Intro Pharm Prac Week 4
Interpreting and Verifying Prescriptions
Course Information
Instructor: Savannah Owen, PharmD, BCACP
Course: PPR 6230 Pharmacy Practice II: Intro to Patient Care
Contact: sowen2@south.edu
Learning Objectives
Interpret and correctly translate standard abbreviations and symbols used on prescriptions.
Recognize abbreviations that are considered error-prone by the Institute for Safe Medication Practices (ISMP) and the Joint Commission.
Identify strategies to reduce the risk of errors when interpreting and verifying prescriptions in the community setting.
Background Information
Definition of "Practice of Pharmacy"
The practice of pharmacy according to Tenn. Code Ann. § 63-10-204 includes:
Patient-oriented health service profession:
Pharmacists interact and consult with patients and other health care professionals to enhance patients' wellness, prevent illness, and optimize outcomes.
Key Responsibilities:
Interpretation, evaluation, and implementation of medical orders and prescription orders.
Responsibility for compounding and dispensing prescription orders, including radioactive substances.
Participation in drug, dietary supplement, and device selection, storage, distribution, and administration.
Drug evaluation, utilization, or regimen review.
Maintenance of patient profiles and other pharmacy records.
Provision of patient education and counseling.
Provision of patient care services and activities pursuant to a collaborative pharmacy practice agreement.
Drug or drug-related research.
Professional acts or services necessary for a patient's pharmacist-provided care.
Cause of Medication Errors
Statistic: Over 7,000 deaths annually due to unclear handwriting by doctors, with an additional 1.5 million Americans injured from preventable medication errors.
Source: Caplan J., 2007, Time Magazine.
Prescription issues result from unclear abbreviations, dosage indications, and illegible writing on about 3.2 billion prescriptions written annually in the U.S.
Current Landscape
Medication errors rank among the most frequent and avoidable sources of patient harm.
A study tracked e-script errors in a community pharmacy, emphasizing the necessity to prevent such incidents.
Written Prescriptions
Structure of a Written Prescription
Prescriber Information: Name, Address, License Number, DEA Number, NPI Number, Telephone.
Patient Information: Name, Address, Date of Birth.
Prescription Details:
Date of Issue
Drug Name and Strength (example: Amoxicillin 400 mg chewable tabs)
Quantity Dispensed (example: #56)
Sig (instructions): Example - "Chew 2 tablets PO BID X 14 days for ear infection"
Refills (example: 0 Refills)
Dispense as Written (DAW) instructions if applicable.
Interpreting Prescription Sigs
Key Components
A complete sig must include:
Verb: Action required (e.g., take, give).
Quantity: Number to be taken (expressed in both digits and words).
Dosage Form: Form the drug is to be in (e.g., tablet, capsule).
Route of Administration: How the drug is taken (e.g., PO, SL).
Frequency: How often the medication is taken (e.g., bid for twice daily).
Additional Instructions: Any further relevant instructions.
Examples of Prescription Sigs
Verb Examples:
Take 1 tablet by mouth once daily.
Administer 5 mL by mouth twice daily.
Apply 1 patch topically to arm once daily as directed.
Quantities
Historical use of Roman numerals in prescriptions:
Basic Numerals:
ss = ½
i = 1
V = 5
X = 10
L = 50
C = 100
D = 500
M = 1000
Rules for Reading Roman Numerals:
A letter repeated adds value (ii = 2, iii = 3).
A letter before a larger letter subtracts (iv = 4).
A letter after a larger letter adds (vi = 6).
Abbreviations in Prescriptions
Quantity Abbreviations
tsp = teaspoonful (5 mL)
tbsp = tablespoonful (15 mL)
Best practice is to write amounts in milliliters (mL).
Dosage Forms Abbreviations
Abbreviation Meaning:
cap = capsule
tab = tablet
ODT = orally-disintegrating tablet
supp = suppository
ung = ointment
Route Abbreviations
Common route abbreviations and their meanings:
PO = by mouth
SL = sublingually
PV = vaginally
PR = rectally
TOP = topically
Frequency Abbreviations
q = every
qd = once daily
bid = twice daily
tid = three times daily
stat = immediately
prn = as needed
Error-Prone Abbreviations by ISMP
Error-Prone Abbreviation List to avoid misinterpretation:
U or u (units): Write out "unit(s)"
Q.D., QD, q.d., qd (once daily): Write "daily"
µg (micrograms): Write out "mcg"
Q.O.D., QOD (every other day): Write "every other day"
Medication Safety Procedures
Verification Before Filling
Confirm the validity of prescriptions:
Ensure all legal components are present.
Verify no alterations or forgery in the prescription.
Filling Prescriptions Steps
Interpret and enter prescription information into the patient's profile.
Bill insurance electronically if applicable.
Generate and print the prescription label.
Prepare and package the medication.
Attach the prescription label to the medication.
Verifying Final Prescriptions
Systematic checks to maintain accuracy during the verification process:
Review patient details including name and address.
Confirm drug name, strength, dosage form, quantity, and auxiliary labels.
Ensure the drug utilization review (DUR) is completed for appropriateness and safety before dispensing.
Responding to Medication Errors
Action Steps:
Listen to the patient's concerns and gather details.
Contact relevant providers if necessary.
Explain the error clearly and correct it.
Document the error and any corrective action taken.
Counseling Practices
Required Counseling Points
Essential information to provide for all new prescriptions:
Medication name and description.
Dosage form, dose, route of administration, and duration of therapy.
Directions and precautions for use.
Common side effects and interactions to be aware of.
Techniques for self-monitoring therapy.
Proper storage instructions.
Refill information.
Actions for missed doses.