2 - Writing Progress Notes and Prescriptions Flashcards
NOTE
There will be no questions on writing progress notes, just use those slides for SPAL prep
What is the purpose of a prescription?
- A prescription is an order for a specific medication for a specified patient at a particular time
- It is the way a health professional communicates a patient’s selected drug therapy to the pharmacist and instructs the patient on how to use the prescribed medication
How can you write or give a prescription?
The order may be written and signed or it may be given orally directly to a pharmacist
How common is it for patients to misuse a prescription?
25% to 50% of patients do not use the prescription as intended, with most errors attributable to the prescription order itself
How are most prescriptions submitted today?
Electronically
What are the EIGHT parts of a prescription order?
KNOW THIS (“SISSY”)
- date prescribed
- name (address, and age) of patient
- superscription (S)
- inscription (I)
- subscription (S)
- signa (S)
- renewal information
- signature of prescriber (your signature) (Y)
Why is the date prescribed important?
Under the Controlled Substances Act, certain drugs can’t be dispensed or renewed more than 6 months from the date prescribed.
Some can never be renewed without a new written prescription (oxycodone and hydrocodone)
Why is the name, address and age important?
Identifies the person for whom the drug is intended.
Name is all that is generally needed
What is a superscription?
The Rx, a contraction of the Latin verb “recipe”, meaning “take thou”.
Serves to introduce the drug prescribed and the directions for use.
Not commonly found on the prescription, but will be on the medication container.
What is inscription?
Name (trade name, generic, or chemical), and strength of drug (use metric terms)
When the trade name is written, the prescription must be filled with the product of the specified manufacturer, unless the prescriber and the patient approved a substitution with another brand
Can indicate this at the end of the prescription by selecting DAW (dispense as written) or generic - most pharmacists will substitute a generic to save the patient money, so indicate if you do not want this.
Describe writing for a mixed drug
If two or more drugs are to be mixed together by the pharmacist, list each separately directly below the preceding one
What is a subscription?
Directions to the pharmacist
- State the specific dosage form [number and form of medication (tablets, capsules, ounces, mls)] to be dispensed or the desired method of preparation
- Usually preceded by “Disp” (Dispense)
- WRITE OUT BOTH WAYS: Disp: Twenty-eight (28) capsules
What is signa?
Directions to the PATIENT
- Preceded by Sig. (Signa, meaning “mark thou”)
- Instructions as to the route of administration, the amount of drug to be taken , and the time and frequency of the dose
What should you avoid saying to patient?
Avoid phrases such as “take as directed” or “use as needed”
Although used extensively, avoid Latin abbreviations, and write in long hand to avoid mistakes on the part of the pharmacist or the patient
What should you use for numbers and units?
Write out numbers- do not use i, ii, iii to represent 1, 2, 3
For liquids, use teaspoon (5 cc or 5 ml), tablespoon (15 cc or 15 ml), or drops when appropriate
1 oz = 30 ml and 1 pint = 473 ml
Give an example of how you should write a prescription
Sig.: One (1) capsule four (4) times a day one (1) hour before meals
“¡ cap q.i.d. ¡ h. a.c.”
Describe renewal information
- Number of refills of the prescription that are authorized by the prescriber
- Drugs that bear the legend “Caution: federal law prohibits dispensing without prescription” may not be renewed without the expressed consent of the prescriber.
Describe renewal of scheduled drugs
- Schedule III or IV drugs may be renewed no more than 5 times within six months of date of issue and can be prescribed over the phone or via fax
- Schedule II drugs may not be renewed and cannot be phoned or faxed to pharmacy
What does DEA allow?
However, DEA will allow prescriber to write up to three separate consecutive prescriptions (each for a 30 day supply) for 90 day supply for schedule II drugs and submit to the pharmacy with the same date on each prescription.
What are some tips to prevent misuse of drugs
- Use legible writing
- Do not use abbreviations
- Include indications for use
- Use a zero before a decimal point (0.5 rather than .5 mgs)
- Never use a trailing zero (5 rather than 5.0)
- Include age and weight when appropriate
- Prohibit “take as directed” instructions
Question: The part of the prescription that conveys instructions to the pharmacist is called the
Subscription
Describe the controlled substances act
CSA
- Legal aspects of prescription writing and dispensing are incorporated in various federal, state, and local laws
- The strictest law regardless of governmental level, always takes precedence unless Federal Law is preemptive
- CSA imposes even more stringent controls on the distribution of all stimulant and depressant drugs and substances with the potential for abuse as designated by the Drug Enforcement Agency (DEA)
- Divides drugs with abuse potential into 5 categories or schedules
Describe schedule I drugs
- High potential for abuse with no currently accepted medical use in the US
- Heroin, marijuana, LSD, mescaline, etc.
- Not available with a prescription, other than for medical marijuana
- May be obtained for research
Describe medical marijuana
- As of May 2014, 22 states and Washington D.C. have legalized the use of medical marijuana
- CO and WA voted to legalize recreational use of marijuana for citizens over 21
- April, 2015: CA federal judge refused to remove it from list as Schedule 1 drug
