One of the primary communication links between the prescriber, pharmacist, and patient is complete, safe and accurate prescription writing. Completion of all “essential elements” of a prescription will assure that it is accurately interpreted and not subject to alteration. Attention to detail when writing prescriptions will prevent the need for the Department of Pharmaceutical Care to contact the prescriber to clarify prescriptions and reduce patient delays. Properly written prescriptions will help ensure continuity of care in the patient’s local community.
Duplicate Prescription System
The Duplicate Prescription System at the UIHC is structured to produce an original and exact copy of the medication order. Under this system, the Department of Pharmaceutical Care is authorized to dispense the take home supply of medication from the copy of the prescription and return the original prescription to the patient to obtain continuing supplies in the local community. The use of other, nonstandard prescription blanks within the UIHC is not authorized.
The “essential elements” of a prescription are depicted in the preceding figure of a UIHC prescription and described
(A) Patient name, address, hospital number, birthdate and date prescription is written. This information may be transmitted to the prescription by using the patient’s addressograph plate. The hospital number is essential to assure that the intended patient receives, and is billed for, the correct medication.
(B) The name, strength, and quantity of the drug. Medications should be ordered by the generic name, not by the proprietary or trade names.
Hospital policy and the Joint Commission on Accreditation of Healthcare Organizations standards permit the use of drug name abbreviations in medication orders only if the abbreviation has been specifically approved by the hospital and it appears on a published list. “Coined” abbreviations such as HCTZ, AZT, T3, MSO4, and ddC are not acceptable medical abbreviations, may be misinterpreted, and may cause drug errors. Medication orders that contain nonapproved drug name abbreviations are not valid. Pharmacists are authorized to withhold dispensing of medications ordered via nonapproved abbreviations.
A separate prescription blank must be used for each drug prescribed. Multiple prescriptions on a single blank are unsafe and greatly increase the potential for medication errors.
For Drug Enforcement Administration (DEA) narcotics and controlled substances, including anabolic steroids, the quantity should be written in words as well as numbers to prevent alteration of the prescription.
The quantity of drug to be dispensed should be indicated. Outpatient prescriptions should be written for no more than a 30 day supply with continuing supplies to be prescribed as refills. In order to minimize patient delays, the pharmacist is authorized to round the quantity dispensed to the nearest available prepackage quantity (usually a one month supply) only for prescriptions with refills authorized.
Outpatient Prescription Medication Supply Limits
The United States Supreme Court has ruled that medications purchased by hospitals (at special institutional prices) must be for inpatient use or for dispensing a limited take home supply. The following rules must apply:
1. A maximum 30 day supply is authorized on prescription orders.
2. Refill requests may not be processed.
3. Exemptions from the above rules:
- Prescriptions for medications not commercially available.
- Prescriptions for UIHC staff and dependents at the same address.
- Prescriptions for state paper eligible patients (as defined by UIHC policy). These patients are eligible for a maximum 90 day supply with a single refill of specific maintenance medications. (See guidelines on pages 9 to 10.)
(C) Directions to the patient. Clear and concise directions will assist your patient in the appropriate use of the medication. “Take as directed” should be avoided. Your patient may forget or confuse verbal directions or lose a separate note. The Department of Pharmaceutical Care will complete a patient medication calendar for tapered or intermittent dosage schedules. The “PRN” designation should include the purpose of the medication (e.g., PRN sleep, PRN pain).
(D) Signature, printed name, prescriber code. In addition to signing the prescription, print your name legibly below your signature along with your UIHC “digit prescriber code, and indicate your practitioner status by circling the appropriate initials to the right of the signature line. This will facilitate communications with health care practitioners throughout the state who have a need to accurately identify the prescriber and it will also decrease the possibility of forgery. To prevent illegal drug diversion, supplies of prescription blanks may not be signed by the prescriber in advance of use. Prescriptions must only be signed by the prescriber at the time prescriptions are written for a specific patient. Physician assistants must also indicate the name of their supervising physician in the designated space.
(E) DEA number. Your personal Drug Enforcement Administration (DEA) registration number (or the UIHC DEA registration number for eligible practitioners) with your personal 4 digit prescriber code must be included on all prescriptions for drugs classified as controlled substances. This step is a safety mechanism to prevent prescription forgery because each DEA number can be checked to verify its validity. When your DEA number is omitted, it is illegal for any pharmacy to fill the prescription. Pharmacy does not have a list of every prescriber’s DEA number; therefore, this omission causes your patient to be inconvenienced until the deficiency is corrected.
Physician assistants and advanced registered nurse practitioners are authorized to prescribe controlled substances after obtaining a mid level practitioner’s registration from the DEA. However, physician assistants are not authorized to prescribe Schedule II substances listed as stimulants or depressants.
Applications forms for personal DEA registration at the UIHC and instructions for completion are available at the Pharmacy Office.
(F) Drug allergies. The patient’s medication allergies should be specified in this space on one of the prescriptions for each set of prescriptions. If there are no known allergies, please check the box next to “NKA.” The pharmacist will obtain or confirm allergy information with the patient as necessary at the time the prescription is presented to the Ambulatory Care Pharmacy.
(G) Containers without safety closures. “Childproof” containers with safety closures are used for dispensing all prescription medications (with limited exceptions) in accordance with the Federal Poison Prevention Packaging Act of 1970. You may indicate the need for nonsafety closures for a patient for whom childproof containers may cause difficulty by checking the designated box.
(H) Refill designation. Always circle “no refills” or specify the number of times and/or the last date the prescription may be refilled. “PRN” is not a valid refill designation.
Prescriptions may be refilled at the Department of Pharmaceutical Care ONLY for hospital staff and dependents at the same address or for patients whose medications are not commercially available. Prescriptions for these eligible patients groups (excluding controlled substances) may be refilled a maximum of 11 times or for 12 months whichever is less. Prescriptions for DEA controlled substances in Schedules III, IV, and V may be refilled a maximum of five times or for six months whichever is less. Prescriptions for Schedule II controlled substances may not be refilled.
(I) Indication for Use. The indication for use should be specified in this space for each prescription. This information permits the pharmacist to reinforce prescriber instructions with the patient and helps the patient understand what the medications are for. Federal regulations require the pharmacist to obtain information on the patient’s disease state(s) so that appropriate utilization review and counseling can occur.