1. 6
The Prescription

2. Multimedia Directory
Slide 59 Pharmacist Video

3. Learning Objectives Give the definition of a prescription
Name the types of prescriptions
Describe medication orders and other types of orders
Describe the difference between the components of a prescription and a medication order
Describe the role of the pharmacist in filling a prescription

4. 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)

5. Definition of a Prescription
A prescription is:
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
a medicolegal document
conveys precise information
legal document that can be used in court

6. Types of Prescriptions
Written prescription
handwritten on a 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

7. Figure 6-1 Prescription form
Figure Prescription form. A prescription form is used to convey to a pharmacist a written record of a physician’s order of a drug for a patient. This physician may be prescribing a new drug or ordering a refill of the drug that is in the prescription bottle. © Frozen Images/The Image Works.

8. 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. 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!

9. Clinical Applications
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.

10. Clinical Applications
Store extra prescription pads in a locked drawer or closet.
Have the physician carry just one prescription pad on his/her person from examining room to examining room.

11. Clinical Applications
Never leave a prescription pad on the counter or in an unlocked drawer in the examining room.
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.

12. Types of Prescriptions
Computerized 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

13. Types of Prescriptions
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

14. Types of Prescriptions
Verbal prescription
given over the telephone
if not for a controlled substance, the pharmacist can fill the prescription
without having a printed-out prescription
without having the physician’s signature

15. Did You Know?
About 3.3 billion prescriptions were filled in the United States in 2006; this is up from 3 billion prescriptions in 2005, 2.5 billion prescriptions in 1998, and 1.5 billion prescriptions in 1989.

16. Medication Orders and Other Types of Orders
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
for facilities with electronic records
typed into the computer on a designated screen
screen serves as the physician’s order sheet

17. Figure 6-2 Physician’s order sheet
Figure Physician’s order sheet. The physician’s order sheet is used to write medication orders for a patient in the hospital. This patient has just come out of surgery, and all drug orders must be rewritten to reflect the patient’s change in status. © Pearson Education/PH College.

18. 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
it is marked as a verbal order (V.O.)
the nurse signs her name
physician must personally sign the order within a specific amount of time

19. Medication Orders and Other Types of Orders
Standing Orders
group of specific orders
preprinted on the facility’s physician’s order sheet
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

20. Medication Orders and Other Types of Orders
Automatic Stop Orders
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

21. Medication Orders and Other Types of Orders
Automatic Stop Orders
pharmacy automatically stops sending the drug
an entirely new order must be written
all drugs carry an automatic stop order

22. Medication Orders and Other Types of Orders
Automatic Stop Orders
activated when a patient
situation changes
is transferred to another nursing unit
discharged
to another healthcare facility
home

23. Figure 6-3 A prescription form
Figure 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, as described in the text.

24. Components of Prescriptions and Medication Orders
Identifying information about the prescriber
Prescription form
preprinted at the top
to identify the prescriber
physician’s
name
office address
phone number
Physician’s order sheet
physician’s signature
after written order
all other information is on file with the hospital

25. Clinical Applications
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.

26. Clinical Applications
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.

27. Clinical Applications
No physician is permitted to write orders, including medication orders, unless he/she is already an approved member of that facility’s medical staff.

28. Components of Prescriptions and Medication Orders
Identifying information about the patient
Prescription form
to positively identify the patient
first and last name
address
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

29. Components of Prescriptions and Medication Orders
Age and weight of the patient
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
Physician’s order sheet
already entered onto demographics face sheet
not included on medication order

30. Components of Prescriptions and Medication Orders
Date of the order
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
Physician’s order sheet
writes 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

31. Components of Prescriptions and Medication OrdersRx
have been written since ancient times
symbol stands for recipere, meaning to take
were at one time actually recipes
listing several ingredients
crushed and mixed by pharmacist before dispensing

32. Components of Prescriptions and Medication OrdersRx
Prescription form
most come with a large Rx
just to the left of the area where the prescription itself will be handwritten
Physician’s order sheet
symbol not preprinted
page is large
used to order other types of treatments in addition to drugs

33. 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 or
trade name
chemical name is not used
abbreviations of drugs are avoided

34. 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

35. 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

36. 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
Physician’s order sheet
does not need to indicate total number
medication order continues while patient is in the hospital
exception: controlled substances
only amount needed for one day is sent to the unit

37. 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
Physician’s order sheet
abbreviation Sig. not included
pharmacist doesn’t translate Latin abbreviations
nurse on the unit understands abbreviations

38. 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
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

39. Components of Prescriptions and Medication Orders
Refills
Prescription form
how many times the patient is permitted refills
preprinted Refills area: 0 (sometimes NR), 1, 2, or 3
only be refilled for a year
no refills for Schedule II
Physician’s order sheet
no indication of refills
pharmacy continues to send
as long as patient is hospitalized
physician discontinues order

40. 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
Physician’s order sheet
hospital has formulary for all stocked drugs
pharmacist will dispense generic equivalent unless physician specifically requests trade name

41. Did You Know?
In 2002, physicians wrote the equivalent of over 10 prescriptions for every person in America.

42. Components of Prescriptions and Medication Orders
DEA number
Prescription form
drugs with potential for abuse or physical/psychological dependence
federal DEA number must be included for prescription to be valid
Physician’s order sheet
does not need DEA number
when physician joins hospital staff, DEA certification is verified and kept on file

43. Clinical Applications
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. Official prescription forms contain security features (a control number, thermochromatic ink, and an imprinted seal) that are designed to prevent alterations and forgeries.

44. Clinical Applications
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.

45. Clinical Applications
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. Occasionally, unscrupulous physicians, dentists, and pharmacists prescribe or dispense Schedule II drugs to patients who have a drug habit in exchange for money.

46. Clinical Applications
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. 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.

47. Clinical Applications
The use of generic rather than trade name drugs can result in considerable savings to consumers, but for certain critical drugs— such as digoxin (Lanoxin) for congestive heart failure, phenytoin (Dilantin) for seizures, and anticoagulant drugs—many physicians prefer to rely on the proven therapeutic action of a trade name drug.

48. Clinical Applications
Prescriptions for generic drugs only accounted for 13 percent of all new prescriptions filled in 1995, but accounted for 45 percent of all new prescriptions filled in 2006.

49. The Pharmacy and the Pharmacist
After prescription submitted
it becomes the property of the pharmacy
pharmacy is responsible for keeping it on file
kept for several years
specified by state law

50. The Pharmacy and the Pharmacist
After prescription received
pharmacist
verifies drug
verifies dose prescribed
fills prescription
in larger facilities
tasks may be performed by pharmacy technician
verified by a pharmacist

51. Figure 6-4 Filling a prescription
Figure Filling a prescription. Tablets or capsules are removed from a larger stock bottle in the pharmacy and placed on a manual pill-counting tray. The number specified in the prescription is counted out, moved into the side section, and then poured into the plastic prescription bottle that is given to the patient. © Pearson Education/PH College.

52. The Pharmacy and the Pharmacist
After prescription received
pharmacist
label is placed on each prescription
pharmacist assigns a prescription number (Rx #)
printed on the label
unique to that prescription
to obtain a refill, patient must provide unique prescription number to the pharmacy

53. Figure 6-5 Label on a prescription bottle
Figure Label on a prescription bottle. The label includes the name, address, and phone number of the pharmacy, the patient’s name, Rx #, and date. It includes the drug name. This prescription is for Cardizem CD, a heart drug. Because the physician requested a trade name drug, the generic name of the drug (diltiazem HCl) is also written below in parentheses. The label also includes the dose (360 mg), frequency, amount of drug dispensed, and number of refills allowed (6), as well as the name of the prescribing physician.

54. Figure 6-6 Childproof cap
Figure Childproof cap. The pharmacist asks patients if they would like childproof caps on their prescription bottles to keep children in their homes from mistaking colored prescription drug capsules and tablets for candy. Getty Images.

55. The Pharmacy and the Pharmacist
As number of prescriptions increases
pharmacies are looking for ways to more effectively serve customers
pharmacies in large corporate chains are linked together through a common computer system
patients can have their prescriptions filled at any pharmacy in that chain
In addition, pharmacists offer personalized assistance to customers

56. Figure 6-7 The pharmacist
Figure The pharmacist. A pharmacist offers personalized services by answering questions and helping customers understand what drugs they are taking and when and how to take them. Corbis—Brand X Pictures.

57. Figure 6-8 Drug information
Figure Drug information. Pharmacists provide free pamphlets to customers to explain how to take drugs safely and, for senior customers, how to enroll and pay for drugs through the Medicare Part D Prescription Drug Program.

58. Clinical Applications
The president of the National Association of Chain Drug Stores (which represents 94,000 pharmacists and 32,000 drug stores) reported that pharmacists “see firsthand the struggle of seniors having to choose between food and their drugs because they lack prescription drug coverage for what have become increasingly complex and effective, but expensive drugs.”

59. Click on the display above to view a video on the topic of the pharmacy profession.
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60. Clinical Applications
Many seniors rely on the kindness of their primary care physicians to supply them with enough drug samples to last until their next visit, they cut down on the frequency of doses, or they simply do without their drugs.

61. The Pharmacy and the Pharmacist
Online Pharmacies
provide convenient service to patients
order prescriptions over the Internet
drugs are mailed to the patients at home
legitimate pharmacies have a seal on the home page of their website: “Verified Internet Pharmacy Provider Site”

62. The Pharmacy and the Pharmacist
Online Pharmacies
patients mail in their actual prescriptions
Internet pharmacy calls the doctor to verify the validity of the prescription
some internet pharmacies
do not require a prescription form
do not check with the patient’s physician

63. The Pharmacy and the Pharmacist
Online Pharmacies
prescription drugs without prescriptions
patient fills out a medical questionnaire online
online pharmacy company doctor
without examining the patient
writes the prescription the patient wants
raises ethical concerns

64. The Pharmacy and the Pharmacist
Online Pharmacies
ethical concerns
easy source of drugs for an addict
people can forge a prescription for a prescription drug or even a schedule drug
send it to several Internet pharmacies at the same time
obtain multiple bottles of drugs
some online pharmacies obtain their drugs from foreign countries
quality and purity of drug may be compromised