The prescription

27


The prescription




Study Points



image The information required on a prescription


image The different types of prescriptions presented at a pharmacy


image The routine procedure for checking and dispensing prescriptions


image Information sources required for prescription dispensing



Introduction


A prescription is a paper or electronic document detailing the medicine or medicines to be dispensed for an individually named patient and issued by an authorized prescriber. A prescription item is one named medicine on a prescription, e.g. aspirin tablets. A prescription may contain more than one prescription item, e.g. aqueous cream, pholcodine linctus and aspirin tablets (three prescription items), in which case the prescription may be referred to as a ‘multiple item’ prescription. In addition to medicines, a prescription may contain other items or appliances required by the patient for their treatment, e.g. wound dressings, elastic hosiery, blood glucose monitoring equipment, needles and syringes, nutritionally complete feeds and gluten-free foods.


Although at present the majority of prescriptions are produced on paper, there will in future be a continued move towards electronic prescriptions in both the community and in hospitals. Electronic prescriptions have the same legal force as prescriptions signed in writing. The benefits of electronic prescriptions include patient convenience, easier ordering of repeat prescriptions and more complete information about prescribing. The production of electronic prescriptions might in the future mean an end to incomplete and illegible prescriptions. Although electronic prescriptions will become routine in the NHS, private prescriptions will, for the foreseeable future, remain as paper documents. The information contained on both paper and electronic prescriptions and the method of dispensing and recording is essentially the same.



Information required on a prescription


When producing a prescription, the prescriber is giving information and instructions to the person who will supply the medicine to the patient. A prescription is in effect three types of document in one, in that it is a clinical document, a legal document and an invoice. Laws may require some of the information on the prescription and some of the information is required to ensure the patient receives the correct medicine. The dispenser will also have to take payment for the medicine from the patient or send the prescription to the appropriate body for reimbursement; hence it is also an invoice.





Name of the medicine (with strength and dosage form, if relevant)


The name of the medicine can be expressed as the generic or proprietary name.



Generic name


The generic name is also known as the approved name. All drugs are given an approved name, which is usually related to their chemical structure and the medical classification of the drug. This name is adopted by the World Health Organization and is known as the recommended international non-proprietary name (rINN). Prescribers in the UK are encouraged to use generic names for cost-saving reasons, as generic products are usually less expensive than the equivalent proprietary product (see below) and hence the generic name is the most commonly used name on prescriptions. If the prescription is written by the generic name, in the UK, any equivalent product can be supplied even if it also has a proprietary name. The person who dispensed the prescription may lose money if they supply a more expensive proprietary product when the prescription is written generically.



Proprietary name


This can also be referred to as the brand name, manufacturer’s name or trade name. The company that first produces and markets a drug will give it a proprietary name. The company will apply for a trademark in respect of the proprietary name. The granting of a trademark means that no other company can use that name. Usually, proprietary names are short, distinct and easy to remember and write. They may reflect the name of the company or the condition the medication is being used to treat or the type of medication. After expiry of the patent (in the UK, 20 years from first date of discovery or, under a certificate of supplementary protection, 15 years from the date of first marketing) the drug may be produced by other companies using the approved (or generic) name. Drugs may be prescribed by their proprietary name. If the prescriber, in the UK, states the proprietary name or the manufacturer of the product, this product or the product manufactured by the stated manufacturer must be supplied.




Directions for use


Directions should be as specific as possible. Ideally, the amount to be used and the number of times a day that it should be taken should be stated. Vague directions – in particular ‘Take as directed’ – are of little value to the patient and should be avoided. In such situations, the pharmacist will have to ensure that the patient is clear about how to use or take their medication.


As well as the dose and dosage regimen, the prescriber may include additional information about the product. This can include how to use (e.g. spread thinly, dissolve in water), where to use (e.g. in the eye, in the ear, on the scalp), why they are using it (e.g. for pain, for sleeping). The prescriber may also indicate a maximum amount that should be taken, particularly if the medicine is dosed on a ‘when required’ basis.




Prescriber’s signature


This is usually a legal requirement of prescriptions.


The above details are not totally inclusive, depending on the prescription type and the legal requirements of the country. It is important that the person dispensing the product is aware of the information they require and is able to take the appropriate action to clarify and complete any missing or ambiguous information. A number of specific terms, for example ‘dose’, ‘dosage regimen’, etc. are used in the above list and are often confused. Example 27.1 demonstrates the terms using an extract from a prescription.



Example 27.1


Examine the following details which have been abstracted from a prescription:



Using the above prescription as an example, the dosage form, strength, dose, dosage regimen, total daily dose, total amount, proprietary name, generic name and length of treatment are:


































Term Example
Dosage form Tablets
Strength 200 mg
Dose 400 mg (2 tablets of 200 mg)
Dosage regimen 400 mg three times a day
Total daily dose 1200 mg
Total amount 84 tablets
Proprietary name Brufen®
Generic name Ibuprofen
Length of treatment 14 days


Types of prescription forms


In the UK, there are two providers of health care: the private sector and the NHS. Concomitantly, there are two categories of prescriptions: private prescriptions and NHS prescriptions. Additionally, prescriptions may be provided in both the primary care sector (e.g. community) and the secondary care sector (e.g. hospitals). The format of prescriptions in these two sectors will be different.





Hospital prescription forms


There is no standard form for hospital prescribing for patients staying in hospital, and the actual format and design will depend on the individual hospital trust. Most hospitals have moved or are moving away from the paper-based system to an online electronic version. However, the forms usually contain much of the same information. They usually have space for the prescription details, as well as space for confirmation of the administration of the medicine by nursing or other staff. For convenience, most hospital forms are divided into three separate areas, namely medicines to be administered on a regular basis, medicines to be administered once only and medicines to be administered on an ‘as required’ basis. Some forms may also have an area for listed medicines that can be administered by nursing staff at their discretion. Such medicines may be simple analgesics, sore throat lozenges, laxatives, etc. In addition, all hospital prescription forms will require space for identification of the patient and will also have room for important details about the patient, such as any allergies.



Routine procedure for dispensing prescriptions


The dispensing of prescriptions requires a logical and very thorough approach in order to ensure the patient gets the right product in the right form, at the right dose with the right advice. It is imperative that the pharmacist conducts a thorough check of the prescription to ensure that it is complete and clinically acceptable. The product should then be assembled and labelled in a manner that ensures the product and all the information is accurate and that it is professional in its appearance. All stages involved in the dispensing process should be covered by a standard operating procedure (SOP, see Ch. 11).


The stages involved in dispensing a prescription are:


< div class='tao-gold-member'>

Related posts:

  1. Oral unit dosage forms
  2. Pharmaceutical calculations
  3. Public health
  4. Emulsions

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 24, 2016 | Posted by in PHARMACY | Comments Off on The prescription

Full access? Get Clinical Tree
Get Clinical Tree app for offline access