PRESCRIPTION WRITING

SULAYMAN ADEMOLA
 Definition
• Prescription is an order for medication
issued by a physician, dentist,
veterinarian or other properly licensed
medical practitioner through a patient
to a duly registered licensed pharmacist
to transmit the order and dispense as
such to the designated patient for the
purpose of treating a particular disease
condition(s).
 Characteristics of a good Prescription
• A good prescription must contain the following :
• Name and logo of the generating Hospital or Clinic.
• Name of the Patient
• File number of the patient
• Sex of the Patient
• Age or Weight of the Patient
• Dosage form of the Drug(s)
• Strength of the Drug(s)
• Frequency of usage
• Period of Usage
• Route of administration
• Precaution(s)
• Name, identification number and Signature of the Prescriber
• Name, identification number and Signature of the Dispenser
 Legal and Professional importance of
Prescription
• It protects the Prescriber, the Dispenser as well as the
Patient.
• It prevents the unwarranted usage of drugs.
• It prevents the usage of dangerous and abuse of
addicted drugs.
• It assists in proper documentation, evaluation and
Monitoring of Drugs usage.
• It guides in Policy making of the Health of the
Population.
• It is a source of research and medical advancement
• Prescriptions designate a specific medication and dosage to
be administered to a particular patient at a specified time.
Commonly the prescribed medication also is referred to ``as
the prescription`` by the patient.
• The prescription order is a part of the professional
relationship between the prescriber, pharmacist and
patient.
• It is the pharmacist’s responsibility in this relationship to
provide the medication needs of the patient.
• The pharmacist must be precise not only in the manual
aspects of filling the prescription order but must provide
the patient with the necessary information and guidance to
the patient in regards to compliance in taking the
medication properly.
• It is also the pharmacist’s responsibility to advise
the prescriber of drug sensitivity and other drug
issues as the patient may have other medications
that the patient may be taking which may alter
the effectiveness or safety of the newly and \or
previously prescribed medication.
• To meet these responsibilities it is essential that
the pharmacist maintains a high level of practice
competence, keeps appropriate records on the
health status and medication history of his
patients and develops professional working
relationships with other health professionals.
• Pharmacists must maintain the trust of the prescriber and
patient including maintaining confidentiality of the medication
being taken by a patient and the nature of his illness is an
important matter which must be respected.

• There are two broad legal classifications of medications:

nonprescription drugs or over the- counter (OTC) drugs.

Prescription drugs or legend drugs.

• The term “legend” must appear on the label of the product as it

is provided to the pharmacist by the manufacturer as:

• Caution: Federal law prohibits Dispensing without prescription.’

• Prescriptions may be written by the prescriber and given
to the patient for presentation at the pharmacy, or they
may be telephoned or communicated directly to the
pharmacist.
• Prescription orders received verbally should be reduced
to proper written form immediately or entered directly
into a prescription computer by the pharmacist .
Form of prescription order
Prescription blanks
• Supplied in the form of a pad.
• Most prescription blanks are imprinted with the name,
address, telephone number and other pertinent
information of the physician or his practice site in case
his name is signed illegibly.
Veteran Health Administration prescription form
• For use only in VA facilities printed on security paper and
sequentially numbered.
• The front of the form, printed in gray tone, has check
off blocks to indicate patient status (e.g., inpatient) as
wells check of blocks to override the general authority to
allow drug substation and require the product name,
strength and quantity to be placed on the label.
• The back of the form in white, which must be
completed for dispensing an original or refill
prescription, provides space to enter the manufacturer
and control number of the product, the date dispensed
or mailed, the signature or initials of the dispensing
pharmacist and any calculations or written notations.
Transposition Prescription blank

• Used by the pharmacist in transcribing verbally

received prescriptions into written prescriptions.

• Commonly imprinted with the name, address

and telephone number of the pharmacist.

• These blanks also may be used by physicians to

write prescriptions; any paper or other writing
material may be used.
 Component parts of a prescription
• Prescriber’s office information
• Patient information
• Date
• Symbol or superscription (Rx)
• Medication prescribed or inscription
• Dispensing directions to pharmacist or subscription
• Directions for patient or signa (to be placed on label) for a refill,
special labeling and / or other instructions.
• Prescriber’s signature and license or DA number as required.
 
• In practice some of the above information (such as the patient’s
address) may be absent when the prescription is received by the
pharmacist.
• In these instances the pharmacist obtains the necessary information
from the patient or physician, as is required.
Patient information-
• The full name and address of the patient are necessary on the prescription
for identification purposes.

• Names and addresses written illegibly should be clarified on acceptance of

the prescription.

• Incorrect spelling of a patient’s name on a prescription label not only

might cause concern in the patient’s mind as to the correctness of the
medication, but also would hamper the desired professional relationship
between the pharmacist and patient.

• Federal law requires that both the full name and address of both the
prescriber and the patient be included on prescriptions for certain
controlled substances.

• Controlled substances are drugs which, because of their potential for

abuse, are controlled under special regulations by the federal government.
• The address of the patient is useful for identification
purposes as well as for delivery of medication to the
patient’s home.
•  Some prescription blanks used by medical specialists,
particularly pediatricians, include a space for insertion of
the patient’s age and / or weight.
• This information is placed on the prescription by the
physician when medication dosage is an important
function of age or weight.
• This information assists the pharmacist in interpreting
the prescription particularly useful when a child has the
same name as one of his parents.
• Example of a physician’s prescription showing typical
form and content. Go to the KIUTH Pharmacy.
 
Date
• Prescriptions are dated at the time they are written and also
when they are received and filled in the pharmacy.
• The date is important in establishing the medication record of
the patient.
• An unusual lapse of time between the date a prescription was
written and the date it is brought to the pharmacy may be
questioned by a pharmacist to determine if the intent of the
physician and the needs of the patient can still be met.
• The date prescribed is also important to a pharmacist in filling
prescriptions for controlled substance.
• The drug abuse control amendments specify that no
prescription order for controlled substances may be
dispensed or renewed more than 6 months after the date
prescribed.
Symbol or superscription
• The Rx symbol generally is understood to be a
contraction of the Latin verb “recipe”, meaning
“take thou” or “you take” .
• Some historians believe this symbol originated
from the sign of Jupiter, employed by the
ancients in requesting aid in healing.
• Gradual distortion through the years has led to
the symbol currently used.
• Today, the symbol is representative of both the
prescription and pharmacy itself.
Medication prescribed or inscription
• This is the body or principal part of the prescription order
containing the names and quantities of the prescribed ingredients.
• Today, the majority of prescriptions are written for medications
already prepared or prefabricated into dosage forms by industrial
manufacturers.
• The medications may be prescribed under their trademarked or
manufacturer’s proprietary names or by their nonproprietary or
generic names.
• Pharmacists are required to dispense the trademarked product
when prescribed, unless substitution of an equivalent product is
permitted by the prescribing physician or by state law.
• In some instances, the patient must also consent to the drug
substitution.
• Some states require the prescriber to write specific instructions on
the prescription to allow or disallow product substitution.
• Prescription orders requiring the pharmacist to mix
ingredients are termed compounded prescriptions.
• Prescriptions requiring compounding contain the names and
quantities of each ingredient required.
• The names of the ingredients generally are written using the
nonproprietary names of the materials, although
occasionally proprietary names may be used.
• Two systems of weights and measures may be used:
 Apothecary system though diminishing.
 Metric system in frequent widespread use
 Here, the decimal is often replaced by a vertical line that may
be imprinted on the prescription blank or drawn by the
prescriber.
• The symbols g or mL often are eliminated, as it is understood
that solids are dispensed by weight and liquids by volume.
Dispensing directions to pharmacist or subscription
• This part of the prescription consists of directions to the
pharmacist for preparing the prescription.
• With diminished frequency of compounded prescriptions,
such directions are likewise less frequent.
• In a large majority of prescriptions, the subscription serves
merely to designate the dosage form (as tablets, capsules,
etc) and the number of dosage units to be supplied.
• Examples of prescription directions to the pharmacist are:-
• M ft caps did no xxiv (mix and make capsules. Dispense 24
such doses)
• Ft supp No xii (make 12 suppositories)
• Mft mg (Mix and make an ointment)
• Disp tabs no c (dispense 100 tables)
Directions for patient or signature
• The prescriber indicates the direction for the patient’s use of the
medication in the portion of the prescription called the signature.
• The word, usually abbreviated “Signa” or “sig” means “mark
thou” .
• The directions in the signa commonly are written using
abbreviated forms of English or Latin terms or a combination of
each. Examples are:
• Tabs ii q 4h (Take two tablets every four hours)
• Caps 1 4xd pc & hs (take one capsule four times a day after meals
and at bedtime)
• Instill gtts ii od (Instill two drops into the right eye)

• The directions are transcribed by the pharmacist onto the lablel of

the container of dispensed medication.
09/13/2020 daniel chans.M
• It is advisable for the pharmacist to reinforce the directions
to the patient upon dispensing the medications.
• Some pharmacists and physicians provide their patients
with written directions.
• These directions frequently include: the best time to take
the medication, the importance of adherence, use of the
medication with respect to food, drink and other
medications as well as information about the drug itself, its
relevance and ADRs.
• As a requirement of law, certain manufacturers have
prepared patient package inserts (PPLs) for specific products
for issuance to patients e.g united states pharmacopoeial
convention or on computer diskette for printing leaflets for
patients or personalized patient – counseling information .
• Many prescribers desire that the name and strength of
the prescribed drug be included on the label of the
dispensed medication being indicated by prescribers to
the pharmacist in the signa .
• Some prescription blanks have the word “label” printed
for circling or checking by the prescribing physician .
• Reason: rapid identification of the medication in times of
accidental or purposeful overdose.
• Other relevant information on the label: expiry date,
auxiliary labels, special labeling and other instructions
such as the number of authorized refills.
• No refills are permitted for schedule II control substances
and prescriptions be validated by the full signature of the
prescriber.
Hospital Medication Orders
• Medication orders for inpatients in hospitals and other
institutions are written by the physician on forms
called the “Physician’s Order Sheet” which varies.
Reducing Medication Errors
• Medication errors include:
 Inappropriate prescribing,
 Patient non compliance,
 Dispensing errors and
 Medication administration errors.
• All these undermine the purpose of drug therapy and
the patients therapeutic outcomes.
Guidelines for the prevention of medication errors
• Medication orders should be complete with regard to
patient information and drug name and dosage and
should be reviewed by the prescriber for accuracy and
legibility immediately after writing.
• Instructions should be written out rather than using
nonstandard or ambiguous abbreviations.
• Vague instructions, as take as directed should not be used;
in stated more drug specific instructions should be given.
• Exact dosage strengths (as 20 milligrams) rather than
dosage units (as one table) should be specified.
• Exact nomenclature for drug names (non-proprietary or
proprietary) should be used, rather than fabricated drug
name abbreviations.
• A leading zero should always precede a decimal
expression of less than one (e.g, 0.5ml)
conversely, a terminal zero should never be used
(e.g. 5.0 mL).
• When possible avoid the use of decimals (e.g,
prescribe 500mg instead of 0.5g).
• The word “units” (e.g. 10 units of regular
insulin) should be spelled out rather than
abbreviated with a “U”.
• Use of the metric system should be required.
 Processing the prescription order
• Receiving
• Reading and checking
• Numbering and dating
• Labeling
• Preparing
• Packaging
• Rechecking
• Delivering
• Counseling & recording
• Filling
• Pricing the prescriptions: many methods of pricing prescriptions have been used
through the years; the most common are:-
• % markup – cost of ingredients + (cost of ingredients x % markup) = dispensing price.
• % markup + minimum fee – cost of ingredients + (cost of ingredients x % markup) +
minimum fee = dispensing price.
• Professional Fee - cost of ingredients + professional remuneration = dispensing price.
• If cost price of a drug product is 10 shillings and
expected % profit or % mark up is 10%, determine (a)
mark up,
• (b) selling price using (i) % profit and (ii) mark up.
• SOLUTION: (a) Mark up (selling price expressed in
proportions or fractions) = Cost price expressed as a
single digit whole number + % mark up = 10/10 + 10%
= 1 + 10/100 = 1 +1/10 = 1 + 0.1 = 1.1.
• (b i) Selling Price = Cost Price x % mark up + cost price =
10 x 10/100 + 10 = 10 x 0.1 + 10 = 1 + 10 = 11 shillings.
• (b ii) Selling price = Mark up x cost price = 1.1 x 10 = 11
shillings.
 WHAT IS PRESCRIPTION ERROR
• A prescription is said not to be correct when
one or more of the followings are present:
• Improper documentation of the patient’s
personal profile
• When the dosage is improperly written.
• When dosage forms are not well stated
• When there is contradications
• When there is drug interactions