Clinical

1. Clinical Prescriptions

2. What is a Prescription? • Prescription: An order that is created by a practitioner for a particular drug to be dispensed to a particular patient. Can be verbal or written

3. Practice of Prescribing • Physician writes prescription on a special pad, and makes a note of order in the patient’s chart • Some physicians prefer to fax prescriptions to the pharmacy so the medication can be ready and waiting for the patient. • Long-term prescriptions should be added to the patient’s medication profile (short-term medications can be listed if desired)

4. Security of Prescriptions • Prescription pads must be kept secure to avoid theft and forgery • Pads should be labeled with physician’s name, address and telephone number • Pads may be sequentially numbered to detect loss • Pads should be locked up and only 1 in use at a time (keep in desk drawers, or physician’s pocket) • Physicians should never pre-sign blank prescription forms • Prescription pads should never be used as notepaper • To prevent changes: • Use tinted pads so erasures will show up • Physician should draw diagonal line through any empty space

5. Security of Prescriptions • If faxes are used: • Fax machines in the physician’s office as well as the pharmacy should be kept in a secure area • Cover sheet should be prepared to include all physician information (including any identifiers), date and time of transmission, pharmacy address and phone number, etc

6. Parts of a Prescription • 1. Heading • Physician’s information (usually preprinted) and patient information (name, address, date, etc) • 2. Superscription • Represents the order for the pharmacist to provide the requested medication • Represented by Rx – an abbrevation which means “Take Thou” • 3. Inscription • Name of the drug, form, strength Dr. E. Miller M.D C.F.P.C. 123 Anywhere St. St. John,NB (567)426-8456 Date ___________ 20__ Name: _______________________________ Address: _____________________________ Micronase 2.5 mg tab 30 sig. 1 tab q.d. a.c. x3 E. Miller_________ Emily Miller, MD 1. 2. 3. 4. 5. 6. 7.

7. Parts of a Prescription • 4. Subscription (Mitte) • Directions for the pharmacist (size of dose, amount to dispense) • 5. Signa (Signatura) • Directions for the patient to be printed on the label (when and how many to take) • 6. Refill • Number of times a refill is allowed on a script • 7. Signature • Signature and identifier of the ordering physician Dr. E. Miller MD C.F.P.C. 123 Anywhere St. St. John, NB (567)426-8456 Date ___________ 20__ Name: _______________________________ Address: _____________________________ Micronase 2.5 mg tab 30 sig. 1 tab q.d. a.c. x3 E. Miller_________ Emily Miller, MD 1. 2. 3. 4. 5. 6. 7.

8. Prescription Abbreviations • stat • p.o. • caps • agit • SL • ad lib. • OD • OS • AS • AD • Rx • a.c. • p.c. • gtt • b.i.d. • t.i.d. • q.i.d • q.d • q.4h. • q.h. • p.r.n. • h.s

9. Drug Measurements • Three systems used: • Canada generally uses the metric system • Other areas use imperial system or apothecaries’ measure • SI Units • International metric system • Drugs measured in milligrams (mg), millilitres (mL), or cubic centimetres (cc) (mL and cc are the same) • May also be measured in micrograms (μg or mcg) • Be aware of decimals when transcribing prescription orders

10. Drug Measurements con’t • Household (Imperial) Measurement • Teaspoon, tablespoon, cup, drop • Often only used when relaying information to patient. Actual prescription written in SI • Apothecaries’ Measure • Minims, fluid drams, fluid ounces for volume • Grains, scruples, drams, pounds, ounces for weight • 1 gr = 60 mg • When encountered, transcribe as given and let pharmacist perform the conversion • International Units • Used for some vitamins and drugs • 1 mL = 1000 IŪ

11. Drug Benefit Program • Ontario Drug Benefit Program • Covers people 65 or older, residents of long-term care facilities and people receiving home care, and Trillium Drug Program recipients • Recipients may have to pay a deductible and/or co-pay • Trillium Drug Program • Helps people who have high drug costs in relation to their income • Covers only specific drugs

12. Limited Use • Some drugs are only covered by the Ontario Drug Benefit program in certain circumstances • Ex: only for certain ailments, only if other drugs have been tried first, etc • In these circumstances, the physician must fill in a Limited Use number on the prescription • If the limited use number is not present, or the patient does not meet the requirements for the drug to be covered, the pharmacist will not fill the prescription

13. Repeats and Renewals • Repeat: • Continuation of long-term medications • Long-term medications are usually given a limited amount of time the prescription is good for before a new prescription is necessary • Renewal: • Extension of a short-term prescription that has run out

14. Repeats and Renewals • Policies for handling renewals vary with the physician • Some will renew over the phone in certain situations, others require a patient to come in for a renewal • If the physician allows telephone renewals, make sure to take all information about the patient and the medication desired and write it down for the physician to review

15. Phoned or Faxed-In Requests • Information required: • Client’s first and last name • Address and phone number • Name of medication • Prescription number • Dose and frequency • Date issued • Preferred pharmacy (unless the pharmacy is the party calling) • Pharmacy’s location and telephone number

16. Deterioration of Drugs • Exposure to: • Light • Moisture • Temperature • Air • Deteriorated and expired drugs should be disposed of properly What is the proper disposal technique?

17. Safe Drug Handling • Keep all medication in their original containers • Check manufacturer’s storage recommendations • Keep drugs in dark containers or dark rooms • Some drugs need to be refrigerated • Do not open bottles unnecessarily • Do not return unused drugs to the original container • Keep external use medications away from internal use medications • Store medications away from cleaning supplies • Organize drugs on the shelf • Discard all unused, expired medication • Never leave drugs out in the exam rooms

18. Avoiding Drug Errors • To check for accuracy, read back any prescription information delivered orally in person or on the phone • Be alert for drugs with similar names when transcribing or entering notes • Ask for interpretation if poor handwriting makes it difficult to read a written prescription

19. Controlled Drugs • Governed by the Controlled Drugs and Substances Act (CDSA) • Establishes 5 schedules of controlled substances and the regulations to control their use • Drugs are scheduled according to: • Potential for abuse • Medical usefulness • Degree of possible physical or psychological dependence

20. Handling Controlled Drugs • Keep a special record of controlled substances dispensed, administered, or prescribed (keep records for two years) • Store all drugs in a safe or locked, immoveable cabinet • Be alert to break-ins • If any loss occurs, report to authorities immediately

21. Preventing Drug Abuse • Physicians may prescribe only small amounts of drugs with high potential for abuse • Be aware of warning signs: • Patient asking for larger quantities or for a drug to be renewed early • Walk-ins looking for narcotics • Patient immediately requesting a specific controlled drug