Medical prescription
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A prescription, often abbreviated ℞ or Rx, is a formal communication from a physician or other registered healthcare professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ (a capital letter R, crossed to indicate abbreviation) comes from the first word of a medieval prescription, Latin recipere (lit. 'take thou'), that gave the list of the materials to be compounded.
Format and definition
℞ | |
---|---|
Medical prescription | |
In Unicode | U+211E ℞ PRESCRIPTION TAKE (℞) |
Related | |
See also | U+2695 ⚕ STAFF OF AESCULAPIUS |
The symbol "℞", sometimes transliterated as "Rx" or "Rx", is recorded in 16th century manuscripts as an abbreviation of the late Latin instruction recipe, meaning 'receive'.[1][a] Originally abbreviated Rc, the later convention of using a slash to indicate abbreviation resulted in an R with a straight stroke through its right "leg".[1][b][c] Medieval prescriptions invariably began with the instruction from the physician to the apothecary to "take" certain materials and compound them in specified ways.[6]
For a communication to be accepted as a legal medical prescription, it needs to be filed by a qualified dentist, advanced practice nurse, physician, or veterinarian, for whom the medication prescribed is within their scope of practice to prescribe.[citation needed] This is regardless of whether the prescription includes prescription drugs, controlled substances, or over-the-counter treatments.[citation needed]
Prescriptions may be entered into an electronic medical record system and transmitted electronically to a pharmacy. Alternatively, a prescription may be
The word prescription, from pre- ('before') and script ('writing, written'), refers to the fact that the prescription is an order that must be written down before a drug can be dispensed. Those within the industry will often call prescriptions simply "scripts".
Contents
Every prescription contains
Drug equivalence and non-substitution
Many
Prescriptions for children
In some jurisdictions, it may be a legal requirement to include the age of child on the prescription.[10] For pediatric prescriptions some[who?] advise the inclusion of the age of the child if the patient is less than twelve and the age and months if less than five. (In general, including the age on the prescription is helpful.) Adding the weight of the child is also helpful.
Label and instructions
Prescriptions in the US often have a "label" box.[11] When checked, the pharmacist is instructed to label the medication and provide information about the prescription itself is given in addition to instructions on taking the medication. Otherwise, the patient is simply given the instructions. Some prescribers further inform the patient and pharmacist by providing the indication for the medication; i.e. what is being treated. This assists the pharmacist in checking for errors as many common medications can be used for multiple medical conditions. Some prescriptions will specify whether and how many "repeats" or "refills" are allowed; that is whether the patient may obtain more of the same medication without getting a new prescription from the medical practitioner. Regulations may restrict some types of drugs from being refilled.
Writing prescriptions
The examples and perspective in this section deal primarily with the United States and the United Kingdom and do not represent a worldwide view of the subject. (September 2017) |
Legal capacity to write prescriptions
National or local (e.g. US state or Canadian provincial)
In August 2013, legislative changes in the UK allowed
Standing orders
Some jurisdictions[19][20] allow certain physicians (sometimes a government official like the state Secretary of Health,[21] sometimes physicians in local clinics or pharmacies[22]) to write "standing orders" that act like a prescription for everyone in the general public. These orders also provide a standard procedure for determining if administration is necessary and details of how it is to be performed safely. These are typically used to authorize certain people to perform preventive, low-risk, or emergency care that would be otherwise logistically cumbersome to authorize for individual patients, including vaccinations,[23] prevention of cavities, birth control, treatment of infectious diseases,[24] and reversal of drug overdoses.[21]
Legibility of handwritten prescriptions
Doctors' handwriting is a reference to the stereotypically
There are several theories about the causes of this phenomenon. Some sources say the extreme amount of writing doctors employ during training and at work leads to bad handwriting,
Some jurisdictions have legislatively required prescriptions to be legible—
Conventions for avoiding ambiguity
Over the years, prescribers have developed many conventions for prescription-writing, with the goal of avoiding ambiguities or misinterpretation.[40][41][42] These include:
- Careful use of decimal points to avoid ambiguity:
- Avoiding unnecessary decimal points and trailing zeros, e.g. 5 mL rather than 5.0 mL, 0.5 rather than .50 or 0.50, to avoid possible misinterpretation as 50.
- Always using leading zeros on decimal numbers less than 1: e.g. 0.5 rather than .5 to avoid misinterpretation as 5.
- Directions written out in full in English (although some common Latin abbreviations are listed below).
- Quantities given directly or implied by the frequency and 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 (three times a day) and especially relationship to meals for orally consumed medication.
- The use of permanent ink is encouraged.
- Avoiding units such as "teaspoons" or "tablespoons".
- Writing out numbers as words and numerals ("dispense #30 (thirty)") as in a bank draft or cheque.
- The use of the minims (♏︎) – is discouraged given the potential for confusion. For example, the abbreviation for a grain ("gr") can be confused with the gram, abbreviated g, and the symbol for minims (♏︎), which looks almost identical to an 'm', can be confused with micrograms or metres. Also, the symbols for ounce (℥) and dram (ℨ) can easily be confused with the numeral '3' and the Latin letter ezh, 'Ʒ' and the symbol for pint (O) can be easily read as a '0'. Given the potential for errors, metricequivalents should always be used.
- The degree symbol (°), which is commonly used as an abbreviation for hours (e.g., "q 2-4°" for every 2–4 hours), should not be used, since it can be confused with a '0' (zero). Further, the use of the degree symbol for primary, secondary, and tertiary (1°, 2°, and 3°) is discouraged, since the former could be confused with quantities (i.e. 10, 20 and 30, respectively).
- milligrams). Even so, pharmacists must be on the alert for inadvertent over- or under-prescribing through a momentary lapse of concentration.
Abbreviations
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 do not follow area conventions may be flagged as possible forgeries.
Some abbreviations that are ambiguous, or that in their written form might be confused with something else, are not recommended and should be avoided. These are flagged in the table in the main article. However, all abbreviations carry an increased risk for confusion and misinterpretation and should be used cautiously.
Non-prescription drug prescriptions
Some medical software requires a prescription.[44]
Legislation may define certain equipment as "prescription devices".
In some jurisdictions,
History
The idea of prescriptions dates back to the beginning of history. So long as there were medications and a writing system to capture directions for preparation and usage, there were prescriptions. The oldest known medical prescription text was found at Ebla, in modern Syria, and dates back to around 2500 BCE.[47][48][49]
Modern prescriptions are actually extemporaneous prescriptions (from the Latin ex tempore, "at/from the time"),[50] meaning that the prescription is written on the spot for a specific patient with a specific ailment. This is distinguished from a non-extemporaneous prescription that is a generic recipe for a general ailment. Modern prescriptions evolved with the separation of the role of the pharmacists from that of the physician.[51] Today the term extemporaneous prescriptions is reserved for compound prescriptions that requires the pharmacist to mix or compound the medication in the pharmacy for the specific needs of the patient.[citation needed]
Predating modern legal definitions of a prescription, a prescription traditionally is composed of four parts: a superscription, inscription, subscription, and signature.[52]
The superscription section contains the date of the prescription and patient information (name, address, age, etc.). The symbol "℞" separates the superscription from the inscriptions sections. In this arrangement of the prescription, the "℞" is a symbol for recipe or literally the imperative "take!" This is an exhortation to the pharmacist by the medical practitioner, "I want the patient to have the following medication"[53] – in other words, "take the following components and compound this medication for the patient".
The inscription section defines what is the medication. The inscription section is further composed of one or more of:[54]
- a basis or chief ingredient intended to cure (curare)
- an adjuvant to assist its action and make it cure quickly (cito)
- a corrective to prevent or lessen any undesirable effect (tuto)
- a vehicle or excipient to make it suitable for administration and pleasant to the patient (jucunde)
The subscription section contains dispensing directions to the pharmacist. This may be compounding instructions or quantities.
The signature section contains directions to the patient[55] and is often abbreviated "Sig."[56] or "Signa."[57] It also obviously contains the signature of the prescribing medical practitioner though the word signature has two distinct meanings here and the abbreviations are sometimes used to avoid confusion.
Thus sample prescriptions in modern textbooks are often presented as:
Rx: medication Disp.: dispensing instructions Sig.: patient instructions
Use of technology
As a prescription is nothing more than information among a prescriber, pharmacist and patient,
Within computerized pharmacies, the information on paper prescriptions is recorded into a database. Afterwards, the paper prescription is archived for storage and legal reasons.
A pharmacy chain is often linked together through corporate headquarters with
Some online pharmacies also offer services to customers over the internet, allowing users to specify the store that they will pick up the medicine from.
Many pharmacies now offer services to ship prescription refills right to the patient's home. They also offer mail service where you can mail in a new, original prescription and a signed document, and they will ship the filled prescription back to you.
Pharmacy information systems are a potential source of valuable information for pharmaceutical companies as it contains information about the prescriber's prescribing habits. Prescription data mining of such data is a developing, specialized field.[59]
Many prescribers lack the digitized information systems that reduce prescribing errors.[60] To reduce these errors, some investigators have developed modified prescription forms that prompt the prescriber to provide all the desired elements of a good prescription. The modified forms also contain predefined choices such as common quantities, units and frequencies that the prescriber may circle rather than write out. Such forms are thought to reduce errors, especially omission and handwriting errors and are actively under evaluation.[61]
See also
- Eyeglass prescription
- Inverse benefit law
- Off-label use
- Medicines reconciliation
- Medical device (such as hearing aids, for example) may be specified by a type of prescription
- Prescription analytics
- Prescription charges (England)
- Prescription drugs
- Private prescription
- Referral
- Special prescription form
- List of abbreviations used in medical prescriptions
Footnotes
- ^ Second person singular imperative form of recipere meaning "receive" or "take".[2]
- ^ Compare with Pound sign#Origin. Transliteration as Rx is ubiquitous but erroneous, it is not an x.
- No objective evidence has been produced for these theories.
References
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a 16th-century symbol, the letter R with a line through its slanted leg-the line signaling that the "R" is functioning as an abbreviation.
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Further reading
- Bennett RR (1906). Medical and Pharmaceutical Latin for Students of Pharmacy and Medicine. J. & A. Churchill.