Prescr

iption Analy

sis

CUSTODIO, M

IGUEL CARLO

S

DAVID, KARISS

A MARIE

DE CASTR

O, DIANNE M

ARIE

DE CEL

IS, SHARMAIN

E

DE LEO

N, SHEEN

ANNE

DELOS REY

ES, K

AMILL

DIZON, QUEN

NIEJOY

FAUNE,

HYACINTH

FELIP

E, PA

TRICIA M

AE

What is a Prescription?Stems from the Latin term “praescriptus” meaning “to write before”Ancient prescriptions were noted for their multiple ingredients and

complexity of preparationNeed for complete understanding and accuracy – universal and standard

language be usedPresent day prescriptions are written in English, doses given in the metric

systemA prescription is a written order for compounding, dispensing and

administering drugs to a specific client or patientOnce signed by the physician, it becomes a legal document.It is an official written document from a physician to signify that an order of

a specific drug and its proper dosage is authorized by a legal physician.Most prescriptions are given to the pharmacy by patient to receive the

prescribed drug or medication.

WHAT IS A Prescription?Instructions on the prescription should include a reminder of the

intended purpose of the drugLearn the units of the quantities and apothecary symbols which can

easily be misread or misunderstood

PARTS OF A PRESCRIPTIONThese are the essential parts of a drug order or prescription

written by physicians.

-full name of the client-date and time the order is written-name of the drug to be administered-dosage of the drug-frequency of administration-route of administration-signature of the person wrting the order

Parts of a prescription

Types of drug orders1. STAT ORDER - indicates that the medication to be given immediately and only once

(e.g., Demerol 100 mg IM stat) 2. SINGLE ORDER or One-Time Order - is for medication to be given once at a specified

time (e.g., Seconal 100 mg hs before surgery) 3. STANDING ORDER - may or may have a termination date. may be carried out

indefinitely (multivitamins) until an order is written to cancel it, or it may be carried out for a specified number of days (Demerol 100 mg IM q4h x 5 days). In some agencies, standing orders are automatically canceled after a specified number of days and must be reordered.

 4. PRN ORDER - permits the nurse to give a medication when, in the nurse's judgement,

the client requires it. (Amphojel 15 mL prn). The nurse must use good judgement about when the medication is needed and when can it be safely administered.

ERRORS IN PRESCRIPTION1. Inadequate knowledge of the patient

Wrong diagnosis2. Inadequate knowledge of the drug3. Calculation error

Dose error4. Illegible handwriting5. Drug name confusion6. Poor history taking

ERRORS IN PRESCRIPTION7. Abbreviations

Abbreviation Intended Meaning Misinterpretationµg microgram Mistaken as “mg”

BT Bedtime Mistaken as “BID”(twicedaily)

cc Cubic centimeters Mistaken as “u” unitsIU International unit Mistaken as IV OR 10o.d. or OD Once daily Mistaken as“right

eye”(OD-oculusdexter)

q.d. or QD Everyday Mistaken as q.i.d., qhs Nightly at bedtime Mistaken as “qhr” or

every hourqn Nightly or at bedtime Mistaken as “qh”

(every hour)q.o.d. or QOD Every other day Mistaken as “q.d.”

(daily) or “q.i.d.” (four times daily)

Drug AbbreviationsAbbreviation Intended Meaning MisinterpretationAPAP acetaminophen Not recognized as

acetaminophen ARAA vidarabine Mistaken as cytarabine(ARAC) AZT zidovudine Mistaken as azathioprine or

aztreonam CPZ Compazine(prochlorperazine) Mistaken as chlorpromazine DPT Demerol-Phenergan-Thorazine Mistaken as diphtheria-

pertussis-tetanus (vaccine) HCl Hydrochloricacidor

Hydrochloride Mistaken as potassium chloride

HCT Hydrocortisone Mistaken as hydrochlorothiazide

HCTZ Hydrochlorothiazide Mistaken as hydrocortisoneMgSO4 Magnesium sulfate Mistaken as morphinesulfateMS, MSO4 Morphines ulfate Mistaken as magnesium

sulfate MTX Methotrexate Mistaken as mitoxantrone PCA Procainamide Mistaken as patient controlled

analgesia PTU Propylthiouracil Mistaken as mercaptopurine TAC triamcinolone Mistaken as tetracaine,

Adrenalin, cocaineZnSO4 Zinc sulfate Mistaken as morphine sulfate

Symbols

Abbreviation Intended Meaning Misinterpretation

/ (slashmark) Separates two doses orIndicates “per”

Mistaken as the number “1”

@ At Mistaken as “2”

& And Mistaken as “2”

+ Plus or and Mistaken as “4”

WHAT DO PHARMACISTS LOOK FOR?1. Legal, legible and complete2. No duplication of pharmacologically similar drugs3. No identified significant ADRs (including allergies)4. No significant drug / disease interactions5. No significant drug / drug interactions6. The dosage, dosage interval and duration of treatment are

reasonable7. The dosage form and route of administration are appropriate.8. No formulation / pharmaceutics problems; incompatibilities,

stability, rate of infusion

Safe practice recommendations 1. Lower case letters or mixed case letters2. Block printing on lightly lined forms3. Symbolic differentiation4. Space between the drug name and dose5. Drug and dose make sense

PGH Documentation of Prescription Errors if incurred by a nurse• Nurse writes an IR then submits it to the charge-nurse• Charge-nurse forwards IR to Head Nurse of ward• Head Nurse forwards the IR to the Chief Nurse of the ward• The Chief Nurse notes the IR then forwards it to the Department of

Nursing Services in PGH

Source: Verbal interview with Kristine Basinang, RN, Nurse-II, RCB2 4 th Floor

References• http://www.mapharm.com/prescr_parts.htm• http://www.mapharm.com/prescription_writing.htm• http://www.yorksandhumberdeanery.nhs.uk/medicine/cmt/

documents/SaferPrescribingv4Oct2009.pdf• http://www.slu.edu/Documents/nursing/LavinPrescribingErrors.pdf