Prescription Overview PDF

Prescription An overview Dr. Fahad Saleem BPharm (Hons), MPhil (Pharmacology), MBA (HRM), PhD (Pharmacy Practice), PDoc (Medicine Management) Email: [email protected]  Background Prescription medication history dates to a...

Prescription An overview Dr. Fahad Saleem BPharm (Hons), MPhil (Pharmacology), MBA (HRM), PhD (Pharmacy Practice), PDoc (Medicine Management) Email: [email protected]  Background Prescription medication history dates to at least 1820 BC when Egyptian physicians prepared and prescribed drugs for their patients. The world’s oldest known prescriptions were recorded on a clay tablet in Mesopotamia (modern-day Iraq), 2400 BC. In ancient Pompeii, many ailments were treated with an infusion of wormwood. While in Babylon, doctors and priests worked together to see if an exorcism was needed.  Background The earliest known record of a compounded medicine is found in the Sushrata Samhita, a classical Sanskrit text on surgery and one of three foundational texts of Ayurveda – or Indian traditional medicine – that dates as early as the 6th century BC. By the early 17th century, Western society had created its first pharmacist guild, and those apothecaries played a central role as healthcare providers. Two centuries later in the United States, apothecaries became known as pharmacists, thanks to Edward Parrish of the American Pharmaceutical Association.  Definition It is an order written by a physician, dentist, veterinarian or a registered medical practitioner (RMP) to a pharmacist to compound and dispense a specific drug for the patient. OR Prescription is a written order for medication, issued by physician or RMP. Prescription is relationship between physician and pharmacist.  Definition The word prescription is derived from the Latin term PRAESCRIPTUS (Prae - 'before' and scribere-meaning 'to write’). Prescription means 'to write everything before' which means prescription had to be written before a drug could be compounded and administered to a patient. Prescription is Prima facie; valid document for official matters.  Types of Medicines There are two broad legal classifications of medications: ❖ The medications which can be obtained only by prescription which are referred as prescription drugs or legend drugs. The medications which may be purchased without a prescription, which are termed non-prescription drugs or over- the-counter (OTC).  Types of Prescriptions Simple prescription: Those written for a single component generally not requiring compounding or admixture by the pharmacist. Compound or complex prescription: Those written for more than a single component and requiring compounding (can be extemporaneous or not). Fixed-dose prescriptions: Those written for fixed components and are available commercially. e-prescriptions (electronic prescription): The use of electronic means for the generation and transmission of prescriptions is used and accepted in major countries nowadays.  Types of Prescriptions In-patient prescription: a medication order form used in the hospital setting (infectious disease, cardiac care, pediatrics, and others). Narcotic prescription: contains a narcotic substance or other habit-forming drugs. It must contain in addition to the contents of the simple prescription, the address of the patient, the narcotic registry number of the prescriber.  Types of Prescriptions Acute Prescriptions ❖ Acute medications are medications that have been issued by your GP but not added to your repeat prescription list. ❖ This could be for several reasons, for example: it is a new medication that the GP needs to monitor for a period to ensure that it is appropriate before adding to repeat. ❖ It is a short-term medication that should not be needed regularly ❖ Or it is a high-risk medication that the GP wants to monitor more closely, thus is not appropriate for repeat prescribing.  Types of Prescriptions Repeat Prescriptions ❖ Repeat medication are the medications the doctor has clinically assessed as stable long-term medications, and therefore appropriate to be added to your repeat medication list ❖ Medications on this list are available for yourself or a trusted representative to order, you will need to order your medication with enough time to ensure you do not run out.  Background Initially verbally Switched to paper based on more strict rules and regulations, code of ethics and patients’ right Today based on HMIS (Health Management Information System) for record maintenance and superior safety.  Parts of Prescriptions A typical prescription consists of the following parts: 1. Prescriber office information 2. Date & time 3. Patient information (Name, Age, Sex And Address Of The Patient) 4. Superscription (symbol ℞) 5. Inscription (Medication prescribed)- Main part of prescription 6. Subscription(Direction to Pharmacist/Dispenser ) 7. Signatura or Transcription (Direction for Patient) 8. Renewal instructions 9. Prescriber’s signature and registration number.  Prescriber office information Information about physician is essential so that the patient could be contact in emergency. Following information is mentioned on the prescription. ❖ Doctor’s and office name ❖ Address with phone number and e-mail ❖ Prescription number, (requiredwhen calling the pharmacy for a refill).  Date & Time It helps a pharmacist to find out the date of prescribing. It also helps in know when the medicines were last dispensed if the prescription is brought for re-dispensing. In case of habit-forming drug, the date prevents the misuse of the drug by the patient. The date also ensures for validity of prescription (1 year in Pakistan and 18 months in Europe).  Patient information Patient information (Name, Age, Sex, Weight and Address of the Patient). ❖ Name and address of the patient for identification purpose. ❖ Age, weight and sex of the patient is required (esp pediatrics) to check the prescribed dose.  Superscription (℞) It is represented by ℞ (Latin term) “recipe‟ which means “take thou” or “you take”. Another theory exists that the "℞" may have originally been a "Px", where the "P" is short for "pre", and the "x" is short for "script". In old days the symbol was considered to be originated from the sign of Jupiter. This symbol was use for requesting God for the quick recovery of the patient. Most possibly, it is related to the ever-looking eye of Amun-Ra  Inscription (Medication prescribed) It is the main part of the prescription. It contains the names and quantities of the prescribed medicaments. The medicament may be official preparation or nonofficial preparation. ❖ Official preparation (i.e., from pharmacopoeia) – Only name of the preparation is written. E.g., Amoxicillin Syrup USP ❖ Nonofficial preparation- Quantity of each ingredient will be given and type of preparation will also be given. E.g., make 20% of ASA, 5% of BM and 10% of Fluconazole in 100 mg of Petroleum jelly.  Subscription (Direction to Pharmacist) The inscription is the part of the prescription, contain the composition of the medicine and amount of dosage. In this part the prescriber gives direction to the pharmacist regarding the dosage form to be prepared. Example- Paracetamol 500mg ; Paracetamol 650 mg etc. For controlled substances write in numbers and letters (like a bank check) #24 (twenty-four)  Signatura (Sig) The signatura is the part of the prescription, contain the direction given by the writer to the patient, how and when should the medicines be taken. The directions are given in Latin short cuts. Example: "BID" means "bis in die" or every twelve hours; "a.c" means before a meal etc. The Pharmacist is responsible for conveying these instructions to the patients.  Signatura (Sig) Normally to be placed on the label Instructions should be written on the label of container so that the patient can follow them. The instructions may include: ❖ Quantity to be taken ❖ Frequency and timing of administration of the preparation ❖ Route of administration ❖ Special instruction/s (if any)  Renewal Instructions The number of times a prescription is to be repeated is written by the physician. It is very important for the case of habit-forming drugs to prevent its misuse. Indicate either no refills or the number of refills you want (don’t leave it blank). Determines maximum duration of therapy. Date the prescription, All prescriptions expire after one year Automatic Stop Orders (inpatient orders) ❖ Antibiotics-7 days ❖ Controlled Substances-3 days  Signature of Prescriber This makes the prescription a legal document Stamp the prescription The physician may write “brand necessary,” “brand medically necessary,” or “DAW” (Dispense as Written).  DEA (if required) All medical prescribers are required to request and receive a DEA number, which contains two letters, six numbers, and one “check digit” before a single narcotic prescription can be dispensed. AA123456# This is a precaution taken by the DEA to ensure that controlled substances are being prescribed by only qualified professionals.  Legal Requirements for a Valid Prescription Prescription should be written in indelible (can not erased) ink (may be handwritten or computer generated) Prescription must be signed in indelible ink by the practitioner using his own name. Prescription must be dated by the prescriber. Prescription should state address of the practitioner If issued by a dentist, the words for dental use only must be there Prescription must space out words and numbers. Prescription must contain complete medication orders. Prescription must be stamped. Thank You