Prescription Dr Hayder B Sahib Prescription is an

Prescription Dr Hayder B Sahib

• Prescription is an order for medication issued by a physician, dentist, or other properly licensed medical practitioner. • A prescription designates a specific medication and dosage to be prepared by a pharmacist and administered to a particular patient. • A prescription is usually written on pre-printed forms containing ®( • (1)the traditional symbol meaning ‘‘recipe, ’’ ‘‘take thou, ’’ or ‘‘you take’’), • (2) name, • (3) address, • (4)telephone number • and other relevant information regarding the physician or other prescriber. • In addition, blank spaces are used by the prescriber to provide information about the patient, the medication desired, and the directions for use.

• A prescription written by a veterinarian generally includes • (1) the animal species and/ or pet’s name • (2)the name of the owner. • A written prescription may be presented at the pharmacy by • (1)the patient or caregiver, • (2) transmitted from the prescriber by telephone or by other electronic means. • In the latter instances, the pharmacist immediately reduces the order to a properly written form or computer entry. • In hospitals and other institutions, the forms are somewhat different and are referred to as medication orders.

• A prescription or medication order for an infant, child, or an elderly person may also include • (1)the age, • (2)weight, • (3) and/or body surface area (BSA) of the patient. • This information is sometimes necessary in calculating the appropriate medication dosage. • It is important to recognize two broad categories of prescriptions: (1) those written for a single component or prefabricated product and not requiring compounding or admixture by the pharmacist (2) those written for more than a single component and requiring compounding.

• A prescription may include the chemical or (generic) name of the substance or the manufacturer’s brand or trademark name (shown in all capital letters in this text). • Prescriptions requiring compounding contain the quantities of each ingredient. • Medications are prepared into various types of dosage forms (e. g. , tablets, syrups, injections) and drug delivery systems (e. g. , transdermal patches) to ensure that the medication properly design • The extemporaneous compounding of prescriptions is an activity for which pharmacists are uniquely qualified by virtue of their • (1)education, • (2)training, • (3) experience.

• By definition, pharmacy compounding involves 1 - the mixing 2 - assembling 3 -packaging 4 - labelling of a medication on receipt of a prescription order for a specific patient.

• In addition to the compounding of individual prescriptions as received, guidelines of the Food and Drug Administration permit the advance preparation of very limited quantities of compounded products in anticipation of prescriptions for specific patients, based on regularly observed prescribing patterns.

Components of a typical prescription are as follows: (1) Prescriber information and signature (2) Patient information (3) Date prescription was written (4) R symbol (the Superscription), meaning ‘‘take thou, ’’ ‘‘you take, ’’ or ‘‘recipe’’ (5) Medication prescribed (the Inscription) (6) Dispensing instructions to the pharmacist (the Subscription) • (7) Directions to the patient (the Signa) • (8) Special instructions. • • •

Tamper-Resistant Prescription Pads • To prevent the unauthorized copying, modification, or counterfeiting of prescriptions, tamper resistant prescription pads have been developed. • Their use is assigned for hand-written prescriptions for outpatient drugs covered by Medicaid. • The tamper-resistant qualities of these prescription forms is accomplished through the use of security paper, erase-resistant paper, thermo-chromatic ink (which results in the appearance of the word ‘‘VOID’’ on photocopies) and/or imbedded holograms.

e-prescribing/e-prescriptions • The use of electronic means for the generation and transmission of prescriptions is accepted throughout the United States. • In the inpatient or outpatient setting, a medication order, for a patient is entered into an automated data entry system as a personal computer (PC) or a handheld device loaded with e-prescribing software and sent to a pharmacy as an e-prescription. • When received, a pharmacist immediately reduces the order to a hard copy and/or stores it as a computer file.

• Among the advantages cited for e-prescriptions over traditional paper prescriptions are: • (1) reduced errors due to prescription legibility; concurrent software screens for drug interactions; • (2)reduced incidence of altered or counterfeit prescriptions • (3)efficiency for both prescriber and pharmacist • (4)convenience to the patient, whose prescription would likely be ready for pick-up upon arrival at the pharmacy.

• Hospital and Other Institutional Medication Order Forms • As noted previously, a typical medication order form used in the hospital setting is shown on slide 15. • In addition, other forms may be used within a hospital by specialized units such as infectious disease, cardiac care, paediatrics, obstetrics, orthopaedics, and others. • Drug-specific forms also may be used, as for heparin dosing, electrolyte infusions, and morphine sulphate in patient-controlled anaesthesia. •

• • • Many different types of health care institutions, as 1 - acute care facilities 2 - outpatient clinics 3 - intermediate- and long-term care facilities 4 - cancer treatment centres 5 - a host of others utilize medication order forms designed to meet their specific requirements. • Clinical drug investigators likewise may use specific medication order forms for their study protocols.

Military Time • Military time is used not only in the military but in civilian life as well, such as in (1)hospitals, • (2)other patient-care institutions, • (3)emergency services • Its use provides an definite expression of time. • • In health care institutions, military time may be used to (1) record the time of a patient’s admission, (2)when a medication was administered, (3)the time of surgery, and so forth. • as for example ‘‘twenty-three hundred hours. • ’’ Colons may be used to separate hours and minutes, as 1331 or 13: 31 hours (31 minutes past 1 o’clock in the afternoon) and when desired

• seconds, as 1331: 42 or 13: 31: 42. • Range of Prescription and Medication Order Calculations • Medication orders and, as such, provides the framework for the majority of the calculations that follow in this text, including calculations of the following: (1) Doses: including the quantity of a prescribed dose, the total number of doses prescribed, and the number of days the prescribed medication will last. (2) Compliance: the patient’s or caregiver’s compliance in meeting the prescribed directions for dosing.

(3)Chemical-physical factors: including calculations to make solutions isotonic, iso-osmotic, equimolar, or buffered. (4) Pharmacoeconomics: including (A)medication costs, (B)cost-benefit analysis, (C) cost-effectiveness analysis, (D)alternative treatment plans, (E)medication pricing. •

The quantities of ingredients to be used almost always are expressed in SI metric units of weight and measurement. In rare instances, units of the apothecaries’ system may be used. In the use of the SI (metric system), the decimal point may be replaced by a vertical line that is imprinted on the prescription blank or hand drawn by the prescriber. In these instances, whole or subunits of grams of weight and millilitres of volume are separated by the vertical line. Sometimes the abbreviations g (for gram) and m. L (for millilitre) are absent and must be assumed.

• Examples of prescriptions written in SI metric units: R Acetylsalicylic Acid 4 g Phenacetin 0. 8 g Codeine Sulfate 0. 5 g Mix and make capsules no. 20 Sig. One capsule every 4 hours.

• Prescription and Medication Order Accuracy • It is the responsibility of the pharmacist to ensure that each prescription and medication order received is • (1)correct in its form and content • (2) appropriate for the patient being treated • (3)subsequently filled, labeled, dispensed, and administered accurately. • In essence, each medication should be: (1)therapeutically appropriate for the patient (2)prescribed at the correct dose (3)dispensed in the correct strength and dosage form (4)correctly labelled with complete instructions for the patient or caregiver

• and for the patient in a hospital or other health care facility, each medication must be administered to the correct patient, at the (1)correct time, • (2)correct rate • (3)route of administration.

• Errors and Omissions • To ensure such accuracy, the pharmacist is obliged to review each prescription and medication order in a step-by-step manner to detect errors or omission of order. This is termed a search for errors and omissions. • A review of the completeness and correctness of a prescription or medication order is an important initial step in the process of ensuring accuracy. • It is important to note that other subsequent and related parameters to ensure the accuracy of medication use—such as • • (1) the application of pharmaco-therapeutics (2) medication therapy management (MTM), (3) the legal and regulatory aspects of drugs (4) prescribing authority—although essential to pharmacy practice and patient care, are not a part of this text

• Among the items that the pharmacist should check for the correct reading and interpretation of a prescription or medication order are: (1) prescriber information, including (A)address and telephone number (B)Drug Implementation Administration (DEA) number (for authority to prescribe schedule drugs including narcotics) (C) an identification number for participating health care providers (D)signature (E)date of the order and its currency to the request for filling (2) patient information, including (A)dose-relevant information, such as the age and/or weight of the patient if the dose of the drug is so based (3)drug prescribed, including • (A)dose, (B)preparation strength (C) dosage form (D)quantity (E) clarity of any abbreviations, symbols, and/or units of measure (F)clarity and completeness of directions for use by the patient or caregiver

(G) refill and/or generic substitution authorization; (4) need for special labelling, such as (A) expiration date, (B) conditions for storage, (C) and foods and/or other medications not to take concomitantly; (D)and a listing of the ingredients and quantities for orders to be compounded; (E) calculations performed should be checked and double-checked, as should the positive identification of all ingredients used along with their measurements.

• • Once the prescription or medication order is filled and the label prepared, before dispensing, the pharmacist should make certain of the following: (1) The filled prescription or medication order contains the correct (A)drug, (B)strength, (C)dosage form, (D) quantity. Placing a medication’s indication (use) on the prescription label has been shown to be of benefit in understanding of the use of their medication for some patients, particularly older patients and those taking multiple medications.

• (2) • The label has the name of the 1 - correct patient and physician 2 - the correct drug name 3 - quantity, and strength 4 - the name or initials of the pharmacist who filled the order • 5 - the number of refills remaining. • • .

• Additional label information and/or auxiliary labels may be required according to good pharmacy practice and by federal and state law depending on the drug dispensed. • A repeat comparison should be made of the drug and drug strength called for on the prescription against the labelling of the product used to fill the prescription to assure that the proper drug was used