Writing a Letter to a Doctor Asking for a Medication Review

I worried so much about prescription writing in my tertiary year of medical school. I probably killed a whole tree tearing up prescriptions that were wrong.

Why did I worry so much about it? Prescription writing was not covered very well at my medical schoolhouse. And with the corporeality of material that needs to be covered in those 4 years, I wouldn't exist surprised if prescription writing isn't covered very well at any medical school.

How to Write a Prescription in 4 Parts

1. Patient's proper name and another identifier, usually appointment of birth.
2. Medication and forcefulness, amount to be taken, route by which it is to exist taken, and frequency.
3. Amount to exist given at the chemist's shop and number of refills.
4. Signature and medico identifiers like NPI or DEA numbers.

That is the basic outline of how to write a prescription. We'll be going into the details of each pace below. But commencement, let's expect at why information technology's so of import to get this skill right.

The Toll of Poor Prescription Writing

Poorly written prescriptions may be ane of the main reasons there are so many medication errors today. Look at some of these normally quoted statistics:

• Medication errors occur in approximately 1 in every 5 doses given in hospitals.
• Ane mistake occurs per patient per day.
• Approximately 1.3 million injuries and 7,000 deaths occur each year in the U.South. from medication-related errors.
• Drug-related morbidity and mortality are estimated to price $177 billion in the U.Southward.

While these are merely estimates from various studies and statistical models, the numbers are staggering. If in that location are 800,000 physicians in the U.s.a., each physician accounts for $221,250! Do you lot withal wonder why malpractice insurance is so expensive?

Approximately 1.three million injuries and vii,000 deaths occur each year in the U.Due south. from medication-related errors. Click To Tweet

Hopefully, if you are reading this, you're interested in not making mistakes. Fifty-fifty though I don't recall I acquired any major harm to whatsoever of my patients with prescription errors, I wish I had read something like this when I beginning started writing prescriptions in my third year of medical school.

How to Write Prescriptions

A prescription is an order that is written by you lot, the physician (or futurity dr.), to tell the pharmacist what medication you lot desire your patient to take. In this post, I'm going to break down all the different parts of a prescription, how to write each section, and what to wait out for. Sentry the video above if that'due south a more appealing format to yous!

Breaking Downward the Prescription Format

Equally I hinted above, here is the basic format of a prescription: Commencement, we accept the patient's name and another patient identifier, usually the appointment of nascence. Then nosotros accept the medication and strength, the amount to be taken, the route by which it is to be taken, and the frequency. For "as needed" medications, there is a symptom included for when information technology is to be taken.

The prescriber also writes how much should be given at the pharmacy and how many refills the patient tin come dorsum for. The prescription is completed with a signature and any other physician identifiers like NPI number or DEA number. And so the prescription is taken to the chemist who interprets what is written and prepares the medication for the patient. At present allow'due south wait at each part of this individually.

Patient Identifiers

According to the Joint Committee on Accreditation of Healthcare Organizations (JCAHO) national patient safety goals, at least two patient identifiers should be used in various clinical situations. While prescription writing is not specifically listed every bit i of these clinical situations, medication assistants is. I retrieve prescription writing should be in this category as well.

Two patient identifiers should be included in a prescription to avert medication errors. Click To Tweet

The two most common patient identifiers are their full name and appointment of nascency. Patient identifiers are the first things to write on a prescription. This mode yous don't write a signed prescription without a patient name on it that accidentally falls out of your white glaze and onto the floor in the cafeteria.

Drug/Medication

This is an easy ane. This is the medication you want to prescribe. It by and large does not matter if you write the generic or the brand name here unless yous specifically want to prescribe the brand name.

If you do want to prescribe the make name only, you specifically demand to indicate, "no generics." There are several reasons you might desire to do this, but we won't go into that here. On the prescription pad, in that location is a small box which can be checked to indicate "brand proper name only" or "no generics."

If y'all only want to prescribe the brand name of a drug, yous need to betoken 'no generics' on the prescription. Click To Tweet

Strength

After you write the medication name, you need to tell the pharmacist the desired strength. Many, if not about, medications come in multiple strengths. Y'all need to write which i you desire.

Oft times, the verbal forcefulness you want is not available, and then the pharmacist will substitute an appropriate alternative for yous. For example, if y'all write prednisone (a corticosteroid) 50 mg, and the chemist's shop only carries 10 mg tablets, the chemist will dispense the 10 mg tabs and adjust the corporeality the patient should take by a multiple of 5.

Amount

Using my previous instance for prednisone, the original prescription was for l mg tabs. And then y'all would have written, "prednisone 50 mg, one tab…." (I'll leave out the rest until we get there). The "one tab" is the amount of the specific medication and strength to take.

Over again using my previous example, due to the 50 mg tabs not beingness available, the instructions would be rewritten past the pharmacist as "prednisone 10 mg, 5 tabs…." You can see that "one tab" is at present "v." Pharmacists brand these changes all the time, often without any input from the physician.

Road

Up until this point, we have been using manifestly English for the prescriptions. The route is the first opportunity we have to beginning using English or Latin abbreviations. Note: It is oft suggested that to help reduce the number of medication errors, prescription writing should be 100% English language, with no Latin abbreviations. I volition testify you both and let you decide.

There are several routes past which a medication can exist taken. Some common ones are by Oral cavity (PO), per rectum (PR), sublingually (SL), intramuscularly (IM), intravenously (IV), and subcutaneously (SQ).

It is often suggested that to help reduce the number of medication errors, prescription writing should be 100% English, with no Latin abbreviations. Click To Tweet

Equally you can meet, the abbreviations are either from Latin roots like PO ("per os") or simply common combination of messages from the English word. Unfortunately, when you are in a hurry and scribbling these prescriptions, many of these abbreviations can look similar. For example, intranasal is oftentimes abbreviated "IN," which, if yous write sloppily, can be mistaken for "IM" or "Iv."

Common route abbreviations for prescription writing:

• PO (past rima oris)
• PR (per rectum)
• IM (intramuscular)
• Four (intravenous)
• ID (intradermal)
• IN (intranasal)
• TP (topical)
• SL (sublingual)
• BUCC (buccal)
• IP (intraperitoneal)

Frequency

The frequency is but how often you desire the patient to take the medication. This can be anywhere from once a day, once a nighttime, twice a day, or fifty-fifty one time every other week. Many frequencies start with the letter of the alphabet "q." This Q is from the Latin word quaque, which means one time.

So in the by, if you wanted a medication to exist taken once daily, yous would write QD, for "one time daily" ("d" is from "die," the Latin word for solar day). Nevertheless, to help reduce medication errors, QD and QOD (every other day) are on the JCAHO "exercise not use" list. So y'all demand to write out "daily" or "every other twenty-four hours."

Common frequencies abbreviations for prescription writing:

• daily (no abbreviation)
• every other mean solar day (no abbreviation)
• BID/b.i.d. (twice a day)
• TID/t.id. (three times a day)
• QID/q.i.d. (4 times a day)
• QHS (every bedtime)
• Q4h (every four hours)
• Q4-6h (every 4 to 6 hours)
• QWK (every week)

To reduce medication errors, QD and QOD are on the JCAHO 'do not use' listing for prescription writing. And then you demand to write out 'daily' or 'every other solar day.' Click To Tweet

The "Why" Portion

Many prescriptions that you write will be for "every bit needed" medications. This is known as "PRN," from the Latin pro re nata, pregnant "as circumstances may require." For case, y'all may write for ibuprofen every four hours "equally needed."

What physicians and medical students ordinarily miss with PRN medications is the "reason." Why would it be needed? You need to add this to the prescription. You should write "PRN headache" or "PRN pain," so the patient knows when to have it.

How Much

The "how much" instruction tells the chemist how many pills should exist dispensed, or how many bottles, or how many inhalers. Typically, you write the number after "Disp #."

I highly recommend that you spell out the number afterwards the # sign, fifty-fifty though this is not required. For instance, I would write "Disp #30 (thirty)." This prevents someone from tampering with the prescription and adding an actress 0 after 30, turning thirty into 300.

Refills

The last instruction on the prescription informs the pharmacist how many times the patient can utilize the aforementioned exact prescription, i.due east. how many refills they tin get.

For example, let's accept refills for oral contraceptives for women. A doctor may prescribe one pack of an oral contraceptive with 11 refills, which would concluding the patient a full year. This is convenient for both the patient and physician for any medications that volition exist used long term.

Prescription Writing Examples

This example is a common medication prescribed when people are leaving the infirmary. Information technology is one 100 mg tablet, taken at bedtime. The prescription is for 30 pills and no refills.

Zofran is a very popular anti-nausea medication used after surgery. Y'all'll notice this script is missing the "amount." Iv medications are a lilliputian unlike in that the corporeality and strength are kind of mixed together. This is not always the case, though. You as well see that this is an "as needed" or "PRN" medication. When the patient complains of nausea, the nurse can give this medication because it has been prescribed.

This example shows a mutual fashion to write prescriptions for liquids, particularly for children. Here I've used the word "liquid" every bit a placeholder for the proper name of a liquid medication. Liquids come in specific strengths per amount of liquid. Here, the strength is 10 mg per 5 mL. We only want to give 5 mg, though, then the "amount" that we prescribe is simply 2.five mL per dose. It'south given by mouth every 4 hours. We are dispensing "1 (one) bottle". You could also only write "1 (i)" every bit the pharmacist would know what y'all mean.

To terminate up, here is a listing of the JCAHO "Exercise Not Use" List:

• U or u (unit) – use "unit"
• IU (International unit) – use "International Unit"
• Q.D./QD/q.d./qd – utilise "daily"
• Q.O.D./QOD/q.o.d./qod – utilize "every other solar day"
• Trailing zeros (#.0 mg) – use # mg
• Lack of leading zero (.#) – use 0.# mg
• MS – use "morphine sulfate" or "magnesium sulfate"
• MS0₄ and MgSO₄ – use "morphine sulfate" or "magnesium sulfate"

Links and Other Resources

• Check out my Specialty Stories podcast for interviews with doctors practicing in a wide variety of specialties and locations.
• Related episode: Resident Duty Hours and the Ripple Issue.
• Related episode: Dr. Pho of KevinMD Talks Almost Healthcare Today.
• Check out my Board Rounds podcast for help preparing for the USMLE Step one and COMLEX Level one exams.

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Source: https://medicalschoolhq.net/prescription-writing-101/

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