The prescription

Prescription
• It is an order for medication issued by a
physician, or other properly licensed medical
practitioner.
• The prescription order is a part of the
professional relationship among the prescriber,
the pharmacist and the patient.
• It is the pharmacist’s responsibiity in this
relationship to provide quality pharmceutical care
that meets the medication needs of the patient.
• Pharmacists should also advice the prescriber of
drug sensitiveness the patient may have,
previous adverse drug reactions or other
medications that the patient may be taking that
may alter the effectiveness or safety of the newly
or previously prescribed medications.
• For this: Pharmacists should maintain a high level
of practice competence, should keep appropriate
records on the health status and medication
history of his patients and develops professional
working relationships with other health
professionals.
 Some questions
• Prescription should be hard copy only. F

• It can be electronic too. T

Information required on a prescription
• Precription
- is a legal document
-clinical document
-an invoice
Minimum information in a Prescription
• Name and address of the prescriber
• Date of the prescription
• Name of the medicine (with strength and dosage
form, if relevant)
• Total amount to be dispensed or length of
treatment line
• Directions for use
• Name and address of the patient
• Prescribers signature
 Common terms
• Dosage form
• Strength
• Dose
• Dosage regimen
• Total daily dose
• Total amount to be supplied
• Generic name
• Proprietary name
• Length of treatment
 Types of prescription forms
• Private
• Public or government
• Hospital prescription forms
 Dispensing
• dispense - Ultimately from Latin dispendere, "weigh
out.“

• dis·pense (d-spns) v. dis·pensed, dis·pens·ing,

dis·pens·es
1. To deal out in parts or portions; distribute.
2. To prepare and give out (medicines).
3. To administer (laws, for example).
4. To exempt or release, as from a duty or religious
obligation.
• dis·pens·er (d-spnsr) n.
One that dispenses or gives out, especially a
machine or container that allows the contents
to be removed and used in convenient or
prescribed amounts.

• The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin
Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.
• dispenser [dɪˈspɛnsə] n
1. a device, such as a vending machine, that
automatically dispenses a single item or a
measured quantity
2. a person or thing that dispenses

• Collins English Dictionary – Complete and Unabridged © HarperCollins Publishers 1991, 1994, 1998, 2000, 2003
 Dispensing
According to Drug act 1978
 Dispensing is the issuing of the drug in a
suitable container, appropriately labeled and
compounded for the subsequent
administration to the patient.
 It has failed to include the duty of a dispenser
about the prescription and counseling to the
patient.
Who can act as dispenser in Nepal
• Any person can dispense the drugs which are
categorized under group 'Ga'.
• But if a person is other than pharmacist or
professional and wants to dispense the drug
under group 'Ka' then the presence of
pharmacist or professional is mandatory.
• Thus all dispensers are equal with respect to
dispensing.
 Aim of dispensing

• The aim of dispensing is to ensure that the

right patient receives the appropriate
medicine in the correct dose and form.
The requisites are:
• The right patient gets the right medicine
• Possible interactions are avoided
• The quality and integrity of the medicine are
maintained throughout the indicated shelf life
 Aim of dispensing

• Correct and clear instructions are given to the patient to

ensure correct and safe use of the medicine, to the
optimal benefit of the patient in line with the objective
of the treatment
• The patient is given, at the least, basic information
regarding special instructions for use, warnings if
applicable, possible adverse/side effect and action to
take in the event of certain events occurring. As far as
possible the basic information like when to take, how to
take and certain precautions should be given in the
written form.
 Steps of proper dispensing
• Dispensing done in an appropriate way can
prevent the mistakes done by the prescriber
and also prevents the medication error due to
the dispenser.
• It can assure that the patient leaves the
counter comfortably.
• But dispensing environment affects the quality
of dispensing a lot.
Prescription Checking
Name: XXXXX XX Sex:F Age:29 yrs Wt:50 kg
Liver: Normal Kidney: Normal Pregnancy: None
Allergy: NKDA

#Hypertension for 2 years (managed by Atenolol 50 mg).

Not well controlled
#Symptoms of respiratory distress and UTI
#occasional GI discomfort and burning

Rx Atenolol 75 mg x 1 x 30 days
Norfloxacin 400mg x 2 x 7 days
Aminophylline 100mg x 3 x 15 days
Antacid syp 10mL x 3 x PRN
Problems include:
 Maximum dose of atenolol for hypertension is 50
mg.
 Atenolol causing respiratory distress
 Life threatening interaction between norfloxacin and
aminophylline
 Atenolol-aminophylline combination use is irrational.
 Physical interaction between antacid and norfloxacin
Problems include:
 Maximum dose of atenolol for hypertension is 50
mg.
 Atenolol causing respiratory distress
 Life threatening interaction between norfloxacin and
aminophylline
 Atenolol-aminophylline combination use is irrational.
 Physical interaction between antacid and norfloxacin
 Prescription checking for
• Unit dose above limit
• Maximum daily dose above maximum limit
• Minimum daily dose below minimum limit
• Frequency above maximum allowable frequency
• Non-PRN medicines given on PRN basis
• Route of administration
• Injection-Injection Incompatibility
• Injection-IV fluid Incompatibility
 Prescription checking for
• Drug-drug interactions
• Drug-disease interactions
• Drug-Lab interactions
• Age wise contraindications
• Pregnancy precautions
• Breast-feeding precautions
• Kidney impairment precautions
• Liver impairment precautions
 Physicians prescription showing typical
form and content
1 . Dhulikhel Hospital
Dhulikhel
2. 3 Patient name : ……… date: ………
Address: ……
4.5 Rx ampicillin 250 mg
6. Disp 40
7. Sig: one qid
8. Label
do not label
Refill 1 2 3 4
PRN
9. ____________________________________________
1. = Prescribers office information
2. = Patient information
3. = date
4. Rx symbol or superscription
5. Medication prescribed or inscription
6. Dispensing directions to pharmacist or subscription
7. Directions for patient or signa (to be placed on label
8. Refill, special labeling, and other instructions
9. Prescriber’s signature and license
 Examples of subscription
• M ft caps dtd no xxiv (Mix and make capsules.
Dispense 24 such doses)
• Ft supp No xii (make 12 suppositories)
• M ft ung (Mix and make an ointment)
• Disp tabs No c (Dipense 100 tablets).
 Examples of signatura
• Tabs ii q4h (take 2 tablets every four hours)
• Caps I 4xd pc and hs (take one capsules four
times a day after meals and at bedtime)
• Instill gtts ii od (Instill two drops into the right
eye).
 Routine procedure for
dispensing prescriptions
or
Filling prescription
 Stages involved
• Receiving the prescription
• Clinical and legal checking of the prescription
• Assembly of the product and labelling
• Accuracy checking the product against the
prescription
• Delivery of the product to the patient with the
appropriate advice about the product
Routine procedure for dispensing prescriptions or Filling
the prescription

Step 1:
• Patients must be made to feel attended and
comfortable by friendly gestures and
ambience as soon as they come into the
pharmacy.
• Communication should be opened in such a
way that it encourages the client to convey
his / her needs by producing a prescription or
by asking for other medicines or advice.
Step 2: Upon receiving the prescription, the
pharmacist or person instructed by the
pharmacist should confirm:
• a. Identity of the client
• b. Whether the prescription is presented by
the client himself/herself or by someone on
the client’s behalf.
Step 3: The client may be politely requested to
wait while the prescription is reviewed for:
a. Therapeutic aspects (pharmaceutical &
pharmacological)
b. Appropriateness for an individual
c. Social, legal and economic aspects
d. Legality and completeness of prescription
Step 4: Prescription should be considered as
incomplete if any of the following information is
missing:
a. Name of the prescriber, his/her address and
council registration number
b. Name, address, age, sex of the patient
c. Name(s) of the medicine(s), potency, dosage,
total amount of the medicines to be supplied
d. Instructions to the patient
e. Refill information if any
f. Prescribers’ signature and date
 review
Mnemonics : IDEAL CASE
• I - nteractions
• D –ose
• E - vidence of harm/benefit
• A- ppropriate (and here is where we make a
CASE for the medication)
• L- egal and complete
• C – ost-effective
• A – cceptable to the patient
• S – afe
• E - ffective
Step 5:
Any incompleteness, ambiguities, confusions,
shortcomings or anomalies in the prescription
should be brought to notice of the prescriber.
Step 6: Correctness of prescribed medicines:
The prescription should be checked for the
following things:
• Dosage regimen: Whether the dosage
prescribed is within the standard minimum or
maximum dosage range.
• Double medication (same medicine or
different medicine with same pharmaco-
therapeutic effect) concurrently prescribed by
the same prescriber or by two or more
prescribers to the same patient.
• Interactions between the currently prescribed
medicines with other medicines being taken by the
patient like Over the Counter medicines (OTC),
medicines from any past prescriptions (record of which
may be available in the Patient’s Medication Records),
vitamins, tonics, or any other herbal medicines. Any
medicine interactions likely to render the therapy
ineffective or cause undesirable effects to the patient
should be brought to notice of the prescriber.

• Contraindications: Age, sex, disease(s), conditions or

other characteristic of a patient that may cause certain
prescribed medicines to be contraindicated.
• History of overuse, under use, or misuse of
medicines by the patient.
• Any of the above as well as handwriting
legibility problems should be brought to the
notice of the prescriber. Any necessary
changes made by the prescriber should be
recorded on the prescription, with the words
"Changes made over the telephone in
consultation with the prescriber (name) at
(time) on (date)" and should be signed and
stamped by the pharmacist.
• Step 7: This exercise necessitates a trust based
professional relationship with the prescriber. In case of
any doubt, the prescription should be suitably amended
from the prescriber.

• Step 8: Appropriate medicine should be taken out, labeled

and dispensed. If a patient is illiterate pictogram should be
used. Dispenser should ensure that patient completely
understands how to take drug. By making patient to
repeat how to take drug a dispenser can ensure that
patient really understands.
Step 9:
If special counseling is required patient should
be taken to a counseling room.

Step 10:
After filling the prescription, the patient should
be provided with a bill in which the batch no,
manufactured date and the expiry date of the
dispensed medicines should be clearly written.
 Instruction to the patient
• The main aim of giving instruction to the patient is to
ensure that the patient knows how and when to take/use
the product. It consists of the following steps.
STEP 1 Instructions are verbal
STEP 2 Instructions are verbal and hand-written and
affixed to the container
STEP 3 Instructions are verbal and printed/typed and
affixed to the container
STEP 4 In addition to step 3, verbal counseling is
given to the patient
STEP 5 In addition to step 4, supplementary written
information is given
 Information sources
• Nepalese National Formulary
• National guidelines
• DDA bulletins
• BNF
• Martindale : the extra Pharmacopoeia
• Pharmaceutical Codex
Assembly of the product and labelling
 Minimum requirement for label
• Generic name & strength of medicine
• Dose, frequency & duration of course, if applicable
• Date of dispensing
• Name of patient
• Name/address of supplier
• Child safety warning

“Good pharmacy practice in community and hospital pharmacy settings”,

FIP, 1992
 Benefits of Dispensing Labels
 Fast and correct counseling with less skilled staffs.

 Uniformity in counseling

 Information read immediately before administration.

This increases compliance and reduces errors.