link to prescription notation symbols?

Discussion in 'General Residency Issues' started by 2007er, 03.07.07.

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  1. 2007er

    2007er Junior Member 2+ Year Member

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    SDN Members don't see this ad. About the ads.
    anyone got a link to how to write various symbols in prescriptions? I've just been writing things out by hand (i.e. 500 mg PO bid) but noticed some attendings use various notations/symbols. I was actually never taught this. Anyone got a link? I tried searching but couldn't find a good page.
     
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  3. Blue Dog

    Blue Dog Avec caféine. SDN Advisor 10+ Year Member

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  4. USAF MD '05

    USAF MD '05 Just another dumb ER doc. 7+ Year Member

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    I've never seen symbols per say, but you've already got the abbreviations correct. I'm sure you aren't writing Five hundred milligrams per os bis in die. That's really as abbreviated as you should get, otherwise the pharm will be on the phone asking for clarification. Steve
     
  5. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

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    And remember that JCAHO requires that you never abbreviate anything. That includes using letters and numbers which are really just abbreviations of your thoughts. The only JCAHO approved way to write a prescription or n order is to paint a highly detailed mural depicting what you have in mind. You should always draw the complete chemical structure of any med you want given. Always take to heart the JCAHO motto: "If no healthcare can be delivered, no mistakes can be made."
     
  6. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    One thing to know: if you write something "prn", you should put what the "prn" is - fever greater than 100.4, nausea, pain (with a caveat such as pain scale (if you're in the hospital) or 'breakthrough pain not treated by ibuprofen' or some such), vomiting, insomnia, and so on. Just "prn" does NOT help the patient, and can put you at risk, if the patient uses it for the wrong "prn" reason, and has an untoward reaction.
     
  7. sdn1977

    sdn1977 Senior Member 10+ Year Member

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    :laugh: :laugh: :laugh: :laugh: yet one more JCAHO sledgehammer to solve a problem!!!
     
  8. 2007er

    2007er Junior Member 2+ Year Member

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    one of symbols i remember seeing is a T w/ a dot on top. Is that a tablet? Sometimes I see what looks like two T's w/ dots on them. anyone know what i'm talking about?
     
  9. Entei

    Entei 7+ Year Member

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    It's a fancy way to say 1 and 2, respectively. Imagine dots over these T's:
    T=1
    TT=2
    TTT=3
    TTTT=obnoxious
     
  10. Samoa

    Samoa 10+ Year Member

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    It's not a T. It's a dash with a hash mark below and a dot above. The dash and the hash mark shouldn't intersect.

    Like this:
    .
    |
     
  11. 2007er

    2007er Junior Member 2+ Year Member

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    oh..thanks..man, seems like it takes more effort to write that than write a number. any other peculiar symbols on scripts?

    Also, is there a standard way to write prescriptions? Does the "Dispense" line go before the "sig" line? Do you really need three lines? I've been sloppy sometimes and just fit everything on 1 or 2 lines:

    doxycycline 100 mg
    1 tab PO bid
    Disp QS 30 days

    or if i'm trying to fit things on one script:

    doxycycline 100 mg PO bid
    Disp QS 30 days


    Do you need the "1 tab" instruction? what happens if it's a capsule? how do u know if it comes in a regular tablet vs capsule w/o looking up? does it matter/ what about liquids?
     
  12. Samoa

    Samoa 10+ Year Member

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    It's more like:
    Disp: doxycycline 100mg #20, NR
    Sig: 1 po bid x 10 days

    The concise format is usually:

    Instructions for pharmacist: medication, dosage, quantity, refills
    Instructions for patient (i.e. labeling): number, units (tabs/tsp/ml), route, frequency, duration
     
  13. sdn1977

    sdn1977 Senior Member 10+ Year Member

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    Either example you gave works.

    You don't know if the product comes in a tablet or capsule unless you look & I may not even have the one you want (ie doxycycline comes in both - I keep tablets because that is the current less expensive product - next year may be different).

    If you say i bid (one unit twice daily) - I get it. I'll dispense the product I have & the instructions will correspond to the product I give.

    If you want a particular product (brand name - Doryx for example) you must specify DNS or do not substitute - but by doing this you may condemn the pt to the full price, higher copay or a call from me. Make sure this is what you want to do & don't do it without good reason (you're pt will get upset & I'll have no reason to substiantiate your reasoning unless you've told them or me).

    In CA, I can change the product legally so if you order azithromycin 100mg/5ml & I only have 200mg/5ml - I can change the qty & sig to match the equivalent dose you are prescribing. No worries - I make SURE the instructions I give are clear & may indeed be different from those which you have given (ie 1/2 tsp rather than 1tsp & WHY).

    No worries - if you have questions or are uncertain - call the rx into the pharmacy & give it directly to the pharmcist. You'll have your immediate concerns addressed particularly if you mention them - ie is this drug covered (I'll run it thru the insurance while you're on the phone since pharmacies have immediate adjuctiation).
     
  14. Samoa

    Samoa 10+ Year Member

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    State laws differ dramatically as to how much latitude the pharmacist has to change the prescription without calling the prescriber. For example, when I practiced in Texas, it was legal to change the dosage form in some situations (i.e. tablet to suppository), but not the concentration (100mg/5ml to 200mg/5ml). People did it, and the Board usually looked the other way, but it wasn't legal, and if you made a mistake your license could be sanctioned both for the mistake and for unauthorized dispensing. So I'd be careful about giving advice based solely on how you practice.

    In general, if you can't remember whether to write for a tablet/capsule, ointment/cream, or solution/suspension, etc., you can leave that part out. Even states that don't allow overt changes will allow the pharmacist to select the appropriate product in that situation.
     
  15. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

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    I always thought they were done that way to make them hard to alter. ie. it's hard to add a 0 and up the dose, tt0? instead of 2 0.

    I did see one of our urologists write for grains of APAP yesterday.
     
  16. Hurricane

    Hurricane Senior Member 5+ Year Member

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    Dude, that is old school. Does he also measure force in foot-pounds?

    BTW, your comment above re the JCHAO anti-abbreviation campaign made my day :laugh:

    Regarding the T notation, is there one for a half tab? Somebody told me there was, but I think they're making it up...
     
  17. sdn1977

    sdn1977 Senior Member 10+ Year Member

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    The symbol for one-half tablet is:

    ss with a line over the top (I can't make my computer do it)


    But - depending on your handwriting, what the drug & dosing is (ie a prednisone taper)....I'd rather you write it out or write the mgs.

    Thanks!
     
  18. fab4fan

    fab4fan TiredRetiredRN Gold Donor 10+ Year Member

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    Make sure you write out the quantity to be dispensed, esp. for narcs. or other controlled substances. If you don't, one day a pharmacy will call you and ask you if you really meant to dispense 200 tabs of Vicodin.
     
  19. Hurricane

    Hurricane Senior Member 5+ Year Member

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    My favorite such story is the post in the old "things I learn from my patients" thread about the guy who stole a prescription pad and then tried to fill a scrip for "one pound of mofine" :laugh:
     
  20. Venus21pam

    Venus21pam Freakin' peachy 5+ Year Member

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    Good discussion here.
    I work as a pharmacy tech and gotta tell you that I learned a lot in terms of prescription writing, sig codes, insurance issues etc.
    And I also have a mental note-to-self: make sure my scripts are legible in the future because when I get a script that's written illegibly it takes a lot of time and effort to figure out what's on it. Sometimes i have to ask 3 people in the pharmacy what they see and everyone has a different opinion.
    For example just yesterday I had a script with a sig code like this:
    1t po with .... meal
    Now there was a word in place of the dots that we couldn't read - it said either "every" or "evening" meal. Unfortunately it was one of those medicines that you can take from 1 to few times a day so go figure.

    So my plea to all the residents - and I'm sure all pharmacists will back me up - please write your scripts legibly.
     
  21. scotto

    scotto

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    I was wondering if someone could me read this.... from the q after...

    [​IMG]
    [​IMG]
     
  22. pmpkn219

    pmpkn219 2+ Year Member

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    Q 6* (degree symbol/hours)

    I always write scrips legibly... mostly b/c I don't want a call-back (right now to my resident, next year to me) for no reason other than "can you clarify what this says?!"
     
  23. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

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    Looks like 1 gram po q 6 hr to me.
     
  24. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

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    We have 100% electronic ordering. I haven't written a paper script in a year, and maybe 15-20 total in past 4 years. :)
     

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