Prescription Writing 101

Gail Feinberg, DO, FACOFP

October, 2009
 Objectives
 Understand what “makes” a prescription
 Intro to Latin abbreviations
 Intro to DEA
 Practice writing prescriptions
The parts of a prescription
 What is a Prescription?
 A prescription order is written for diagnosis,
prevention or treatment of a specific patient's disease
 Is written by a licensed practitioner
 Is written as part of a proper physician-patient
relationship
 Is a legal document, "prima facie" evidence in a
court of law.
• (side note…A prima-facie case is a lawsuit that alleges facts
adequate to prove the underlying conduct supporting the cause
of action and thereby prevail.)
 Definition
 Literally, "Recipe" means simply "Take...."
and when a medical practitioner writes a
prescription beginning with "℞", he or she
is completing the command.
 Was probably originally directed at the
pharmacist who needed to take a certain
amount of each ingredient to compound the
medicine (rather than at the patient who
must "take/consume" it).
 Definition
 The word "prescription" can be
decomposed into "pre" and "script" and
literally means, "to write before" a drug
can be prepared.
• Another theory exists that the "℞" may have
originally been a "Px", where the "P" is short
for "pre", and the "x" is short for "script".
 Parts of the Prescription
 Patient Information
 Superscription
 Inscription
 Subscription
 Signa
 Date
 Signature lines, signature, degree, brand name indication
 Prescriber information
 DEA# if required
 Refills
 Warnings/label
 Patient Information
 Name
 Address
 Age
 Weight (optional, but useful - esp in peds)
 Time (used only with inpatient medication
orders)
 Superscription
 RX
 Traditional symbol for prescription
 Use it to line up the other parts of the Rx
 Inscription
 What is the pharmacist to take off the shelf?
• Drug Name
• Dose = Quantity of drug per dose form
• Dose Form = The physical entity needed, i.e. tablet,
suspension, capsule
• Simple vs. Compound Prescriptions
• Manufactured vs. compounded prescriptions
• Clarity of number forms 0.2, 20 not 2.0 (Zeros lead but
do not follow!)
 Subscription
 What is the pharmacist to do with the
ingredients?
• Quantity to be dispensed (determines amount in bottle)
Dispense # 24
• For controlled substances write in numbers and letters
(like a bank check)
 #24(twenty four)
• Any special compounding instructions
 Signa, Signatura or Transcription
 Sig—write, or let it be labeled (Latin terms: signa or signetur)
 Instructions for the patient
• Route of administration
 Oral, nasally, rectally, etc
 Take by mouth.., Give, Chew, Swallow whole, etc.
• Number of dosage units per dose
 Take one tablet, Give two teaspoonfuls, etc.
• Frequency of dosing
 every six hours, once a day…
• Duration of dosing
 for seven days,... until gone, ...if needed for pain.
• Purpose of medication
 for pain, for asthma, for headache, etc.
 VERY IMPORTANT to include purpose as this reduces errors!
 Do not use “As directed”
• Special instructions (shake well, refrigerate etc.)
• Warnings
 Refills and Date Prescribed
 Indicate either no refills or the number of refills you
want (don’t leave it blank)
• Determines maximum duration of therapy.
 Date the prescription
• All prescriptions expire after one year
• Schedule II drugs can only be dispensed within 7 days of date on
RX
 CV-CIII can be refilled for 5 time in 6 mo. maximum.
 Automatic Stop Orders (inpatient orders)
• Antibiotics-7 days
• Controlled Substances-3 days
 Signature of Prescriber
 This makes the prescription a legal document
 Include your degree
 You must write “brand necessary,” “brand
medically necessary,” or “DAW” (Dispense as
Written) to get non-generics.
DEA
 DEA (if required)
 All medical prescribers are required to request
and receive a DEA number, which contains
two letters, six numbers, and one “check digit”
before a single narcotic prescription can be
dispensed.
 This is a precaution taken by the DEA to
ensure that controlled substances are being
prescribed by only qualified professionals.
 DEA Number detail…
The first letter in the code is the type of practice
 A – Deprecated  L – Reverse Distributor
 P- Narcotic Treatment
 B –Hospital/Clinic
Program
 C – Practitioner  R – Narcotic Treatment
 D – Teaching Institution Program
 E – Manufacturer  S – Narcotic Treatment
 F – Distributor Program
 T- Narcotic Treatment Program
 G – Researcher  U – Narcotic Treatment
 H – Analytical Lab Program
 J – Importer  X – Suboxone/Subutex
 K – Exporter Prescribing Program
 DEA Number detail…
 The second letter is the initial of the
practitioners last name.
 The third, fourth, fifth, and sixth numbers are
randomly selected by a computer. The check
digit is a calculation of the following:
• Addition of the first, third and fifth digits
• Addition of the second fourth and sixth digits times two
• Add the sums of the two numbers
• The sum is the last digit
Latin abbreviations
 Latin Used in Prescription Writing
Abbreviation Latin Meaning
bid Bis in die Twice daily
tid Ter in die Three times daily
qid Quarter in die Four times daily
hs (or qhs) (Quaque) hora somni At bedtime (each night)
pc Post cibum After meals (or not on an
empty stomach
prn Pro re nata As circumstances may
require
po Per os By mouth (orally)
pr Per rectum Rectally (suppository)
ac Ante cibum Before meals
gtt (gtts) Guttae Drop(s)
 Latin Used in Prescription Writing
 file:///C:/Documents%20and%20Settings/Gail
%20Feinberg/Desktop/List_of_abbreviations_
used_in_medical_prescriptions.htm
 file:///C:/Documents%20and%20Settings/Gail
%20Feinberg/Desktop/List_of_medical_abbre
viations%20_Do-not-use_list.htm
Preventing Medical Errors
 Avoiding Medical Errors
 Prescribing incorrectly
• Can be due to slips, lapses or lack of knowledge
(mistakes) (Always check dosage calculations!!!!!!)
 Using ambiguous symbols
 Poor handwriting
 Avoiding Ambiguity
 Careful use of decimal points to avoid ambiguity:
• Avoiding unnecessary decimal points: a prescription will be written as 5 mL instead of 5.0
mL .
• Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation of .5 as
5.
• Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 to avoid misinterpretation.
• Avoiding decimals altogether by changing the units: 0.5 g is less easily confused when
written as 500 mg.
 “mL" is used instead of “cc" or "cm³" even though they are technically
equivalent to avoid misinterpretation of 'c' as '0' or the common medical
abbreviation for "with" (the Latin "cum"), which is written as a 'c' with a bar
above the letter.
 Directions written out in full in English
 Quantities given directly or implied by the frequency and duration of the
directions.
 Where the directions are "as needed", the quantity should always be
specified.
 Avoiding Ambiguity
 Where possible, usage directions should specify times (7 am, 3 pm,
11 pm) rather than simply frequency (3 times a day) and especially
relationship to meals for orally consumed medication.
 The use of permanent ink.
 Avoiding unspecified prn or "as needed" instructions—instead,
specific limits and indicators are provided e.g. "every 3 hours prn
pain."
 For refills, the minimum duration between repeats and number of
repeats should be specified.
 Providing the indication for all prescriptions even when obvious to
the prescriber, so that the pharmacist may identify possible errors.
 Avoiding units such as "teaspoons" or "tablespoons."
 Avoiding Ambiguity
 Writing out numbers as words and numerals ("dispense
#30 (thirty)“)
 The use of apothecary units and symbols of measure is
discouraged
• pint (O), ounce (℥), drams (ℨ), scruples (℈), grains (gr), and minims (♏)
• Given the potential for errors, metric equivalents should always be used.
 The use of the degree symbol (°), which is commonly used
as an abbreviation for hours (e.g., "q 2-4°" for every 2 - 4
hours), should not be used, since it can be confused with a
'0'.
• In addition, the use of the degree symbol for primary, secondary, and
tertiary (1°, 2°, and 3°) is discouraged, since the former could be confused
with quantities (i.e. 10, 20 and 30, respectively).
 Prescription Security
 To prevent copying of prescription/pad
• Anti-copy Watermark.
 By tipping the paper towards the light, a picture
appears to verify that the prescription is an original.
Usually a Rx appears.
• Anti-Coy Coin Rub.
 By rubbing a penny across the back of the prescription
the words “Secure Prescription Paper” appears.
• Hidden Message Technology.
 The word “Void” appears if a copy is made.
 Prescription Security
 To prevent modification of prescription
• Toner Bond Security.
 The paper is treated with a compound that fuses with
any ink used on it (including toner from printers).
• Blue Security Background.
 Prevents erasing of prescription.
 Prescription Security
 Security measures to prevent counterfeiting of prescription
forms
• Unique Production Batch Numbers.
 Unique numbers are assigned to every printed batch by the manufacturer.
• Security Warning Band.
 Visible warning band provides warning of security measures on paper to
prevent counterfeiting
• UV Fiber Secure.
 Invisible fluorescent fibers and threads that can only be seen under blacklight
 While some physicians use printers and a specific
program to write their prescriptions, the same strict
guidelines are used in the design of the printer paper used
for prescriptions as well.
Practice Problems
 Practice #1
 Write a prescription for Amoxil, which can be
given either 125mg/5mL or 250mg/5mL to a
child who is 45 lbs (approx 20kg). The dose is
20-40mg/kg/day divided into 3 doses per day.
Child needs to be on the antibiotic for 10 days
 Prescription should say…
 Amoxil 250/5ml
 Disp: 150mL
 Sig: 5mL tid until gone
Denise Watermark
Oct. 6, 2009

Amoxil 250/5ml
Disp: 150mL
Sig: 5mL tid until gone (also acceptable is
5mL tid x 10 days)

Gail Feinberg, DO, FACOFP

none
 Practice #2
 Jane Doe need refill of her digoxin. Her dose
is 1.25mg daily and she takes one daily. She
needs a 30 day prescription to take to the
pharmacy today and another one for 3 months
to mail off…write both for her.
 30 day will look like…
 Jane Doe
 Digoxin 1.25 mg
 Disp: #30
 Sig: One p.o. daily (here can also add for CHF
or whatever appropriate)
 No refill
Jane Doe

10/7/09

Digoxin 1.25mg
Disp # 30
Sig: One (1) po daily (can also add for CHF)
 90 day will look like
 Jane Doe
 Digoxin 1.25 mg
 Disp # 90
 Sig: One p.o. daily
 No refill
Jane Doe

10/7/09

Digoxin 1.25mg
Disp # 90
Sig: One (1) po daily (can also add for CHF)
 Practice #3
 Tom Smith has pulled his back out and you are
going to give him some Flexeril
(Cyclobenzaprine) as a muscle relaxer. This is
given as 10mg up to three times daily as
needed for muscle spasm. You only want to
give him at most a weeks worth.
 Prescription should look like..
 Tom Smith
 Flexeril 10mg
 # 21 (twenty one)
 i p.o. up to tid prn muscle spasm
• (note the i…represents one ii=2, iii=3, iiii or iv = 4 etc.)
• Can also write one (1) po up to …
 Tom Smith
10/7/2009

Flexeril 10mg DAW

#21 (twenty one)
1 po up to tid prn muscle spasm

Caution: May cause drowsiness

none