The Mechanics Of Writing Prescription Orders

The written prescription consists of the superscription, the inscription, the subscription, the signa, and the name and signature of the prescriber, all contained on a single form (Figure A-1). The superscription includes the date the prescription order is written; the name, address, weight, and age of the patient; and the Rx (or recipe). The body of the prescription, or inscription, contains the name and amount or strength of the drug to be dispensed, or the name and strength of each ingredient to be compounded. The subscription is the instruction to the pharmacist, usually consisting of a short sentence such as: "make a solution," "mix and place into 30 capsules," or "dispense 30 tablets." The signa or Sig is the instruction for the patient as to how to take the prescription, interpreted and transposed onto the prescription label by the pharmacist. In the U.S., these generally are written in English. Many physicians continue to use Latin abbreviations; for example, "1 cap tid pc," will be interpreted by the pharmacist as "take one capsule three times daily after meals." However, the use of Latin abbreviations only mystifies the prescription, which can hinder proper patient-physician communication and may lead to errors. Since the pharmacist always writes the label in English (or as appropriate in the language of the patient), the use of such abbreviations or symbols is unnecessary and discouraged.

The instruction "take as directed" should be avoided; Such directions can only be seen as inadequate by the pharmacist, who must determine the intent of the physician before dispensing the medication, and who shares the responsibility for safe and proper use of the medication by the patient. The best directions to the patient include a reminder of the intended purpose of the medication by including such phrases as "for relief of pain," or "to relieve itching." The correct route of administration is reinforced by the choice of the first word of the directions. For an oral dosage form, the directions would begin with "take" or "give"; for externally applied products, the word "apply"; for suppositories, "insert"; and for eye, ear, or nose drops, "place" is preferable to "instill."

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