PRESCRIPTION AND PRESCRIPTION HANDLING: A TEACHER’S COMPREHENSIVE GUIDE
Welcome, future pharmacists and healthcare professionals!
A medical prescription is a written order from a doctor to a chemist that includes instructions for preparing and dispensing medicines to a patient. It represents a method through which a treatment modality is provided to the patient. A prescription order may be written and issued by a physician, dentist, veterinarian, or other properly licensed medical practitioner. The prescription for each patient is a unique entity, designating a specific medication for a specific patient at a specific time.
Dpharmguru’s exam insights:
In my years of teaching community pharmacy, I have observed that students often overlook the importance of prescription handling. Remember: A prescription is a legal document and must be handled with utmost care. Understanding the parts of a prescription and the dispensing process is essential for every pharmacy student.
TYPES OF PRESCRIPTION
1. Compounded Prescription
In these prescriptions one or more active ingredients are mixed with one or more pharmaceutical additives (vehicle, suspending agent, preservatives, etc.). Drug, doses, and pharmaceutical forms required by the patient are selected by the physician and thereafter the medication is prepared accordingly by the pharmacist.
Each drug in the prescription is written on a separate line in a sequence. Ingredients in the prescription are written in the following pattern:
- Remedium cardinale (Basis): This includes the principal drug which gives its primary action to the prescription.
- Remedium adjuvans (Adjuvant): This includes the drug which helps in increasing the action of the main therapeutic agent.
- Remedium corrigens (Corrective): This corrects or modifies the adverse effects found in the basic or the adjuvant.
- Remedium constituens (Vehicle): This is used as a solvent in the solution in order to increase the size and volume or dilute the mixture.
2. Non-compounded Prescription
These prescriptions are also called formula officinalis, a Latin word meaning workshop. In order to obtain a finished product, two or more ingredients are not required to be mixed in these prescriptions. It is a pre-compounded order comprising of either a single drug or a mixture of drugs provided by a pharmaceutical company by its official or proprietary name.
Dpharmguru’s exam insights:
A common exam question is: “What are the four parts of a compounded prescription?” Remember: Basis, Adjuvant, Corrective, and Vehicle. This is frequently tested!
PARTS OF PRESCRIPTION
Prescription comprises of the following mentioned information:
- Date: Date is essential for a pharmacist to identify the cases if the prescription is brought for dispensing after a long time of its issued date.
- Name, Age, Sex, and Address of the Patient: Information regarding patient’s name, age, sex, and address should be mentioned on the prescription.
- Superscription: Rx is commonly used to symbolise superscription. This symbol is mentioned at the beginning of the prescription.
- Inscription: It is the most important part of the prescription which contains the names and quantities of each prescribed ingredients.
- Subscription: In this part, the prescriber provides directions to the pharmacist concerning the dosage form type to be compounded and dose number to be dispensed.
- Signature/Sign: The abbreviated form of this term used on the prescriptions is Sig. It provides the information regarding the drug administration by the patient.
- Signature, Address, and Registration Number of the Prescriber: Except the prescriber’s hand-written name and his/her inked signature, all other prescription parts are either printed or typed.
LEGALITY OF PRESCRIPTIONS
Prescriptions are authorised and dispensed by medical practitioners in accordance with existing laws and regulations that are considered legal.
- Prescribing Authority: Prescriptions can only be written by authorised healthcare providers with prescribing authority, such as medical doctors (MDs), physician assistants, and nurses.
- Regulatory Framework: The laws and rules governing the prescription dispense, and usage of pharmaceuticals varies by country or region.
- Controlled Substances: These are medications with great potential of abuse and dependence to enhance regulatory control.
- Patient Evaluation: A thorough evaluation of the patient’s symptoms should be done before making their prescriptions.
- Documentation and Record-keeping: The prescription issued including all details should be accurately recorded by healthcare professionals.
- Adherence to Standards of Practice: When prescribing drugs, prescribers are supposed to follow ethical norms and professional standards of practice.
- Regulatory Oversight: The Food and Drug Administration (FDA) and government organisations play a significant role in monitoring the safety and legality of prescription drugs.
PRESCRIPTION HANDLING
A pharmacist should give equal attention to every patient and must make them feel comfortable through friendly gestures and atmosphere within the pharmacy. The pharmacist should interact with the patients in a way to encourage them to tell their needs either through a prescription or inquire about other health products or related advices.
Steps in Prescription Handling
- After receiving the prescription, a pharmacist must ensure the patient’s identity and if the prescription is offered by the patient himself or by someone else on the patient’s behalf.
- The pharmacist should respectfully ask the patient to wait while the prescription is reviewed for therapeutic, social, legal, and economic aspects.
- The pharmacist should check that the prescription contains the doctor’s name, address, and registration number; the patient’s name, address, age, and sex; the medicine’s name, potency, dosage, and total amount to be supplied; instruction to the patient; refill information; and the doctor’s signature.
Dpharmguru’s exam insights:
When checking a prescription, always verify: doctor’s details, patient’s details, medicine details, instructions, and doctor’s signature. This is a systematic approach that prevents dispensing errors. Remember: “DPDII” – Doctor, Patient, Drug, Instructions, Identity.
LABELLING OF DISPENSED MEDICATIONS
A label is mandatory to communicate the medicine-related information effectively to the patient and ensuring proper and safe use of medicine. The label on dispensed medicine must bear the essential information regarding safe and effective consumption of medicines.
Purpose of Labelling
- To describe and identify the product.
- To avoid medication errors.
- To contribute towards ideal therapeutic result.
- To achieve proper handling and storage of the product.
- To allow the product to be traced in case of any problem, like a quality issue.
Types of Dispensed Labelling
- Main Label: Includes patient’s name and address, name and address of the supplier, date of supply, precise details regarding the contents of container, storage conditions, and instructions to the patient.
- Ancillary Labels: Additional labels with warnings like “For External Use Only,” “May Cause Drowsiness,” “Do Not Take with Alcohol,” etc.
- Pictograms: Standardised graphic images to illustrate medicine-related directions, precautions, and/or warnings to consumers.
Dpharmguru’s exam insights:
Pictograms are especially useful for patients with low literacy. Remember: USP pictograms are standardised and tested for comprehension. Common pictograms include “Take with meals,” “Do not drink alcohol,” and “May cause drowsiness.”
GOOD DISPENSING PRACTICE
Good dispensing practices should be followed to correctly deliver right medicines of desired quality to the right patient in right dose, strength, frequency, dosage form and quantity, along with clear instructions in written form and verbally, and with appropriate packaging for maintaining the medicine quality and efficacy.
Dispensing Process (6 Steps)
- Receiving and Validating the Prescription: Confirm the patient’s name to avoid mixing up of prescriptions.
- Understanding and Interpreting the Prescription: Read the prescription, understand abbreviations, confirm doses, and detect drug interactions.
- Preparing and Labelling Items for Issue: Select stock container, measure/count quantity, pack and label medicine.
- Making a Final Check: Another staff member should check the dispensed medicines against the prescription.
- Recording the Action Taken: Record the issued medicines for tracing and stock verification.
- Issuing Medicine to the Patient: Provide clear instructions and advice about the use of medicine.
Common Dispensing Errors
| Prescriber’s Intention | Misinterpretation |
|---|---|
| AD, AS, AU (right ear, left ear, each ear) | OD, OS, OU (right eye, left eye, each eye) |
| god (every other day) | qd (daily) or qid (4 times a day) |
| U or u (units) | Zero, causing a 10-fold increase in dose |
| Trailing zero (1.0mg) | 1.0mg mistaken as 10mg |
| Naked decimal point (0.5mg) | 0.5mg mistaken as 5mg |
Dpharmguru’s exam insights:
Common dispensing errors include misinterpretation of abbreviations, misplaced zeros, and decimal points. Always use leading zeros (0.5mg) and avoid trailing zeros (use 1mg instead of 1.0mg). This is frequently tested in pharmacy exams!
Strategies to Minimise Dispensing Errors
- Ensuring correct entry of the prescription
- Confirming that the prescription is correct and complete
- Being careful about LASA (Look-Alike Sound-Alike) drugs
- Being careful with zeros and abbreviations
- Organising the workplace
- Reducing distraction
- Reducing stress and balancing heavy workloads
- Storing drugs properly
- Thoroughly checking all prescriptions
- Providing detailed patient counselling
Dpharmguru’s exam insights:
Prescription handling is one of the most important skills for a community pharmacist. Remember: The six steps of dispensing (Receive, Interpret, Prepare, Check, Record, Issue) and strategies to minimise dispensing errors are essential topics that frequently appear in exams!
REFERENCES AND FURTHER READING
- Pharmacy Council of India (PCI). (2022). Good Dispensing Practice Guidelines. New Delhi: PCI.
- International Pharmaceutical Federation (FIP). (2022). Dispensing and Prescription Handling Standards. Retrieved from https://www.fip.org.
- World Health Organization (WHO). (2022). Good Pharmacy Practice in Community and Hospital Pharmacy Settings. Retrieved from https://www.who.int.
- Ministry of Health and Family Welfare. (2022). Drugs and Cosmetics Act, 1940 and Rules, 1945. Government of India.
- Smith, M. C., & Wertheimer, A. I. (2021). Social and Behavioral Aspects of Pharmacy Practice. Pharmaceutical Press.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals for medical concerns.
written by:
Dr. N. Sujith Kumar
