A Professional way of writing Prescription

By: Pharma Tips | Views: 2008 | Date: 26-Aug-2013

When a patient is received in hospital or clinic, immediately medication is started to save the patient. In performing the medicine administration, one should adhere to the six rights of medication administration1. Right patient,2. Right medication,3. Right dose,4. Right route,5. Right time,6. Right documentation

A Professional way of writing Prescription




Whena patient is received in hospital or clinic, immediately medication is startedto save the patient. In performing the medicine administration, one shouldadhere to the six rights of medication administration

1.Right patient
2.Right medication
3.Right dose
4.Right route
5.Right time
6.Right documentation

RightPatient
Ensuringthat the right patient receives the right drug is usually not a problem inprehospital care because typically only one patient is being treated. However,in some circumstances more than one patient may be undergoing treatment,especially in multiple casualty incidents in which many patients are involved.Care should be taken to distinguish the patients to avoid confusion andpossible medication error.

RightMedication
 A common error in prehospital drugadministration is selection of the wrong medication. Most emergency medicationsare supplied in ampules, vials, or prefilled syringes. Many look very similar.To ensure that the right drug is selected, one should carefully read the label.If the drug is supplied in a box, they should check the label on the box andcompare it with the label on the vial or ampule itself after removing it fromthe box.
Drugpreparations and concentrations can vary. In addition to checking the drugname, drug concentration should always be checked to ensure that the is the onedesired. After the physician’s verbal order, pharmacist should repeat the orderback to confirm that medication is correct and according to the physicianorder. The expiration date of a drug should always be checked prior toadministration. The medication should be held up to the light and inspected fordiscoloration or particles in the solution. Expired and discolored medicationsshould be discarded.

RightDose
Administrationof the correct drug dose is crucial. Errors in dosage occur in eithercalculating the correct dose or preparing the correct dose. Most drug ordersare fairly straightforward, and many medications are supplied in unit-doseforms. In these cases, drug dosage calculation and drug preparation are easy.However, many medications, especially those administered by intravenousinfusion, are much more difficult to dose. For these medications, paramedicsshould refer to standardized dosage charts to assist with preparation andadministration of the desired dose.

RightRoute
Mostmedications used in hospitals are designed to be given by the intravenousroute. However, certain medications can be given by other routes depending onthe physician’s orders. It is the pharmacist’s responsibility to know thevarious routes by which a particular drug can be administered. For example, thedrugs hydroxyzine and promethazine are frequently used in the treatment ofnausea. Promethazine can be administered both intravenously andintramuscularly. Hydroxyzine, in comparison, can be administered only by theintramuscular route.

RightTime
Duringthe medication therapy, drugs may be administered repeatedly at specific timeintervals. An important consideration is the rate and time during which a drugis administered. Many drugs can be administered rapidly as an intravenousbolus. Others must be administered at a specific rate.

RightDocumentation
Thedrugs administered in the field can affect the medication therapy when patientget admitted in the hospital. So medication therapy must be completelydocumented that patient can get right medication while staying in the hospital.
Allthese six medication rights are only well managed when they are documentedproperly. The documentation from physician is called Prescription.

THE PRESCRIPTION
The word "prescription" stems fromthe Latin term praescriptus. Praescriptus is made up of two Latin word parts,prae-, a prefix meaning before, and scribere, a word root meaning to write.Putting it all together, prescription means "to write before," whichreflects the historical fact that a prescription traditionally had to bewritten before a drug could be mixed and administered to a patient.
The prescription is one of the most importanttherapeutic transactions between physician, Pharmacist and patient. The art ofprescription writing is an ancient inheritance. The ancients started theirprescription with an appeal to the gods for its success. The ancient symbol,Rx, signifying the appeal, was established centuries ago and has been carrieddown to the present time.
Many ancient prescriptions were noted fortheir multiple ingredients and complexity of preparation. The importance of theprescription and the need for complete understanding and accuracy made itimperative that a universal and standard language be employed. Thus, Latin wasadopted, and its use was continued until approximately a generation ago.Present-day prescription practices lead, for the most part, to prescriptionscontaining a single ingredient, written in English, with doses given in themetric system. The ancient "Rx" and the Latin "Signatura,"abbreviated as "Sig.," are all that remain of the ancient art of theprescription.
Drug use is a complex process and there aremany drug related challenges at various levels, involving prescriber,pharmacists and patients. While medication misadventure can occur anywhere inthe health care system from prescriber to dispenser to administration andfinally to patient use, To avoid undesirable and/or serious effects on thepatient, both physician and pharmacist must render the highest of professionalservices. Accurate diagnosis; proper selection of medication, dosage form androute of administration; proper size and timing of dose; precise dispensing;accurate labeling; and correct packaging all must be provided.

Types of Drugs

Prescriptioned/Legend Drugs: These drugsmay not be dispensed by a pharmacist without a prescription from a physician,veterinarian, dentist.

Controlled Drugs: In addition torequiring a prescription, these drugs require additional safeguards forstorage. Refills are also limited. Both Government agencies promulgateregulations regarding these drugs.

Over-the-Counter (OTC) Drugs: These drugsdo not require a prescription.

Pattern of Prescription

A prescription consists of;

o  Descriptionof Prescriber
o  Descriptionof Patient
o  Superscription
o  Inscription
o  Subscription
o  Signa
o  Signatureof the Physician


Description of Prescriber
The name, qualification either MBBS, DVM,BDS, MD contact information including office number, emergency hours numbersand mobile number and address of the Prescriber are written in this section.

Description of Patient
Name of owner, address, description of thepatient including age, color, sex, specie, breed, temperature, pulse,respiration, any physical abnormality should be mentioned in this section. Thedate when the prescription order is written with daily, monthly and yearlynumber should also be mentioned in this section.

Superscription

Rx is an important abbreviation written inthis section. There are two school of thoughts about this abbreviation. One isabout the Romans. They claimed that it is their symbol, they added in theprescription to add the blessings of their god of health called Jupiter just toadd the blessing in the cure of disease. Second is about the Latins. Theyclaimed that this word resemble to the symbol written in latin language whichmeans "recipe," the Latin for "take thou." The English “youtake”.

Inscription                                     
It is also called the body of theprescription. It consist of one or all of followings
  • A "basis" or chief ingredient indended to cure
  • An "adjuvant" to assist its action and make it cure quickly
  • A "corrective" to prevent or lessen any undesirable effect
  • A "vehicle" or "excipient" to make it suitable for administration and pleasant to the patient
Subscription
In this section directions are given to thepharmacist, usually consisting of a short sentence such as: "make asolution," "mix and place into 10 capsules," or "dispense10 tablets" from the prescriber.

Signatura
From the Latin "signa," meaning"write," "make," or "label," this section. Itcontains the directions to the patient. These should always be written inEnglish; however, physicians continue to insert Latin abbreviations, e.g."1 cap t.i.d. pc," which the pharmacist translates into English,"take one capsule three times daily after meals." Since thepharmacist always writes the label in English. The directions to the patientshould include a reminder of the intended purpose of the medication byincluding such phrases as "for pain," "for relief ofheadache," or "to relieve itching". Labeling; when the physician wants his patient to know the name ofthe drug, the box on the prescription form marked "label" should bechecked. Refills; the physicianshould designate the number of refills he wishes the patient to have.Proprietary vs. Non-Proprietary ("Generic") Prescriptions.
In recent years, some hospitals and privatephysicians are indicating on the prescription their willingness or desire thatthe pharmacist dispense a non-proprietary or "generic-named"preparation instead of the trade name item written on the prescription. Somehave a box on the prescription designated "N.P.P." In this way, thepharmacist can use a form of the drug which may be less expensive to thepatient.
The amount to be dispensed should be clearlystated and should be that needed by the patient. Excessive amounts should neverbe dispensed, as it is not only expensive to the patient, but may lead toaccumulation of medicines in the home, which later can cause harm to thepatient or members of his family. It is far better to have several refills of aprescription than to have an excessive amount prescribed at one time.

LAWS AFFECTING PRESCRIPTION WRITING

Controlled Substances Act of 1970
Schedules of Controlled Drugs: The drugs that come under the jurisdictionof the Controlled Substances Act are divided into five schedules. Drugs can bescheduled, unscheduled, or moved from one schedule to another as the needarises. Schedules are as follows:
Schedule I
Drugs in this schedule have no acceptedmedical use in the United States and have a high abuse potential. Examples areheroin, marijuana, LSD, peyote, etc.
Schedule II
Drugs in this schedule have a high abusepotential with severe psychic or physical dependence liability. Included arecertain narcotic analgesics, stimulants, and depressant drugs. Examples areopium, morphine, codeine, hydromorphone, methadone, meperidine, oxycodone,anileridine, cocaine, amphetamine, methamphetamine, phenmetrazine, methylphenidate,amobarbital, pentobarbital, secobarbital, methaqualone, and phencyclidine.
Schedule III
Drugs in this schedule have an abusepotential less than those in Schedules I and II and include compoundscontaining limited quantities of certain narcotic analgesic drugs, and otherdrugs such as barbiturates, glutethimide, methyprylon, and chlorphentemine. Anysuppository dosage form containing amobarbital, secobarbital, or pentobarbitalis in this schedule.
Schedule IV
Drugs in this schedule have an abusepotential less than those listed in Schedule III and include such drugs asbarbital, phenobarbital, chloral hydrate, ethchlorvynol, meprobabmate,chlordizepoxide, diazepam, oxazepam, chloroazepate, flurazepam, etc.
Schedule V
Drugs in this schedule have an abusepotential less than those listed in Schedule IV and consist primarily ofpreparations containing limited quantities of certain narcotic analgesic drugsused for antitussive and antidiarrheal purposes.

USE OF TECHNOLOGY IN PRESCRIPTION WRITING
Asprescription is nothing more than information among a prescriber, pharmacistand patient. Information technology can be applied to it. Existing informationtechnology is adequate to print out prescriptions. Medical information systems in some hospitals do away with prescriptions within thehospital. There are proposals to securely transmit the prescription from theprescriber to the pharmacist using smartcard or theinternet. In the United Kingdom a project called the Electronic Transfer ofPrescriptions (ETP) within the National Program for IT is currently pilotingsuch a scheme between prescribers and pharmacies.
Withincomputerized pharmacies, the information on paper prescriptions is recordedinto a database. Afterwards, the paper prescription is archived for storage andlegal reasons.
A pharmacychain is often linked together through corporate headquarters with computernetworking. Walgreens (largestAmerican drug retailing chain)for example, uses satellite technology to share patient information. A personwho has a prescription filled at one Walgreens can get a refill of thatprescription at any other store in the chain, as well as have their informationavailable for new prescriptions at any Walgreens.

Some onlinepharmacies also offer services to customers over the internet. They allowcustomers to order refills for medicine over the internet, and allows them tospecify the store that they will pick up the medicine from. Many pharmacies nowoffer services to ship prescription refills right to the patient's home.
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