Anatomy of a Prescription

Writing a Prescription and Whisper-Down-the-Lane

A prescription is an order that is written by a physician to communicate to a pharmacist or other healthcare provider what medication is to be given to a patient.  Sometimes that order is filled by an outside pharmacy, and sometimes that order is filled by a pharmacy within the hospital walls.  Sometimes the medication is administered by another healthcare provider such as a nurse or physicians’ assistant, and sometimes the medication is taken directly by the patient.  Whatever the mechanism, the message goes from Point A to Point B to Point C.  And just as in the age-old game of Whisper-Down-the-Lane, the message has the potential of getting confused as it progresses down the chain.  Unlike the game, however, the accuracy of the information contained in the message of a prescription can mean the difference between life and death.


The basic anatomy of a prescription

The basic anatomy of a prescription includes the patient’s name and another patient identifier, such as the date of birth.  It also includes information such as the name of name of the medication, the strength of the dose, how often it is to be taken and how it is to be administered.  The prescription also includes the number of refills permitted and the signature of the prescriber.   The effective communication of the prescription by the physician directly impacts the accurate interpretation by the pharmacist, which in turn, directly impacts the patient.  At times, the process feels hauntingly similar to Whisper-Down-the-Lane.

What Can Go Wrong?

  • Patient identifier, such as name or date of birth, is wrong.
  • Medication intended to be filled is confused with a different similar-sounding or similar-spelled medication resulting in the wrong medication being dispensed to the patient.
  • Strength of the medication, which may come in various strengths (such as 5, 10 or 50 mgs.) is improperly calculated.  For example, if the pharmacist only has 5 mg tablets and you need to take 10 mg tablets, the adjusted amount you will need to take is a multiple of two.  The original instructions by the physician, “Take one a day,” therefore, will have to be adjusted.
  • Amount of the medication, meaning, the number of pills to be taken, is easily confused when the strength of the medication is being adjusted.
  • The frequency by which a medication is to be taken can be confused when Latin abbreviations such as “BID, TID, or PRN” are used instead of plain English.
  • The route by which the medication is to be ingested is wrong.  A medication that is to be taken by mouth may not be effective if taken rectally.  A medication that is to be given intramuscularly may be deadly if administered intravenously.

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