Prescription Handling

1. PREPARED BY:
AJIT KUMAR VARMA
Asst. Professor,
M. Pharm , P.hD*
Faculty of Pharmaceutical Sciences,
RAMA UNIVERSITY , KANPUR-209217
GUIDELINES FOR WRITING PRESCRIPTIONS

2. History
 Prescriptions have been
in use since ancient
times
Latin adopted as
standard
language
“Rx” =
prescription

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

4. Definition
A prescription is a
written, verbal, or
electronic order from a
practitioner or
designated agent to a
pharmacist for a
particular medication
for a specific patient.

5. Writing Prescriptions
Who can write a Rx?
 Practitioners
 Physicians, veterinarians, dentists.

6. Prescription Formatting
Heading
Body
Closing

7. Current Prescription Formatting
Heading
Name, address, and telephone
number of the prescriber
Name, sex and age of the
patient
Date of the prescription
3

8. Contents of the Prescription
 Patient Name and Address
 Full first and last name
 Middle initial may be helpful
 DOB – not required, but will be helpful in further
identifying the correct patient to prevent medication
errors

9. Contents of the Prescription
 Practitioner’s Name, Address, and Phone number
Validates prescription
Provides contact information to clarify
any questions

10. Contents of the Prescription
 Date
◦ Date the prescription is issued or
written
◦ Allows the determination of the life
of the prescription to validate
refills
◦ Ensures continual patient
supervision
◦ Promotes patient follow - up

12. Current Prescription Formatting
Body
The Rx symbol
Name
dose size or concentration
(liquids) of the drug
Amount to be dispensed
Directions to the patient
4

13. Contents of the Prescription
Selecting the drug
Medication Allergies
Availability
Cost

14. Contents of the Prescription
 Name of the drug
 Multiple drugs per prescription can add to
confusion
 KEEP IT SIMPLE

15. Contents of the Prescription
 Name of the drug - CAUTION:
Look Alike/Sound Alike drug names
 Massive number of new drug releases
 Massive number of reformulations
 Drug marketing strategy
 Build on established names
 New combination drugs – Use
converged names

16. Contents of the Prescription
 Name of the drug
AVOID THE USE OF:
 Abbreviations
 Many drugs identified with abbreviations
 EX: HCT for hydrochlorothiazide, MSO4
for morphine sulfate
 Attempts to standardize abbreviations
have been unsuccessful

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

18.  Tablets - tab
 Capsule – cap
 Syrup – syr
 Suspension – susp
 Injection – Inj
 Metered dose inhaler – as such
 Lotion – as such

19. Contents of the Prescription
Strength of the drug
Be familiar with drugs and their
various dosing strengths and
dosage forms
When in doubt, use references

20. Dosing cont;
 Weight – based dosing
 Always convert patient weight to correct units (kg)
 Liquid medications
 One product may be available in a number of
concentrations
 Be familiar with various product concentrations
 Indicate BOTH concentration and dose of medication
 Example: Cephalexin suspension 125 mg/ 5 ml
1 teaspoon/ every 8 h

21. Contents of the Prescription
 Strength of the drug
Decimal points
Avoid trailing zeros.
EX. 5 mg vs. 5.0 mg; can be mistaken
for 50 mg
Always use leading zeros.
EX. 0.8 ml vs. .8 ml; can be mistaken
for 8 ml

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

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

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

25.  For some drugs, a maximum dose may need to
be stated ( for eg. ergotamine in migraine &
colchicine in gout).
 Eg: Ergotamine 1 mg at onset of attack & repeat
every 30 min if necessary . Do not take more
than 6 mg in one day or more than 12mg in one
week

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

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

29. Contents of the Prescription
 Determine preference for brand or generic product
 Brand vs. generic
 Is Brand always better? NO
 If practitioner prefers brand, must indicate
in print, - do not substitute

30. Sample Prescription-

31. Contents of the Prescription
Indication
◦ Encouraged, seldom practiced
◦ Helps confirm appropriateness of
medication
◦ Reminds patient of drug’s purpose
◦ Facilitates communication
between health care providers

32. Current Prescription Formatting
 Closing
Prescriber’s signature
Refill instructions
Generic substitution instructions
5

33. Contents of the Prescription
 Refills
 To avoid interrupting maintenance therapy,
practitioners can authorize refills on a
written prescription
 Refills authorized are valid only for life of the
prescription – 1 year

34. Controlled Substances
Definition - a prescription drug
whose use and distribution is tightly
controlled because of its abuse
potential or risk
Regulation is more strict

35. 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.

36. CASE #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

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

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

39. Contents of the Prescription
 Date of the order
 Patient Name and Address
 Name of the drug
 Strength of the drug
 Quantity of the drug
 Directions for use
 Practitioner Name, Address, Telephone
number

40. Model Prescription
1) Name: ABC 2) Date: 31.07.07
3) Age: 70yrs. 4) Sex: male
Diagnosis: Idiopathic Parkinsonism
Rx
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

41. Model Prescription
1) Name: ABC 2) Date: 31.07.07
3) Age: 70yrs. 4) Sex: male
Diagnosis: Idiopathic Parkinsonism
Rx
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

42. THANK YOU