A prescription is a written order from an authorized healthcare professional to dispense a specific medicine to a patient. It is both a legal document and a communication tool between the prescriber and the pharmacist. Understanding the parts, handling rules and legality of prescriptions is essential for all community pharmacists.
Parts of a Prescription
A typical prescription form contains the following parts:
1) Date
The date helps the pharmacist know when the prescription was issued. For narcotic or habit-forming drugs, the date is very important to prevent misuse of old prescriptions.
2) Patient Details
The prescription must include the patient’s:
- Name
- Age
- Sex
- Address
If any detail is missing, the pharmacist may politely ask the patient and update it. Age and sex help verify correct dosage, especially for children.
3) Superscription
This is the “Rx” symbol. It comes from the Latin word recipe meaning “take thou.” Historically, it was also believed to be a symbol invoking the blessings of Jupiter, the God of healing.
4) Inscription
This is the main part of the prescription. It contains the names and quantities of the ingredients or the medicines prescribed.
In complex prescriptions, inscription may include:
- Base – active ingredient
- Adjuvant – helps improve action or palatability
- Vehicle – used to dissolve ingredients or increase volume
Today, most medicines are available in ready-made formulations, so compounding is rarely required.
5) Subscription
Instructions from the prescriber to the pharmacist regarding preparation and the number of doses. These days, since compounding is uncommon, many prescribers leave this part blank.
6) Signatura
Instructions from the prescriber to the patient. It includes:
- How much to take
- How often to take it
- Route of administration
- Special instructions like dilution or shaking
The pharmacist must transfer the signatura clearly onto the label in simple language.
7) Renewal Instructions
Shows whether the prescription can be refilled and if yes, how many times. This is especially important for narcotic and habit-forming drugs.
8) Prescriber’s Details
The prescription must include the prescriber’s:
- Signature
- Address
- Registration number
Legality of Prescriptions
Prescriptions are legal documents and must follow laws and regulations. Important points include:
1) Prescribing Authority
Only authorized healthcare professionals can write prescriptions, such as:
- MBBS doctors
- Specialists (MD/MS)
- Registered medical practitioners (as permitted by law)
In some countries, nurse practitioners, physician assistants and clinical pharmacists may also prescribe with authorization.
2) Regulatory Framework
National and state regulations define rules related to:
- Controlled substances
- Prescription validity
- Electronic prescriptions
- Record-keeping
3) Controlled Substances
These drugs have high abuse potential. Their prescriptions require special precautions, specific forms and strict refill limits.
4) Patient Evaluation
A proper medical evaluation must be done before writing a prescription. A genuine patient–doctor relationship should exist.
5) Documentation
All prescription details must be documented accurately for legal and auditing purposes.
6) Professional Standards
Prescribers must follow ethical guidelines, avoid unnecessary medicines and ensure patient safety.
7) Regulatory Oversight
Government agencies ensure safe prescribing and monitor drug safety after approval.
Eligibility to Write Prescriptions
- Legally qualified and registered medical practitioners (MBBS, MD, MS)
- In some regions: certified nurses, licensed physician assistants, optometrists, clinical pharmacists (depending on local laws)
- Medical students are not eligible to prescribe
Prescription Handling
Before dispensing, the pharmacist must ensure:
- The prescription is genuine
- The person presenting it is the actual patient or caretaker
Prescriptions written on random papers, wrappers or old strips should not be accepted.
A pharmacist must:
- Check if the medicine and dose are reasonable
- Verify for interactions and contraindications
- Clarify doubts with the prescriber without alarming the patient
- Never fill a prescription that seems incorrect
Triple Verification Rule
To avoid errors, verify the label three times:
- When removing the medicine from the shelf
- When taking out the strip or bottle
- Before returning the container to the shelf
No substitution should be done without the doctor’s permission.
Prescription Labeling
Labeling helps patients take medicines correctly. A good label must contain:
- Patient name, age, gender
- Medicine name and strength
- Directions for use
- Route of administration
- Prescriber details
- Pharmacy details
Additional instructions may include:
- Shake well before use
- For external use only
- Keep refrigerated
After dispensing, affix a “DISPENSED” stamp to prevent reuse unless refills are allowed.
Filing of Prescriptions
In many regions, pharmacies must store original prescriptions for several years. These records may be needed for:
- Legal verification
- Audits
- Insurance reimbursements
- Continuity of care
If the pharmacy closes, prescriptions must be transferred to patients or a nearby pharmacy.
Identification of Medication-Related Problems
1. Drug Interactions
- Antagonistic: one drug reduces the effect of another
- Synergistic: two drugs increase each other’s effects
2. Adverse Drug Reactions (ADRs)
Unwanted, harmful effects such as allergies, rashes or stomach upset.
3. Medication Errors
Errors in prescribing, dispensing or administration.
4. Duplication of Therapy
Two medicines from the same class being used unnecessarily.
5. Contraindications
Conditions where a medicine should not be used (e.g., liver disease, pregnancy).
Managing Medication-Related Problems
- Consultation with a pharmacist
- Patient education
- Regular medication review
- Using technology and interaction checkers
Detailed Notes:
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