prescription writing

1. Prescription writing
Dr Arijit Ghosh, MD (Pharmacology)

2. Syllabus
• Define prescription
• Understand the content of prescription
• Understand and apply the steps of prescription
• List the abbreviations used in prescription writing
• Discuss the importance writing prescriptions clearly and legible hand
writing

3. What is prescription?
• Prescription is the written order of a registered medical practitioner
for one or more medicines together with the directions to
pharmacists for their preparations and to the patient for their use
• Who can write a prescription?
• Physician
• Dentist
• Veterinarian
• Nurses are authorized to administer medications
• Pharmacists are authorized to prepare and dispense drugs

4. 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.

5. Components of prescription
• An ideal prescription should have the following parts:
1. Date
2. Patient’s Name, Age, Sex and Address
3. Superscription
4. Inscription
5. Subscription
6. Signatura
7. Signature, address and registration number of the prescriber

6. Example of an Extemporaneous prescription
1
2
3
4
5
6
7

7. Components of prescription
• Date:
• Every prescription must bear the date on which the particular medicines are
prescribed
• Signifies when was prescription written
• This helps the pharmacist to keep day to day Patient’s record in chronologic
order which helps the pharmacist or a physician to refer the old case in future
• To avoid misuse of the narcotic or other habitat forming drugs containing
prescriptions by the patient a number of times for dispensing.

8. Components of prescription
• Name, Age, Sex and Address of the patient:
• Name helps the pharmacist to identify the correct Patients
• Patient’s full name must be written instead of nicknames or surnames
• Age of the patient becomes important in the case of the Pediatric (children)
and Geriatric(old people) cases.
• Because the dose of drugs in such cases varies(due to their differences in
ability to metabolize drugs).
• In some cases weight and height of the patients required.
• Dose of drugs may also vary based on the sex/gender of the patient(as their
abilities to metabolize/ response towards drugs may vary in many cases).
• Address of the patient generally recorded to contact the person at the later
stage

9. Components of prescription
• Superscription:
• This part of the prescription represented by the symbol RX.
• In the ancient times it is considered as a prayer to Jupiter the God of healing
for the fast recovery of the patient.
• Now a days it is used as a abbreviation for the Latin term “Take Thou” which
means “you take”
• If superscription is missing from prescription it will not be considered as
legally valid prescription.

10. Components of prescription
• Inscription:
• Main part of the prescription order.
• Contains the names and quantities of the prescribed ingredients.
• Name of each ingredient is written on a separate along with its quantity.
• Complex prescription containing several ingredients the inscription can be divided
into following parts:
• Base (active medicament of therapeutic action)
• Adjuvants(substances added to increase action of medicament/ its palatability)
• Vehicle(substance used to dissolve medicament/increase volume of preparation)
• Subscription:
• Contains directions of the prescriber to the pharmacist
• Regarding the type and compounding of dosage form along with number of doses to
be dispensed.

11. Components of prescription
• Signatura:
• This part contains directions to the patient regarding the administration of the drugs.
• Generally represented as ‘Sig’ on the prescription
• The instructions may include:
• The quantity to be taken
• The frequency of administration
• The mode of administration
• The special instructions such as dilation direction
• Signature, Address and Regd.no of the prescriber:
• Required for turning the prescription into legal and authentic order to the
pharmacist.
• This helps in preventing the use of spurious drugs.
• Regd.no is of utmost importance in prescription containing narcotic drugs.

12. What are the parts of
this prescription?
Example of a Pre compounded prescription
1
2
3
4
5
6
7

13. Steps of rational prescription writing
• Understand the patient’s complain
• Make a specific diagnosis
• Consider the pathophysiologic implications
• Select a specific therapeutic objective
• Select a drug of choice
• Determine the appropriate dosing regimen (Dose, frequency, duration)
• Devise a plan for monitoring the drug’s action and determine an end point
for therapy
• Plan a program of patient education

14. Rational prescription writing
• Rule of Right
• Right drug, for the right patient, with the right diagnosis, at the right dose, right
route, right intervals, right duration of therapy under prevailing constraints
• SANE Criteria:
• Safety
• Affordability
• Need
• Efficacy
• Choose drugs that are clearly needed and scientifically proven to be
effective
• Do not be influenced by patient pressure or med rep pressure

15. List of Abbreviation commonly used
Abbreviation Full words/ Phrases Meaning
R/ Recipe Take thou
ad. Ad Upto
a.c. Ante cibum Before food
p.c. Post cibum After food
b.d./ b.i.d Bis in die Twice daily
ft. Fiat Let it be made
h.s. Hora somni At bed time
M. Misce Mix

16. List of Abbreviation commonly used
Abbreviation Full words/ Phrases Meaning
q.s. Quantum sufficiat A sufficient quantity
q.d/q.i.d/q.d.s. Quarter in die Four times daily
s.o.s Si opus sit When necessary
stat Statim Immediately
t.d./t.i.d. Ter in die Thrice daily
o.d. Omni die Every day
o.m. Omni nocte Evey night

17. Prescribing Error
• A clinically meaningful prescribing error occurs when, as a result of a
prescribing decision or prescription writing process, there is an
unintentional significant reduction in the probability of the
treatment being timely and effective or and increased risk of harm
when compared to generally accepted practice.
• Prescriptions should be legible, unambiguous, dated and timed
• Should contain sufficient information to permit the pharmacist or
nurse to discover possible errors before the drug is dispensed or
administered

18. Prescribing Error
• Physician writes prescription without considering
• Patient’s clinical status
• Age and bodyweight
• Comorbid condition
• Knowledge of allergic status
• Ability to administer medication properly
• Drug drug interaction potential
• Continuing a prescription for longer duration than necessary
• Writing an ambiguous medication order

19. Prescribing Error
• Continuing a drug in the event of a clinically significant ADR
• Writing a drug’s name using abbreviations or other non standard
nomenclature
• Not writing a prescription in full if a change has been made to it
• Overuse of drug without therapeutic benefit
• Failure to follow system’s policies and drug specific instruction.

20. Compliance
• The extent to which patients follow the treatment instructions
• Types of noncompliance
• The patient fail to obtain the medication
• The patient fail to take the medication as prescribed: wrong dosage, wrong
frequency of administration, improper timing, wrong route or technique of
administration, taking medication for the wrong purpose
• The patient prematurely discontinue the medication
• The patient takes medication improperly

21. How to prevent prescribing error
• Verbal order should be minimized, prescription document legible
• May include a brief notation of purpose (like ‘for cough’)- helpful
extra safety check
• Metric system should be used except for therapies that use standard
units such as insulin, vitamins etc. Units spelled out rather than
writing “U”
• Should avoid use of abbreviations and Latin direction for use.
• Use leading zero preceding a decimal expression of less than one and
a terminal zero should never be used after decimal to avoid ten fold
error in strength.

22. How to prevent prescribing error
• Appropriate drug name, dosage form, strength, schedule, duration
should be mentioned, clear handwriting a must. Try use caps.
• Provision of rechecking by nurse or pharmacist on any confusion
• Patient’s age, sex, weight, condition, comorbidities should be
mentioned clearly to allow double check by other healthcare
professional
• Avoid vague instructions, proper counselling with the patients
required to avoid nonadherence

23. Thank you