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Table of Contents    
CORRESPONDENCE
Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 1106-1108

Prescription writing: Time to revisit!


Assistant Professor, Department of Pharmacology, Maulana Azad Medical College, New Delhi, India

Date of Web Publication12-Sep-2016

Correspondence Address:
Bhupinder S Kalra
Assistant Professor, Department of Pharmacology, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.190248

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How to cite this article:
Kalra BS. Prescription writing: Time to revisit!. Neurol India 2016;64:1106-8

How to cite this URL:
Kalra BS. Prescription writing: Time to revisit!. Neurol India [serial online] 2016 [cited 2019 Sep 22];64:1106-8. Available from: http://www.neurologyindia.com/text.asp?2016/64/5/1106/190248




Sir,

The skills achieved by medical students with regard to patient examination and therapeutics are learned from immediate seniors or faculty members. The art of writing a prescription is usually imbibed by medical students during their tenure in Pharmacology (MBBS/BDS). It has been observed that undergraduates attain the skill of writing prescriptions in the second professional year (may be, out of fear of the examinations); however, the moment they move to clinics, de-learning ensues. Is it because of work pressure, patient overload, casual attitude, aping their seniors, lack of awareness, or, no fear of evaluation; the reason for this callousness needs to be deciphered.

A prescription is a written, or electronic order, from a practitioner or designated agent to a pharmacist for a particular medication for a specific patient. Prescription is a medicolegal document, hence utmost care is needed while writing a prescription. All components of a prescription should be complete. There is no global standard for the prescriptions and every country has its own regulations.[1]

The most important requirement is that a prescription should be legible and should indicate precisely what should be given. Although, till date, no standard format for prescription has been agreed upon or thought of, recently, the Medical Council of India has proposed a format for the prescription [Figure 1].[2] Medication errors due to an error in the act of writing (prescription errors) have resulted in morbidity and mortality.[3]
Figure 1: The prescription format proposed by the Medical Council of India for registered prescribers

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Elements of a prescription

Superscription (Prescriber's details)

Inscription (Name of drug, amount, duration and frequency)

Subscription (Direction to the Pharmacist; [Figure 2])
Figure 2: Description of the parts of prescription. Adopted from Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 12th ed. McGraw Hill Publication

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Signa (Instruction to patient)

Signature of prescriber.

Common prescribing errors

Wrong/Inappropriate drug (e.g., drugs that sound similar)

Wrong/Inappropriate dose

Inappropriate units

Poor/Illegible prescriptions

Failure to take account of drug interactions

Two drugs from the same class

Omissions

Wrong/Multiple routes (IV/SC/PO)

Calculation errors (important in pediatrics)

Infusions with not enough details of diluent, rate, etc.

Significance of date in the prescription

Important part of the medical record

It can assist the pharmacist in recognizing potential problems

Compliance behavior can be estimated using date of filling and refilling

Duration of therapy.

All the orders for controlled substances be dated and signed on the day issued.

Steps or instructions for a good prescription

Write legibly (use block letters)

Sign and date the prescription (it is a legal document!)

Never abbreviate drug names

Never use proprietary names; always use generic names

Use plain English for dosing directions

Be careful with lookalike/sound alike names e.g., Clotrimazole/Co-trimoxazole, Carbamazapine/carbimazole

Do not guess (check the name or the dose of the drug)

Avoid 10-fold dosing errors; write 1 mg instead of 1.0 mg

Do not allow patient to prescribe for you.

What can be done to inculcate the practice of writing a sound prescription

  1. Revisit prescription writing class at start of the internship
  2. Prescription audit to be taken up at regular intervals
  3. Make it a part of medical education workshops
  4. Awareness and sensitization workshops to be conducted by the Department of Pharmacology
  5. Clinical discussions to be followed by prescription writing exercise
  6. Education and training of prescribers and the use of online aids
  7. Introduction of automated systems or uniform prescribing charts, in order to avoid transcription and omission errors that might result in prescribing faults.


In the government setup, due to patient overload, lack of manpower, and financial issues, the use of a prescription writing software is a far-fetched idea. However, it is the will to change one's attitude that is required at this point of time. Simply writing in block letters [4] (the name of the drugs), the use of symbols (for dose frequency), the use of generic names as far as possible (brand names for combinations only), and the appropriate instructions to the patients in the prescription will suffice for a beginning.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Guide to Good Prescribing-A Practical Manual. Available from: http://apps.who.int/medicinedocs/en/d/Jwhozip23e/5.4.html#Jwhozip23e. 5.4 [Last accessed on 2015 Jun 05].  Back to cited text no. 1
    
2.
Model Prescription format for purpose of making prescription by registered medical practioners. Available at http://www.delhimedicalcouncil.org/pdf/modalprescription.pdf. [Last accessed on 2015 Jun 05].  Back to cited text no. 2
    
3.
Velo GP, Minuz P. Medication errors: Prescribing faults and prescription errors. Br J Clin Pharmacol 2009;67:624-8.  Back to cited text no. 3
[PUBMED]    
4.
MCI circular regarding code of medical ethics. Available from http://www.mciindia.org/tools/announcement/Circular_Ethics_21.01.2013.pdf. [Last accessed on 2015 Jun 05].  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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