Medical prescription

A medical prescription (℞) is a written order by a medical doctor to a pharmacist for a treatment to be provided to the doctor's patient.

Writing prescriptions

Who can write prescriptions

Who can issue prescriptions are governed by local legislation. In the United States, physicians, veterinarians, dentists, and podiatrists have full prescribing power. In all states optometrists will also issue eyeglass prescriptions for corrective eyeglasses though technically these are not medical prescriptions. In many states, optometrists cannot prescribe medication. States allow mid-level practitioners different prescription privileges. Nurse practitioners (also known as advance practice nurses), physician assistants, optometrists, homeopathic physicians, registered pharmacists, naturopathic physicians, and doctors of oriental medicine currently represent the spectrum of mid-level practitioners. Each state regulates what (if any) prescription powers members of the above group are allowed. Florida, for example, prohibits every member of the above group from any prescription power, where as North Dakota allows registered pharmacists to prescribe certain medicationshttp://www.deadiversion.usdoj.gov/drugreg/practioners/index.html.In some states, clinical psychologists (PhD's or PsyD's) who have also undergone specialized training in script-writing my prescribe a limited number of drugs to treat nervous and mental disorders.

Related Topics:
Physicians - Veterinarian - Dentist - Podiatrist - Optometrist - Eyeglass prescription

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Legibility of prescriptions

Prescriptions, when handwritten, are notorious for being often illegible (5% according to an Irish study http://www.imj.ie/news_detail.php?nNewsId=2553&nVolId=98). Contrary to popular belief, pharmacists do not have special deciphering skills. When in doubt, they call the doctor. At other times, even though some of the individual letters are illegible, the position of the legible letters and length of the word is sufficient to distinguish the medication based on the knowledge of the pharmacist. For doctors that the pharmacist deals with regularly, they learn to read the doctor's handwriting. Patients are advised to ensure that the prescription is legible before leaving the doctor's office. Some jurisdictions have made legible prescriptions a law (e.g. Floridahttp://www.flsenate.gov/data/session/2003/senate/bills/billtext/pdf/s2084er.pdf). Some have advocated the elimination of handwritten prescriptions altogether http://www.ismp.org/msaarticles/whitepaper.html and computer printed prescriptions are becoming increasingly common in some places. However, in the United States, computer-printed prescriptions cannot be used to prescribe Schedule II medications; prescriptions for these medications must be in the physician's handwriting, or typewritten, and actually signed by the physician.

Related Topics:
Computer printed - United States - Schedule II

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Writing good prescriptions

Independent of the actual prescribing decision, elements of a good prescription writing include:

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http://bnf.org/bnf/bnf/current/doc/29420.htm

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http://www.healthlibrary.com/reading/rdb/april98/good.htm

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http://www.aafp.org/fpm/20020700/27pres.html

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• careful use of decimal points to avoid ambiguity:
• avoid unnecessary decimal points: 5 mL instead of 5.0 mL to avoid possible misinterpretation of 5.0=50
• always zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation with .5=5
• never have trailing zeros on decimals: e.g. use 0.5 instead of .50 to avoid misinterpretation with .50=50
• avoid decimals altogether by changing the units: 0.5 g =500 mg
• "mL" is used instead of "cc" or "cm³" even though they are technically equivalent
• directions should be written out in full in English although some common Latin abbreviations are listed below
• quantities can be given directly or implied by the frequency & duration of the directions
• where the directions are "as needed" the quantity should always be specified
• where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (3 times a day) and especially relationship to meals for orally consumed medication
• use permanent ink
• avoid prn "as needed" - limits & indicators should be specified e.g. "q 3h prn pain"
• for refills - minimum duration between repeats & number of repeats should be specified

Abbreviations

See Appendix 1 for a complete list of common abbreviations found on prescriptions. Many abbreviations are derived from Latin phrases. Hospital pharmacies have more abbreviations, some specific to the hospital. Different jurisdictions follow different conventions on what is abbreviated or not. Prescriptions that don't follow area conventions may be flagged as possible forgeries.

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Some abbreviations which are ambiguous, or which in their written form might be confused with something else, are not recommended and should be avoided. These are included in a separate list in Appendix 1.

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