1. Understanding Pharmacology for Health Professionals CHAPTER Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved FIFTH EDITION Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley The Prescription, Pharmacy, and Pharmacist 6

2. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Learning Objectives 1.Give the definition of a prescription. 2.Name and describe the types of prescriptions. 3.Describe medication orders and other types of orders. 4.Describe the difference between the components of a prescription and a medication order. continued on next slide

3. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Definition of a Prescription Origin comes from Latin praescriptio, meaning a written order. Prescription  The action of writing [that takes place] before [a drug is dispensed]  pre- (before)  script/o- (write)  -ion (action) continued on next slide

4. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Definition of a Prescription A written, computerized, electronic, or verbal order from a physician (or other qualified healthcare provider) to a pharmacist, giving instructions as to how to dispense a drug to a specific patient continued on next slide

5. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Definition of a Prescription A medicolegal document Conveys precise information Legal document that can be used in court

6. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Figure 6–1 Prescription abbreviation. Prescriptions have been written since ancient times. The practice of medicine began with the Romans and Greeks, and the familiar abbreviation Rx stands for the Latin word recipere, meaning to take. Prescriptions were, in the past, actually recipes listing several ingredients to be mixed by the apothecary before dispensing.

7. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Types of Prescriptions Handwritten prescription  Single preprinted form from a prescription pad  Must be written in ink  Must be recorded in the patient's medical record  Traditional way in which prescriptions have been written for centuries

8. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Figure 6–2 Handwritten prescription. A prescription form is used by a physician to convey to a pharmacist a written record of a drug order for a patient. This physician may be prescribing a new drug or ordering a refill of a drug for the patient. Source: Monkey Business/Fotolia

9. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Drug Alert Handwritten prescriptions can be notoriously difficult to read. Various studies have found that 5 percent or 16 percent or even 25 percent of all handwritten prescriptions are illegible. Pharmacists often become familiar with a particular physician's handwriting and can decipher illegible handwriting. continued on next slide

10. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Drug Alert However, when in doubt, the pharmacist always calls the physician to confirm the drug and dose. Some states, such as Florida, have passed a law that all handwritten prescriptions must be legible.

11. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care It is not uncommon for people to steal prescription pads and write prescriptions on them for drugs of abuse. To prevent theft of prescription pads, medical office personnel know that it is important to take these precautions.  Store extra prescription pads in a locked drawer or closet. continued on next slide

12. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care To prevent theft of prescription pads, medical office personnel know that it is important to take these precautions.  Have the physician carry just one prescription pad on his/her person from examining room to examining room.  Never leave a prescription pad on the counter or in an unlocked drawer in the examining room. continued on next slide

13. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care To prevent theft of prescription pads, medical office personnel know that it is important to take these precautions.  The physician should sign the prescription form only at the time he/she writes the prescription.  The physician should never pre-sign blank prescription forms.

14. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Types of Prescriptions Computerized or electronic prescription  Typed into the medical office's software system  Copy of prescription is printed out.  Signed by the physician and given to the patient  May be faxed directly to the pharmacist continued on next slide

15. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Types of Prescriptions Computerized or electronic prescription  Generated by a computer  Not signed by the physician  Digital electronic signature is automatically imprinted.  May also be faxed directly to the pharmacist

16. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Types of Prescriptions Verbal prescription  Given over the telephone  If not for a controlled substance, the pharmacist can fill the prescription without: A printed-out prescription The physician's signature

17. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Did You Know? In 2012, there were 4 billion prescriptions written, compared to 3.3 billion in 2006. On average, 48% of people taking at least one prescription drug

18. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Medication order  Written record of a physician's orders  Handwritten on large preprinted order sheet known as the physician's order sheet  Located in the front of the patient's medical record

19. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Medication order  For facilities with electronic records Typed into the computer on a designated screen Screen serves as the physician's order sheet.

20. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Verbal order (telephone orders)  When a patient is in the hospital  Physician may give a verbal order over the phone to a licensed nurse.  The nurse writes the order on the physician's order sheet. continued on next slide

21. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Verbal order (telephone orders)  It is marked as a verbal order (V.O.).  The nurse signs his or her name.  Physician must personally sign the order within a specific amount of time.

22. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Stat order  Physician wants drug to be dispensed and administered immediately. Standing order  Group of specific orders  Preprinted on the facility's physician's order sheet continued on next slide

23. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Standing orders  Often pertain to protocol of treatment to a specific disease or surgical procedure  In addition, a physician would also write more specific medication orders to address a particular patient's medical needs.

24. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Automatic stop order  Originates with the hospital pharmacy and not the physician  For certain types of drugs Controlled substances  Only valid for a certain number of days  Determined by hospital's Pharmacy Committee policy continued on next slide

25. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Automatic stop order  Pharmacy automatically stops sending the drug.  An entirely new order must be written.  All drugs carry an automatic stop order. continued on next slide

26. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Medication Orders and Other Types of Orders Automatic stop order  Activated when a patient: Has a change in situation Is transferred to another nursing unit Is discharged to another healthcare facility or home

27. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care In a hospital or other healthcare facility, the physician's office address and phone number are not needed on the physician's order sheet because the physician is already a member of the facility's medical staff.

28. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care Prior to joining the medical staff, each physician must provide his/her name, office address, home address, and phone numbers (as well as Social Security number, state medical license number, federal and state DEA number, educational background, and board certifications) in a written application that is kept on file in the facility's credentialing department.

29. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care No physician is permitted to write orders, including medication orders, unless he/she is already an approved member of that facility's medical staff.

30. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Identifying information about the physician  Prescription form Preprinted at the top To identify the prescriber Name Office address Phone number

31. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Figure 6–3 A prescription form. Prescription forms are used for handwritten prescriptions when patients are seen in a medical office or when patients are discharged from the hospital. The blank prescription form has several standard component parts.

32. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Identifying information about the physician  Physician's order sheet Physician's signature All other information is on file with the hospital.

33. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Identifying information about the patient  Prescription form To positively identify the patient First and last name Address continued on next slide

34. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Identifying information about the patient  Physician's order sheet Patient information already on order sheet If computerized record, it is preprogrammed to be there. If paper record, hospital card is created and used to imprint order sheet.

35. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Patient's age and weight  Prescription form Not always included but can be useful Age Child Mandatory for Schedule II Weight Dose may be adjusted for low or high weights. continued on next slide

36. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Patient's age and weight  Physician's order sheet Already entered onto demographics face sheet Not included on medication order

37. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Date  Prescription form Physician writes full date Month/day/year Prescription good for: 1 year from date of prescription 6 months for Schedule III through Schedule V drugs 7 days for Schedule II drugs continued on next slide

38. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Date  Physician's order sheet Full date and time next to each medication order Orders in the hospital are time sensitive. Must be filled and administered in a timely manner

39. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Rx  Have been written since ancient times  Symbol stands for recipere, meaning to take  Were at one time actually recipes Listed several ingredients Crushed and mixed by pharmacist before dispensing continued on next slide

40. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Rx  Prescription form Most come with a large Rx Just to the left of the area where the prescription itself will be handwritten continued on next slide

41. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Rx  Physician's order sheet Symbol not preprinted Page is large Used to order other types of treatments in addition to drugs

42. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Drug name  Same for both prescription form and physician's order sheet  May write either: Drug's generic name Trade name  Chemical name is not used.  Abbreviations of drugs are avoided.

43. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Drug strength  Same for both prescription form and physician's order sheet  A number appears right after the drug indicating strength.  Followed by a unit of measurement  Must prescribe a drug strength that corresponds exactly to the strength the drug is manufactured continued on next slide

44. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Drug strength  Example If drug is manufactured in 25mg and 50 mg tablets, physician cannot order 80 mgs. However, if the tablet is scored, physician can order exactly one half of amount of one tablet.

45. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Drug form  Same for both prescription form and physician's order sheet  Specific form must be included.

46. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Quantity to be dispensed  Prescription form Symbol # read as number Indicates to the pharmacist the number of capsules, tablets, etc. to dispense Sometimes will preface the number with the word dispense continued on next slide

47. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Quantity to be dispensed  Physician's order sheet Does not need to indicate total number Medication order continues while patient is in the hospital. Exception is controlled substances. Only amount needed for one day is sent to the unit

48. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Directions for use  Prescription form Abbreviation Sig. indicates directions Pharmacist will type on the label, translating any Latin abbreviations Amount of dose Route of administration Frequency of the dose continued on next slide

49. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Directions for use  Physician's order sheet Abbreviation Sig. not included Pharmacist doesn't translate Latin abbreviations Nurse on the unit understands abbreviations

50. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Signature  Prescription form At the bottom of form Preprinted line with M.D. Physician must sign his or her name on that line for prescription to be valid continued on next slide

51. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Signature  Physician's order sheet Physician signs name, with M.D. following Directly below the last medication order Prevents insertion of an order at a later time

52. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Refills  Prescription form How many times the patient is permitted refills Preprinted Refills area: 0 (sometimes NR for "no refills"), 1, 2, or 3 Only be refilled for a year No refills for Schedule II continued on next slide

53. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Refills  Physician's order sheet No indication of refills Pharmacy continues to send as long as patient is hospitalized or until physician orders drug to be discontinued.

54. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Generic substitution  Prescription form Some states mandate pharmacists fill prescriptions with a generic drug. If physician wants trade name, must specifically state so Dispense as written ("DAW") No substitution continued on next slide

55. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders Generic substitution  Physician's order sheet Hospital has formulary for all stocked drugs. Pharmacist will dispense generic equivalent unless physician specifically requests trade name.

56. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders DEA number  Prescription form If drug has potential for abuse Controlled substance Assigned federal DEA number in order for prescription to be valid Consists of 9 characters continued on next slide

57. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Components of Prescriptions and Medication Orders DEA number  Physician's order sheet Does not need to be provided when physician in hospital or other healthcare facility Kept on file in hospital's credentialing department

58. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care Prescriptions for Schedule II drugs must be written on a special prescription form. This is known as an "official prescription form," and it is only printed by certain printing companies designated by that state. continued on next slide

59. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care Official prescription forms contain security features (a control number, thermochromatic ink, and an imprinted seal) that are designed to prevent alterations and forgeries. continued on next slide

60. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care This is a precaution to avoid the unauthorized use of drugs that have a high potential for drug abuse and addiction. In addition, these prescription forms may include background repetition of the word "void" that becomes visible if someone attempts to photocopy or fax these forms. continued on next slide

61. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care Even with this precaution, thousands of prescriptions for Schedule II drugs are forged each year. A pharmacist may contact a physician's office to verify that a Schedule II prescription is indeed valid and not forged. continued on next slide

62. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care Occasionally, unscrupulous physicians, dentists, and pharmacists prescribe or dispense Schedule II drugs to patients who have a drug habit in exchange for money. continued on next slide

63. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care These individuals can be investigated by the state licensing board and the DEA and denied renewal of the federal DEA number needed to prescribe schedule drugs. continued on next slide

64. Copyright © 2016, 2010, 2003 by Pearson Education, Inc. All Rights Reserved Understanding Pharmacology for Health Professionals, 5th Ed. Susan M. Turley Focus on Health Care Of interest is the fact that some states (e.g., New York in 2006) now require that an "official prescription form" be used to prescribe all prescription drugs, not just Schedule II drugs.