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.
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!
