Prescription Notes

Prescription, Latin Terms

Definition of Prescription

• The word “prescription” comes from the Latin term praescriptus, derived from prae (before) and scribere (to write).
• A prescription is an order written by a physician, dentist, veterinarian, or registered medical practitioner (RMP) to a pharmacist.
• It instructs the pharmacist to compound and dispense a specific medication for an individual patient.
• It includes directions for both the pharmacist and the patient.
• Prescription means ‘to write before.’
• Historically, prescriptions were necessary before a drug could be compounded and administered.

Types of Prescription

• Pre-compounding prescription: For already prepared drugs by pharmaceutical companies (e.g., Cap. Ciprofloxacin 500 mg).
• Extemporaneous prescription: The pharmacist prepares the medication according to the drugs and dosages directed by the physician (rare nowadays).

Parts of a Prescription

• Prescriber office information
• Date
• Patient information (Name, Age, Gender, and Address)
• Superscription (symbol ℞)
• Inscription (Medication prescribed) - Main part
• Subscription (Direction to Pharmacist/Dispenser)
• Signatura or Transcription (Direction for Patient)
• Renewal instructions
• Prescriber’s signature and registration number.

Heading

• Date: Written by the prescriber to know when the medicines were last dispensed and prevent misuse.
• Personal data of patient: Name, Age, Gender & Address.
  • Helps identify the prescription.
  • Age & gender help the pharmacist check the prescribed dose, especially for children.

Body

• Superscription: Represented by the symbol Rx, abbreviation of the Latin word recipe, meaning ‘take thou’.
  • Most drugs are now prescribed in ready-made formulations, so compounding is almost eliminated.
• Inscription: The main part, containing the name and quantities of the prescribed medicaments for exact formulation.
  • Parts:
    • Base: Active medicaments for therapeutic effect.
    • Adjuvants: To enhance the action of the drug.
    • Vehicle: Main carrier of the drug.
• Subscription: Prescriber’s directions to the pharmacist, including:
  • Type of dosage form to be prepared.
  • Number of doses to be dispensed.
• Signatura: Direction to the patient regarding the administration of the drug, written as ‘Sig.’. Includes:
  • The quantity to be taken.
  • The frequency and timing of administration.

Closing

• Renewal Instruction: Indicates how many times the prescription can be renewed to prevent misuse of habit-forming drugs.
• Signature, address, and registration number of the prescriber:
  • Essential information for contacting the doctor in an emergency.
  • Required for narcotic or habit-forming drugs to prevent misuse.

Requirements

• A prescription should be kept simple and abbreviation-free (Latin abbreviations can be used if necessary).

Example Prescription

• Date: 10.2.2023
• Patient Information:
  • Name: Mr. Ram
  • Age: 45 years
  • Sex: Male
  • Address: 45, Brook Road, PD
  • Phone No: 552248, 552284
• Prescriber Information:
  • Dr. Aswini Sharma M.B.B.S., M.D.
  • Regn. No. 14328
  • SHARMA NURSING HOME, 5, Model town, PD
• Superscription: ℞
• Inscription:
  • Sodium bicarbonate 3g
  • Compound tincture of cardamom 2ml
  • Simple Syrup 6ml
  • Purified Water q.s. 90ml
• Subscription: Fiat Mistura.
• Signatura: Sig. Cochleare magnum ter in die post cibos sumendus.
• Refill: (Renewal instruction)

Processing a Prescription: A Step-by-Step Approach

• 5 basic steps for filling a prescription:
  1. Taking in the prescription
  2. Translating the prescription
  3. Entering information into the computer system
  4. Filling the prescription
  5. Patient counseling
• Steps 1-4 relate to the Pharmacy Assistant (PA), step 5 to the pharmacist.
• Requires complete presence of mind & concentration.

Important Patient Information

• Patient Information:
  • Name
  • Phone number & address
  • Age or date of birth
• Provider’s Information:
  • Name
  • Phone Number & address
• Medication Details:
  • Name of medication
  • Strength
  • Dosage form
  • Quantity
  • Route of administration
  • Sig.
  • Refill information
  • Date written

Necessary Patient Information in a Hospital Setting

• Patient:
  • Patient name
  • Medical record number
  • Room number
• Prescriber:
  • Name of medication
  • Strength
  • Route of administration
  • Dosage form
  • Sig. (route & frequency)
  • Prescriber’s signature
  • Date & time written
• Other important information:
  • Allergies
  • Weight
  • Age
  • Height & weight (pediatrics & geriatrics)
  • Diagnosis

Translation of an Order

• If an order is hard to decipher:
  • Look at the whole order.
  • Consider the clinic the order came from.
  • Identify the strength or dose.
  • Note the route of administration.
  • Determine the frequency of medication.
  • Verify the dosage form.
  • Check for refills.

Filling the Script

• 10 steps to prevent errors:
  1. Check the label on the stock bottle.
  2. Pull the appropriate medication from the shelf.
  3. Measure or count out the necessary amount.
  4. Fill the vial, avoid touching the medication.
  5. Ensure the lid is appropriate and affixed properly.
  6. Apply labels onto the vial and prescription back.
  7. Place technician’s initials on labels.
  8. Apply necessary auxiliary labels.
  9. Put the medication on top of the original prescription.
  10. Pass it to the pharmacist for final inspection.
• The PA should check the medication against the script and/or against the label at steps marked with *.

Checking the Label Against the Script

• Hold the original script next to the label and check for any apparent errors or discrepancies.
  • Drug name
  • Strength or dose
  • Dosage form
  • Amount
  • Sig
• Make sure all information matches.

Handling of Prescription

• Receiving
• Reading & checking
• Collecting the materials
• Weighing
• Compounding
• Finishing

Receiving

• The prescription should be received by the pharmacist.
  • Reading the prescription
  • Checking the prescription
• A pharmacist should maintain a neutral facial expression.

Reading & Checking

• Read completely and carefully from top to bottom.
• Note the nature of the dosage form and time required for preparing.
• Inform the patient if a long time is needed for compounding.
• Careful examination should be done behind the counter.
• If there is any doubt or error, consult with another pharmacist or prescriber without alarming the patient.
• Interpret every word and abbreviation correctly.
• Never guess the meaning of illegible or confusing words.
• Check for any incompatibility.

Collecting and Weighing the Materials

• Before compounding, collect all materials on the LHS of the balance.
• After dispensing, collect materials on the RHS of the balance.

Compounding, Labeling, and Packaging

• Compounding should be done in a neat place.
• Equipments should be cleaned and dried thoroughly.
• Dispense one prescription at a time.
• Dispense ingredients according to instructions.
• Medications should be dispensed properly.
• Labeled suitably.
• Label fixed suitably.
• Container should be polished.
• Delivery: Pharmacist explains the mode of administration, direction for use, and storage.

Counting & Filling The Medication

• After the PA locates the medication and removes it from the shelf, return to the counter and fill the script.
• Check the label & script against the medication bottle for accuracy.
• Count medications using counting trays, preferably in multiples of five.

Compounding, Labeling & Packaging Details

• Compounding: Accuracy, cleanliness & proper technique
• Suitable containers: Glass, plastic, metal containers
• Quantity to be dispensed
• Labeling: Size of label, good quality paper & adhesive, information and special directions
• Packaging

PA’s Initials

• Orders should be initialed by PA.
• To answer patient questions. If an error occurs, the PA can be notified & learn from that error.

Auxiliary Label

• Labels must adhere neatly to the vials.
• Know when medications need special auxiliary labels.
• Read auxiliary labels before adhering them to the bottle.

Commonly Used Auxiliary Labels for Side Effects

Errors in Prescription

• Sources of error:
  • Abbreviation
  • Name of the drug
  • Strength of the preparation
  • Dosage form of the drug prescribed
  • Dose
  • Instructions for the patient
  • Incompatibilities

Check list: The Five Rights

• Drug: Is this the RIGHT drug?
• Dose: Is this the RIGHT dose?
• Patient: Is this the RIGHT patient?
• Route: Is this the RIGHT route?
• Time: Is this the RIGHT time?

Modern Prescription

• Four types:
  • Prescription in general practice
  • Private prescriptions
  • Hospital Prescriptions for outpatients.
  • Hospital Prescriptions for inpatients
• Advantages:
  • Proprietary names are easy to remember.
    • Eg. Panadol – paracetamol.
  • Easy to communicate with the patient.
  • Continuity can be maintained.
• Disadvantages:
  • Cheaper to prescribe drugs by their official name.
  • Difficult to dispense substitutes if not in stock.

E-Prescription

• Defined as the process of electronically generating and sending a prescription order.
• Physicians and other medical practitioners can transmit electronic prescriptions to a pharmacy directly from the point of care.

Types of E-Prescribing Systems

• Systems integrated with electronic health records, which include comprehensive patient information.
• Stand-alone systems, which are less costly and easier to implement.

How E-Prescription Works

1. During the consultation, the doctor will send you an SMS or e-mail.
2. You will then take it to your pharmacy or send it to them.
3. If you have repeats, a new SMS or email will be sent to you when you get your medicine.

Benefits of Using E-Prescription

1. Fewer Callbacks from Pharmacies:
   • Poor physician handwriting can lead to pharmacists contacting your office for clarification.
2. Paper Files Replaced:
   • Replace storage room devoted to patient paper files.
3. Improved Patient Outcomes:
   • Easier to spot mistakes.

Abbreviation Meaning (with LaTeX)

• $$: g/100 finished units: commonly, g/100 mL or g/100 g
• $g$: gram
• $IU$: International unit
• $mg$: Milli gram
• $mEq$: Milli equivalent
• $U$ or $u$: unit

Drug Form

• If the drug comes in more than one form, the prescriber will need to identify the desired form

Total amount of drug product

• The number of dosage units in each dose is usually specified in Arabic numerals preceded by a # sign but sometimes roman numerals are used
• They may be written in either capital or small letters & precede or follow the name of the dosage form
• For example;
  • 5 tab = 5 tablets
  • Caps ii = 2 capsules
  • i gtt = 1 drop
  • 250 mg #40 tabs = 40 tablets of 250 mg

Interpreting the directions

• The directions written on a prescription by a prescriber will contain abbreviations in the dose, the route, the frequency and the frequency modifiers
• Example;
  • Sig : gentamicin opth sol i/i gtt OU q4h x 5 days
  • Meaning: ONE DROP EACH ON BOTH EYES EVERY 4 HOURS for five days
  • oculus uterque: both eyes
• Latin abbreviations are often used to describe the frequency of administration
• Some of the commonly used abbreviations are listed in table

Latin Abbreviation (with LaTeX)

Example

• Consider these directions to the patient;
  • Sig: 1 tab q 3 h
  • [Take one (1) tablet every three (3) hour]
  • Sig: Chart II h.s.
  • [Take two (2) powders at bedtime]

More Latin Terms and Abbreviations

TLAs in Hospital Pharmacy

• TLA* stands for three-letter acronym, and describes a plethora of abbreviations used to save time when discussing medical conditions, writing
  • stat - immediately
  • QDS - four times a day
  • ac - before meals
  • TDS - three times day
  • PRN - as occasion requires

More TLAs and Abbreviations

• A&E stands for Accident and Emergency.
• Other abbreviations and TLAs used to denote hospital departments:
  • CCU - critical care unit
  • OPD - out patient department
  • ENT - ear, nose and throat
  • SCBU - special care baby unit
  • ICU - intensive care unit
  • ITU - intensive therapy unit or intensive treatment unit

Dosage Based on Drops

• Liquid medication intended for use in the eye, ear or nose or for oral use by pediatric patients
• Usually dispensed in a dropper bottle
• The Latin abbreviations listed are frequently used;
  • gtt – drop
  • o.d – right eye
  • o.s – left eye
  • o.u – both eye
• Translate:
  1. 2 gtt o.s. od
     • Put two (2) drops in the left eye once a day
  2. Gtt. i o.u. b.i.d
     • Put one (1) drop in both eyes twice a day

Common Latin Rx Terms

• ac (ante cibum) means "before meals"
• bid (bis in die) means "twice a day“
• gt (gutta) means "drop"
• hs (hora somni) means "at bedtime"
• od (oculus dexter) means "right eye"
• os (oculus sinister) means "left eye"
• po (per orem) means "by mouth"
• pc (post cibum) means "after meals"
• prn (pro re nata) means "as needed"
• q 3 h (quaque 3 hora) means "every 3 hours"
• qd (quaque die) means "every day"
• qid (quater in die) means "4 times a day"
• Sig (signa) means "write"
• tid (ter in die) means "3 times a day"

Important Questions

1. What is a Prescription? (2M)
2. What are the main parts of prescription? (2M)
3. What are the parts of the prescription? (essay)
4. Write a note on modern prescription.
5. Write the Latin and English equivalents for the terms.
6. What are the sources of error in Prescription?