The Pharmaceutical Agent Order

Transcription

1 The Pharmaceutical Agent Order Course Practicum in Health Science - Pharmacology Unit II Communication Essential Question What are the essential components to a prescription written by a physician? TEKS (c) 1A, 1B, 2A Prior Student Learning Students should have some personal experience with what a medicine bottle looks like and the information written on it. Estimated time 1-2 hours Rationale To avoid serious effects on a patient, both prescriber and pharmacist must render the highest of professional services. Accurate diagnosis, proper selection of medication, proper dose, correct dispensing, and correct packaging all must be provided. Objectives Upon completion of this lesson, the student will be able to: Identify the critical components of a prescription, physician s order, and prescription label Interpret samples of prescriptions, physician s orders, and prescription labels Engage Bring in a few training samples of prescriptions written by a local pharmacist showing what an actual physician s order looks like. Have the students try to read and interpret the orders. Key Points I. Prescription is an oral or written record of a physician s order to the pharmacist to dispense medication to the patient. A. Script written form 1. Superscription is the heading of a prescription; it contains a. the symbol Rx (an abbreviation for "recipe") the Latin for "take thou" b. prescriber s name and title (MD, DDS, DMD, DO, etc.) c. prescriber s office address d. prescriber s phone number e. patient s name and address f. patient s age g. date on which prescription was written 2. Inscription is the actual body of the prescription indicating the drug name, strength and dosage form 3. Subscription contains the directions to the pharmacist, usually consisting of a short sentence such as: "make a solution," "mix and place into 20 capsules," or "dispense 20 tablets" 4. Signature -- not to be confused with the prescriber s signed name -- contains clearly written and understandable instructions a. may be written in Latin, using commonly accepted medical terminology and abbreviations b. directions need to be translated into plain English for the patient when transcribing instructions to prescription label c. Sig. should contain amount of medication to be taken, the

2 frequency, and the route of administration d. may also include reason for taking the medication 5. Refill instructions 6. Prescriber s signature 7. Prescriber s DEA number a. Drug Enforcement Agency (DEA) is the federal agency within the Department of Justice overseeing controlled substance traffic b. required for all prescriptions containing controlled substances c. special duplicate scripts are required for schedule II drugs B. Physician s Order (Written Form) Form to order medication for the hospitalized patient. 1. Category and dosage forms of drugs may be different than in retail pharmacy e.g., IV administration, cytotoxic drugs, etc. 2. Major elements of the physician s order a. patient s name and hospital number b. patient s room or ward location c. attending physician d. patient s date of birth e. allergies or sensitivities to drugs, foods, and other substances f. diagnosis g. date of admission h. patient s condition i. services to be performed (i.e. tests, activities, diet, etc.) j. medications ordered k. strength of each medication ordered l. dosage form specified to avoid any questions regarding the form to be administered most drugs come prepared in more than one dosage form; patient s condition often determines route of administration m. directions for use or frequency of administration for each drug nurse s or physician s signature with date and time of entry on the physician s order C. Oral Prescriptions 1. Phoned in usually done by a prescriber known to pharmacists; not applicable to schedule II drugs 2. Components of oral prescription a. doctor s name b. doctor s phone number c. patient s name d. patient s address e. patient s phone number f. DEA number g. name of drug h. quantity of drug i. directions

3 j. refill instructions D. E-Prescribing is a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care, and is an important element in improving the quality of patient care. II. Prescription Label is an identification label placed on the outside of the bottle A. A prescription serial number (referred to as the RX number) and the date the prescription was filled B. Patient s full name C. Clearly typed (or printed) instructions for taking the medication 1. The first word of the directions should infer the route of administration, e.g., a. take for internal/oral route b. instill or place for eye/ear/nose c. apply for topical medication d. insert for rectal/vaginal application D. Name of the drug (labeling), unless specifically requested by prescriber not to label E. Pharmacist s initials and initials of the tech preparing the drug for dispensing F. Prescriber s name G. Drug s expiration date (usually can be obtained from stock bottle, except in case of freshly reconstituted medication according to manufacturer s recommendation H. Number of refills left available, if any, or no refills, if none I. Additional labels, strip labels, accessory labels, informing patient of particular way to take medication assuring optimal effect, e.g. TAKE ON EMPTY STOMACH, DO NOT TAKE WITH MILK, KEEP REFRIGERATED, SHAKE WELL BEFORE USE, etc. Activity I. Interpret the sample prescription labels for accuracy. II. Transcribe sample prescriptions into prescription labels. III. Complete the Pharmacology Abbreviations Worksheet. Assessment Correct completion of prescription labels Accurate transcription of prescription and physician s orders The Drug Order Materials Prescription Checklist Pharmacology Abbreviations Worksheet Key Blank labels to be used as prescription labels

4 Samples of physician s hospital orders Samples of prescriptions Reference materials, e.g. PDR, etc. The Drug Order Key Show and tell samples Accommodations for Learning Differences For reinforcement, the student will develop flashcards for key terms. For enrichment, the student will research prescriptive errors (causes, consequences, and steps of preventions) and present results to class. National and State Education Standards National Health Science Cluster Standards HLC02.01 Communications Health care workers will know the various methods of giving and obtaining information. They will communicate effectively, both orally and in writing. HLC Health Care Workers will apply technical skills required for all career specialties. They will demonstrate skills and knowledge as appropriate. TEKS (c)(1)(A) interpret data from various sources in formulating conclusions; (c)(1)(b) compile information from a variety of sources to create a technical report; (c)(2)(a) accurately describe and report information, according to facility policy, observations, and procedures; Texas College and Career Readiness Standards English/Language Arts I. A. Compose a variety of texts that demonstrate clear focus, the logical development of ideas in well-organized paragraphs and the use of appropriate language that advances the author s purpose. B.1 Listen critically and respond appropriately to presentations B.2 Listen actively and effectively in a one-on-one communication

5 NAME: DATE: THE DRUG ORDER 1. Prescriptions come in two forms: and. 2. The format that has been translated from the original prescription into a language clearly understandable by the patient is the. 3. In complete, well-structured sentences compare and contrast prescription, prescription label, and physician s order. 4. Define Drug Formulary. 5. What do the letters R x stand for?

6 Answer Key to Unit Quiz: THE DRUG ORDER 1. prescription; physician s order 2. prescription label 3. prescription -- Written record of a physician s order to the pharmacist to dispense medication to the patient; usually used for ambulatory, non-hospitalized patients. prescription label -- Identifies the patient and instructs the patient on how to take medication ordered by physician; should be clearly typed or printed in language easily understood by the patient. physician s order -- Form to order medication for the hospitalized patient; not all items pertaining to the prescription apply to the physician s order. 4. listing of drugs available in the hospital; reviewed by the Pharmacy Therapeutics Committee (PT Committee); recommended for inventory based on therapeutic and economic benefits 5. Latin for recipe; take thou

7 Prescription Checklist 1. Legitimate prescription blank with prescriber s information clearly written or printed on the blank? 2. Patient s full name written on script? Initials are not acceptable present potential for errors. 3. Date the prescription was written important because controlled substances should not be filled or refilled (if refills permitted) more than six months after script was issued to patient. 4. Patient s address a legal requirement for prescriptions containing controlled substances: A good practice to complete on ALL scripts Helpful in preventing potential errors especially where common family names occur frequently, or specific names are customary for a particular region 5. Is inscription complete? If unclear regarding the medication, e.g. old drugs with new modifications or uses, or new drugs, if existence of drug cannot be established. 6. Does the quantity seem adequate? Learn the customary length of treatment for the most common ailments. 7. Directions written clearly enough to avoid misinterpretation by the patient? 8. Refill instructions? If no refill instructions indicated must be interpreted as NO REFILLS ordered. legally clearly defined requirements and timeframes for refills refills should be entered on the back of the script, noting date, dispenser s initials, and quantity dispensed even if computerized system is used to record keeping 9. Prescriber s signature? DEA number? signature, DEA number and office information legally required on all prescriptions for controlled substances if prescription written at the practitioner s office, it should be signed telephone orders do not require signature for non-controlled substances; also holds true for limited (!) number of controlled substances 10. Check with the patient for any known drug allergies! Physician can be expected not to prescribe any medications that might trigger allergic reactions, but patients may have forgotten to report previous allergic reactions to physician patients may see more than one physician for same or different condition and physician not aware of same

8 Interpret Prescription Labels Mr. Peanut Ima Sick O. N. Abed M&M plain (50) Take one by mouth as needed for energy 3 12/24/00 RMS SM Molly Malone Tussinex Liqu. (120 ml) Take 1 tablet by mouth three times daily for cough 0 01/01/01 CPR HR Sam Goody Tyelnol # 3 (12) Take one teaspoon every 8 hours as needed for pain 0 11/11/01 VIT BP W.J. Clinton Darvocet N 100 (30) Take one or two twice daily 2 02/31/01 ABC DKY Donald Duck Synthroid 100 mcg (100) Take one tablet by mouth every day 0 04/01/02 HMP Mary Hadalittlelamb Tagamet 300mg/15 ml (480) 800 mg at bedtime 11/11/00 RPH CT Mycelex Cream (1) Apply to affected areas twice daily as directed 2 CK OYE Osay Canusee Cardizem 30 mg Tablets (120) One qid before and after meals 1 12/31/99 GW AL M. I Kneehurts Liver and Onion (7) Take one per day at lunch for anemia 0 NYC Inderal 40 mg (50) Take 80 mg daily 0 GWB AG Aida Soprano Zantac 150 mg Tabs (100) One tablet twice daily 3 NO YES I. Dontfeelgood Sleep 8 hours (365) Take one at bedtime for fatigue 0 REP ONE 1. Interpret the above prescription labels for accuracy. Are there any mistakes? Any omissions? Make corrections as indicated. 2. Recreate what the original prescription may have said, using proper terms and abbreviations used in the medical language.

9 TRAINING CLINIC 123 MAPLE DRIVE SUITE 425 MED, TEXAS EXT. 45 Dr. R. U. Sick, Dr. A. Puddentane, Dr. I. Feelbetter Patient Name: Address: Age: TRAINING TOOL! [ ] Contents are labeled unless checked Signed M.D. Refills: , 2 DEA No. TRAINING CLINIC 123 MAPLE DRIVE SUITE 425 MED, TEXAS EXT. 45 Dr. R. U. Sick, Dr. A. Puddentane, Dr. I. Feelbetter Patient Name: Address: Age: TRAINING TOOL! [ ] Contents are labeled unless checked Signed M.D. Refills: , 2 DEA No.

10 PHYSICIAN S ORDER SHEET TRAINING CENTER MED, TEXAS PATIENT IMPRINT A GENERIC EQUIVALENT MAY BE DISPENSED UNLESS THE BOX AT THE RIGHT IS CHECKED DATE TIME C H A R T C O P Y DATE TIME C H A R T C O P Y DATE TIME C H A R T C O P Y

11 Prescription Labels 1. Create appropriate prescription labels for the sample prescriptions. Remember that most patients are not familiar with medical jargon and need to be able to clearly understand what the label says. 2. Based on the type of medication, what auxiliary or warning label would you attach to the medication bottle, if any?

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18 Abbreviation a.c., ac ACE ad lib APAP ARB b.i.d., bid c Caps Cc FDA gm, g gtt h h.s., hs H 2 blocker HRT IM INH IV MAOI mg mil, ml NPO NSAID p p.c., pc PCA PDR PO, p.o., po p.r.n., prn Pt q q.h., qh q2h q.i.d., qid q.s., qs qam qpm Rx s SERM Sig. SL s.o.s. SSRI SQ tab TCA t.i.d., tid Pharmacology Abbreviations Meaning

19 Abbreviation a.c., ac ACE ad lib APAP ARB b.i.d., bid c Caps Cc FDA gm, g gtt h h.s., hs H 2 blocker HRT IM INH IV MAOI mg mil, ml NPO NSAID p p.c., pc PCA PDR PO, p.o., po p.r.n., prn Pt q q.h., qh q2h q.i.d., qid q.s., qs qam qpm Rx s SERM Sig. SL s.o.s. SSRI SQ tab TCA t.i.d., tid Pharmacology Abbreviations Key Meaning Before meals Angiotensive-converting enzyme Freely, as desired Acetaminophen (Tylenol) Angiotensin II receptor blocker Two times a day with Capsules Cubic centimeter US Food and drug Administration Gram Drops Hour At bedtime Histamine H 2 receptor antagonist Hormone replacement therapy Intramuscular Isoniazid antituberculosis agent Intravenous Monoamine oxidase inhibitor Milligram Milliliter Nothing by mouth Nonsteroidal anti-inflammatory drug After (post) After meals Patient-controlled analgesia Physician s Desk Reference By mouth As needed; as necessary Patient Every Every hour Every 2 hours Four times a day Sufficient quantity Every morning Every evening Prescription Without Selective estrogen receptor modulator Directions how to take the medication Sublingual If it is necessary Selective serotonin reuptake inhibitor Subcutaneous Tablet Tricyclic antidepressant Three times daily