The prescription
The information required on a prescription
The different types of prescriptions presented at a pharmacy
The routine procedure for checking and dispensing prescriptions
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 and address of the prescriber
This identifies who the prescriber is and informs the pharmacist where to contact the prescriber should there be an issue related to the prescription. A telephone number on the prescription is helpful, but if the pharmacist suspects the prescription is a forgery, this number should not be used as there have been cases where the telephone number has been changed so the pharmacist has contacted someone who has then pretended to be the prescriber.
Date of the prescription
This identifies when the prescription was written. The law usually defines the length of time from being written that a prescription remains valid. In the UK, all NHS prescriptions should be dispensed within 6 months of the date on the prescription except for certain types of Controlled Drugs where the requirement is that they are dispensed within 28 days.
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.
Total amount to be dispensed or length of treatment time
This can be stated as the number of units or can be stated by indicating the dose and dosage regimen with a number of days’ treatment. In the UK, the prescription has a number of days’ treatment box, which can be used to indicate the quantity required.
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.
Name and address of the patient
This identifies the patient who is to receive the medicine. The age of the patient would also be useful to enable the pharmacist to check the dose of the medicine, particularly if the person is very young or very old.
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.
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.
Private prescription forms
Private prescriptions do not have a standard format and may just be a piece of paper containing all the required information. Normally some of the information, such as the name, the address and qualifications of the prescriber, are pre-printed on the paper. The symbol ‘Rx’ is often used on private prescription forms to indicate that the form is a prescription. Changes in the law relating to Controlled Drugs in the UK have led to the production of a standard form for private prescriptions for controlled drugs for human use. All veterinary prescriptions are private prescription.
NHS prescription forms
NHS prescriptions are only issued to NHS patients. There are a number of different types of NHS prescription forms available in the UK that may be dispensed at any community pharmacy. Each type of prescription form is given a different number and colour. They may have a different format depending on where in the UK they originate and the type of prescriber who generated the prescription.
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:
Clinical and legal checking of the prescription
Assembly of the product and labelling
Accuracy checking the product against the prescription
Handover of the product to the patient with the appropriate advice about the product.
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