Lect.

3 pharmaceutical calculation Ghada Ali

Interpretation of prescription or medication orders

prescription is an order for medication issued by a physician, dentist, or other properly
licensed medical practitioner. A prescription designates a specific medication and dosage to
be prepared by a pharmacist and administered to a particular patient.
A prescription is usually written on preprinted forms containing the traditional symbol Rx
(meaning ‘‘recipe,’’ ‘‘take thou,’’ or ‘‘you take’’), name, address, telephone number, and
other pertinent information regarding the physician or other prescriber. In addition, blank
spaces are used by the prescriber to provide information about the patient, the medication
desired, and the directions for use.
. A prescription written by a veterinarian generally includes the animal species and/ or pet’s
name and the name of the owner.
A written prescription may be presented at the pharmacy by the patient or caregiver, or it
may be transmitted from the prescriber by telephone or by other electronic means. In the
latter instances, the pharmacist immediately reduces the order to a properly written entry. In
hospitals and other institutions, the forms are somewhat different and are referred to as
medication orders i:e medication orders sheet
A prescription or medication order for an infant, child, or an elderly person may also
include the age, weight, and/or body surface area (BSA) of the patient . This information
is sometimes necessary in calculating the appropriate medication dosage. It is important
to recognize two broad categories of prescriptions: (1) those written for a single
component or prefabricated product and not requiring compounding or admixture by
the pharmacist, and (2) those written for more than a single component and requiring
compounding. A prescription may include the chemical or nonproprietary (generic)
name of the substance or the manufacturer’s brand or trademark name Prescriptions
requiring compounding contain the quantities of each ingredient required. Medications
are prepared into various types of dosage forms (e.g., tablets, syrups, injections) and
drug delivery systems (e.g., transdermal patches) to ensure that the medication is
administered accurately and appropriately.
.
Prescriptions and medication order accuracy
It is the responsibility of the pharmacist to ensure that each prescription and
medication order received is correct in its form and content; is appropriate for the
patient being treated; and is subsequently filled, labeled, dispensed, and administered
accurately. In essence, each medication should be:
• therapeutically appropriate for the patient;
• prescribed at the correct dose;
• dispensed in the correct strength and dosage form;
• correctly labeled with complete instructions for the patient or caregiver; and
• for the patient in a hospital or other health care facility, each medication must be
administered to the correct patient, at the correct time, and by the correct rate and
route of administration.
errors and omissions
To ensure such accuracy, the pharmacist is obliged to review each prescription and
medication order in a step-by-step manner to detect errors of omission and
commission. This is termed a search for errors and omissions.
A review of the completeness and correctness of a prescription or medication order is
an important initial step in the process of ensuring accuracy. It is important to note that
other subsequent and related parameters to ensure the accuracy of medication use—
such as the application of pharmacotherapeutics, disease state management ,and the
legal and regulatory aspects of drugs and prescribing authority. Among the items that
the pharmacist should check for the correct reading and interpretation of a prescription
or medication order are:
• prescriber information, including address and telephone number, Drug Enforcement
Administration (DEA) number (for authority to prescribe schedule drugs including
narcotics), state license number and/or the National Provider Identifier (NPI), an
identification number for participating health care providers, and signature;
• date of the order and its currency to the request for filling;
• patient information, including dose-relevant information, such as the age and/or weight
of the patient if the dose of the drug is so based;
• drug prescribed, including dose, preparation strength, dosage form, and quantity;
• clarity of any abbreviations, symbols, and/or units of measure;
• clarity and completeness of directions for use by the patient or caregiver;
• refill and/or generic substitution permission;
• need for special labeling, such as expiration date, conditions for storage, and foods
and/or other medications not to take concomitantly; and
• a listing of the ingredients and quantities for orders to be compounded; calculations
performed should be checked and double-checked, as should the positive identification of all
ingredients used along with their measurements . Once the prescription or medication order
is filled and the label prepared, before dispensing, the pharmacist should make certain of the
following:
• The filled prescription or medication order contains the correct drug, strength, dosage
form, and quantity. Placing a medication’s indication (use) on the prescription label has been
shown to be of benefit in understanding of the use of their medication for some patients,
particularly older patients and those taking multiple medications. The bar-coding of
pharmaceutical products used in hospital settings is required by the federal Food and Drug
Administration (FDA) as an added protection to ensure accurate product dispensing and
administration
• The pharmacy-imprinted serial number on the label matches that on the order.
• The label has the name of the correct patient and physician; the correct drug name,
quantity, and strength; the name or initials of the pharmacist who filled the order; and the
number of refills remaining. Additional label information and/or auxiliary labels may be
required according to good pharmacy practice and by federal and state law depending on the
drug dispensed. A repeat comparison should be made of the drug and drug strength called
for on the prescription against the labeling of the product used to fill the prescription to
assure that the proper drug was used.
Use of roman numerals in prescription :
Roman numerals commonly are used in prescription writing to designate quantities, as
the: (1)quantity of medication to be dispensed and/or (2) quantity of medication to be
taken by the patient per dose. The student may recall the eight letters of fixed values
used in the Roman system:
Use of Abbreviations and Symbols
The use of abbreviations is common on prescriptions and medication orders. Some are derived
from the Latin through its historical use in medicine and pharmacy, whereas others have
evolved through prescribers’ use of writing shortcuts. medication errors can result from the
misuse, misinterpretation , and illegible writing of abbreviations, and through the use of ad
hoc, or made-up, abbreviations. The use of a controlled vocabulary, a reduction in the use of
abbreviations, care in the writing of decimal points, and the proper use of leading and
terminal zeros have been urged to help reduce medication errors. It should be emphasized
that a misplaced or misread decimal point represents a minimum of a 10-fold error. Among the
specific recommendations to help reduce medication errors arising from poorly written,
illegible, or misinterpreted prescriptions and medication orders are the following:
• A whole number should be shown without a decimal point and without a terminal zero
(e.g., express 4 milligrams as 4 mg and not as 4.0 mg).
• A quantity smaller than one should be shown with a zero preceding the decimal point (e.g.,
express two tenths of a milligram as 0.2 mg and not as.2 mg).
• Leave a space between a number and the unit (e.g., 10 mg and not 10mg).
• Use whole numbers when possible and not equivalent decimal fractions (e.g., use 100 mg
and not 0.1 g).
• Use the full names of drugs and not abbreviations (e.g., use phenobarbital and not PB).
• Use USP designations for units of measure (e.g., for grams, use g and not Gm or gms; for
milligrams, use mg and not mgs or mgm).
• Spell out ‘‘units’’ (e.g., use 100 units and not 100 u or 100 U since an illegible U may be
misread as a zero, resulting in a 10-fold error, i.e., 1000). The abbreviation I.U., which stands
for ‘International Units,’’ should also be spelled out so it is not interpreted as I.V., meaning
‘‘intravenous.’’
• Certain abbreviations that could be mistaken for other abbreviations should be
written out (e.g., write ‘‘right eye’’ or ‘‘left eye’’ rather than use o.d. or o.l., and spell
out ‘‘right ear’’ and ‘‘left ear’’rather than use a.d. or a.l.).
• Spell out ‘‘every day’’ rather than use q.d.; ‘‘every other day,’’ rather than q.o.d;
and ‘‘four times a day,’’ rather than q.i.d to avoid misinterpretation.
• Avoid using d for ‘‘day’’ or ‘‘dose’’ because of the profound difference between
terms, as in mg/kg/ day versus mg/kg/dose.
• Integrate capital or ‘‘tall man’’ letters to distinguish between ‘‘look alike’’ drug
names, such hydrALAZINE; and DIGoxin.
• Amplify the prescriber’s directions on the prescription label when needed for
clarity (e.g., use ‘‘Swallow one (1) capsule with water in the morning’’ rather than
‘‘one cap in a.m.’’).
Medication Scheduling
and Patient Compliance
Medication scheduling may be defined as the frequency (i.e., times per day) and
duration (i.e., length of treatment) of a drug’s prescribed or recommended use. Some
medications, because of their physical, chemical, or biological characteristics or their
dosage formulations, may be taken just once daily for optimum benefit, whereas other
drug products must be taken two, three, four, or more times daily for the desired effect.
Frequency of medication scheduling is also influenced by the patient’s physical condition
and the nature and severity of the illness or condition being treated. Some conditions, such
as indigestion, may require a single dose of medication for correction. Other conditions,
such as a systemic infection, may require multiple daily, around-the-clock dosing for 10
days or more. Long-term maintenance therapy for conditions such as diabetes and high
blood pressure may require daily dosing for life. For optimum benefit from prescribed
therapy or from the use of over-the-counter (nonprescription) medications, it is necessary
of the patient to adhere to the recommended medication schedule
Patient compliance with prescribed and nonprescribed medications is defined as patient
understanding and adherence to the directions for use. The compliant patient follows the
label directions for taking the medication properly and adheres to any special instructions
provided by the prescriber and/or pharmacist. Compliance includes taking medication at the
desired strength, in the proper dosage form, at the appropriate time of day and night, at the
proper interval for the duration of the treatment, and with proper regard to food and drink
and consideration of other concomitant medications (both prescribed or nonprescribed)
and herbal remedies.
Patient noncompliance is the failure to comply with a practitioner’s or labeled direction in
the self-administration of any medication. Noncompliance may involve underdosage or
overdosage,incompatible or sporadic dosing, incorrect duration of treatment, and drug
abuse or misadventuring with medications. Patient noncompliance may result from a
number of factors, including unclear or misunderstood directions, undesired side effects of
the drug that discourage use, lack of patient confidence in the drug and/or prescriber,
discontinued use because the patient feels better or worse, economic reasons based on the
cost of the medication, absence of patient counseling and understanding of the need for and
means of compliance, confusion over taking multiple medications, and other factors.
Frequently, patients forget whether they have taken their medications. Some of the different
types of problems relating to patient compliance with medication are represented by the
following examples.
RX
Penicillin V Potassium Oral Solution 125 mg/5 mL
Disp.————mL
Sig. 5 mL q 6h ATC X10 d
How many milliliters of medicine should be dispensed?
Answer: 5 mL times 4 (doses per day) equals 20 mL times 10 (days) equals 200 mL.

A pharmacist may calculate a patient’s percent compliance rate as follows:

% Compliance rate
Number of days supply of medication
Number of days supply of medication
%Compliance rate= ------------------------------------------------------- X100
Number of days since last Rx refill
What is the percent compliance rate if a patient received a 30-day supply of medicine and
returned in 45 days for a refill

30 days
%Compliance rate= --------------x100 =66.6%, answer
45 days
In determining the patient’s actual (rather than apparent) compliance rate, it is important to
determine if the patient had available and used extra days’ dosage from some previous filling
of the prescription