Recipe. Basic prescription rules

Plan:
What is the prescription?;
Parts of prescription;
Rules of prescription in Kazakhstan;
Examples of recipe of drugs;
Conclusion;
Literature.

A prescription is an instruction from a prescriber to a dispenser. The prescriber is not always a doctor but can also be a paramedical worker, such as a medical assistant, a midwife or a nurse. The dispenser is not always a pharmacist, but can be a pharmacy technician, an assistant or a nurse.

Every country has its own standards for the minimum information required for a prescription, and its own laws and regulations to define which drugs require a prescription and who is entitled to write it. Many countries have separate regulations for opiate prescriptions.
The most important requirement is that the prescription be clear.

It should be legible and indicate precisely what should be given. Few prescriptions are still written in Latin; the local language is preferred. If you include the following information, not much can go wrong.

Parts of prescriptions

Name and address of the prescriber, with telephone number (if possible)
This is usually pre-printed on the form. If the pharmacist has any questions about the prescription (s)he can easily contact the prescriber.

Date of the prescription
In many countries the validity of a prescription has no time limit, but in some countries pharmacists do not give out drugs on prescriptions older than three to six months.

Name and strength of the drug
R/(not Rx) is derived from Recipe (Latin for ‘take’). After R/you should write the name of the drug and the strength. It is strongly recommended to use the generic (nonproprietary) name. This facilitates education and information. It means that you do not express an opinion about a particular brand of the drug, which may be unnecessarily expensive for the patient.

The strength of the drug indicates how many milligrams each tablet, suppository, or milliliter of fluid should contain. Internationally accepted abbreviations should be used: g for gram, ml for milliliter. Try to avoid decimals and, where necessary, write words in full to avoid misunderstanding. For example, write levothyroxin 50 micrograms, not 0.050 milligrams or 50 ug.

Legal obligation to write clearly
Doctors are legally obliged to write clearly, as emphasized in the UK Court of Appeal ruling in the following case. A doctor had written a prescription for Amoxil tablets (amoxicillin). The pharmacist misread this and dispensed Daonil (glibenclamide) instead. The patient was not a diabetic and suffered permanent brain damage as a result of taking the drug.

Dosage form and total amount
Only use standard abbreviations that will be known to the pharmacist.

Information for the package label
S stands for Signa (Latin for ‘write’). All information following the S or the word ‘Label’ should be copied by the pharmacist onto the label of the package. This includes how much of the drug is to be taken, how often, and any specific instructions and warnings. These should be given in lay language.

Do not use abbreviations or statements like ‘as before’ or ‘as directed’. When stating ‘as required’, the maximum dose and minimum dose interval should be indicated. Certain instructions for the pharmacist, such as ‘Add 5 ml measuring spoon’ are written here, but of course are not copied onto the label.

Incomplete labels
The label on the drug package is very important for the patient as a reminder of the instructions for use. In many cases, however, labels are incomplete. An analysis of 1533 (=100%) labels showed:
No label or illegible 1 %
Quantity not recorded 50 %
No directions, or only ‘as before’/’as directed’ 26 %
No date 14 %

The data listed above are the core of every prescription. Additional information may be added, such as the type of health insurance the patient has. The layout of the prescription form and the period of validity may vary between countries. The number of drugs per prescription may be restricted.

These Rules for prescribing, recording and storing prescriptions are developed in accordance with paragraph 5 of article 69 of the Code of the Republic of Kazakhstan dated September 18, 2009 "On the health of the people and the health system" and determine the procedure for writing, recording and storing prescriptions.

2. Prescriptions are issued in paper and (or) electronic form by medical workers of health care organizations that provide outpatient, preventive, diagnostic, therapeutic, rehabilitation or palliative care
3. Prescriptions in paper form are certified by the signature of the medical professional who wrote the prescription. Prescriptions in electronic form are confirmed by an electronic digital signature of the medical professional who wrote the prescription.

6. Prescriptions for medicines that are not registered or approved for use in the Republic of Kazakhstan are not issued.
8. The content and number of the prescription for free or preferential receipt of medicines are reflected in the patient's outpatient card.

12. When prescribing a drug in a dose that exceeds the highest single dose, the doctor in the prescription indicates the dose of the drug in words and an exclamation mark.
16. Prescriptions for medicines specified in paragraph 11 of these Rules are valid for 10 calendar days from the date of their issuance.

Examples:

Woman, 70 years. Moderate congestive cardiac failure. For several years on digoxin 0.25 mg 1 tablet daily. She phones to ask for a repeat prescription. As you have not seen her for some time you ask her to call. During the visit she complains of slight nausea and loss of appetite. No vomiting or diarrhoea. You suspect side effects of digoxin, and call her cardiologist. As she has an appointment with him next week, and he is very busy, he advises you to halve the dose until then.

Man, 53 years. Terminal stage of pancreatic cancer, confined to bed at home. You visit him once a week. Today his wife calls and asks you to come earlier because he is in considerable pain. You go immediately. He has slept badly over the weekend and regular painkillers are not working. Together you decide to try morphine for a week. Making sure not to underdose him, you start with 10 mg every six hours, with 20 mg at night. He also has non-insulin dependent diabetes, so you add a refill for his tolbutamide.

Conclusion:
A prescription drug is a pharmaceutical drug that legally requires a medical prescription to be dispensed.
A prescription should include:
* Name, address, telephone of prescriber
* Date
* Generic name of the drug, strength
* Dosage form, total amount
* Label: instructions, warnings
* Name, address, age of patient
* Signature or initials of prescriber

Literatures:
https://apps.who.int/medicinedocs/en/d/Jwhozip23e/5.4.html
https://tengrinews.kz/zakon/pravitelstvo_respubliki_kazahstan_premer_ministr_rk/zdravoohranenie/id-V1500011465/
https://patient.info/doctor/general-prescribing-guidance
https://en.wikipedia.org/wiki/Prescription_drug