42
TIPS ON PRESCRIPTION WRITING
(Adapted from "Tips on Prescription Writing", a pamphlet available from the
Saskatchewan College of Pharmacists.)
Properly issued prescriptions are in the best interest of the patient, the pharmacist and the prescriber. This information is designed to assist prescribers to issue prescriptions most effectively. These guidelines will help to reduce the time involved in the prescription process, increase patient safety and maximize patient compliance.
For further information on the provincial requirements for prescriptions please refer to the
College of Physicians and Surgeons Bylaw 53.
Information regarding the documentation of verbal prescription is stated in the
Saskatchewan College of Pharmacists Bylaw 14.13.3.
PRESCRIPTION CONTENT
Prescriptions need to be issued clearly and completely to minimize errors. Clear pronunciation or legible writing with accurate spelling is essential.
The prescription may be written, or verbal for certain classes of drugs, (for more information refer to the chart Saskatchewan College of Pharmacists – Prescription
Regulations also published in this Supplementary Information section) and must include the following information: date physician's name and signature patient's name full name of the medication medication concentration where appropriate medication strength where appropriate dosage amount prescribed or the duration of treatment administration route if other than oral explicit instructions for patient usage of the medication number of refills where refills are authorized
The prescriber's name, address and telephone number should be preprinted on the prescription form, or hand printed beneath the signature.
VERBAL PRESCRIPTIONS
Federal and Provincial legislation states that a verbal prescription or refill authority must be given by a duly licensed practitioner prescribing within their scope of practice directly to a pharmacist. Having a receptionist or nurse (other than a RN-NP) assume this responsibility is contrary to the law.
Direct prescriber/pharmacist communication is necessary to provide the best quality of care for the patient. The pharmacist may wish to discuss an aspect of the drug therapy prior to dispensing the medication. As well, the prescriber may wish to ask the pharmacist about a particular medication, or a patient's medication history, compliance, or pattern of drug use. Both the professionals and the patient will benefit from this direct communication. MEDICATION DIRECTIONS
Pharmacists maintain patient profiles, which contain information concerning prescriptions dispensed, directions for use, drug allergies, medical conditions, and other pertinent information. These profiles are used to monitor the patient's drug usage and compliance, and drug interactions. As this information is now transmitted to Saskatchewan Health
43
and retained for review by designated health care practitioners, pharmacists must ensure the accuracy and integrity of information provided for use by The Prescription
Information Program. Thus, it is very important that directions on the prescription be consistent with verbal instructions given to the patient. Clear directions enable the pharmacist to effectively counsel the patient and reinforce the prescriber’s instructions.
Prescriptions with closing instructions written "As Directed" create problems for the patient, particularly the elderly or those assisting them. Patients taking more than one medication may become confused if all instructions read "As Directed". Such labelling also makes it impossible for pharmacists to monitor compliance, or assist patients with medication concerns.
It is helpful for a patient taking more than one medication, or for the caregiver, to know what the medication is used for. The prescriber may wish to indicate the use of the medication on the prescription (e.g. for heart), to enable the pharmacist to include this information on the label.
REFILLS
When a patient is stabilized on medication, refills, where permitted by law, should be indicated on the prescription. Authorization should allow for sufficient refills until the patient's next appointment, to a maximum of one year. If refills are not properly indicated on the prescription, the pharmacist must by law, contact the prescriber for refill authorization. Specific regulations apply to various categories of prescription drugs. Your pharmacist would be pleased to review the regulations with you. Please refer to the chart
Saskatchewan College of Pharmacists – Prescription Regulations (also published in this
Supplementary Information section) for a summary of requirements.
SUBSTITUTION
Unless the prescriber directs otherwise, the pharmacist may select and dispense an interchangeable pharmaceutical product, other than the one prescribed, according to the
Saskatchewan Prescription Drug Plan Formulary. An interchangeable pharmaceutical product is a product containing a drug or drugs in the same amounts, of the same active ingredients, in the same dosage form as that directed by the prescription. Those which conform to the criteria for interchangeability determined by the Saskatchewan Formulary
Committee are designated as "interchangeable" in the Saskatchewan Formulary Listing.
A prescriber may request that a specific brand of a drug be dispensed by indicating in his own handwriting at the time of issuing a written prescription, or verbally at the time of giving a verbal prescription, No Substitution, No Sub, or N/S. In most cases, the patient is responsible for the incremental cost of "No Sub" prescriptions.
TRANSFER OF PRESCRIPTIONS
Schedule F drugs may be transferred from one pharmacist to another at the request of a patient. Prescriptions for benzodiazepines and other targeted substances may be transferred once. Prescriptions for Schedule 2 and 3 drugs and Narcotic and Controlled
Drugs may NOT be transferred.
When a prescription is transferred, the original prescription shall remain on file, and on it shall be entered:
1. the date of the transfer;
2. an indication that no further sales nor transfers may be made under the prescription
(i.e. the word "VOID");
3. the name of the pharmacy and pharmacist to whom the prescription was transferred;
4. the patient profile, manual or electronic, must also indicate the prescription is "VOID".
44
The pharmacist receiving the transferred prescription shall indicate:
1. the name of the pharmacist transferring the prescription;
2. the name and address of the pharmacy transferring the prescription;
3. the number of authorized repeats remaining, if any;
4. the date of the last fill or refill.