PRESCRIBING

Pharmaceutical Medicine Department

Medical Faculty of Udayana University

PROCESS THERAPY
DIAGNOSE

Drug
Therapy

Non Drug
Therapy
Rational
Pharmacotherapy

Choose drug

Writing Prescription
skills

Writing Prescriptions Skills as a

medical competence

Clinical
features
Basic and
Clinical
Pharmacology

Pharmaceutical
Medicine

Biomedical
Science

Rational Prescribing Skills

Objective:
to comprehend
What is a prescribing error?
Analyze
Why do errors occur?
Different drug charts
Examples of common errors
High risk drugs
Applied
Good prescribing principles

Outline
Prescribing
Parts of prescription
Good prescribing
How to use drug

Wrong drug (e.g. drugs that sound alike) Clotrimazole/Cotrimoxzasole, Carbimazole/Carbamazepine

Inappropriate Units Insulin mixtard 10IU read by 101 unit

Poor/illegible prescriptions
Failure to take account of drug interactions
Digoxin/Warfarin-Amiodaron
Omission

Wrong route/multiple routes (IV/SC/PO)

Calculation errors (important in Paediatrics)
Poor cross referencing

Infusions with not enough details of diluent, rate etc.

Poor cross-referencing between charts
Once weekly drugs
Multiple dose changes
Wrong dose

Common
prescribing errors

Rational Pharmacotherapy?
The rational use of drugs requires that
patients receive medicines appropriate to
their clinical needs, in doses that meet
their own individual requirements, for an
adequate period of time, and at the lowest
cost to them and the community.
Rational prescribing is rational therapy also

World Health Organization, 1988

WHY Rational Prescribing must be

applied?
Irrational Drug
Therapy as global
issues and Medical
education have many
important roles in
reducing the problem

Patien
pressure

Drugs
Techno
logy >

Attitude

Drug
promot
ion

>> Length of stay

>>Therapeutic Cost
<Safety
Morbidity, Mortality

Drug
Formulary
Standar d
Therapy

Irrational
drug
therapy

Knowled
ge< <

Me too
Drugs >

Educatio
nal
system

The Process of Rational Prescribing

Define the patients problems
Establish the working diagnose

Specify the therapeutic objective

Establish the diagnose

Verify whether the P drugs suitable for patients

the effectivity, safety, acceptability, and cost, clinical reasoning

Start the therapy

advice an explanation of the drug

Give information, instruction and warning

Farmakodinamik,farmakokinetik and advice when they come back

Evaluation, monitor or stop therapy

WHO, Guide to Good Prescribing

How to prevention medication error?

Indication
appropriate

Affordable
cost

Drug
appropriate

Be aware to
drugs side
effect

Dose
regiment
appropriate
Appropriate
to the
Patient
(Dosage form)

Frequency and the

amount of
administration

P drug
Physician/Health provider need 40-70 kinds of
medicines
Know the pharmacology entity, effectivity, safety,
rute of administration and cost
P drug:

Need therapeutic experience

-Consider all essential information Drug
List ( Standard Therapy, Drug
Formularies) including existing
treatment guidelines
- Scientific data,evidence based >>

Principles of Good Prescribing

1.
2.
3.
4.
5.
6.
7.
8.

9.
10.
11.
12.
13.

Use addressograph for patient details

Complete allergy box and alert label
Use brand name/generic product
State drug, dose, strength, route and frequency
State dose as grams, mg, mcg.
Make administration of once weekly drugs clear
Avoid abbreviations
Give a sign when prescribe the emergency or critical care
medicines
Inform when prescribe the drugs that the patient can not apply the
medicines by themselves
Be careful to prescribe ethical drugs and opiates contents (depend
on each country)
Prescribe Opthalmic preparation/ Nasal/ otic/Rectal, vaginal
preparation or topical preparation clearly or Avoid multiple route
prescribing (i.e. im/sc/po)
Prescribe when the drug usage unregularly (pain relieves) and
educate the patient
Repeat prescription, to amend a prescribed drug draw a line
through it, date and initial, then rewrite as new prescription.

Sources of Prescribing Info

Trust Prescribing Policy
Farmakope Indonesia
BNF/eBNF
IV guides/monographs
Trust Formulary
Specialist references (e.g. Paediatric)
Summary of Product Characteristics ISO,

MIMS
Pharmacist
Medicines Information
Electronic access to central library of Trust
approved guidelines.

Prescribing
Use Latin Language or international language
Name of drug dosage form product with the

dose, preparation form which is available in

the market
The amount
How to use
Patient identity

Paper Work of Rational Prescribing

Physician Identity ..............dr

Made Satrya Wirana

...Name
...Address
Jl Mawar No.7, Denpasar
...Registration no
Telp. (0361)222881
SIK:
City/Date........ ...................
Denpasar, 23 November 2007
Superscription................. Rx
Inscription............................ Amoxicilin 125 mg
...Primary drugs
...Adjuvant
Paracetamol 125 mg
...How to use/apply?
Vit
B
Complex
tab
1/3
Subscription........................
M f l a pulv dtd No XV
Signatura.............................
S 3 d d Pulv No I
Sign ..................................
Patient Identity

#
Pro: Anne (2th) BB: 14 kg
Alamat: Jl Kamboja 6, Dps

Name

Age/Body weight
Address/Telp no

Latin Abbreviation
Purpose of Latin Language:
Standard language in medical, dead language

because it is not use daily

English also can be used in prescription

Abbreviations
1 gram (g)
1 milligram (mg) (1 x 10~3 g)
1 microgram3 (1 x 10-6 g)
1 nanogram3 (1 x 10-9 g)
1 decilitre (dL) (1 x 10-11)
1 millilitre (mL) (1 x 10-31)
Home/domestic measures. A standard 5 ml
spoon and a graduated oral syringe are
available.
Otherwise the following approximations will
serve:
1 tablespoonful = 14 ml (or mL)
1 dessertspoonful = 7 ml (or mL)
1 teaspoonful = 5 ml (or mL)

Latin Abbreviation

EXAMPLES

Examples
R/ Paracetamol mg 120
Amoxycillin mg 200
Actifed
tab 1/3
Sl qs.
m. f pulv. dtd No XII
S t d d pulv

R/ Parasetamol tab No X
S t d d tab I prn
===============

R/ Amoxil 500 mg cap No XV

S 4 d d cap I
===============

brand and generic name

Brand name
R/ Amoxyl 500 cap
No XII
S 3 dd cap I
Generic name
R/ Amoxyllin syr fl.No I
S t d d Cth (5 cc) I

R/
R/
R/
R/

Otopain ear drop

S tdd gtt II a d s
Cendostatrol eye drop
S 6 dd gtt I od et s
WF zalp
sue
Bioplacenton
Sue

fl. No I
fl No I
10 g
tube I

R/

OBH
250 cc
S 4 dd C I

R/

OBH
140 cc
S 3 dd C I

Thank you