Writing prescriptions properly is something that not all medical schools teach.
Although this is the case, a physician still must learn how to correctly write a prescription since the health of your patient relies on the medicine intake.
It is critical for you to invest the time and effort in perfecting the skill of writing a prescription. Since you have opened this article, I am assuming that you are wanting to do just that.
Well, you’ve come to the right place as I will be giving you an overview of the parts of a prescription, an example of a properly written prescription, and the things that you must absolutely remember when writing prescriptions.
Parts Of A Prescription
A prescription is an instruction of a physician to a pharmacist on what medication must be dispensed to the patient.
The following are the essential elements of a prescription that a physician must always include.
This portion of a prescription essentially contains the prescriber’s name, contact information, and office address.
These are usually already printed onto the prescription form for the sake of convenience. It is important to include this in a prescription to enable the pharmacist to contact the prescriber in case he wants to clarify or ask something.
There could be instances wherein the handwriting of the prescriber is not legible (which is something that you do not want to do, by the way) or the acronyms used are vague. Since information on the prescriber is available, the pharmacist is free to contact the prescriber.
Information on the patient usually includes their full name, age, and date of birth. Sometimes, the address can also be included. There are what a physician first writes on the prescription since these are patient identifiers.
As a physician, you are mostly going to write prescriptions for a variety of people that belong to different age groups, are exposed to different environmental conditions every day, have different lifestyles, and have different health conditions. Therefore, each prescription that you are going to write will most likely be unique to cater to the different needs of your patients.
You don’t want a prescription that is meant for another patient to end up in the wrong hands. You may end up harming someone, and you don’t want that to happen.
Write down the date on which you wrote the prescription in order to provide the pharmacist some discretion on whether he is to dispense medication to a patient or not.
In the U.S., the validity of a prescription depends on whether the prescriber has indicated the number of refills or if the medication is a controlled or non-controlled substance.
Non-controlled substances are the commonly used prescription drugs for infections or for chronic conditions.
Examples of these are medications for blood pressure, cholesterol, diabetes, as well as antibiotics, and asthma inhalers. In most states in the U.S., a prescription for non-controlled substances is valid for 1 year after it has been written by a physician.
If the number of refills is indicated, this is also valid for just 1 year. However, some states provide extensions to this 12-month prescription limit, such as Idaho (15 months), Illinois (15 months), Iowa (18 months), Maine (15 months), South Carolina (24 months), and Wyoming (24 months).
Once your prescription has expired, you must schedule an appointment with your physician.
Controlled substances, on the other hand, can possibly lead to physical or psychological dependence.
In other words, if it is a drug that can be abused, it is controlled. Hence, the Drug Enforcement Administration (DEA) has divided controlled substances into schedules based on their medical value and potential for abuse.
Schedule 1 drugs like Marijuana, Heroin, LSD, and Ecstacy don’t really possess medical value but have a high potential for abuse.
Schedule 2 through 5 drugs, on the other hand, include Cocaine (2), anabolic steroids (3), Xanax (4), and Lyrica (5) wherein schedule 2 drugs progressing through schedule 5 drugs have increasing medical value and decreasing potential for abuse, respectively.
Thus, how long a prescription for controlled substances is valid depends on its schedule. For example, prescriptions for schedule 2 drugs are not refillable whereas prescriptions for schedule 3 and 4 drugs are valid for only six months.
Basically, the recipe of a prescription is the medication that the pharmacist must dispense to the patient. It also includes its strength and dosage form.
The word Recipe is actually Latin for ‘take’. This is where the letters Rx are derived from.
The prescriber usually writes the name of the drug, its prescribed strength, and what form it should be consumed right after where Rx is written.
First, the prescriber is recommended to write down the generic name of the drug, rather than writing down a specific brand name. This is important because this gives the pharmacist the authority to dispense the cheapest drug available to the patient if he is trying to cut down on his medical expenses.
However, there are some cases that physicians prescribe a specific brand name for a particular reason that only he knows. Of course, the physician has the power to do so.
The prescriber also writes down the strength of the drug which indicates the milligrams or milliliters that the drug must contain.
The dosage should indicate if the drug must be in the form of a liquid such as syrup, or in solid forms such as capsules and tablets, or if it should be in a form that can be externally administered to the patient such as ointments, liniments, inhalants, etc.
It is important for the prescriber to also spell out the strength and total amount of drugs rather than just in numerical form to avoid tampering.
Overall, the recipe for a relatively healthy 73-year-old patient in need of blood pressure maintenance medications should look something like this: “Amlodipine 5 (five) mg tabs”, “Losartan 100 (one hundred) mg tabs (Cozaar)”, “Atorvastatin 10 (ten) mg tabs”.
Once the prescriber has written down the recipe, he then proceeds to write down the signatura, usually seen as Sig in the prescription.
The signatura indicates the instructions on how the patient should take the medication – including information on the amount to consume, how frequently to take it, and by which route it should be intake.
For example, if a patient is to take one tablet of 100 mg Losartan by mouth every 24 hours, the prescriber would have to write down “Take 1 (one) tablet orally once a day”. This is one way to do it.
Another way to write this down is by the use of abbreviations. First, let’s talk about the routes in which the drugs can be taken by the patient.
The most common routes can be by mouth (PO), intramuscularly (IM), per rectum (PR), sublingually (SL), intravenously (IV), subcutaneously (SQ), intradermal (ID), topical (TP), buccal (BUCC), intraperitoneal (IP), intranasal (IN), and the list goes on.
When writing down the frequency, on the other hand, some of the most common abbreviations that you can write down include: twice a day (BID/b.i.d.), three times a day (TID/t.i.d.), four times a day (QID/q.i.d.), every bedtime (qHS), every 4 hours (q4h), every 4 to 6 hours (q4-6h), and every week (QWK) among others.
Hence, also taking Losartan as an example, an abbreviated signatura would look like: 1 (one) tab PO daily (there is no available abbreviation for daily, so it is written as it is).
Moreover, most of the medications that physicians prescribe are only taken as needed by the patient. These medications would require “PRN” (derived from the Latin pro re nata which means “as circumstances may require”) to be written right after the amount, route, and frequency.
After PRN has been written down, the prescriber must then indicate the reason why the PRN medication would be needed. Hence, it can be written down as “PRN pain” or “PRN headache”.
For example, the patient is prescribed to take one tablet of 650 mg Acetaminophen by mouth every 6 hours if body temperature has exceeded 101 °F. The prescriber would then have to write “Take 1 (one) tablet orally every six hours as needed for body temperature exceeding 101 °F” or “1 (one) tab PO q6h PRN temp > 101 °F.”
Here, the prescriber is to indicate how much medication should the pharmacist dispense to the patient and in which dosage form it should be released.
It is typically written down as “Disp #”. Take note that the number should also be spelled out in order to prevent tampering.
For example, if the physician would like the patient to receive a one-month supply of Atorvastatin tablets, it would have to be written down as “Disp #30 (thirty) tabs”.
Number Of Refills
Right after the dispensing instructions, the number of refills that the physician would like the patient to receive should be written down.
Since Atorvastatin is an example of a maintenance drug, the physician would most likely provide the patient with 11 refills so that it could provide the patient with an entire year of medication supply. This can be written down as “11 (eleven) refills”.
The last part of the prescription is the prescriber’s signature.
Aside from the signed name of the prescriber, it often includes his National Provider Identifier (NPI) and Drug Enforcement Agency (DEA) number for controlled drugs. This is to give the pharmacist assurance that the medication to be dispensed to the patient is indeed prescribed by a licensed physician.
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Example Of A Properly Written Prescription
Here is an example of a properly written prescription that you can use as a reference.
This sample prescription form includes all the necessary elements of a correct and proper prescription:
- the prescriber’s information which consists of his full name, office address, and his contact information;
- the patient’s information consisting of her full name, age, date of birth, and her home address;
- the date when the medication has been prescribed;
- the recipe comprising of the drug (Pantoprazole), its strength (40 mg), and dosage form (capsule);
- the signatura which includes the amount (1), route (PO – orally), frequency (q8h – every 8 hours), and PRN (as needed for acidity or bloatedness);
- dispensing instructions indicating the amount of medication to be dispensed (Disp #21 tabs);
- the number of refills which is none;
- and the prescriber’s signature together with his National Provider Identifier, and Drug Enforcement Agency (DEA) number.
Things To Remember When Writing Prescriptions
Always Write Legibly
Most of the prescriptions written nowadays are being printed out, and this is good since computerized prescriptions are easier to read.
However, there will come a time wherein you will inevitably have to handwrite your prescriptions. Hence, it is important for you to write legibly as much as possible.
I know that doctors are always busy but please make a little more time in making your prescriptions readable and legible.
Did you know that an estimate of 1.3 million injuries and 7,000 deaths occur annually in the U.S. due to medication-related errors? It is also said that morbidity and mortality in relation to drugs cost $177 billion in the U.S. alone.
Taking these statistics into account, legible handwritten prescriptions aim nothing more but to lessen medication-related errors and provide patients the right medication for their needs.
This most especially applies when you are using abbreviations in the prescription. It is often very easy to misread the abbreviations if you write hastily or sloppily. For example, ID (intradermal) can be misread as IP (intraperitoneal) which can compromise the way how the patient would take the medication.
Use The Right Abbreviations
Apparently, there are a lot of abbreviations that can be used when writing the signature of prescriptions. Even so, only write down the most commonly used abbreviations.
Also, don’t forget to explain the abbreviations to your patients. While pharmacists have a large breadth of knowledge when it comes to abbreviations, your patients most likely do not.
Hence, take the time to explain it to the patients since the signature is specifically written down for them and not for the pharmacist.
If the signature for a particular drug uses complicated and not commonly known abbreviations, it would be better for you to write it down completely.
Spell Out The Numbers
Numbers alone are prone to tampering.
For example, in the dispensing instructions, you may have written it down as “Disp #10 capsules”. Then, someone may tamper this and add another 0 to 10, making it “Disp #100 capsules”.
Since this may be an overwhelming amount to the patient and could potentially be harmful due to the possibility of an overdose, always spell out the numbers when writing a prescription.
Well, that’s it! I hope I have given you all the necessary information you need on how to write a prescription and that you will utilize what you have learned in this blog post to correctly prescribe your patients the medication that they need.
I would like to give credit to Medical School Headquarters, Kunal Sindhu of studentdoctor.net, Health Grades, Pharmaceutical Guidelines, and WHO’s Guide to Good Prescribing – A Practical Manual, for they have served as references in the making of this blog post.
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