried’s rule
Child dose= [Age (month) / 150] × Adult dose
Rechecking

Each prescription should be rechecked After

labeling container should be thoroughly polished
to remove finger-prints
Recording

A variety of prescription files are available which

serve to maintain and preserve original
prescription in numerical order
Pricing of Prescription
The prescription should be priced
immediately after receiving it & informed
the patient about it. This should be done
before starting the compounding to avoid
any dispute..
Delivering the prescription
Three types
Store Delivery
Home Delivery
Mail Delivery
Disposal of prescription form
 NHS form -------------Retain until the end of month
 Private form for prescription only medicine
 ----------------------- Retain to 2 years
 Hospital inpatient form ------------- Return to ward
 Hospital outpatient form --------------- Retain in
 pharmacy (usually 2 years)
Errors in prescription writing
 Medication errors affect more then 1.5 million Americans each year
in hospitals alone, according to the Institute of Medicine.
 Error can be made in the following areas:
 Similar spellings / pronunciations / names
Inderal and Adderrall
Zyrtec and Zantac
Celebrex and Cerebyx
 Others include Aciphex (for stomach reflux) and Aricept (for
memory), Allegra (for allergies) and Viagra (for erectile dysfunction)
or Fosomax (for bone) and Flomax (for veins and arteries).
Cont……..
 Incorrect dosage
 Drug interactions (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 patient. Certain
antibiotics should not be given with meals since it significantly decrease the
absorption of the drug.)
 Human error
 Doctors, notorious for bad handwriting, may choose the right drug, but the
pharmacist may read it incorrectly.
 Sometimes the prescription gets transferred by phone from the doctor's
office to the pharmacy, but the people making or receiving the phone calls
make mistakes.
Ten Steps To Minimize Prescription Error
 1.Correctentry of the prescription must
be ensured.
 2.It should be confirmed that the
prescription is correct and complete.
 3.A prescriber or pharmacist must be
aware of look-alike, sound alike drugs.
 4.Extracare should be given with zeros
and abbreviations.
 5.Workplace must be organized.
Cont….
 6.Distraction should be reduced when
possible.
 7.Focus must be given on reducing stress and
balancing heavy workloads.
 8.Drugs should be stored properly taking
adequate time.
 9.All prescriptions should be checked
thoroughly.
 10.Thorough patient counseling should be
provided.
Electronic prescribing

Electronic prescribing or e-prescribing is the

electronic transmission of prescription information
from the prescriber's computer to a pharmacy
computer.
Sample
e-prescription
How it works?
 Thedoctor logs on to the system and authenticates their
identity.(i.e. log on their passwords)
 The doctor looks up the patient in the system.
A drug is chosen, with parameters including strength,
quantity, directions, and number of refills .
 The patient's active medication list and known allergies
are reviewed for potential adverse drug reactions
Cont…..
 The software may suggest alternative drugs that are either more effective or
less costly.
 Select a pharmacy that will process the order, and place the order.
 The connection may be direct peer-to-peer, but usually it is indirectly routed
over a commercial network of pharmacies such as Sure Scripts or eRx
Network.
 Orders take the form of standardized electronic messages that both the
prescriber's system and the pharmacist's system must implement.
 The order appears in the pharmacist’s computer system, where it may be
filled.
 Thepatient shows up at the pharmacy to pick up and pay for their
medications.
Benefits
 It improves beneficiary health outcomes
 It improves quality and efficiency
 Ithelps in reducing costs by actively promoting
appropriate drug usage
 It speeds up the process of renewing medications
 It reduces the incidence of drug interaction
 It saves the time of pharmacist
Cont…..
 Each prescription can be checked electronically
 Reducing / eliminating the error.
 Information on prescription can be linked with the
 patient’s medical records.
 Refill request can be expedited.
 Facilitation of data transfer between physician and
pharmacist.
 Disadvantages
 Accidental data entry errors such as selecting the
wrong patient or clicking on the wrong choice in a
menu of dosages.
 Inadvertently divulging protected health information
on the internet through inadequate security practices
 Inabilityto use electronic prescribing when the
power is out
Use of computer system to process prescription
Take care