Principles of Prescription Writing

Dr Sanjeewani Fonseka
Department of Pharmacology
 History
 Prescriptions have
been in use since
ancient times
 Latin adopted as
standard
language
 “Rx” =
prescription
 Prescription drug
 drugthat requires a prescription
because it is considered
potentially harmful if not used
under the supervision of a
licensed health care practitioner
 Definition
A prescription is a
written, verbal, or
electronic order
from a practitioner
or designated agent
to a pharmacist for
a particular
medication for a
specific patient.
 Writing Prescriptions
Who can write a Rx?
 Practitioners
 Physicians, veterinarians, dentists
 Prescription Formatting
 Heading

 Body

 Closing
 Current Prescription
Formatting
 Heading

 Body

 Closing
 Current Prescription
Formatting
 Heading
 Name, address, and telephone
number of the prescriber
 Name, sex and age of the
patient
 Date of the prescription

3
 Contents of the Prescription
 Patient Name and Address
 Full first and last name
 Middle initial may be helpful

 DOB – not required, but will be helpful in

further identifying the correct patient to
prevent medication errors
 Contents of the Prescription
 Practitioner’s Name, Address, and Phone
number

 Validates prescription

 Providescontact information to clarify

any questions
 Contents of the Prescription
 Date
 Date the prescription is issued or
written
 Allows the determination of the life
of the prescription to validate refills
 Ensures continual patient
supervision
 Promotes patient follow - up
 Current Prescription
Formatting
 Heading

 Body

 Closing
 Current Prescription
Formatting
 Body
 The Rx symbol

 Name

 dose size or concentration

(liquids) of the drug
 Amount to be dispensed

 Directions to the patient

4
 Contents of the Prescription
 Selecting the drug

 Medication Allergies

 Availability

 Cost
 Contents of the Prescription
 Name of the drug
 Multiple drugs per prescription can add to
confusion
 KEEP IT SIMPLE
 Contents of the Prescription
 Name of the drug - CAUTION:

Look Alike/Sound Alike drug names

 Massive number of new drug releases

 Massive number of reformulations

 Drug marketing strategy

 Build on established names

 New combination drugs – Use converged

names
 Contents of the Prescription
 Name of the drug
AVOID THE USE OF:
 Abbreviations
 Many drugs identified with
abbreviations
 EX: HCT for hydrochlorothiazide,
MSO4 for morphine sulfate
 Attempts to standardize abbreviations
have been unsuccessful
 List of dangerous abbreviations, acronyms, and symbols

Abbreviation Potential Problem Preferred Term

U (unit) Mistaken as zero, four Write “unit”

IU (international unit) Mistaken as IV or 10 Write “international unit”

Q.D., Q.O.D. Mistaken for each other. Write “daily” and “every
Period after Q and O after Q other day”
can be mistaken for “I”

MS, MSO4, MgSO4 Confused for one another Write “morphine sulfate” or
“magnesium sulfate”
 Tablets - tab
 Capsule – cap
 Syrup – syr
 Suspension – susp
 Injection – Inj
 Metered dose inhaler – as such
 Lotion – as such
 Contents of the Prescription
 Strength of the drug

 Befamiliar with drugs and their

various dosing strengths and
dosage forms
When in doubt, use references
 Dosing cont;
 Weight – based dosing
 Always convert patient weight to correct units (kg)

 Liquid medications
 One product may be available in a number of
concentrations
 Be familiar with various product concentrations
 Indicate BOTH concentration and dose of medication
 Example: Cephalexin suspension 125 mg/ 5 ml

1 teaspoon/ every 8 h
 Contents of the Prescription
 Strength of the drug
 Decimal points

 Avoid trailing zeros.

EX. 5 mg vs. 5.0 mg; can be mistaken

for 50 mg
 Always use leading zeros.

EX. 0.8 ml vs. .8 ml; can be mistaken

for 8 ml
 Contents of the Prescription
 Quantity of the drug
 Prescribe only necessary quantity
 Write for specific quantities rather than time
period (for example: dispense #30 vs.
dispense for 1 month)
 Calculate: quantity = frequency per day x
treatment days
 Writing out “Dispense # X” is helpful
 Rules for writing quantity of
drug:
 Quantities of 1 gram or more should be
written in grams.
 Ex - write 2 g.
 Quantities less than 1 gram but more than
1 milligram should be written in Milligrams
For eg, write 100 mg, not 0.1 g
 Quantities less than 1 milligram should be
written in micro / nano gram as appropriate.
 DO NOT abbreviate micro/ nanograms;
since that can lead to Prescribing errors.
For eg. write 100 micrograms, not 0.1 mg,
nor 100 mcg, nor 100 μg
 Use ml or mL for milliliters
 For some drugs, a maximum dose may need to
be stated ( for eg. ergotamine in migraine &
colchicine in gout).

 Eg: Ergotamine 1 mg at onset of attack & repeat

every 30 min if necessary . Do not take more than
6 mg in one day or more than 12mg in one week
 Contents of the Prescription
 Directions for use
 Write out in full English or use Latin
abbreviations
 Latin abbreviations – more convenient, more
potential for mistakes
 Avoid Dangerous Abbreviations
 Provide clear and specific directions
 Should be clearly indicated
Atenolol 100mg once daily

Amoxicillin 250mg t.d.s.

 - Tell the patient what you mean be these

times a day/ four times a day!
Contents of the Prescription
 Determine preference for brand or generic
product
 Brand vs. generic

 Is Brand always better? NO

 If practitioner prefers brand, must indicate

in print, - do not substitute
Sample Prescription-
 Contents of the Prescription
 Indication
 Encouraged, seldom practiced

 Helps confirm appropriateness of

medication
 Reminds patient of drug’s purpose

 Facilitates communication between

health care providers
 Prescription Formatting
 Heading

 Body

 Closing
 Current Prescription
Formatting
 Closing

 Prescriber’s signature
 Refill instructions

 Generic substitution
instructions

5
 Contents of the Prescription
 Refills
 To avoid interrupting
maintenance therapy,
practitioners can authorize refills
on a written prescription
 Refills authorized are valid only
for life of the prescription – 1 year
 Controlled Substances

 Definition - a prescription drug

whose use and distribution is
tightly controlled because of its
abuse potential or risk
 Regulation is more strict
Prescription for controlled drugs must(e.g.morphine)
1. Be completely written in the prescriber’s hand
writing in ink
2. Be signed & dated
3. Carry the prescribers’ address
4. Carry the name & address of the patient
5. State the form of the drug
6. State the total quantity of the drug or the number
of dose units to be disposed in both words &
figures
7. State the exact size of each dose in both words &
figure.
 CASE #1

Poor handwriting contributed to a medication dispensing error

that resulted in a patient with depression receiving the antianxiety
agent Buspar 10 mg instead of Prozac 10 mg
 CASE #2

A hypertensive patient accidentally received Vantin 200 mg

instead of Vasotec 20 mg when a pharmacist misread this
prescription
 SUMMARY
 MAXIMIZE PATIENT SAFETY
 ALWAYS write legibly.
 ALWAYS space out words and numbers to
avoid confusion.
 ALWAYS complete medication orders.
 AVOID abbreviations.
 When in doubt, ask to verify.
Contents of the Prescription
 Date of the order
 Patient Name and Address
 Name of the drug
 Strength of the drug
 Quantity of the drug
 Directions for use
 Practitioner Name, Address, Telephone
number
Model Prescription

1) Name: ABC 2) Date: 31.07.07

3) Age: 70yrs. 4) Sex: male

Diagnosis: Idiopathic Parkinsonism

Rx
9) Tab Levodopa 100mg
Tab Carbidopa 25mg

2 tablets by mouth 3 times daily for one month .

Take with food.

Dr. Sathya MD
Assistant Prof. Neurology,
Reg. No. 34523