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How to write prescriptions?

Discussion in 'Pharmacy' started by takotsubo, 08.28.07.

  1. takotsubo

    takotsubo

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    I'm an ER intern and I constantly have to write prescriptions and I'm always wondering if I'm doing it right. I especially hate writing prescriptions for kids and calculating the liquid amounts and how much to dispense. Is there a website that teaches doctors how to write prescriptions?

    I primarily use epocrates but i always find it confusing when calculating liquids and especially if it's like a "div every 6-8h" which is different than just plain "q6-8h"

    some have told me to write, "use as directed" or whatever but that seems kinda wrong and extra work for the pharmacy.
  2. bananaface

    bananaface Pharmacy Supernerd Staff Member Administrator SDN Senior Moderator Lifetime Donor

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    http://www.db.uth.tmc.edu/faculty/vlewis/medphar/04-Blue_Parts_of_RXd.pdf

    This may be helpful for learning to write a complete Rx. I'm not sure exactly what you are looking for, though. Are you having trouble with components, dosing calculations, figuring out what doses and dose forms are available, or what?

    I'm not a fan of "Use as directed" either. It's actually impermissable in some states.
  3. sdn1977

    sdn1977 Senior Member

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    This is what I recommend to interns for peds. On the rx, always note the pts weight (this way we can double check your calculations). Also, not what you are treating (ie...for cough, for infection, for rash, etc..) - helps to make sure we are reading what you are writing correctly & gives us some idea of what to reinforce when we counsel mom or dad.

    Now, for dosing, I recommend writing your dose in mg amounts - that way I can choose the most appropriate package size to fit your needs. Know, however, that some dosage forms are not interchangeable - if you order Augmentin liquid 250mg q6h for bronchitis - I can't give tablets - because the clavulanate component is different. But, by writing the mgs you want in each dose.....I can choose if I give 100mg/5ml, 200mg/5ml, 250mg/5ml - whatever...

    When your dosing recommends using divided doses q 6-8 hours....this means that it can be dosed 3-4 times a day (take the total mg/kg/day dose & divide it up 3-4 times per day). For most parents (in fact, for most people in general...) a 3 times per day drug has more compliance than a 4 times per day drug. This is especially true for school age children - they can get the first dose in the AM before school, right after school & then again at bedtime. A fourth dose means the school has to get involved (teachers, office, extra bottle - was it refrig - not?, will it get home???) - just too much trouble. So - choose the longer dosing interval unless you have some clinically compelling reason to do otherwise.

    That is different than q 6-8h prn pain or fever or spasm. That dosing means the pt can take it as frequently as every 6 hours if they need it, but it could go 8 hours (a night's sleep for example). The prn added reinforces that it should be stopped when sx stop. That helps us encourage mom or dad to let Johnny sleep - don't wake him if he's not coughing (you'd be surprised!!!).

    Dont use "as directed" unless you've also got some other instructions - ie Prednisone 5mg - Start with 5 tablets once daily & taper as directed over 4 days. Hopefully, you've written this out day by day for the parent & we can reinforce the taper without writing a whole novel on the label.

    Good luck - I hope this helps!
  4. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    Other good pearls off the top of my head:

    Print good. Cursive bad.
    Print your name above your signature.
    Don't forget your DEA number.
    Don't dispense a brand medication without finding out if its on the insurance forumulary or not. Generic meds are always a plus for everyone.

    Those alone with save you and your local retail pharmacist a great deal of time. We don't want to call you as much as you don't want us to call you.
  5. psurocks

    psurocks Junior Member

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    yea totally agree...whenever we are real busy, and i get a script which i cant decipher what doctor wrote it cuz the signature and the dea # are too messy to comprehend, it really slows things down....the best thing imo for scripts with a multi-doctor practice which has each docs name on the top part of script, if they would just circle their name up their too, itd help
  6. MountainPharmD

    MountainPharmD custodiunt illud simplex

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    1st tip...for the love of God please, please, please if you write for a controlled substance clearly print your name and DEA number and sign the RX. In fact never ever write any RX in cursive writing.

    Also if you want a hydrocodone product just write for Hydrocodone/APAP and the desired strengths. Norco, Vicodin, Anexsia, Lorcet, Lortab, and Zydone are specific brand name products tied to certain strengths. So stop writing for Norco 5/500, it doesn’t exist.

    Epocrates is great and so is Lexi-Comp. Use those to get the strengths and dosage forms if you are not familiar with them. Honestly, if you are writing scripts in an ER I would expect you to know and understand how to figure out how many ml's to give if you write for 1 tsp tid x 10 days.
  7. Mags

    Mags

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    Its illegal now in our state (writing in cursive on rx that is):D:thumbup::thumbup::thumbup::thumbup:

    But I swear some physicians print is worse than cursive, damned chicken scratch
  8. pharmdog22f

    pharmdog22f

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    To help with calculations just learn dimensional anaylsis and your q6-8H problems are over:thumbup:
  9. azPharmD2B

    azPharmD2B

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    IANAPharmacist (yet) but I do work as a CPhT for a mail order pharmacy and do data entry, so I see around 300 RXs a day. And I used to do hospital pharmacy.

    use as directed should only be for drugs that actually have very, very specific instructions included with every single package of the drug. Things like take with a full glass of H20, dont lie down, eat, sleep, or take antacides for two hours. That's a tad much to put on the Rx, but if its a 1 pack that comes with these directions, by all means, use as directed is the way to go. Don't give me an Rx for 100 Coumadin and say uad. At the very least tell me what the days supply is.

    If multiple prescribers are printed at the top of the RX, for the love of Pete circle your name. If you aren't on the pad, print your name and DEA number. Oh, and make sure your DEA info is up to date please.

    Know the various laws, especially concerning refills, for controls. I'm sorry, you want how many refills for that Schedule II?

    AFAIAC every Rx should indicate what its for, and that should be part of the sig and printed on the label. This is not only for the pharmacist's benefit, but studies have shown patients are more likely to stay on maintenance meds when they know why they are taking them.

    Don't assume. I'm sure you know the saying. Don't put a check mark when you mean 'check' just write it out. Don't draw a little stick figure lying down with a cross through it to indicate not to lie down. Reading scripts is hard enough, I shouldn't have to decipher hieroglyphs to do my job. If you aren't sure about something, call the pharmacy and ask for a pharmacist. A 30 sec phone call can save a whole mess of time down the road. We'd rather field a stupid a question from the prescriber ahead of time than have to go through 3 nurses to get a straight answer after the fact.

    0.125mg good
    .125mg bad

    100mg good
    100.0mg bad

    The decimal in a number should not look like the dot on an i, it should be painfully obvious you intended to put that decimal there.

    If a patient says they are allergic to X, ask them what actually happens to when they take X. Being allergic to something is far different than being sensitive to it. Darn near everyone is sensitive to opiate derivatives, very few are actually allergic.

    If you aren't sure how many drops/mls/tabs are in a package, don't guess. Just give us an accurate SIG and days supply and we'll pick what's best for the patient. Same thing for doses that change depending on the day of the week, just give us a clear SIG and how many days/weeks.

    If you need an Rx stat and want to call it in, no problem. Just don't send a damn respiratory tech to pick it up, lol. We'll have something written up that just requires a signature or you can scribble it on a pad and sign it, but it better be you or someone else authorized to write a script that actually shows up at the window.

    If the Rx should be DAW, make it painfully obvious.
  10. McZyprexalynn

    McZyprexalynn

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    I second what everyone else has said about DEA numbers and circling or printing your name. I also agree on utd, indications, and pediatric pt. weights.

    Please read over the script before you hand it to the patient and make sure you aren't missing any essential information. I don't know how many scripts I've gotten where it was obvious the doctor was talking and writing at the same time and forgot to finish writing.

    Don't call in a prescription for a patient who is leaving your office and driving staight over to the pharmacy. Chances are it won't even be off the voicemail when the patient shows up looking for it. Just give them the written RX or tell them to give the pharmacy at least a 1/2 hr to hr to fill the prescription (and let the pharmacy know that the patient is on the way).

    If you're calling in a prescription, spell the patient's name and leave their birthdate. Also make sure you leave your name with spelling and phone number.

    Don't make promises to the patient that aren't your responsibilty to fufill. Don't tell them a drug costs "under $20" unless you know that for a fact. Don't tell them the pharmacy will have it ready in 15 minutes unless you spoke to someone at the pharmacy.

    Generics = good. 90% of insurance companies don't cover or have extremely high copays for any PPI except Omeprazole and any non-sedating antihistamine besides Loratadine or Fexofenadine. A lot won't cover brand name antidepressants anymore either If you want to prescribe Aciphex, Nexium, Zyrtec, or Lexapro, be prepared to deal with a prior authorization.
  11. Dr JPH

    Dr JPH Removed

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    Most ERs now have automatic Rx programs.

    These programs will even do interaction checks with the patients home meds if you want them to.

    I didnt write one prescription during my ER month, all came from the computer. And I didnt get one call from a pharmacist either. :thumbup:

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