Prescription Writing Flashcards
What components make up Rational Prescribing?
-Make a specific diagnosis
-Consider the pathophysiologic implications of the diagnosis
-Select a specific therapeutic objective
-Select a drug of choice
-Determine the appropriate dosing regimen
-Devise a plan for monitoring the drug’s action
-Determine an end point of therapy
-Plan a program of patient education
What are the required 17 elements of a prescription?
1) Prescriber’s name
2) Prescriber’s license classification
3) Prescriber’s address
4) Prescriber’s telephone number
5) Date script is written*
6) Patient’s name
7) Patient’s address
8) Name of the medication*
9) Strength of the medication (metric units)
10) Quantity to be dispensed*
11) Complete directions for use*
12) Number of refills & expiration date of script
13) Waiver of the requirement for childproof containers
14) Addition instructions/warnings
15) Prescriber’s signature
16) Prescriber’s National Provider Identification (NPI#)
17) State license number
Which components of the required elements for a prescription are ALSO required of inpatient orders?
5) Date & time script is written*
8) Name of the medication*
9) Strength of the medication (metric units)
10) Quantity to be dispensed*
11) Complete directions for use*
15) Prescriber’s signature
11) Complete directions for use is referred to as “Sig”. What does “Sig” mean?
Sig = Signa. Latin = “write on the label”
What is important to know regarding Complete Directions for Use?
-Directions for use should be both drug-specific and patient-specific
-The simpler the better
-The less # of drugs & doses per day results in increased patient compliance.
10) Quantity dispensed should reflect:
-Anticipated duration of therapy
-The cost
-The need for continued contact with the clinic or physician
-The potential for abuse
-The potential for toxicity or overdose
-Initially #’s for meds that are used to treat chronic illnesses should be small, reduces the cost burden to the patient if he/she cannot tolerate it.
What should a pharmacist do if too much time has elapsed since a prescription being written?
A pharmacist should verify the order by phone or refuse to fill an order if too much time has elapsed since it’s writing.
What are the requirements for an inpatient prescription?
-Compliance with the institution (Pharmacy committee creates the formulary for the facility)
-Patient’s name
-Name & strength of med
-Dose, route, & frequency
-Date & time of the order
-Other pertinent info
-Signature of the prescriber
What do you have to do to stop inpatient orders?
Have to discontinue them (not true with outpatient).
-If you don’t specify number of doses, it continues until the order is d/c’d.
-Outpatient has a defined end date
For inpatient orders, if the duration of therapy or the number of total doses is not specified, the medication is ______ until the prescriber discontinues the order or until it is terminated as a matter of policy.
If the duration of therapy or the number of total doses is not specified the medication is continued until the prescriber discontinues the order or until it is terminated as a matter of policy. (Blue Box!)
What are common omissions in prescribing errors?
-D/C a prior med when a new one has begun
-State whether a regular or long-acting form should be used
-Fail to specify a strength or notation for long-acting forms
-“PRN” but fail to state what conditions justify the need
What are examples of poor prescription writing?
-Illegible handwriting
-Misplaced or ambiguous decimal point (always precede the decimal point with a zero)
-Use of unnecessary zero (Do not follow whole numbers with a zero)
-Use of slash “/” in place of decimal point (misread as the number 1)
-Use of “U” for Units (Units should always be written out)
-Use of ug for micrograms (micrograms should always be written out).
-Orders specifying dosage units and not the total dose required (ex: One ampule of furosemide = bad)
-OD mistaken for QD (OD only used for right eye or write it out)
-QD or Q.D. mistaken for QID (Write out once daily or four times a day)
-Use of acronyms and drug abbreviations (Ex: ASA. Write out aspirin).
What is wrong with the order?
.1 mg of Epi
Need a zero in front of decimal point. Should be 0.1 mg
What is wrong with the order?
1.0 mg of Epi
Do not follow whole numbers with a zero. Should be 1 mg of Epi.
How do inappropriate drug prescriptions occur?
-Failure to recognize C/I from other conditions the patient has
-Failure to obtain information about other drugs the patient is taking
-Failure to recognize possible physiochemical incompatibilities between two drugs (Parenteral drug administration)
How can you avoid inappropriate drug prescriptions?
-Do a thorough H&P
-Check the Physician’s Desk Reference
-Consult the Handbook of Injectable Drugs- compatibility
What is the example of the two drugs that wen combined form cement in the IV line?
-Thiopental + Succinylcholine = cement
-Have to flush between meds
What are the pros of E-Prescribing?
-Prescribers have information readily available
-Prescriptions are clearly written
-Renewals can be processed electronically (Misuse or Abuse can be identified)
What are the cons of e-prescribing?
-Must be HIPAA Compliant (Health Insurance Portability & Accountability Act)
-Pull down drug lists can create new errors
What are the 4 types of patient noncompliance?
1) Patient fails to obtain the medication
2) Patient fails to take the medication as prescribed
3) Patient prematurely discontinues the medication
4) Patient (or someone else) takes the medication inappropriately
What are factors that encourage noncompliance?
-Diseases with no symptoms
-Changing medications in hopes of finding one that works better
-Multiple doses per day
-Living alone
-Packaging (childproof containers, arthritis patients)
-Transportation
-Social or personal beliefs
What are ways to improve compliance (Blue Box!)?
-Communication
-Assess personal, social & economic conditions
-Assist in the development of a routine for taking medications
-Mailing of refill reminders
What are controlled substances classified based on?
Abuse potential
What are the Schedule I drugs?
-High potential for abuse
-No accepted medical use; lack of accepted safety as a drug
What are Schedule II Drugs?
-High potential for abuse
-Current accepted medical use.
-Abuse may lead to psychological or physical dependence
-Need a new prescription for refills
-Prescribed by MDs, APRNs, and PAs (defined by state licensing boards)
What are Schedule III Drugs?
-Less potential for abuse than II
-Current accepted medical use
-Moderate or low potential for physical dependence and high potential for psychological dependence
-Can do a max of 5 refills, but past 6 months cannot be refilled without a follow-up visit.
What are Schedule IV Drugs?
-Less potential for abuse than III
-Current accepted medical use
-Limited potential for dependence
What are Schedule V Drugs?
-Less potential for abuse than IV
-Current accepted medical use
-Limited dependence possible
What are the pros/cons of Generic Drugs?
Pros:
-Offer flexibility in filling the order
-Cost reduction
Cons:
-Not all generic products are as satisfactory as the trade name drug
What has to be written on the prescription for a brand name drug to be used?
“Dispense as written” must be on the script or generic will be used
What is generic substitution?
A drug equivalent to the trade name drug is given.
What is Therapeutic Substitution?
Using a different drug within the same class without the prescriber’s permission.
-Can be done by pharmacists if they work in a managed care organization with a specific formulary.
-otherwise, have to ask permission
What is a Managed Care Organization?
Organization that has a specific formulary.
-Pharmacists can make therapeutic substitutions without provider knowledge
All orders must be signed with____? (Blue Box!)
Name and credentials
