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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5576_Библиотеки_им_академика_М_И_Перельмана
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Figure 4.4. A.Example of a prescription written for a generic
drug. B.Label of product which may be used by a pharmacist in
filling the prescription called for in Figure 4.7A. (Source:
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?
setid=4c0f348a-a65d-409c-8668-207c82a5e3cb. Courtesy of
Teva Pharmaceuticals USA, Inc.)
Figure 4.5. Example of a prescription requiring compounding.
Tamper-Resistant Prescription Pads
To prevent the unauthorized copying, modification, or counterfeiting of
prescriptions, tamper-resistant prescription pads have been developed.
The tamper-resistant qualities of these prescription forms are
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accomplished through the use of security paper, erase-resistant paper,
thermochromatic ink (which results in the appearance of the word “VOID”
on photocopies), and/or imbedded holograms.
Electronic Health Record
An electronic health record (EHR) is a digital version of a patient’s paper
chart. EHRs are real-time, patient-centered records that make information
available instantly and securely to authorized users. An EHR can contain a
patient’s medical history, diagnoses, medications, treatment plans,
immunization dates, allergies, radiology images, and laboratory and test
results. Integrated electronic health information systems allow doctors,
nurses, pharmacists, and other health care providers to appropriately
access and securely share a patient’s vital medical information
electronically—with the intent of improving the speed, quality, safety, and
cost of patient care. In the hospital and in other institutional settings, these
systems include computerized physician order entry (CPOE) by which a
physician can order medications and provide other instructions for a
patient’s care.
Electronic Prescribing/Electronic Prescriptions
Electronic prescribing (e-prescribing) is the computer-to-computer
transfer of prescription information among authorized prescribers,
pharmacies, intermediaries, and payers under nationally accepted
standards.1 In the inpatient or outpatient setting, a medication order for a
patient is entered into an automated data entry system such as a personal
computer or a handheld device loaded with e-prescribing software and sent
to a pharmacy as an e-prescription, or e-script. Some e-prescribing
operational functions within EHR software programs are displayed in
Table 4.1. When an e-prescription is received in the pharmacy, it is printed
out as shown in Figure 4.6.
Table 4.1 SOME e-PRESCRIBING OPERATIONAL
FUNCTIONS WITHIN ELECTRONIC HEALTH RECORD
(EHR) SOFTWARE PROGRAMS
Figure 4.6. Illustration of an electronically transmitted
prescription as received by a pharmacy. DEA, Drug
Enforcement Administration; NPI, National Provider Identifier.
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Among the advantages cited for e-prescriptions over traditional paper
prescriptions are reduced errors due to prescription legibility, concurrent
software screens for drug allergies and drug interactions, integrated
information exchange among health care providers, efficiency for both
prescriber and pharmacist, and convenience to the patient, whose
prescription would likely be ready for pickup upon arrival at the
pharmacy.2 Because electronic prescriptions also reduce the incidence of
altered or forged prescriptions, many states require that all controlled
medications be prescribed only electronically.
Additional e-prescribing images are displayed in Authors’ Extra Point
B at the end of this chapter.
Hospital and Other Institutional Medication
Order Forms
As noted previously, a typical paper medication order form used in the
hospital setting is shown in Figure 4.2. In addition, other forms may be
used within a hospital by specialized care units such as infectious disease,
cardiac care, pediatrics, obstetrics, orthopedics, and others.3 Drug-specific
forms also may be used, as for heparin dosing, electrolyte infusions, and
morphine sulfate in patient-controlled anesthesia. An example of the latter
is shown in Figure 4.7.
Figure 4.7. Example of a hospital form for prescribing a specific
drug treatment: patient-controlled anesthesia. (Adapted from
www.hospital-forms.com3)
Other types of patient care facilities, such as outpatient clinics,
intermediate- and long-term care facilities (Fig. 4.8), cancer treatment
centers, and others, utilize institution-specific forms for medication orders.
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Figure 4.8. Example of a nursing home medication order form.
Paper medication forms in most health care institutions have been largely
replaced by CPOE as a part of the transition to EHR systems (EHRs).
Military Time
Military time is used not only in the military but also in civilian life, such
as in hospitals, law enforcement, and emergency services. Its use provides
an unambiguous expression of time. In health care institutions, military
time may be used to record the time of a patient’s admission, when a
medication was administered, the time of surgery, and so forth.
Table 4.2 compares the expressions of military time and regular time.
Military time is verbalized as, for example, “twenty-three hundred hours.”
Colons may be used to separate hours and minutes, as 1331 or 13:31 hours
(31 minutes past 1 o’clock in the afternoon), and, when desired, seconds,
as 1331:42 or 13:31:42.
Table 4.2 Comparative Expressions of Regular and Military
Time
Form of Compounded Prescriptions
The quantities of ingredients designated on prescriptions to be
compounded are usually written using SI metric units as illustrated in the
following examples.
In prescription writing, the decimal point may be replaced by a vertical
line to designate whole or decimal fractions of grams or milliliters. If the
designations “g” or “mL” are absent, as in the second illustration, they are
presumed. Unless otherwise noted, solid materials are presumed to be
measured in grams and liquids in milliliters. This practice, however, can
lead to confusion and inconsistency, so it is best to always designate units.
Illustration of prescriptions written in SI metric units:
Prescription and Medication Order Accuracy
and Verification
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:
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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
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
Medication verification is the term used when there is a process in
place to ensure that these bulleted requirements are met. It is performed
initially through the careful reading, filling (including calculations),
checking, and dispensing of the prescription or medication order. The
process often is enhanced by technologies, such as the computer matching
of a drug package bar code with the prescription order and/or by matching
the drug’s bar code to a patient’s coded wristband in a patient care facility
(termed bedside medication verification).
Errors and Omissions
To ensure such accuracy, the pharmacist is obliged to review each
prescription (both traditional and e-prescription) and medication order in a
step-by-step manner to detect errors and omissions. If there is any question
regarding a prescription or medication order, the pharmacist must seek
clarification from the prescriber.
The items that the pharmacist should check for the correct reading and
interpretation of a prescription or medication order are as follows:
Prescriber information, including address and telephone number,
Drug Enforcement Administration (DEA) number (for authority to
prescribe scheduled 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 identification information and, if pertinent to dose
determination, the patient’s age, weight, and/or other parameters
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 authorization
Need for special labeling, such as expiration date, conditions for
storage, and foods and/or other medications not to take concomitantly
A listing of the ingredients and quantities for orders to be
compounded
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 to
some patients, particularly older patients and those taking multiple
medications, in understanding of the use of their medication.4 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 (Fig. 4.9).
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.
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