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Prescription

Prescription. Writing. It is essential that the prescription is legible. Electronic Prescribing. Most prescriptions in General Practice are now computer generated.

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Prescription

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  1. Prescription Writing

  2. It is essential that the prescription is legible.

  3. Electronic Prescribing • Most prescriptions in General Practice are now computer generated. • Recently this has been introduced for some prescriptions written in hospital i.e. those written together with an electronic discharge summary.

  4. Prescription Writing • Name (name and initials) • Address • MCNZ registration number need to be clearly identified on the prescription form.

  5. Prescription Writing • The name • Full residential address • Age if under 13 years has to be recorded to be on the prescription form.

  6. Prescription Writing • In the future … although not yet... it will be a requirement to include the patient’s NHI on the prescription. • In practice most prescriptions already have an NHI on them.

  7. Prescription Writing Record patient codes on the prescription. • A = adult • J = under 16 years • Y = under 6 years • O = script for oral contraceptive

  8. Prescription Writing • 1 = Community Services Card • 3 = Others • Z = High User Card

  9. Prescription Charges • Prescriptions are free for children under 6 years of age. • Holders of Community Services Cards and High User Cards pay $3 per item. • 6-18 years and  65years pay $3 if registered with PHO • All patients of Low Cost Access practices pay $3 per item (regardless of age). • Others pay $15 Further changes will occur with additional funding for Primary Health Care organisations – eventually everyone will pay $3 per item.

  10. Prescription Writing Each prescription has three parts.

  11. Prescription Writing The first part of the prescription lists: • Name of medicine • Formulation e.g. caps, tabs, syrup • Strength of medicine

  12. Prescription Writing Rx or Recipe (translates as Take thou) If prescription is for amoxicillin this part of the prescription may read as: Rx Amoxicillin caps 250 mg or Rx Amoxicillin syrup 125mg/5ml

  13. Prescription Writing Second part of prescription are the instructions that go on the label. Traditionally begins with Sig. This is short for Signa which means mark or write. For amoxicillin this may be written as: Sig: i t.i.d. p.o.

  14. Prescription Writing Instructions on how to take medicines can be more detailed e.g. Sig: Take one hour before food along with a large glass of water. Do not lie down afterwards

  15. Prescription Writing Third part of prescription specifies the quantity to be dispensed. Traditionally prefaced by Mitte or M: For amoxicillin may specify one weeks supply M: 1 weeks supply. Largest quantity dispensed is 3 months supply except for oral contraceptive which is 6 months supply.

  16. Prescription Writing Rx Amoxicillin caps 250mg Sig: i t.i.d. p.o. M: 1 weeks supply

  17. Prescription Writing If a prescription is written as a three month supply it will be dispensed all at once: • Unless it is an expensive medicine • Close Control or CC is written on the script Consider close control: • where there is potential for harm • possibility of confusion with medicines

  18. Prescription Writing Remember: • CHEM numbers for Special Authorities (www.pharmac.govt.nz) • To annotate for Specialist Recommendation where appropriate.

  19. SpecialAuthorities Alimentary Tract and Metabolism Acarbose Alpha Tocopheryl Acetate Budesonide - Cap 3 mg Controlled Release Imiglucerase Insulin Aspart Insulin Lispro Pioglitazone Ursodeoxycholic Acid - Cap 300 mg

  20. It is not a legal prescription unless it is signed and dated.

  21. Controlled Medicines • Controlled drugs include: • Morphine • Fentanyl • Methadone • Methylphenidate • Pethidine

  22. Controlled Medicines • Fill in form in triplicate (Classes A and B) • All of prescription must be written in doctors own hand i.e. no sticker • Can only prescribe 30 days at a time. • Only 10 days supply dispensed at once

  23. Abbreviations • Once daily o.d. or q.d. • Twice daily b.i.d. • Three times daily t.d.s. • Four times daily q.i.d. • Morning mane • Midday midi • Night time nocte

  24. Abbreviations • Orally p.o. • Intramuscular i.m. • Intravenous i.v. • Subcutaneous s.c. • Rectally p.r. • Before food a.c. • After food p.c. • As required p.r.n.

  25. Medicines Information • MIMS • Pharmaceutical Schedule • Hospital Formulary • BNF and Australian Medicines Handbook • Websites e.g. www.medsafe.govt.nz

  26. 50% of medication errors are due to inadequate knowledge by prescriber. • If in doubt - seek advise.

  27. Medication Error Another common source of medication error is poor communication: • with patient • with other health professionals

  28. Discharge Summary • List all medicines including dose, route and frequency • Specify any changes to medicines and why they were started, stopped or the dose changed.

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