WRITING A PRESCRIPTION blonsberry@pacificu.edu Definition Writing - PDF document

PRINCIPLES OF SYSTEMIC THERAPY & PRESCRIPTION WRITING Blair Lonsberry, MS, OD, MEd., FAAO Professor of Optometry Pacific University College of Optometry WRITING A PRESCRIPTION blonsberry@pacificu.edu Definition Writing an Rx  Prescriptions are often written on preprinted pads (scripts) which should  Prescription = Verbal, written, or electronic order for a contain the following information about the practitioner: drug issued by a properly licensed and authorized  Prescriber’s Name  Office Address health care practitioner.  Telephone Number  Fax number (Optional)  Must be legible to decrease risk of error. Controlled Substances Preventing Opioid Abuse: PDMP  A prescription drug monitoring program (PDMP) is All Schedule an electronic database that tracks controlled Medications that are substance prescriptions. monitored are required to be written on tamper  PDMPs can help identify patients who may be resistant notepads. misusing prescription opioids or other prescription The Rx must also include drugs and who may be at risk for overdose. an identifying number for the patient (e.g., health card number). https://www.cdc.gov/drugoverdose/data/overdose.html

Preventing Opioid Abuse: PDMP What if you find something suspicious in the PDMP?  PDMPs improve patient safety by allowing clinicians  Patients should not be dismissed from care based to: on PDMP information. Use the opportunity to provide potentially life-saving information and  Identify patients who are obtaining opioids from multiple providers. interventions.  Calculate the total amount of opioids prescribed per day  Confirm that the information in the PDMP is correct. (in MME/day-morphine milligram equivalent).  Assess for possible misuse or abuse.  Identify patients who are being prescribed other  Discuss any areas of concern with your patient and substances that may increase risk of opioids—such as emphasize your interest in their safety. benzodiazepines. https://www.cdc.gov/drugoverdose/data/overdose.html https://www.cdc.gov/drugoverdose/data/overdose.html Required Elements Requirements  Patient Info:  Patient’s Name and Current Address  Date Rx was written  Must have name and address so patient can immediately be reached.  Rx symbol (Superscription)  Age is highly recommended – helps distinguish between patients  Medication Prescribed (Inscription) with the same name and allows pharmacists to verify medication  Dispensing directions to pharmacist (Subscription) quantity recommended for that age group.  Directions for Patient Use (Signa or Signatura)  Date: Flag to the pharmacist if medications are not being filled  Refill , special labeling, or any additional instructions promptly. Can facilitate communication with provider.  Prescribers signature, address, phone # (Typically Preprinted)  Rx Symbol (Superscription) is an ancient symbol of healing.  Additional Information to Include: Patient’s age, height, weight, or additional laboratory data and indications for why the drug is prescribed.  Means “take thou” or “you take” in Latin. Inscription = Medication Prescribed Inscription = Medication Prescribed  Concentration or dosage units  Name of the drug to be dispensed  Examples: 0.5%, 150 milligrams, etc  Brand name or generic  Remember that a zero always holds its place before a  Do not use medication abbreviations decimal, but never after to avoid confusion.  Ex) No HCTZ for hydrochlorothiazide

Inscription = Medication Prescribed Subscription = Dispensing Directions  Formulation  Very brief if the medication is pre-manufactured.  Examples: Solution, Suspension, Capsule, etc  Ex) Dispense one five mL bottle, Dispense thirty tablets  Important to specify ophthalmic when using topical  Must be much more detailed if pharmacy is to compound medications the medication themselves.  Recommend using the metric system for measurements.  Write out your numbers, especially for controlled substances. Signature = Patient Directions Latin Abbreviations Commonly Used Abbreviation Latin English Translation  Provide directions for how to use the medication. bid bis in die Twice a day Including the amount to take each time, when to take it, tid ter in die Three times a day what route to use, how and where to administer the qid quarter in die Four times a day medication, and when to stop. Hs hora somni At Bedtime  Often written using abbreviations or Latin. qh quaque hora Every hour  Recommendation is moving away from Latin to writing out fully in English. sol solutio solution  Avoid using periods, commas, or any extra notations. tab tabella tablet  Ex) Sig: Instill one drop in your right eye every four hours ung unguentum Ointment while awake X ten days gt(t) gutta(e) Drop(s) Sig Continued… JCAHO Do Not Use  Be specific especially if you plan to taper a medication.  QD (daily) or QOD (every other day)  Include number of drops, which eye, frequency of instillation, and  Mistaken for each other duration (number of days) for each component.  Write "daily” vs. "every other day"  Ex) Instill one drop in right eye every four hours X four days, one drop in right eye every six hours X three days, one drop in right eye every eight hours X two days, and one drop every twelve hours X one day  Trailing zero (X.0 mg) or Lack of leading zero (.X mg)  It is best to be specific on times – writing twice per day  Write 0.X mg can mean at 8 and 10 AM.  Always avoid as needed directions.

Refills Additional Elements to the Rx  Be sure to designate number of refills  Consider Indication  Some prescription forms require writing in the information rather than circling the  Especially important when medications are approved for multiple areas. number  This is very helpful for patients especially when on multiple medications.  Acute Treatment = No Refills  Extra Labeling that provides directions to the patient on use.  Ex) Shake well before use, Keep in the refrigerator, Take 30 minutes before  Chronic Treatment = Multiple bed, Avoid alcohol, etc.  Provide the number of refills required to get the patient to their next appointment.  These have become automatic computer print outs for pharmacies at this  Allows you to monitor compliance issues as well. point but is still valuable to include.  One mL = Approximately 20 drops  Average 5mL bottle = 100 drops  Patient using medication 2X/day in each eye uses ~120 drops per month. Points to Remember Age and Medications  When considering drug use in children, the  If you do not have an established relationship with a following age groups should be used: Preterm pharmacy as a provider, you must include your (born before 37 weeks), neonate (birth to 1 license # on the Rx in addition to the elements month), infant (1 month to 12 months), child (1 to discussed. 12 years) and adolescent (12 to 18 years).  Unless the age is specified, the term 'child' in the British National Formulary (BNF) includes persons aged 12 years and younger. Pediatric Patients Northeastern State University College of Optometry Jenna Lighthizer, OD 1001 North Grand Avenue Phone: 918.444.4019 Tahlequah, OK 74464 Fax: 918.458.2104  Not just smaller adults when it comes to drug use.  Must be more aware of details on the individual patient and the drug that Date_______________ will be used. Patient Name _______________________________________________________  Calculation of dosage commonly performed for oral medications based Patient Address____________________ Patient Age_________________ on age, weight, or body surface area. Rx : erythromycin 0.5% ophthalmic ointment  Young’s Rule  Pediatric Dose = Adult Dose X [Age in years/(Age + 12)] Disp : one 3.5 gram tube  Clark’s Rule Sig: Apply one ¼ inch strip every night before bed X ten days  Pediatric Dose = Adult Dose X [Weight in kg/70]  Pediatric Dose = Adult Dose X [Weight in lbs/150]  Body surface area calculator: http://patient.info/doctor/body-surface- Refills: None area-calculator-mosteller Doctor Signature________________________