PH3.1 Write a rational, correct and legible generic prescription for a given condition and communicate the same to the patient

1. PH3.1 Write a rational, correct and
legible generic prescription for a given
condition and communicate the same
to the patient
Dr Pankaj Gupta, MD
Assistant Professor,
Department of Pharmacology,
Al Falah School of Medical Science & RC,
Faridabad (HARYANA) INDIA

7. Learning Objectives
• Definition of prescription
• Parts of Prescription
• Sample prescription
• Abbreviations used in prescription
• Sample Prescription format suggested by MCI
• Sample Prescription format suggested by MOHFW in Telemedicine
guidelines
• Parts of prescription (In detail)
• Communication to the patient
• Rational prescribing
• Medication Error
• Good prescription writing practices

8. Definition
• A prescription is a written order by a
registered physician directing the pharmacist
to prepare or dispense pharmacological
agents for the diagnosis, prevention or
treatment of a disease.
Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for MBBS, First Edition 2021. Avichal Publishing Company.

9. Parts of prescription
• Broadly Prescription has 4 components:
– Superscription
– Inscription
– Subscription
– Transcription
Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for MBBS, First Edition 2021. Avichal Publishing Company.

10. Parts of Prescription
SN Parts of prescription Content
1 Superscription •Doctor details (Name, qualification, registration no., address &
contact details)
•Patient details (Name, age, gender, weight, address, unique
registration no., address, diagnosis
•Rx Symbol (It is an abbreviation of Latin term “Recipe”,
meaning “you take” or “take thou”)
2 Inscription •Main body of prescription
•Name of drug & amount
3 Subscription •Direction to pharmacist regarding dosage forms of medicine,
instructions for preparation and amount to be sent
4 Transcription •Direction to patient as how to administer or apply, dose,
frequency.
5 Signature of doctor •Hand written signature of doctor along with stamp
Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for MBBS, First Edition 2021. Avichal Publishing Company.

11. Particulars of Doctors:-
Name-
Address- Mobile no:-
Qualification-
Registration No-
Date-
Particulars of patient:-
Name- Age:-
Gender- Weight-
Address- Mobile no-
Diagnosis – Stage 1 hypertension
RX-
Inscription: Tablet AMLODIPINE 5 mg
Subscription: send such 30 tablets
Transcription: one tablet once a day before breakfast, follow up after 1 month
Signature with stamp
Sample prescription
DISPENSED
Date:___________________ Pharmacist_________________________
Name of Pharmacy___________________________________________
City:_______________________________________________________

12. Abbreviations used in prescription
• They are ‘Latin’ words.
• Less commonly used now (past practice) as
the prescription goes to patient directly
(current practice), not through pharmacist.
Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for MBBS, First Edition 2021. Avichal Publishing Company.

13. Abbreviations used in prescription
Abbreviations Latin word/phrase Meaning
a.a. ana of each
a.c. ante cibum before meals
ad. adde to, up to
ad lib. ad libitum at pleasure
aq. aqua water
b.i.d. or b.d. bis in die twice a day
gtt (g) guttae drops
h.s. hora somni at bedtime
m. misce mix
mist mistura mixture
non rept or n.r. non re petatur do not repeat
o omni every
o.h. omni hora every hour
Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for MBBS, First Edition 2021. Avichal Publishing Company.

14. Abbreviations used in prescription
Abbreviations Latin word/phrase Meaning
o.d. omni die every day (daily)
o.m. omni mane every morning
o.n. (ON) omni nocte every night
p.c. post cibum after meals
p.r.n. pro re nata as needed
q.i.d. quarter in die four times a day
q.s. quantum sufficiat sufficient quantity
Rx recipe take thou
Rept. Or r. repetatur repeat
Sig. signetur let it be labelled
Stat statim immediately
t.d.s ter in die summendum to be taken three times a day
t.i.d. ter in die three times a day
s.o.s. si opus sit if necessary
Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for MBBS, First Edition 2021. Avichal Publishing Company.

15. Sample Prescription format suggested by MCI
(Jan2015)
https://www.researchgate.net/figure/The-prescription-format-proposed-by-the-Medical-Council-of-India-for-registered_fig1_308022532

16. https://www.researchgate.net/figure/The-prescription-format-proposed-by-the-Medical-Council-of-India-for-registered_fig1_308022532

17. Sample Prescription format suggested by MOHFW
in Telemedicine guidelines in March 2020
https://www.mohfw.gov.in/pdf/Telemedicine.pdf.

18. https://www.mohfw.gov.in/pdf/Telemedicine.pdf.

19. https://www.mohfw.gov.in/pdf/Telemedicine.pdf.

20. https://www.mohfw.gov.in/pdf/Telemedicine.pdf.

21. Parts of prescription (in detail)
• Doctor details- (Name, Qualification, registration no., address, contact
details)
• Patient details- (Name, Age, Gender, Weight, Address, contact details)
• Date of Prescription-
• Clinical details- (Vitals, Chief complaints, Past history, Lab work suggestions)
• Diagnosis (provisional/definitive)
• Rx
• Prescribed drug details- (Drug Formulation + DRUG NAME + Dose +
Frequency + Food relation + Duration of therapy)
• Refill information- (SHOULD NOT BE REFILLED/ DO NOT DISPENSE MORE THAN
ONCE / How many times it will be refilled
• Direction to the patient/follow up details
• Signature of the prescriber with stamp

22. Inscription formula for writing any medicine
Drug Formulation + DRUG NAME (in capital letter with
generic name) + Strength + Frequency + Food relation +
Duration of therapy
Most critical for
minimizing
medication errors

23. Communication to the patient
• The patient should be informed about the medicines
prescribed and about method of use of certain medications.
• The following information should be given to each patient
after writing prescription.
• Disease for which patient is suffering
• Purpose of drug prescribed i.e. why the drug was prescribed
(to cure/control the disease/to provide symptomatic relief
or palliation/for prophylaxis)
• Name of the drugs prescribed, main drug and other drugs as
applicable
• They should be informed to check generic name of drug, if
prescribed by brand name, amount and expiry before they
start taking any medicine prescribed.

24. Communication to the patient
• How to use the drug, when to take, at what interval and how long
to take?
• Information about expiry of a drug formulation?
• What to do if a dose is missed, if it matters?
• How to recognize ADR and interactions with food and other drugs
including alcohol and effect on operating machinery including
driving vehicle and what to do if it is significant.
• Special instructions e.g. use of ergotamine, use of colchicine etc.
• Storage of medicines should be informed
• Patient should be encouraged to ask if they have any query.
• If there is no problem, even then when to come for follow up.
Patient need not to be informed about all the side effect but only those
which are significant and specific adverse side effect e.g. Rifampicin on
secretions, metallic taste by Metronidazole.

25. Exercise

26. Q. A woman of 29 years, Asha weight 58 KG comes
to hospital. Her history reveals last menstrual
cycle 3 months back. Blood test confirms the
pregnancy. Investigations shows the Hb level of
10.2 g/dl.
On examination her Temp is 98 F, RR-16/min, BP-
120/80 mmHg, Pulse-76/min
• Write a rational, correct and legible prescription
for her

27. Sample Prescription to be written on exam sheet

28. •Your details
•Regn no. can be your roll no
•Patient details
•Your signature with stamp
•Tab Ferrous Sulphate 100
mg OD after lunch for 1
month
•Patient’s clinical details

30. Rational prescribing
Prescribers should follow below principles for
rational prescribing:
– Maximize clinical effectiveness
– Minimize harms
– Avoid wasting scarce healthcare resources
– Respect patient choice
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297291/

31. Process of Rational Prescribing
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297291/

32. Medication Error
• “… any preventable event that may cause or lead to
inappropriate medication use or patient harm while the
medication is in the control of the healthcare professional,
patient, or consumer. Such events may be related to
professional practice, health care products, procedures, and
systems, including prescribing; order communication; product
labeling, packaging, and nomenclature; compounding;
dispensing; distribution; administration; education;
monitoring; and use.”
https://www.ncbi.nlm.nih.gov/books/NBK519065/
Each year, in the United States alone, 7,000 to 9,000 people die due to a
medication error.

33. Points of error
• Ordering/prescribing
• Documenting
• Transcribing
• Dispensing
• Administering
• Monitoring
•Errors are most common at this
place
•Errors include
•Writing the wrong
medication
•Wrong route, dose, frequency
•Illegible handwriting
•Confusion over similarly
named drugs
•These ordering errors account for
almost 50% of medication errors
https://www.ncbi.nlm.nih.gov/books/NBK519065/

34. Correct and legible hand-writing

35. Correct and legible hand-writing
• Doctors, notorious for bad handwriting, may
choose the right drug, but the pharmacist may
read it incorrectly.
• Sometimes, the prescription gets transferred
by phone from the doctor's office to the
pharmacy, but the people making or receiving
the phone calls make mistakes while writing or
filling the prescription and one of the reason is
similarly named drug or brand.

36. Similarly Named Drugs
Inderal (Propranolol used for HT) Adderall (Amphetamine mixture used for
ADHD & Narcolepsy)
Zyrtec (Cetirizine used for allergy) Zantac (Ranitidine used for relief and
prevention of heartburn)
Celebrex (Celecoxib used for pain &
inflammation)
Cerebyx (Fosphenytoin, an anti-epileptic
drug)
Aciphex (Rabeprazole for stomach reflux) Aricept (Donepezil for memory in AD)
Allegra (Fexofenadine for allergies) Viagra (Sildenafil for erectile dysfunction)
Fosomax (Alendronic acid for bone in
osteoporosis)
Flomax (Tamsulosin for BPH & kidney
stones).
https://dailymed.nlm.nih.gov/dailymed/index.cfm

37. Conclusion
Good Prescription writing practices include-
– Rational prescription
– Correct prescription
– Legible prescription
– Generic prescription
– Communication with patient for proper use of
prescribed medications

38. References
• Srivastava SK, Srivastava Rohan. Manual of practical pharmacology for MBBS, First
Edition 2021. Avichal Publishing Company.
• https://www.researchgate.net/figure/The-prescription-format-proposed-by-the-
Medical-Council-of-India-for-registered_fig1_308022532
• Telemedicine practice guidelines. Available from:
https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2022 Feb21].
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297291/
• https://www.ncbi.nlm.nih.gov/books/NBK519065/
• https://dailymed.nlm.nih.gov/dailymed/index.cfm
• https://medicaldialogues.in/writing-brand-name-of-drugs-not-illegal-dr-girish-
tyagi-delhi-medical-council?infinitescroll=1
• https://medicaldialogues.in/writing-a-prescription-guidelines?infinitescroll=1

39. Do’s and Don’ts for Doctors
• Only allopathic doctors (including Dentists, Veterinarians) can prescribe
allopathic medicines.
• Nursing staff, Pharmacists and Practitioners of Traditional /
Complimentary system of medicines cannot prescribe Allopathic
Medicines.
• Doctors should refrain from prescribing medicines of other systems of
medicine. This amounts to cross practice and is prohibited by the Supreme
Court of India.
• Overwriting on a prescription should be avoided. In case of overwriting
Doctor must initial each correction.
• If prescription is typed or printed the Doctor must sign with date in blue
indelible ink. Must sign as close as possible to last drug listed in
prescription.
• For prescription to be dispensed once, write “SHOULD NOT BE REFILLED”
OR “DO NOT DISPENSE MORE THAN ONCE” If wants prescription to be
refilled, then clearly mentions how many times.

40. • In strength of the drug avoid trailing zeros. EX. 5 mg vs. 5.0 mg; can be mistaken
for 50 mg. Always use leading zeros. EX. 0.8 ml vs. .8 ml; can be mistaken for 8 ml.
• Quantities of 1 gram or more should be written in grams. Ex - write 2 g. Quantities
less than 1 gram but more than 1 milligram should be written in Milligrams. Ex -
write 100 mg, not 0.1 g.
• Quantities less than 1 milligram should be written in micro / nano gram as
appropriate. DO NOT abbreviate micro/ nanograms; since that can lead to
Prescribing errors. Ex - write 100 micrograms, not 0.1 mg, nor 100 mcg, nor 100
μg. Use ml or mL for milliliters.
• Doctor should not use another Doctor’s prescription pad even with his consent.
Doctor should avoid using prescription pad having names of two or more Doctors.
• Doctor should not use prescription pad with message at bottom “Available at XYZ
Medical Store” Doctors should exercise caution while prescribing drugs which have
potential of abuse.
• Doctor should always encourage the Pharmacist to call them up in case of any
problem/discrepancies/doubts/queries in their prescription.
• Pharmacist are authorized to refuse to dispense prescription which do not
conform to the guidelines and if do so liable for prosecution.
Do’s and Don’ts for Doctors

42. Thanks