Appendix 2The prescription

The prescription is the means by which medicines that are not considered safe for sale directly to the public are delivered to patients. Its format is officially regulated to ensure precision in the interests of safety and efficacy and to prevent fraudulent misuse; full details will be found in national formularies and prescribers have a responsibility to comply with these.

Prescriptions of pure drugs or of formulations from the British National Formulary (BNF)1 are satisfactory for almost all purposes. The composition of many of the preparations in the BNF is laid down in official pharmacopoeias, e.g. British Pharmacopoeia (BP). There are also many national and international pharmacopoeias.

Traditional extemporaneous prescription-writing art, defining drug, base, adjuvant, corrective, flavouring and vehicle is obsolete, as is the use of the Latin language. Certain convenient Latin abbreviations do survive for lack of convenient English substitutes (chiefly in hospitals where instructions are given to nurses and not to patients). They are listed below, without approval or disapproval.

The elementary requirements of a prescription ace that it should state what is to be given to whom and by whom prescribed, and give instructions on how much should be taken how often, by what route and for how long or total quantity to be below.

2. Address of doctor.

3. Name and address of patient: age is also desirable for safety reasons; in the UK it is a legal requirement for children under age 12 years.

This is a traditional esoteric symbol2 for the word 'Recipe' — 'take thou', which is addressed to the pharmacist. It is pointless; but since many doctors gain a harmless pleasure from writing it with a flourish before the name of a proprietary preparation of whose exact nature they are ignorant, it is likely to survive as a sentimental link with the past.

5. The name and dose of the medicine. Abbreviations. Only abbreviate where there is an official abbreviation. Never use unofficial

1 Supplied free to all doctors practising in the UK National Health Service.

2 Derived from the eye of Horus, ancient Egyptian sun god.

abbreviations or invent your own; it is not safe to do so.

Quantities (after BNF)

— Less than 1 g: write as milligrams: 500 mg, not 0.5 g.

— Less than 1 mg: write as micrograms, e.g. 100 micrograms, not 0.1 mg.

— For decimals a zero should precede the decimal point where there is no other figure, e.g. 0.5 mL, not .5 mL, or for a range, 0.5 to 1 g.

— Do not abbreviate microgram, nanogram or unit.

— Use millilitre, ml or mL, not cubic centimetre, cc.

— Home/domestic measures, see below.

State dose and dose frequency; for 'as required', specify minimum dose interval or maximum dose per day.

6. Directions to the pharmacist, if any: 'mix', 'make a solution'. Write the total quantity to be dispensed (if this is not stated in 5 above); or duration of supply.

7. Instruction for the patient, to be written on container by the pharmacist. Here brevity, clarity and accuracy are especially important. It is dangerous to rely on the patient remembering oral instructions. The BNF provides a list of recommended 'cautionary and advisory labels for dispensed medicines' representing a balance between 'the unintelligibly short and the inconveniently long', e.g. 'Do not stop taking this medicine except on your doctor's advice'.

Pharmacists nowadays use their own initiative in giving advice to patients.

8. Signature of doctor.

Example of a prescription for a patient with an annoying unproductive cough. 1,2,3, as above

5. Codeine Linctus, BNF, 5 ml

7. Label: Codeine Linctus [or NP]. Take 5 ml twice a day and on retiring.

8. Signature of doctor.

Computer-issued prescriptions must conform to recommendations of professional bodies. If altered by hand (undesirable), the alteration must be signed.

Medicine containers. Reclosable child-resistant containers and blister packs are increasingly used, as is dispensing in manufacturers' original sealed packs containing a patient information leaflet. These add to immediate cost but may save money in the end (increased efficiency of use, and safety).

Unwanted medicines. Patients should be encouraged to return these to the original supplier for disposal.

Drugs liable to cause dependence or be the subject of misuse. Doctors have a particular responsibility to ensure that (1) they do not create dependence, (2) the patient does not increase the dose and create dependence, (3) they are not used as an unwitting source of supply to addicts. To many such drugs special prescribing regulations apply (see BNF).

Abbreviations (see also Weights and measures, below)

before food twice a day (bid is also used)

British National Formulary British Pharmacopoeia British Pharmaceutical Codex i.m.: intramuscular by intramuscular injection IU International Unit i.v.: intravenous by intravenous injection NP: nomen a.c.: ante cibum b.d.: bis in die

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