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.
CAPSULES
TABLETS
