SRS0263 ; PHARMACY PRACTICE 1

Topic 2:
Writing prescription
 Medical prescription

 A prescription (℞) is a health-care program implemented by

a physician or other qualified healthcare practitioner in the
form of instructions that govern the plan of care for an
individual patient.

 Prescriptions may include orders to be performed by a patient,

caretaker, nurse, pharmacist or other therapist.

 Prescriptions are often written, though they may be typed into

a computerized physician order entry system or issued
verbally to the patient, a nurse, a pharmacist or other therapist
.

 Prescriptions have legal implications, as they may indicate

that the prescriber takes responsibility for the clinical care of
the patient and in particular for monitoring efficacy and safety
.
Format and definition
 Prescriptions are either entered into a Computerized Physician Order Entry
system, handwritten on preprinted prescription forms that are assembled
into pads, or alternatively printed onto similar forms using a
computer printer

 The symbol "Rx" meaning "prescription" is a transliteration of a symbol

resembling a capital R with a cross on the diagonal (℞).

 The word "prescription" can be decomposed into "pre" and "script" and
literally means, "to write before" a drug can be prepared. Those within the
industry will often call prescriptions simply "scripts".
 Contents of the prescription
 Both pharmacists and prescribers are regulated professions in most
jurisdictions. A prescription as a communications mechanism between them
is also regulated and is a legal document. of the prescription (including the
Regulations may define what constitutes a prescription, the contents and
format he size of the piece of paper - Many jurisdictions will now allow
faxed or phone prescriptions containing the same information.

 Drug companies use direct-to-prescriber advertising in an effort to convince

prescribers to dispense as written with brand-name products rather than
generic drugs.

 Many brand name drugs have less expensive generic drug substitutes that
are therapeutically equivalent. Prescriptions will also contain instructions
on whether the prescriber will allow the pharmacist to substitute a generic
version of the drug.
 This instruction is communicated in a number of ways. In some
jurisdictions, the preprinted prescription contains two signature lines: one
line has "dispense as written" printed underneath; the other line has
"substitution permitted" underneath. Some have a preprinted box "dispense
as written" for the prescriber to check off (but this is easily checked off by
anyone with access to the prescription). Other jurisdictions the protocol is
for the prescriber to handwrite one of the following phrases: "dispense as
written", "DAW", "brand necessary", "do not substitute", "no substitution",
"medically necessary", "do not interchange“

 As a guideline, pediatric prescriptions should include the age of the child if

the patient is less than twelve and the age and months if less than five. (In
general, including the age on the prescription is helpful.) In some
jurisdictions, it may be a legal requirement to include the age of child on
the prescription Adding the weight of the child is also helpful.
 Prescriptions often have a "label" box. When checked, pharmacist is
instructed to label the medication. When not checked, the patient only
receives instructions for taking the medication and no information about the
prescription itself.

 Some prescribers further inform the patient and pharmacist by providing

the indicator for the medication; i.e. what is being treated. This assists the
pharmacist in checking for errors as many common medications can be
used for multiple medical conditions.

 Some prescriptions will specify whether and how many "repeats" or

"refills" are allowed; that is whether the patient may obtain more of the
same medication without getting a new prescription from the doctor.
Regulations may restrict some types of drugs from being refilled.

 In group practices, the preprinted portion of the prescription may contain

multiple prescribers' names. Prescribers typically circle themselves to
indicate who is prescribing or there may be a checkbox next to their name.
Form of the Written Prescription

 A prescription, stripped to its barest form, consists of the superscription, the

inscription, the subscription, the signa, and the name of the prescriber - written
within the confines of a form.

 Superscription
The date when the prescription order is written; the name, address and age of the
patient; and the symbol Rx (an abbreviation for "recipe," the Latin for "take thou."

 Inscription
The body of the prescription, containing the name and amount or strength of each
ingredient.

 Subscription
The directions to the pharmacist, usually consisting of a short sentence such as:
"make a solution," "mix and place into 10 capsules," or "dispense 10 tablets."
• Signatura
From the Latin "signa," meaning "write," "make," or "label," this sections 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 use of such
abbreviations or symbols should be discouraged.

• The instruction, "take as directed," is not satisfactory and should be avoided. 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.
 PARTS OF PRESCRIPTION

• i) Prescribers or Physician details

• ii) Patient details
• iii) The superscription
• iv) The inscription
• v) The subscription
• vi) The signa
• vii) Instruction for Renewal
• viii) Name and signature of Physician

• Prescribers or Physician detail (Date on which prescribed and name and address of
the prescriber)
• Date of prescribing and the date of presentation for filling are necessary for keeping
accurate records and ascertaining the needs of the patient.

• Patient details (Name, address and age of the patient)

• Age and sex of the patient if mentioned, help the pharmacist to check the prescribed
dose of medication.
 The superscription
The superscription consists of the symbol Rx which is the abbreviation of the Latin
word Recipe meaning you take.
 The inscription
Inscription contains the names and quantities of the ingredients to be compounded
or dispensed by the pharmacist.
 The subscription
It embodies the directions to the pharmacist for preparing the prescription.
 The signa
Signa or Signatura contains the directions for the patient regarding administration of
drugs.
 Instruction for Renewal
The number of times a prescription prescribed by the Physician be repeated is
prescribed by the physician under refill information.
 Name and signature of Physician
The prescription must bear the signature of the prescriber with the seal contain
name and registration number. With out the signature and seal the prescription is
invalid.
Continued: PARTS OF PRESCRIPTION

 Inscription :
 Contains : dosage form, name of medication, strength, dose,
frequency of dose, duration.

 Name of medication:
 Most drug have 3 different name:
• 1. chemical name : ( refer to chemical structure name)
• 2. generic (non-proprietary) name : simplified chemical name
• 3. trade (proprietary )name : trademark name from manufacturer.

Exp:
T. Paracetamol 1gram tds PRN 3/7
T. Panadol 500mg ii tds PRN 3/7
Sy. Panadol 250mg 5ml 4H PRN 3/7
Continued: PARTS OF PRESCRIPTION
Continued

[R-(R*, R*)]-2-(4-fluorophenyl)-b, d -dihydroxy-5- (1-

methylethyl)-3- phenyl-4-[(phenylamino)carbonyl]- 1H-
pyrrole-1-heptanoic acid, calcium salt (2:1) trihydrate.

atovarstatin calcium Lipitor 10mg Atorlip-10

Handling of the prescription

• When filled by a pharmacist, as a matter of business

practice, the pharmacist may write certain
information right on the prescription.

• This may also be mandated by legislation .

• Information such as the actual manufacturer of the

drug and the date the medication was dispensed may
be written right onto the prescription.

• Legislation may require the pharmacist sign the

prescription.

• In computerized pharmacies, all such information is

printed and stapled to the prescription.

• Sometimes such information is printed onto labels

and the labels affixed right onto the prescription .
Continued :Handling of the prescription

 When filled by the pharmacist, prescriptions are typically assigned a

"prescription number “that is unique to the pharmacy that filled the
prescription.

 The prescription number is written right on the prescription by the

pharmacist.

 The prescription number has the practical purpose of uniquely

identifying the prescription later on while filed (both manual and
electronic).

 The prescription number is also put on the label on the dispensed

medication.
Continued :Handling of the prescription

 As a legal document, some jurisdictions will mandate the archiving of the

original paper prescription in the pharmacy.

 Often the patient cannot take the original prescription with them. Some
jurisdictions may entitle patients to a copy.

 The retention period varies but can be as long as six years.

 Once the retention period has passed, privacy legislation may dictate what
can be done with the original paper prescription.

 Legislation may also dictate what happens to the prescriptions if the

pharmacy closes or is sold. For example, if the pharmacy goes out of
business, the pharmacist may be required to return the prescription to the
patient, to the next closest pharmacy or to the governing body for
pharmacists.
Continued : Handling of the prescription

 Prescriptions for non-narcotic drugs may

also be "transferred" from one pharmacy to
another for subsequent repeats to be
dispensed from another pharmacy.

 The physical piece of paper that is the

prescription is not transferred, but all the
information on it is transferred from one
pharmacy to another.

 Legislation may dictate the protocol by

which the transfer occurs and whether the
transfer needs to be noted on the original
paper prescription.