To avoid this, include leading zeroes when using decimal expressions less than one e. This step also helps avoid age-inappropriate prescriptions, such as quinolones for children.
Provide clear and specific directions. Treat prn as one-third of a phrase in which a symptom and a specific dose pattern are the complementary components e. Most medications have narrow dosing regimens. Respect these, and accurately transfer them to prescriptions. Specifying directions reinforces care plans and prompts pharmacist counseling of patients. Error reduction relies upon these professional redundancies. Specify the therapeutic duration.
The number of prescribed pills should be matched to the expected duration of treatment and necessary reassessment visits. Keep therapeutic plans intact by writing for medicines in specific quantities e.
This especially applies when using bridging doses during active medication titration. Prescribing the specific number of doses necessary until reassessment compels patients to comply with follow-up appointments and prevents them from accumulating old medications.
Similarly, match prescriptions for acute events to the total number of tablets needed to treat the single episode of care. For example, treat acute maxillary sinusitis one episode at a time. Adding extra tablets or refills for theoretic recurrences confuses the duration of therapy of the original illness.
Remain cognizant of lethal doses of medications. For example, tricyclic antidepressants should be prescribed in sublethal amounts with frequent reassessments, and warfarin should be prescribed on a monthly basis. Specify the indication. Writing the indication on prescriptions is a frequently encouraged, yet seldom followed, practice. This step facilitates professional pharmacist counseling, reinforces care plans and provides multiple opportunities for patient education.
Also, one serendipitous effect is to improve physician-to-physician communication. For example, gabapentin and corticosteroids have a plethora of uses ranging from beneficial to whimsical and are frequently prescribed in abundance.
A written indication on a pharmacy bottle may be the only documentation available to judge the effectiveness of these or other medications. Add supplemental instructions. Prescriptions should also include additional warnings that guide patients and inhibit medication side effects e. Specific instructions to the pharmacist can also be added.
Report all errors. This often overlooked duty closes the error loop and avoids dangerous repetitions. I think prescription writing should be in this category as well. Two patient identifiers should be included in a prescription to avoid medication errors. Click To Tweet. The two most common patient identifiers are their full name and date of birth. Patient identifiers are the first things to write on a prescription.
This is an easy one. This is the medication you want to prescribe. It generally does not matter if you write the generic or the brand name here unless you specifically want to prescribe the brand name. If you only want to prescribe the brand name of a drug, you need to indicate 'no generics' on the prescription. After you write the medication name, you need to tell the pharmacist the desired strength. Many, if not most, medications come in multiple strengths. You need to write which one you want.
Often times, the exact strength you want is not available, so the pharmacist will substitute an appropriate alternative for you. For example, if you write prednisone a corticosteroid 50 mg, and the pharmacy only carries 10 mg tablets, the pharmacist will dispense the 10 mg tabs and adjust the amount the patient should take by a multiple of 5. Using my previous example for prednisone, the original prescription was for 50 mg tabs.
Up until this point, we have been using plain English for the prescriptions. The most common errors in dosage result in pediatric and geriatric populations. For weight-based or body surface area-based drugs, the dose basis should be included.
The age and weight of a patient can help dispensing health care professionals in their double check of the appropriate drug and dose. Strength should be expressed in metric amounts and concentration should be specified. Each order for a medication should be complete. The pharmacist should check with the prescriber if any information is missing or questionable. A leading zero always precedes a decimal expression of less than one use 0.
A terminal or trailing zero should never be used after a decimal express as 4 mg, not 4. Ten-fold errors in drug strength and dosage have occurred with decimals due to the use of a trailing zero or the absence of a leading zero.
Also mistaken for "cc" cubic centimeters when poorly written. Latin abbreviation for every day The period after the "Q" has sometimes been mistaken for an " I, " and the drug has been given "QID" four times daily rather than daily. Confusing abbreviations can lead to drug errors.
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Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Child Abuse: Approach and Management. Next: An Abscess on the Forehead. Jan 15, Issue. Abstract Step 1. Specify the Therapeutic Objective Step 3. Select the Appropriate Drug Therapy Step 4.
Give Information, Instructions, and Warnings Step 6. Evaluate Therapy Regularly Step 7. Article Sections Abstract Step 1. C 2 , 10 Discontinue use of abbreviations and non-English characters in prescription writing.
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