This presentation covers different aspects of prescription, and safe prescription writing, including examples from NHS, and India.

1. FOUNDATION COURSE
PRESCRIPTION
WRITING
Sandeep Kumar, MD

2. As someone said, “I worried so much about
prescription writing in my 3rd Year of Med school, I
probably killed a whole tree tearing up
Prescriptions that were wrong.”
- medschoolhq.net

3. The eye of Horus. Attribution: By Jon Bodsworth [Copyrighted free use
via Wikimedia Commons. https://commons.wikimedia.org/wiki/File:
Wedjat_(Udjat)_Eye_of_Horus_pendant.jpg

4. In ancient Egypt, this symbol was written on
prescriptions as a prayer to the God of
healing.
Rx is also a symbol for the Eye of Horus.
Horus was an Egyptian God who had his eye
damaged and taken out of him. He had his
eye healed by another god and Horus then
gave his healed eye to his dead father to bring
him back to life.
In the days of mythology and superstition,
the symbol was considered as a prayer to
Jupiter, the God of healing, for the quick
recovery of the patient.
In Latin, it means “recipe” or “take thou,”
that is, “you take””

5.  Definition Written, Verbal,
or Electronic
order
Registered
Medical
Practitioner
Pharmacist
Particular
Medication
Particular
Patient

7.  Poorly written prescriptions may be one of the main reasons there are so many medication
errors today. Look at some of these commonly quoted statistics:
 Medication errors occur in approximately 1 in every 5 doses given in hospitals.
 One error occurs per patient per day.

8.  Approximately 1.3 million injuries and 7,000 deaths occur each year in the U.S. from
medication-related errors.
 Drug-related morbidity and mortality are estimated to cost $177 billion in the U.S.
 It is the eighth leading cause of death in the United States with more than 98,000 people
dying because of it annually.

9.  The National Patient Safety Agency revealed that medication errors in all care settings in the
United Kingdom occurred in each stage of the medication treatment process, with
 16% errors occurring in the prescribing,
 18% in the dispensing, and
 50% in the administration of drugs.
 In India, studies done in Uttarakhand and Karnataka have documented the medication errors
rate in hospitalized patients to be as high as 25.7% and 15.34%, respectively.

10. HOW TO WRITE A
PRESCRIPTION IN 4 PARTS
Patient’s name and another identifier, usually date of birth.
Medication and strength, amount to be taken, route by which it is
to be taken, and frequency.
Amount to be given at the pharmacy and number of refills.
Signature and physician identifiers like NPI or DEA numbers.

12. PRESCRIBER'S DETAILS
It consists of the
1.Name,
2.Address,
3.Registration number, and
4.Contact number of the treating doctor.
The importance of having the prescriber's details on the
prescription is for the benefit of the patient:
a.To contact the doctor in case of emergency or adverse drug
reaction
b.The registration number of the doctor is clearly written and is
an assurance for the patient that the prescriber is registered
with a medical council. This reflects the authenticity of the

13.  Prescribers must write clearly, in indelible black pen. Each individual letter must be legible.
 All prescriptions must be signed and dated by the prescriber with bleep number/ contact details
and Medical Council Registration No. (use of an individual name stamp is recommended).
 Prescribers are expected to adopt a concordant approach to prescribing and keep the patient
informed about proposed changes to their prescription (wherever possible).
 Prescribers MUST ensure they are familiar with the drug they are prescribing including
indication, cautions, contraindications, doses, monitoring and drug interactions. It is not
acceptable to ‘copy’ drugs without considering their safety for the patient.
 Nurses must be made aware of changes to inpatient prescriptions.
 Prescribers must only prescribe for patients registered with the hospital – not staff, visitors or
relatives

14.  According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
national patient safety goals:
 at least two patient identifiers should be used in various clinical situations.
 The two most common patient identifiers are their
 Full name and
 Date of birth.
 Patient identifiers are the first things to write on a prescription. This way you don’t write a
signed prescription without a patient name on it that accidentally falls out of your white coat
and onto the floor in the cafeteria.

15.  Patient’s first name and family name.
 Date of Birth.
 Address.
 Patient’s MRD and/or hospital number.
 Ward name, or name of department/specialty, and hospital site.
 Name of consultant responsible for the patient

17. GENERIC VS. BRAND
 The brand name of a medication is the name given by the company that
makes the drug and is usually easy to say for sales and marketing purposes.
 The generic name, on the other hand, is the name of the active ingredient.
 The key to understand is, though the generic name exists, the company who
developed the drug, through its patents, receives an exclusivity period where
it has the only rights to sell the medication under either the brand or generic
name.
 During the period of patent protection, the company sets the price to a point
where it can recover research and development costs along with other cost,
like marketing, while trying to make a profit.

19.  It contains the
 names and
 quantities of the prescribed medicines.
Physicians are supposed to write the
 generic name of the drug prescribed by them,
 its dose,
 frequency, and
 the duration of therapy.
This part of prescription is the most important area where the physician has to be very
careful and vigilant. His knowledge about the medicines and his competence is
reflected by what and how he writes

20. You can write the generic or the brand name here unless
you specifically want to prescribe the brand name.
If you do want to prescribe the brand name only, you
specifically need to indicate, “no generics.”
On the prescription pad, there is a small box which can be
checked to indicate “brand name only” or “no generics.”

21.  After you write the medication name, you need to tell the pharmacist the desired
strength.
 Many, if not most, medications come in multiple strengths. You need to write
which one you want.
 Often times, the exact strength you want is not available, so the pharmacist will
substitute an appropriate alternative for you.
 For example, if you write prednisone (a corticosteroid) 50 mg, and the pharmacy
only carries 10 mg tablets, the pharmacist will dispense the 10 mg tabs and adjust
the amount the patient should take by a multiple of 5.

22.  Using the previous example for prednisone,
 the original prescription was for 50 mg tabs. So you would have written,
“prednisone 50 mg, one tab….” (I’ll leave out the rest until we get there). The “one
tab” is the amount of the specific medication and strength to take.
 Again using my previous example, due to the 50 mg tabs not being available, the
instructions would be rewritten by the pharmacist as “prednisone 10 mg, five
tabs….” You can see that “one tab” is now “five.” Pharmacists make these changes
all the time, often without any input from the physician.

23.  To reduce the number of medication errors, prescription writing should be 100% English,
with no Latin abbreviations.
 There are several routes by which a medication can be taken.
 The abbreviations are either from Latin roots like PO (“per os”) or just common combination
of letters from the English word. For example, intranasal is often abbreviated “IN,” which, if
you write sloppily, can be mistaken for “IM” or “IV.”
 All other routes of administration must be written out in full, e.g. intrathecal, epidural,
sublingual, buccal.
 Prescribers must specify the precise location or area to be covered for topical drugs.

24.  IV – intravenous
 PV – vaginally
 SC – subcutaneous
 JEJ – via jejunostomy tube
 IM – intramuscular
 INH – inhalation
 NEB – nebulised
 PEG – via percutaneous endoscopic gastrostomy tube
 PO – oral
 NG – nasogastric
 TOP – topical
 PR – rectal
 PV – vaginal

25. What Q Means?

26.  Frequency = How often you want the patient to take the medication.
 Many frequencies start with the letter “q.”
 This Q is from the Latin word quaque, which means once.
 So in the past, if you wanted a medication to be taken once daily, you would write
QD, for “once daily” (“d” is from “die,” the Latin word for day).
 However, to help reduce medication errors, QD and QOD (every other day) are on
the JCAHO “do not use” list.
 So you need to write out “daily” or “every other day.”

27.  Many prescriptions that you write will be for “as needed” medications.
 This is known as “PRN,” from the Latin pro re nata,
 meaning “as circumstances may require.”
 For example, you may write for Ibuprofen every 4 hours “as needed.”
 What physicians and medical students commonly miss with PRN medications is the
“reason.”
 Why would it be needed?
 You need to add this to the prescription. You should write “PRN headache” or “PRN
pain,” so the patient knows when to take it.
 For example, you may write for Paracetamol 650 mg “as needed for Fever.”

28.  The “how much” instruction tells the pharmacist
 how many pills
 how many bottles, or
 how many inhalers.
 Typically, you write the number after “Disp #.”
 Spell out the number after the # sign, even though this is not required.
 For example, I would write “Disp #30 (thirty).”
 This prevents someone from tampering with the prescription and adding an extra 0 after 30,
turning 30 into 300, e.g. drug addicts.

29.  The last instruction on the prescription informs the pharmacist how many times
the patient can use the same exact prescription, i.e. how many refills they can get.
 For example, let’s take refills for anti-anxiety medications for a patient.
 A physician may prescribe 1 pack [10 Tablets] of a BZDs with 1 refills, which
would last the patient, three weeks.
 This is convenient for both the patient and physician for any medications that will
be used long term.

30. Prescriber’s signature
Date
Refill instructions
Generic/Brand substitution instructions
The onus lies on the prescriber for being responsible for the facts
mentioned in the prescription.
Hence, it is important to safeguard one's interest; the prescriber
should be well acquainted with the art of writing a prescription.
There is no margin for any error as a prescription directly deals with
the patient's well-being and life.
5

31. All details must be completed in the prescriber’s handwriting. The following details are
required:
 Name and address of patient (an addressograph with the prescriber’s initials can be
 used).
 Name of drug
 Form of drug e.g. MR tablet. Check what form the preparation is available in.
 Strength.
 Dose the patient is to take, including frequency.
 Total quantity of the preparation or the number of dose units – in both words and
 figures (except inpatient medication charts).
 Prescribers signature, registration number and contact details

32.  U or u (unit) – use “Unit”
 IU (International unit) – use “International Unit”
 Q.D./QD/q.d./qd – use “daily”
 Q.O.D./QOD/q.o.d./qod – use “every other day”
 Trailing zeros (#.0 mg) – use # mg
 Lack of leading zero (.#) – use 0.# mg
 MS – use “morphine sulfate” or “magnesium sulfate”
 MS04 and MgSO4 – use “morphine sulfate” or “magnesium sulfate”

34. Define the patient’s problem
Make a specific diagnosis
Consider the pathophysiologic implications of the Diagnosis
Define the therapeutic objective
Select a Drug of Choice [Efficacy, Safety, Suitability, Cost]
Write the drug with the appropriate dosing regimen
Start the treatment and discuss adverse effects or warnings, instructions and give information
Monitor the therapy and give advice on follow up

35. Colace =
Docusate is a
stool softener

42.  Inadequate knowledge of the patient and their clinical status
 Inadequate drug knowledge
 Calculation errors
 Illegible handwriting
 Drug name confusion {LASA}
 poor history taking
 Fatigue and workload may also contribute to the risk of slips and lapses.

45.  ALWAYS write legibly.
 ALWAYS space out words and numbers to avoid confusion.
 ALWAYS complete medication orders.
 AVOID abbreviations.
 When in doubt, ask to verify.

49.  a. the patient’s full name, address, date of birth and hospital/health record number on the
front page together with the ward and consultant’s name, either written directly or by
affixing an addressograph label.
 b. the patient’s name and health record number should be visible on each subsequent
page of the chart to reduce the risk of prescribing and administration error.
 c. recording the date of admission of the patient to hospital on the front page.
 d. where relevant, the recording of hospital site.

50.  a. a box for drug allergies and sensitivities [a single box using both descriptors] in a
prominent place on the front page, preferably in a different eye-catching colour and
with sufficient space to describe any previous reaction(s).
 b. space to document a finding of no known allergies/sensitivities
 c. a clear, bold statement that allergies/sensitivities recording must be documented
before prescription/administration except in exceptional circumstances.
 d. space for the name and designation of the person recording the drug
allergy/sensitivity history.

51.  3. There should be a box of sufficient size to allow the recording of dose units
written in full e.g. micrograms, units etc for each item.
 4. There should be a box for additional information for each item e.g. duration,
review date, special use, monitoring requirements.
 5. There should be boxes to add details of the patient’s age, height, weight (with
date of measurement) and body surface area. The mandatory completion of these
boxes will be a matter for local policy.
 6. There should be space for the inclusion of a statement that venous
thromboembolism risk assessment has been undertaken.

52. Patient Identifier
Patient specific
Red Flags
High risk Medication details
Single Use Medications

53. Good prescribing practice:
Where a patient is known to have a
specific
reaction to a medicine;
- record the reaction clearly,
- sign and date your entry.
Where the patient is thought to have an
allergy or reaction to a medicine but the
type of reaction is not known write
‘Unknown’ sign and date the entry.
Remember: Update the allergy status
should any new reactions occur.

54. Dedicated page for Antibiotics
Notice how different
components of
Prescription writing are
used in this section

55. Sections for PRN(As Required)
Medications

56. Up to 2 Pages for all
Regular medications

57. Nutritional Products

58. Wound care and
Oxygen Prescription

60. Example

73. BEST WISHES FOR THE FUTURE AHEAD