Step 3: Understanding Components of "Prescription"

What is a prescription (Rx)?

It's an order issued by a qualified physician/dentist to a pharmacist to dispense a medication or a medical device to diagnose, treat or prevent a disease. 

COMPONENTS OF PRESCRIPTIONS:

Observe the following prescription:

Generally, a prescription includes EIGHT main components:

1. Prescriber information: Prescriber’s name, degree, speciality, address and telephone number.
2. Patient information: Patient’s name, address, age, and the date of prescription.
3. Superscription: The Latin sign Rx which means ‘‘take thou’’ or ‘‘you take’’ or ‘‘recipe’’. 
4. Inscription: The general content of the prescription. It includes name and strength of the medication whether generic name (Active constituent) or Trade name (proprietary name). 
5. Subscription: Which represents directions of use. It includes type of dosage form or the number of dosage units. 
6. Signa: Also called Transcription, represents the directions to the patient. It includes dose, route of administration (Dosage Form), frequency of use, duration of use and amount to be dispensed. 
7. Prescriber’s signature: Important to assure Legality of Rx. 
8. Refill directions: if indicated, represents number of times for the refill.

Important Abbreviations used in Rx:

The following is the most common abbreviations used in prescriptions which the pharmacist must be aware of.

References:

1. Pharmacy Prescription Requirements - StatPearls - NCBI Bookshelf (nih.gov)
2. 210_pht_pharmaceutics_i_lecture_-4.pdf (ksu.edu.sa). 
3. lecture-2.pdf (ramauniversity.ac.in)
4. Prescription Abbreviations (umn.edu)

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Step 2: Decoding physicians' handwriting

 

It's of no doubt that handwritten prescriptions are one of the main obstacles that face pharmacists in all healthcare settings. Imagine you receive a prescription as in the opposite figure. Of course, a prescription like that is impossible to read. This will necessitate contacting the prescribing physician to understand what is written in such Rx.

Luckily, only few prescriptions are that bad, and most of Rx can be easily read with a little difficulty. So here are some tips you can use to "Decode any Rx"

1. Look at prescribing physician speciality: This can be beneficial because pharmacists are aware of medications prescribed for each condition especially common and chronic conditions. So by knowing what speciality the physician is, you can interpret the list of medications.
2. Look at the Diagnosis: Again, each condition has specific medications that are commonly prescribed to treat it. Knowing what condition the patient has might help decode the Rx easily.
3. Patient Medical and Medication History: In cases of chronic diseases or recurrent conditions, the patients come for a refill or repetition of therapy. By checking the patient medical and medication history, you can easily know what medications they are frequently prescribed. This is a very good way to interpret the Rx. 
4. Search the databases: Sometimes, a couple of letters are not clear. This is problematic in case of medications that are alike Examples: Zyprexa and Zyrtec, Celebrex and Celexa, Chloropamide and chlorpromazine and a lot more. It's important to know the diagnosis and the medical and medication history of the patient, Then you can search the database such as Google you write the letters that you can read and the unclear letters you can leave a blank, Google will suggest the common Names for your search. Although it is not a very efficient way, it is of help when you never have heard of the trade name before. 
5. Know your patient: Most of the times, the person who wants to dispense the Rx is not the patient himself. So, you must know for who the Rx is being dispensed for. This is important of course in case of pediatric Rx. Doses in Pediatrics differ completely from adults. Also, Pregnant or breastfeeding women. Some drugs are a complete contraindication to this population. Geriatrics and those with kidney or liver impairment also are a population we must consider while dispensing medications. Thus, it's very important to know the patient for whom you are dispensing the Rx as this might eliminate a handful of medications and help you with the decoding process.
6. Talk to your patient: Sometimes patients are well educated enough to know their medications especially if they have a chronic condition. Even in less educated patients, they might know the shape of the medication or even have the old one with them. This of course can be so helpful to identify the medications in the new Rx.
7. When all fails, Contact the physician: In case you tried all the above tips and still you couldn't Decode the Rx, you have no other choice but to contact the physician. Don't ever dispense any product you are not a 100% that it's the one prescribed. We are talking about a patient's life here. 

So, here is a simple to Example to try and test yourself and check if the previous tips work

Decoding Rx is a very important and a crucial step for all pharmacists. Wrong interpretation of medications and dispensing completely wrong ones can lead to deleterious effects that might lead to morbidities or in worst cases, Mortality. So be careful and be patient because this is a matter of Life and Death.

References:

https://dx.doi.org/10.1258%2Fjrsm.99.12.645

Step 1: Filling in a Complete, Proper Patient Profile

A very important step that most of pharmacists miss especially those working in a community pharmacy is "Patient Profiling". Pharmacist should treat their patients as patients not just a consumer coming into their pharmacy to purchase a product. In any setting, there must be an electronic database for all patients demanding service from a pharmacy. If electronic version is hard to accomplish, A well organized paper-based database will do the job. So let's discuss in detail what is a patient profile. 

A patient profile is:

A readily retrievable, centrally located information record that contains patient demographics, allergies, and medication profile. There are a lot of templates and forms for patient profile that might differ from one place to another. 

Important components of any patient profile includes:

1. Demographic Data: This includes age, sex, weight, height, pregnancy/breastfeeding (female), Residency, occupation, marital status, Social and family history. (some forms might contain more information as social number, phone number, etc)
2. Current illness: This field includes what the patient is suffering from right now, which led to admission to a hospital or visiting a physician or even requiring therapy.
3. Medical History: This includes all condition that the patients suffers from. The importance of this field is to understand the need for prescribed medications (medication history), to interpret the effect of newly prescribed medications on patient condition and to detect any possible drug-disease interaction that might have or will happen. This field might also include any operations the patient has undergone.
4. Medication History: This field includes the medications that the patient is already taking due to other conditions. It is very important to document both POM and OTC medication plus other supplements/herbal products the patient is taking. This field is very important to understand drug-drug interactions and to detect effect of drugs on the patient current/previous condition. 
5. Allergy: This is a very important field. sometimes it's incorporated with medical history but it's preferred to be separate field. Here we document all patient allergies whether food, medications, insects, etc. This of course is important to avoid deleterious effects when prescribing medications that the patient is allergic to. Of the most common examples: Penicillins, allopurinol. 
6. Medications: This field includes the newly prescribed medications. All information about the medication should be documented including date, dose, frequency, duration of use. Sometimes, in case of hospitals, the medication field is in the form of a table and a checklist to check each day that the patient is taking their medications. Of course in a community pharmacy this can't be achieved. 

Patient profiling is a very important step to optimize drug therapy to patients. Having all information regarding each patient in one or 2 pages or on a computer database will make it feasible to detect any problems or errors, also make the pharmacist aware of side effects, major interactions or any adverse events that occurred or might occur from therapy. Thus, new software and databases are being developed to ensure a flawless system is available to pharmacists to make it easier to document patient information.

References:

1. https://doi.org/10.1080/07448481.1982.9938924

2. https://europepmc.org/article/pmc/pmc2378816

3. https://doi.org/10.1177%2F106002807000400306

An Overview

Pharmacy is a Nobel profession. Being a pharmacist isn't just about selling medicinal products and devices. Recently, pharmacy profession has shifted from being product- oriented to being patient-oriented. In other words, a pharmacist role isn't limited to providing medications or medicinal products to the consumer, but it widens to involve other roles, all revolve around providing what is known as "Pharmaceutical Care". 

According to ASHP (American Society of Hospital Pharmacists), Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life. This definition as simple as it may seem, yet it incorporates multiple aspects which we will discuss in detail. 

Principle Elements of Pharmaceutical Care:

1. Medication related: This means that pharmacists' role is not only dispensing medications but in involves much more. First of all, the pharmacist should check that the medications comply with the condition they are prescribed for (Guidelines). Secondly, Pharmacists should check the dosing regimen (correct dose, correct frequency, correct duration, dose modifications in case of kidney/liver dysfunctions). Third, they should check for drug-drug and drug-Food interactions (including OTC and Herbal/supplement products). Lastly, Pharmacists should provide correct patient counselling and offer a monitoring plan for the patients to assess both efficacy and safety of medications.
2. Care: Pharmacists should treat their patients as patients not just consumers who come to their pharmacies to buy a "Product". Thus, one of the important roles of a pharmacist is taking proper Medical and medication history (including social and family history if present). This is to ensure that the patients are receiving proper therapy.
3. Definite outcomes: The purpose of any medical therapy is ensuring optimal treatment of the patients. Thus, definitive outcomes must be discussed and decided on before any therapeutic plan. Outcomes can vary according to the patient's condition, either treatment, relive of symptoms, preventing complications, preventing progression of disease or palliative treatment. So, the pharmacist should be aware of the desired outcome to ensure that optimal therapy is provided to the patient.
4. Quality of Life: Quality of life is a very important component that most people miss or ignore. As discussed, the aim of a therapeutic plan is providing optimal treatment regimen for the patient. But this doesn't always mean it improves "Quality of life". In order to achieve this component, all other components must be implemented. Thus, a complete, proper, therapeutic and monitoring plan are to be provided to each patient and then, this would improve their quality of life.

When we talk about pharmaceutical care, most of us would think that it is limited to clinical pharmacists only, yet this is NOT true. So let's understand more about clinical pharmacy and know the difference between both terms.

Clinical Pharmacy Definition by ESCP (European Society of Clinical Pharmacy) is as follows: 

It’s a health specialty which describes the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices.

From the previous definition, we can deduce that clinical pharmacy profession is actually the implementation of the concept of Pharmaceutical Care. Both concepts represent a shift from product centered à patient centered philosophy in practice. Thus, any Pharmacist (clinical, community, hospital) is obliged to implement concepts and practices of pharmaceutical care. Nevertheless, there is no difference between pharmacists working in different sectors. All must implement the same concepts and roles in their job to improve patient outcomes and quality of life. 

Thus, to sum it up, the role of Pharmacists is to implement pharmaceutical care concepts (Promote correct and appropriate use of medicinal products and devices) during their practice which can be summarized in the following points:

•    Maximize clinical effect of medicines. i.e. using the most effective treatment for each type of patient.
•   Minimize the risk of treatment-induced adverse events. i.e. Monitor therapy course and patient’s compliance with therapy.
•   Trying to provide the appropriate alternative for the greatest number of patients. 

In the following posts, we will start discussing how to implement pharmaceutical care in practice, discuss information resources, and understand how to search properly for required information.

Hope this was of benefit to you. Thank you and Good Luck

References:

1.https://doi.org/10.1093/ajhp/50.8.1720

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058439/

3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758081/

4.https://doi.org/10.1007/978-3-319-92576-9