Gail Feinberg DO FACOFP October 2009 Objectives Understand what makes a prescription Intro to Latin abbreviations Intro to DEA Practice writing prescriptions The parts of a prescription ID: 318883
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Slide1
Prescription Writing 101
Gail Feinberg, DO, FACOFP
October, 2009Slide2
Objectives
Understand what “makes” a prescription
Intro to Latin abbreviations
Intro to DEA
Practice writing prescriptionsSlide3
The parts of a prescriptionSlide4
What is a Prescription?
A prescription order is written for diagnosis, prevention or treatment of a specific patient's disease
Is written by a licensed practitioner
Is written as part of a proper physician-patient relationship
Is a legal document,
"prima facie" evidence
in a court of law.
(side note…A prima-facie case is a lawsuit that alleges facts adequate to prove the underlying conduct supporting the cause of action and thereby prevail.) Slide5
Definition
Literally, "Recipe" means simply "Take...." and when a medical practitioner writes a prescription beginning with "℞", he or she is completing the command.
Was probably originally directed at the pharmacist who needed to
take
a certain amount of each ingredient to compound the medicine (rather than at the patient who must "take/consume" it
).Slide6
Definition
The word "prescription" can be decomposed into "pre" and "script" and literally means, "to write before" a drug can be prepared.
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".Slide7
Parts of the Prescription
Patient Information
Superscription
Inscription
Subscription
Signa
Date
Signature lines, signature, degree, brand name indication
Prescriber information
DEA# if required
Refills
Warnings/label Slide8
Patient Information
Name
Address
Age
Weight (optional, but useful -
esp
in
peds
)
Time (used only with inpatient medication orders)Slide9
Superscription
RX
Traditional symbol for prescription
Use it to line up the other parts of the RxSlide10
Inscription
What is the pharmacist to take off the shelf?
Drug Name
Dose = Quantity of drug per dose form
Dose Form = The physical entity needed, i.e. tablet, suspension, capsule
Simple vs. Compound Prescriptions
Manufactured vs. compounded prescriptions
Clarity of number forms 0.2,
20
not 2.0
(Zeros lead but do not follow!)Slide11
Subscription
What is the pharmacist to do with the ingredients?
Quantity to be dispensed (determines amount in bottle) Dispense # 24
For controlled substances write in numbers and letters (like a bank check)
#24(twenty four)
Any special compounding instructionsSlide12
Signa, Signatura or Transcription
Sig—write, or let it be labeled (Latin terms: signa or signetur)
Instructions for the patient
Route of administration
Oral, nasally, rectally, etc
Take by mouth.., Give, Chew, Swallow whole, etc.
Number of dosage units per dose
Take one tablet, Give two teaspoonfuls, etc.
Frequency of dosing
every six hours, once a day…
Duration of dosing
for seven days,... until gone, ...if needed for pain.
Purpose of medication
for pain, for asthma, for headache, etc.
VERY IMPORTANT to include purpose as this reduces errors!
Do not use “As directed”
Special instructions (shake well, refrigerate etc.)
WarningsSlide13
Refills and Date Prescribed
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
Schedule II drugs can only be dispensed within 7 days of date on RX
CV-CIII can be refilled for 5 time in 6 mo. maximum.
Automatic Stop Orders (inpatient orders)
Antibiotics-7 days
Controlled Substances-3 daysSlide14
Signature of Prescriber
This makes the prescription a legal document
Include your degree
You must write “brand necessary,” “brand medically necessary,” or “DAW” (Dispense as Written) to get non-generics.Slide15
DEASlide16
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.
This is a precaution taken by the DEA to ensure that controlled substances are being prescribed by only qualified professionals. Slide17
DEA Number detail…
The first letter in the code is the type of practice
A – Deprecated
B –Hospital/Clinic
C – Practitioner
D – Teaching Institution
E – Manufacturer
F – Distributor
G – Researcher
H – Analytical Lab
J – Importer
K – Exporter
L – Reverse Distributor
P- Narcotic Treatment Program
R – Narcotic Treatment Program
S – Narcotic Treatment Program
T- Narcotic Treatment Program
U – Narcotic Treatment Program
X – Suboxone/Subutex Prescribing ProgramSlide18
DEA Number detail…
The second letter is the initial of the practitioners last name.
The third, fourth, fifth, and sixth numbers are randomly selected by a computer. The check digit is a calculation of the following:
Addition of the first, third and fifth digits
Addition of the second fourth and sixth digits times two
Add the sums of the two numbers
The sum is the last digitSlide19
Latin abbreviationsSlide20
Latin Used in Prescription Writing
Abbreviation
Latin
Meaning
bid
Bis in die
Twice daily
tid
Ter in die
Three times daily
qid
Quarter
in die
Four
times daily
hs (
or
qhs)
(Quaque) hora somni
At bedtime
(each night)
pc
Post cibum
After meals (or not on an empty stomach
prn
Pro re nata
As circumstances may require
po
Per os
By mouth (orally)
pr
Per rectum
Rectally (suppository)
ac
Ante cibum
Before meals
gtt (gtts)
Guttae
Drop(s)Slide21
Latin Used in Prescription Writing
file:///C:/Documents%20and%20Settings/Gail%20Feinberg/Desktop/List_of_abbreviations_used_in_medical_prescriptions.htm
file:///C:/Documents%20and%20Settings/Gail%20Feinberg/Desktop/List_of_medical_abbreviations%20_Do-not-use_list.htmSlide22
Preventing Medical ErrorsSlide23
Avoiding Medical Errors
Prescribing incorrectly
Can be due to slips, lapses or lack of knowledge (mistakes) (Always check dosage calculations!!!!!!)
Using ambiguous symbols
Poor handwritingSlide24
Avoiding Ambiguity
Careful use of decimal points to avoid ambiguity:
Avoiding unnecessary decimal points: a prescription will be written as 5 mL instead of 5.0 mL .
Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation of .5 as 5.
Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 to avoid misinterpretation.
Avoiding decimals altogether by changing the units: 0.5 g is less easily confused when written as 500 mg.
“mL" is used instead of “cc" or "cm³" even though they are technically equivalent to avoid misinterpretation of 'c' as '0' or the common medical abbreviation for "with" (the Latin "
cum
"), which is written as a 'c' with a bar above the letter.
Directions written out in full in English
Quantities given directly or implied by the frequency and duration of the directions.
Where the directions are "as needed", the quantity should always be specified.Slide25
Avoiding Ambiguity
Where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (3 times a day) and especially relationship to meals for orally consumed medication.
The use of permanent ink.
Avoiding unspecified
prn
or "as needed" instructions—instead, specific limits and indicators are provided e.g. "every 3 hours prn pain."
For refills, the minimum duration between repeats and number of repeats should be specified.
Providing the indication for all prescriptions even when obvious to the prescriber, so that the pharmacist may identify possible errors.
Avoiding units such as "teaspoons" or "tablespoons."Slide26
Avoiding Ambiguity
Writing out numbers as words
and
numerals ("dispense #30 (thirty)“)
The use of apothecary units and symbols of measure is discouraged
pint (
O
), ounce (
℥
), drams (
ℨ
), scruples (
℈
), grains (
gr
), and minims (
♏
)
Given the potential for errors, metric equivalents should always be used.
The use of the degree symbol (°), which is commonly used as an abbreviation for hours (e.g., "q 2-4°" for every 2 - 4 hours), should not be used, since it can be confused with a '0'.
In addition, the use of the degree symbol for primary, secondary, and tertiary (1°, 2°, and 3°) is discouraged, since the former could be confused with quantities (i.e. 10, 20 and 30, respectively).Slide27
Prescription Security
To prevent copying of prescription/pad
Anti-copy Watermark.
By tipping the paper towards the light, a picture appears to verify that the prescription is an original. Usually a Rx appears.
Anti-Coy Coin Rub.
By rubbing a penny across the back of the prescription the words “Secure Prescription Paper” appears.
Hidden Message Technology.
The word “Void” appears if a copy is made.Slide28
Prescription Security
To prevent modification of prescription
Toner Bond Security.
The paper is treated with a compound that fuses with any ink used on it (including toner from printers).
Blue Security Background.
Prevents erasing of prescription. Slide29
Prescription Security
Security measures to prevent counterfeiting of prescription forms
Unique Production Batch Numbers.
Unique numbers are assigned to every printed batch by the manufacturer.
Security Warning Band.
Visible warning band provides warning of security measures on paper to prevent counterfeiting
UV Fiber Secure.
Invisible fluorescent fibers and threads that can only be seen under blacklight
While some physicians use printers and a specific program to write their prescriptions, the same strict guidelines are used in the design of the printer paper used for prescriptions as well.Slide30Slide31
Practice ProblemsSlide32
Practice #1
Write a prescription for Amoxil, which can be given either 125mg/5mL or 250mg/5mL to a child who is 45 lbs (approx 20kg). The dose is 20-40mg/kg/day divided into 3 doses per day. Child needs to be on the antibiotic for 10 daysSlide33
Prescription should say…
Amoxil 250/5ml
Disp
: 150mL
Sig: 5mL tid until goneSlide34
Denise Watermark
Oct. 6, 2009
Amoxil 250/5ml
Disp
: 150mL
Sig: 5mL
tid
until
gone (also acceptable is 5mL
tid
x
10 days)
Gail Feinberg, DO, FACOFP
noneSlide35
Practice #2
Jane Doe need refill of her
digoxin
. Her dose is 1.25mg daily and she takes one daily. She needs a 30 day prescription to take to the pharmacy today and another one for 3 months to mail off…write both for her.Slide36
30 day will look like…
Jane Doe
Digoxin
1.25 mg
Disp
: #30
Sig: One
p.o
. daily (here can also add for
CHF
or whatever appropriate)
No refillSlide37
Jane Doe
10/7/09
Digoxin
1.25mg
Disp
# 30
Sig: One (1)
po
daily (can also add for
CHF
)Slide38
90 day will look like
Jane Doe
Digoxin
1.25 mg
Disp
# 90
Sig: One
p.o
. daily
No refillSlide39
Jane Doe
10/7/09
Digoxin
1.25mg
Disp
# 90
Sig: One (1)
po
daily (can also add for
CHF
)Slide40
Practice #3
Tom Smith has pulled his back out and you are going to give him some
Flexeril
(
Cyclobenzaprine
) as a muscle relaxer. This is given as 10mg up to three times daily as needed for muscle spasm. You only want to give him at most a
weeks worth.Slide41
Prescription should look like..
Tom Smith
Flexeril
10mg
# 21 (twenty one)
i
p.o
. up to
tid
prn
muscle spasm
(note the
i
…represents one ii=2, iii=3,
iiii
or iv = 4 etc.)
Can also write one (1)
po
up to …Slide42
Tom Smith
10/7/2009
Flexeril
10mg
DAW
#21 (twenty one)
1
po
up to
tid
prn
muscle spasm
Caution: May cause drowsiness
none