Prescription and Medication Order PDF-1 (OUR LADY OF FATIMA UNIVERSITY)

OUR LADY OF FATIMA UNIVERSITY College of Pharmacy DISPENSING 1 (PDIS 211) Week 1: INTRODUCTION TO DISPENSING, THE PRESCRIPTION and MEDICATION ORDERS  UNIT OUTCOMES At the end of this unit, the students are expected to: 1. Demonstrate understanding about dispensing and good d...

OUR LADY OF FATIMA UNIVERSITY College of Pharmacy DISPENSING 1 (PDIS 211) Week 1: INTRODUCTION TO DISPENSING, THE PRESCRIPTION and MEDICATION ORDERS  UNIT OUTCOMES At the end of this unit, the students are expected to: 1. Demonstrate understanding about dispensing and good dispensing practices in pharmacy. 2. Demonstrate understanding of the format and components of a typical prescription. 3. Identify the different types of prescription. 4. Describe e-prescription and identify its advantages.  UNIT OUTCOMES At the end of this unit, the students are expected to: 5. Differentiate medication order from a prescription. 6. Demonstrate understanding about format and component of medication order. 7. Interpret correctly the standard abbreviations and symbols used on prescription and medication orders.  UNIT OUTLINE I. Dispensing III. E-Prescribing/e- a. Definition of dispensing prescriptions b. Good dispensing a. Definition of e- practices in pharmacy prescribing b. Advantages of e- prescriptions II. Prescription a. Types of prescription b. Parts of prescription  UNIT OUTLINE IV. Medication Order a. Prescription and medication order V. Parts of medication order VI. Abbreviations used in prescription and medication orders CHECKLIST u Read unit outcomes u Read course guide prior to class attendance u Proactively participate in discussions u Watch videos related to the topic u Participate in discussion board (Canvas) u Answer and submit course unit tasks  REQUIRED READINGS u WHO Manual for Medicines Good Dispensing Practice, Second Edition, May 2012, Ethiopia https://apps.who.int/medicinedocs/en/p/topics/az,R.html u FDA Circular No. 2020-007 || Guidelines in the Implementation of the use of Electronic Means of Prescription for Drugs for the Benefit of Individuals Vulnerable to COVID-19 https://www.fda.gov.ph/wp-content/uploads/2020/03/FDA-Circular- No.-2020-007.pdf u Lester, C. A., Tu, L., Ding, Y., & Flynn, A. J. (2020). Detecting Potential Medication Selection Errors During Outpatient Pharmacy Processing of Electronic Prescriptions With the RxNorm Application Programming Interface: Retrospective Observational Cohort Study. JMIR medical informatics, 8(3), e16073. https://doi.org/10.2196/16073  WEEK 1 THE PRESCRIPTION AND MEDICATION ORDER  DISPENSING u refers to the process of preparing and giving medicine to a named person on the basis of a prescription. u It involves a correct interpretation of the wishes of the prescriber and the accurate preparation and labeling of medicines for use by the patient.  DISPENSING u Dispensing includes all the activities that occur between the time the prescription is presented and the time the medicine or other prescribed items are used to the patient.  GOOD DISPENSING PRACTICE u Good dispensing practice ensure that an effective form of the correct medicine is delivered to the right patient in the correct dosage and quantity, with clear instructions, and in a package that maintains the potency of the medicine. PRESCRIPTION u It contains names and quantities of the desired substances, with instructions for the pharmacist for the preparation of the medicine and to the patient for the use of the medicine at a particular time u a formula written on a piece of paper PRESCRIPTION u Prescriptions are orders for medications, nondrug products, and services that are written by a licensed practitioner or midlevel practitioner who is authorized by state law to prescribe. u An order of medication issued by a physician, dentist, veterinarian or other properly licensed medical practitioner PRESCRIPTION Prescriptions may be written, presented orally (by telephone), or presented electronically (i.e., via fax or computer network) to the pharmacist. The prescription serves as a vehicle for communication from the prescriber to the pharmacist about the needs of the patient. u Written by pharmacist in pursuant to the telephoned dictation of the physician u Oral instructions that direct use of certain drugs or call for the use of some physical agent u Finished product compounded and dispensed by a pharmacist in pursuant to the instructions of a prescriber PRESCRIPTION FORMS u Prescription blanks are printed forms containing blank spaces for filling in the required information, usually supplied in pads u Most prescription blanks are imprinted with the name, address, telephone number and other pertinent information of physician or his/her practice site u Medication order forms are used for in-patients TYPES OF PRESCRIPTION u Simple prescription – with only one ingredient, those written for a single component or prefabricated product and not requiring compounding or admixture by the pharmacist. u Compound prescription – with more than one ingredient, those written for more than a single component and requiring compounding. TYPES OF PRESCRIPTION u Dangerous Drug Prescription - Prescription for controlled substances contains a narcotic substance or other habit-forming drugs. u Yellow Prescription u e-prescriptions- these are prescriptions transmitted to a pharmacy by computer.  TYPES OF PRESCRIPTION u Polypharmacy – with ten or more than two ingredients of the same therapeutic uses. Also called the shotgun preparation u Magistral prescription - is a prescription which is prescribed very often by the same doctor, of the same ingredients and compounded by the same pharmacist u Coded prescription also called the blind prescription and consists of word, symbols, to represent the names of the drugs. This is unethical practice. PARTS OF PRESCRIPTION PARTS OF PRESCRIPTION 1. PATIENT INFORMATION u The full name and address of the patient are necessary on a prescription for identification purposes. u Failureof the physician to supply necessary information prompts the pharmacist to complete it. PARTS OF PRESCRIPTION 2. DATE u Date on which the prescription was issued u It is important in establishing the medication record of the patient. u An unusual lapse of time between the date a prescription was written and the date it was brought to the pharmacy may be questioned by the pharmacist to determine if the intent of the physician and needs of the patient can still be met. PARTS OF PRESCRIPTION 3. Rx SYMBOL or SUPERSCRIPTION u A contraction of the Latin verb “recipe” meaning you take or take thou u Symbol originated from the sign of Jupiter (god of healing) u It forms the beginning of a direct order from the prescriber to the compounder u Today, the symbol is both the representation of prescription and pharmacy itself  PARTS OF PRESCRIPTION 4. MEDICATION PRESCRIBED or INSCRIPTION u The body or principal part of the prescription u Containsthe names and quantities of the prescribed medications (for fabricated medicines) u Compounded prescriptions are orders requiring mixing of ingredients. It will include the names and quantities of each ingredients  PARTS OF PRESCRIPTION 4. MEDICATION PRESCRIBED or INSCRIPTION u The body or principal part of the prescription u Contains the name and dosage strength of the prescribed medications (for fabricated medicines) u The name can be any of the following: a. Proprietary (brand) b. Nonproprietary (generic) c. Chemical u Compounded prescriptions are orders requiring mixing of ingredients. It will include the names and quantities of each ingredients  PARTS OF PRESCRIPTION 4. MEDICATION PRESCRIBED or INSCRIPTION u Product strength. The strength of the product is not required if only one strength is commercially available or if the product contains a combination of active ingredients. u It is advisable to include the strength to reduce the chance of misinterpreting the prescription. If the dose is to be calculated by the pharmacist, then the pharmacist can decide the strength of the product dispensed after calculating the patient's dose.  PARTS OF PRESCRIPTION 5. DISPENSING DIRECTIONS TO THE PHARMACISTS OR SUBSCRIPTION Directions may be required for: u a. Preparation (e.g., compounding) u b. Labeling (i.e., information to be put on the prescription label) u In common prescription, this may be the quantity to be dispensed or the dosage form of the drug u In a compounded prescription, this is the part that gives direction to the pharmacist for preparing the prescription  PARTS OF PRESCRIPTION Typical compounded prescription has the following parts: u Basis – chief, active ingredient u Adjuvant – used as assist to the basis u Corrective - qualifies the action of basis and the adjuvant u Vehicle – added to dilute the active ingredients processing the prescription order  PARTS OF PRESCRIPTION 5. DISPENSING DIRECTIONS TO THE PHARMACISTS OR SUBSCRIPTION u Quantity to be dispensed. This should include the amount and the units of measure (e.g., grams, ounces, tablets). If the amount is not specified, the directions should specify the dose to be taken and the duration of therapy so that the pharmacist can calculate the quantity required for the patient. PARTS OF PRESCRIPTION 6. DIRECTIONS FOR THE PATIENT or SIGNA u “signatura” or mark thou u usually using abbreviated forms of English or Latin terms u this includes: method of administration, dose, frequency and special instructions u pharmacist transcribed these information onto the label of the dispensed medication PARTS OF PRESCRIPTION u it is the duty of the pharmacist, if in Latin, to translate to English or to any vernacular language on the label clearly and distinctly u signa written as “As directed” is discouraged and pharmacist should confirm this with the physician  ROUTE OF ADMINISTRATION - for oral dosage forms --- “take” or “give” - for externally applied products --- “Apply - for suppositories ---- “Insert” - - for eye, ear, nose drops ---- “Place” is preferable to “instill”  PARTS OF PRESCRIPTION 7. REFILL INSTRUCTIONS u indicated by the prescriber and any refills should likewise be marked by the pharmacist u If refill information is not supplied, it is generally assumed that no refills are authorized. u “As needed” (pro re nata [prn]) refills are usually interpreted as allowing for refills for 1 year unless laws or regulations restrict the amount or time period in which a prescription is valid.  PARTS OF PRESCRIPTION 8. PRESCRIBER’S INFORMATION u This should include the name, office address, signature of the prescriber, the S2 number (for controlled substances only) and the PTR number. e-PRESCRIBING / e-PRESCRIPTIONS e-PRESCRIBING/e- PRESCRIPTIONS u The use of electronic means for the generation and transmission of prescriptions is already accepted. u In the inpatient or outpatient setting, a medication order, for a patient is entered into an automated data entry system as a personal computer (PC) or a handheld device loaded with e-prescribing software and sent to a pharmacy as an e- prescription. u When received, a pharmacist immediately reduces the order to a hard copy and/or stores it as a computer file.  ADVANTAGES OF e- PRESCRIPTIONS u Among the advantages cited for e-prescriptions over traditional paper prescriptions are: u reduced errors due to prescription legibility; u concurrent software screens for drug interactions; u reduced incidence of altered or forged prescriptions; u efficiency for both prescriber and pharmacist; and, u convenience to the patient, whose prescription would likely be ready for pick-up upon arrival at the pharmacy.  u Medication orders are used in the inpatient or institutional health Medication system setting. order u Prescription are used in the outpatient, or ambulatory setting.  u Both can be handwritten, typed, preprinted, verbal or entered into a medication computer program and order submitted to the pharmacy by the patient via fax, computer or other electronic means.  A medication order is written directions provided by a prescribing practitioner for a specific medication to be administered to an individual. Medication Order The prescribing practitioner may also give a medication order verbally to a licensed person such as a pharmacist or a nurse.  Medication order Before dispensing the prescription or medication This includes ensuring the order, the pharmacist’s correct drug, dose, dosage responsibility is to evaluate form, frequency, route of the prescription or administration, duration of medication order for therapy and indication. appropriateness.  u Additionally, the patient’s profile is evaluated for therapeutic duplication, drug allergies, drug- Medication order disease state interactions, and drug-drug interactions, and laboratory data are reviewed if available.  1. Copy of a written prescription 2. Written order on a consultation form signed by the practitioner 3. Written list of medication order signed by the practitioner Examples of 4. Copy of a pharmacy call in order, given to you by the different types pharmacist of medication 5. A verbal order given to a orders are: licensed person 6. Electronic prescriptions signed electronically via a secured system  Medication order contains the following information: Medication orders typically contain similar information that would be included in a prescription. This includes: 1. Patient’s name, date of birth, medical record number 2. Patient’s location and room number 3. Date and time of order 4. Drug name 5. Dosage strength  Medication order contains the following information: 6. Route of administration 7. Frequency of administration 8. Duration of therapy 9. Allergies 10. Special considerations in administering the medication, if applicable, as directed by the prescribing practitioner or the pharmacist 11. Name and signature of physician  Name of the patient BASIC Address INFORMATION INCLUDED IN Physician MEDICATION ORDER Birthday/age Date of admission Insurance Typical hospital medication order sheet Sample medication order sheet  Types of orders 1. Stat Order – A single dose of medication that should be administered immediately 2. Single Order – One time medication. Drug is to be given at a certain time. 3. Standing – Drug is to be given for a certain number of doses or for a certain number of days - administered routinely until order is cancelled by another order 4. PRN – Drug is administered when necessary or as needed based on the patient’s needs Prescription and Medication Order Accuracy u It is the responsibility of the pharmacist to ensure that each prescription and medication order received is correct in its form and content; is appropriate for the patient being treated; and is subsequently filled, labeled, dispensed, and administered accurately.  Prescription and Medication Order Accuracy In essence, each medication should be: therapeutically appropriate for the patient; prescribed at the correct dose; dispensed in the correct strength and dosage form; correctly labeled with complete instructions for the patient or caregiver; and for the patient in a hospital or other health care facility, each medication must be administered to the correct patient, at the correct time, and by the correct rate and route of administration.  u A pharmacist should never guess at the meaning of an indistinct Abbreviations and word or unrecognized symbols commonly abbreviation. used in prescriptions and medication orders: u Unfamiliar or unclear abbreviations represent a source of error in interpreting and dispensing prescriptions.  u No official or standard list of Abbreviations and prescription abbreviations symbols commonly used in prescriptions exists. Many of those in use and medication are derived from the Latin orders: and generally are recognized. However, many others may be simply short- hand creations of the individual prescriber.  u In hospital practice, the Pharmacy and Therapeutics Committee may identify a list of approved abbreviations for the institution. Abbreviations and symbols commonly used in prescriptions and medication orders: u In community practice, there is no such list. Pharmacy abbreviations may be found in the inscription, subscription, or the sig (signa) of the prescription.  u The inscription contains the name of the medication and its quantity, Abbreviations and symbols commonly the subscription informs the used in prescriptions and medication pharmacist how to compound the orders: prescription, and the sig are the directions for taking the medication. u Common prescriber abbreviations for drug names include Pb for phenobarbital, HCTZ for Abbreviations and hydrochlorothiazide, MTX for symbols commonly methotrexate, and ASA for aspirin. used in prescriptions Diseases and conditions also are and medication orders: commonly abbreviated (eg, CHF for congestive heart failure, BPH for benign prostatic hypertrophy, URI for upper respiratory tract infection, HBP for high blood pressure). u Other abbreviations, such as ATC for around-the-clock, WA for while awake, and BM for bowel movement, also are used in prescription writing.  WRITING prescriptions and medication orders: u The use of Latin words, phrases, and abbreviations in prescriptions is a carryover from the time that Latin was considered the international language of medicine. u Latin was used extensively in writing prescription orders until the early part of although its use gradually has diminished, it is still used widely, in the form of abbreviations, in the subscription and signa portions of prescriptions.  WRITING prescriptions and medication orders: u Unfortunately, medication errors can result from the misuse, misinterpretation, and illegible writing of abbreviations, and through the use of ad hoc, or made-up, abbreviations. u The use of a controlled vocabulary, a reduction in the use of abbreviations, care in the writing of decimal points, and the proper use of leading and terminal zeros have been urged to help reduce medication errors.  WRITING prescriptions and medication orders: Among the specific recommendations to help reduce medication errors arising from poorly written, illegible, or misinterpreted prescriptions and medication orders are the following: uA whole number should be shown without a decimal point and without a terminal zero (e.g., express 4 milligrams as 4 mg and not as 4.0 mg). uA quantity smaller than one should be shown with a zero preceding the decimal point (e.g., express two tenths of a milligram as 0.2 mg and not as 0.2 mg). u Leavea space between a number and the unit (e.g., 10 mg and not 10mg). u Use whole numbers when possible and not equivalent decimal fractions (e.g., use 100 mg and not 0.1 g).  WRITING prescriptions and medication orders: u Use the full names of drugs and not abbreviations (e.g., use phenobarbital and not PB). u Use USP designations for units of measure (e.g., for grams, use g and not Gm or gms; for milligrams, use mg and not mgs or mgm). u Spell out ‘‘units’’ (e.g., use 100 units and not 100 u or 100 U since an illegible U may be misread as a zero, resulting in a 10- fold error, i.e., 1000). The abbreviation I.U., which stands for ‘‘International u Units,’’ should also be spelled out so it is not interpreted as I.V., meaning ‘‘intravenous.’’  WRITING prescriptions and medication orders: u Certain abbreviations that could be mistaken for other abbreviations should be written out (e.g., write ‘‘right eye’’ or ‘‘left eye’’ rather than use o.d. or o.l., and spell out ‘‘right ear’’ and ‘‘left ear’’ rather than use a.d. or a.l.). u Spell out ‘‘every day’’ rather than use q.d.; ‘‘every other day,’’ rather than q.o.d; and ‘‘four times a day,’’ rather than q.i.d to avoid misinterpretation. u Avoid using d for ‘‘day’’ or ‘‘dose’’ because of the profound difference between terms, as in mg/kg/day versus mg/kg/dose.  WRITING prescriptions and medication orders: u Integrate capital or ‘‘tall man’’ letters to distinguish between ‘‘look alike’’ drug names, such as AggreSTAT and AggreNOX; hydrOXYZINE and hydrALAZINE; and DIGoxin and DESoxyn. u Amplify the prescriber’s directions on the prescription label when needed for clarity (e.g., use ‘‘Swallow one (1) capsule with water in the morning’’ rather than ‘‘one cap in a.m.’’). ABBREVIATIONS AND SYMBOLS COMMONLY USED IN PRESCRIPTIONS AND MEDICATION ORDERS u Although they may save time for the prescriber, they are sometimes the source of confusion and can be misinterpreted, resulting in medication errors. ABBREVIATIONS AND SYMBOLS COMMONLY USED IN PRESCRIPTIONS AND MEDICATION ORDERS ABBREVIATIONS AND SYMBOLS COMMONLY USED IN PRESCRIPTIONS AND MEDICATION ORDERS ABBREVIATIONS AND SYMBOLS COMMONLY USED IN PRESCRIPTIONS AND MEDICATION ORDERS ABBREVIATIONS AND SYMBOLS COMMONLY USED IN PRESCRIPTIONS AND MEDICATION ORDERS REFERENCES u WHO Ensuring Good Dispensing Practice u Remington, J. P., Beringer, P. Remington, The Science and Practice of Pharmacy. 21st Edition (2015) u Thompson, Judith E (2009) A Practical Guide to Contemporary Pharmacy Practice. 3rd Edition u Ansel, H. (2010) Pharmaceutical Calculations. 14th Edition.  ASSIGNMENT Reminder: u Prepare for online quiz u Memorize the abbreviations used in prescription and medication order Assignment: 1. What is medication order? How does it differ to a prescription? 2. Explain how abbreviations and symbols have been associated with errors. 3. What are the ways to avoid errors from abbreviations and symbols? Note: Submit this before the first lecture on Week 2.