Medical prescription

Source: Wikipedia, the free encyclopedia.

The prescription symbol, ℞, as printed on the blister pack of a prescription drug

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 UnicodeU+211E PRESCRIPTION TAKE (℞)
Related
See alsoU+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

computer printer or even on plain paper, according to the circumstances. In some cases, a prescription may be transmitted orally by telephone from the physician to the pharmacist. The content of a prescription includes the name and address of the prescribing provider and any other legal requirements, such as a registration number (e.g., a DEA Number in the United States). Unique to each prescription is the name of the patient. In the United Kingdom and Ireland, the patient's name and address must also be recorded. Each prescription is dated, and some jurisdictions may place a time limit on the prescription.[7] In the past, prescriptions contained instructions for the pharmacist to use for compounding the pharmaceutical product, but most prescriptions now specify pharmaceutical products that were manufactured and require little or no preparation by the pharmacist.[citation needed] Prescriptions also contain directions for the patient to follow when taking the drug. These directions are printed on the label
of the pharmaceutical product.

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

what is prescribed
. Some jurisdictions, drug types or patient groups require additional information as explained below.

Drug equivalence and non-substitution

Many

more deserving cases.[9]

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

Legal capacity to write prescriptions

National or local (e.g. US state or Canadian provincial)

clinical psychologists
who are registered as medical psychologists and have also undergone specialized training in script-writing, to prescribe drugs to treat emotional and mental disorders.

In August 2013, legislative changes in the UK allowed

paramedics.[17]
[18]

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

medical practitioners, which sometimes causes errors in dispensing. In the US, illegible handwriting has been indirectly responsible for at least 7,000 deaths annually.[25][26][27][28]

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,

handwriting style.[31][32] The issue may also have a historical origin, as physicians from Europe-influenced schools have historically used Latin words and abbreviations to convey prescriptions; many of the abbreviations are still widely used in the modern day[citation needed
] and could be a source of confusion.

Some jurisdictions have legislatively required prescriptions to be legible—

electronic health records and electronic prescriptions may alleviate the need for handwritten prescriptions altogether.[38] In Britain's NHS, remaining paper prescriptions are almost invariably computer printed, and electronic (rather than paper) communication between surgery and pharmacy is increasingly the norm.[39]

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:

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

dressings, which do not require a prescription, may also be prescribed. Depending upon a jurisdiction's medical system, non-prescription drugs may be prescribed because drug benefit plans may reimburse the patient only if the over-the-counter medication is taken at the direction of a qualified medical practitioner. In the countries of the UK, National Health Service (NHS) prescriptions are either free or have a fixed price per item;[43]
a prescription may be issued so the patient does not have to purchase the item at commercial price.

Some medical software requires a prescription.[44]

Legislation may define certain equipment as "prescription devices".

braces to tooth surfaces), various prostheses, gut sutures, sickle cell tests, cervical cap and ultrasound monitor.[citation needed
]

In some jurisdictions,

hypodermic syringes are in a special class of their own, regulated as illicit drug use accessories[46] separate from regular medical legislation. Such legislation often allows syringes to be dispensed only with a prescription.[citation needed
]

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,

National Programme for IT (NPfIT) is currently[when?
] piloting such a scheme between prescribers and pharmacies.

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

computer networking
. A person who has a prescription filled at one branch can get a refill of that prescription at any other store in the chain, as well as have their information available for new prescriptions at any branch.

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

Footnotes

  1. ^ Second person singular imperative form of recipere meaning "receive" or "take".[2]
  2. ^ Compare with Pound sign#Origin. Transliteration as Rx is ubiquitous but erroneous, it is not an x.
  3. Jupiter, (), gods whose protection may have been sought in medical contexts.[5]
    No objective evidence has been produced for these theories.

References

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Further reading