A PROFESSIONAL WAY OF WRITING PRESCRIPTION

When a patient is received in hospital or clinic, immediately medication is started to save the patient. In performing the medicine administration, one should adhere to the six rights of medication administration

1. Right patient

2. Right medication

3. Right dose

4. Right route

5. Right time

6. Right documentation

Right Patient

Ensuring that the right patient receives the right drug is usually not a problem in prehospital care because typically only one patient is being treated. However, in some circumstances more than one patient may be undergoing treatment, especially in multiple casualty incidents in which many patients are involved. Care should be taken to distinguish the patients to avoid confusion and possible medication error.

Right Medication

 A common error in prehospital drug administration is selection of the wrong medication. Most emergency medications are supplied in ampules, vials, or prefilled syringes. Many look very similar. To ensure that the right drug is selected, one should carefully read the label. If the drug is supplied in a box, they should check the label on the box and compare it with the label on the vial or ampule itself after removing it from the box.

Drug preparations and concentrations can vary. In addition to checking the drug name, drug concentration should always be checked to ensure that the is the one desired. After the physician’s verbal order, pharmacist should repeat the order back to confirm that medication is correct and according to the physician order. The expiration date of a drug should always be checked prior to administration. The medication should be held up to the light and inspected for discoloration or particles in the solution. Expired and discolored medications should be discarded.

Right Dose

Administration of the correct drug dose is crucial. Errors in dosage occur in either calculating the correct dose or preparing the correct dose. Most drug orders are fairly straightforward, and many medications are supplied in unit-dose forms. In these cases, drug dosage calculation and drug preparation are easy. However, many medications, especially those administered by intravenous infusion, are much more difficult to dose. For these medications, paramedics should refer to standardized dosage charts to assist with preparation and administration of the desired dose.

Right Route

Most medications used in hospitals are designed to be given by the intravenous route. However, certain medications can be given by other routes depending on the physician’s orders. It is the pharmacist’s responsibility to know the various routes by which a particular drug can be administered. For example, the drugs hydroxyzine and promethazine are frequently used in the treatment of nausea. Promethazine can be administered both intravenously and intramuscularly. Hydroxyzine, in comparison, can be administered only by the intramuscular route.

Right Time

During the medication therapy, drugs may be administered repeatedly at specific time intervals. An important consideration is the rate and time during which a drug is administered. Many drugs can be administered rapidly as an intravenous bolus. Others must be administered at a specific rate.

Right Documentation

The drugs administered in the field can affect the medication therapy when patient get admitted in the hospital. So medication therapy must be completely documented that patient can get right medication while staying in the hospital.

All these six medication rights are only well managed when they are documented properly. The documentation from physician is called Prescription.

THE PRESCRIPTION

The word "prescription" stems from the Latin term praescriptus. Praescriptus is made up of two Latin word parts, prae-, a prefix meaning before, and scribere, a word root meaning to write. Putting it all together, prescription means "to write before," which reflects the historical fact that a prescription traditionally had to be written before a drug could be mixed and administered to a patient.

The prescription is one of the most important therapeutic transactions between physician, Pharmacist and patient. The art of prescription writing is an ancient inheritance. The ancients started their prescription with an appeal to the gods for its success. The ancient symbol, Rx, signifying the appeal, was established centuries ago and has been carried down to the present time.

Many ancient prescriptions were noted for their multiple ingredients and complexity of preparation. The importance of the prescription and the need for complete understanding and accuracy made it imperative that a universal and standard language be employed. Thus, Latin was adopted, and its use was continued until approximately a generation ago. Present-day prescription practices lead, for the most part, to prescriptions containing a single ingredient, written in English, with doses given in the metric system. The ancient "Rx" and the Latin "Signatura," abbreviated as "Sig.," are all that remain of the ancient art of the prescription.

Drug use is a complex process and there are many drug related challenges at various levels, involving prescriber, pharmacists and patients. While medication misadventure can occur anywhere in the health care system from prescriber to dispenser to administration and finally to patient use, To avoid undesirable and/or serious effects on the patient, both physician and pharmacist must render the highest of professional services. Accurate diagnosis; proper selection of medication, dosage form and route of administration; proper size and timing of dose; precise dispensing; accurate labeling; and correct packaging all must be provided.

Types of Drugs

Prescriptioned/Legend Drugs: These drugs may not be dispensed by a pharmacist without a prescription from a physician, veterinarian, dentist.

Controlled Drugs: In addition to requiring a prescription, these drugs require additional safeguards for storage. Refills are also limited. Both Government agencies promulgate regulations regarding these drugs.

Over-the-Counter (OTC) Drugs: These drugs do not require a prescription.

Pattern of Prescription

A prescription consists of;

o   Description of Prescriber

o   Description of Patient

o   Superscription

o   Inscription

o   Subscription

o   Signa

o   Signature of the Physician

Description of Prescriber

The name, qualification either MBBS, DVM, BDS, MD contact information including office number, emergency hours numbers and mobile number and address of the Prescriber are written in this section.

Description of Patient

Name of owner, address, description of the patient including age, color, sex, specie, breed, temperature, pulse, respiration, any physical abnormality should be mentioned in this section. The date when the prescription order is written with daily, monthly and yearly number should also be mentioned in this section.

Superscription

Rx is an important abbreviation written in this section. There are two school of thoughts about this abbreviation. One is about the Romans. They claimed that it is their symbol, they added in the prescription to add the blessings of their god of health called Jupiter just to add the blessing in the cure of disease. Second is about the Latins. They claimed that this word resemble to the symbol written in latin language which means "recipe," the Latin for "take thou." The English “you take”.

Inscription                                     

It is also called the body of the prescription. It consist of one or all of followings

• A "basis" or chief ingredient indended to cure
• An "adjuvant" to assist its action and make it cure quickly
• A "corrective" to prevent or lessen any undesirable effect
• A "vehicle" or "excipient" to make it suitable for administration and pleasant to the patient

Subscription

In this section directions are given to the pharmacist, usually consisting of a short sentence such as: "make a solution," "mix and place into 10 capsules," or "dispense 10 tablets" from the prescriber.

Signatura

From the Latin "signa," meaning "write," "make," or "label," this section. It contains the directions to the patient. These should always be written in English; however, physicians continue to insert Latin abbreviations, e.g. "1 cap t.i.d. pc," which the pharmacist translates into English, "take one capsule three times daily after meals." Since the pharmacist always writes the label in English. The directions to the patient should include a reminder of the intended purpose of the medication by including such phrases as "for pain," "for relief of headache," or "to relieve itching". Labeling; when the physician wants his patient to know the name of the drug, the box on the prescription form marked "label" should be checked. Refills; the physician should designate the number of refills he wishes the patient to have. Proprietary vs. Non-Proprietary ("Generic") Prescriptions.

In recent years, some hospitals and private physicians are indicating on the prescription their willingness or desire that the pharmacist dispense a non-proprietary or "generic-named" preparation instead of the trade name item written on the prescription. Some have a box on the prescription designated "N.P.P." In this way, the pharmacist can use a form of the drug which may be less expensive to the patient.

The amount to be dispensed should be clearly stated and should be that needed by the patient. Excessive amounts should never be dispensed, as it is not only expensive to the patient, but may lead to accumulation of medicines in the home, which later can cause harm to the patient or members of his family. It is far better to have several refills of a prescription than to have an excessive amount prescribed at one time.

LAWS AFFECTING PRESCRIPTION WRITING

Controlled Substances Act of 1970

Schedules of Controlled Drugs: The drugs that come under the jurisdiction of the Controlled Substances Act are divided into five schedules. Drugs can be scheduled, unscheduled, or moved from one schedule to another as the need arises. Schedules are as follows:

Schedule I

Drugs in this schedule have no accepted medical use in the United States and have a high abuse potential. Examples are heroin, marijuana, LSD, peyote, etc.

Schedule II

Drugs in this schedule have a high abuse potential with severe psychic or physical dependence liability. Included are certain narcotic analgesics, stimulants, and depressant drugs. Examples are opium, morphine, codeine, hydromorphone, methadone, meperidine, oxycodone, anileridine, cocaine, amphetamine, methamphetamine, phenmetrazine, methylphenidate, amobarbital, pentobarbital, secobarbital, methaqualone, and phencyclidine.

Schedule III

Drugs in this schedule have an abuse potential less than those in Schedules I and II and include compounds containing limited quantities of certain narcotic analgesic drugs, and other drugs such as barbiturates, glutethimide, methyprylon, and chlorphentemine. Any suppository dosage form containing amobarbital, secobarbital, or pentobarbital is in this schedule.

Schedule IV

Drugs in this schedule have an abuse potential less than those listed in Schedule III and include such drugs as barbital, phenobarbital, chloral hydrate, ethchlorvynol, meprobabmate, chlordizepoxide, diazepam, oxazepam, chloroazepate, flurazepam, etc.

Schedule V

Drugs in this schedule have an abuse potential less than those listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotic analgesic drugs used for antitussive and antidiarrheal purposes.

USE OF TECHNOLOGY IN PRESCRIPTION WRITING

As prescription is nothing more than information among a prescriber, pharmacist and patient. Information technology can be applied to it. Existing information technology is adequate to print out prescriptions. Medical information systems in some hospitals do away with prescriptions within the hospital. There are proposals to securely transmit the prescription from the prescriber to the pharmacist using smartcard or the internet. In the United Kingdom a project called the Electronic Transfer of Prescriptions (ETP) within the National Program for IT is currently piloting such a scheme between prescribers and pharmacies.

Within computerized pharmacies, the information on paper prescriptions is recorded into a database. Afterwards, the paper prescription is archived for storage and legal reasons.

A pharmacy chain is often linked together through corporate headquarters with computer networking. Walgreens (largest American drug retailing chain) for example, uses satellite technology to share patient information. A person who has a prescription filled at one Walgreens can get a refill of that prescription at any other store in the chain, as well as have their information available for new prescriptions at any Walgreens.

Some online pharmacies also offer services to customers over the internet. They allow customers to order refills for medicine over the internet, and allows them to specify the store that they will pick up the medicine from. Many pharmacies now offer services to ship prescription refills right to the patient's home.