Homoeopathic Prescription :
- Sumit Goel.
In prescribing, a homoeopathic physician first uses his knowledge of homoeopathic therapeutics to select the drug that is most suitable for the treatment of the patient. He then decides on the right potency, dose and mode of administration of the similimum. Prescribing must be based on an accurate diagnosis, but the importance of the whole process is lost, if at the end of the process, the physician is unable to summarize his requirements in the form of an intelligent prescription.
Dispensing is the part of clinical pharmacy in which the physician himself or the dispenser (compounder or the pharmacist) interprets the physician's requirement and delivers the medicine to the patient. The physician may do so himself or may give oral or written instructions to the dispenser, his compounder or a homoeopathic pharmacist.
A prescription is a written document (order) given by a physician to the dispenser for the preparation of the required medication as well as instructions about the mode of intake, for a particular patient, at a particular time.
'Prescription' is derived from the Latin word 'praescripto' (pre - before; scripto - write).
The physician may choose to dispense the medication himself, where he needs to record the details of the prescription in his case record. But when directions are given to the dispenser, it becomes a valuable document and must be properly written and preserved by the pharmacist, compounder or the patient after it has been served.
The prescription order is a part of the professional relationship between the prescriber, pharmacist and the patient. It is the pharmacist's responsibility in this relationship to provide the medication needs of the patient. Pharmacists should maintain the trust of the prescriber and the patient. This includes maintaining confidentiality. The medicine being taken by a patient and the nature of the illness is a private matter, which must be respected.
FORM OF THE PRESCRIPTION
Prescriptions are usually written on printed forms, usually in the form of a pad and imprinted with the name, address, telephone number, registration number and other relevant information.
A complete prescription must consist of the following information, in definite order.
1. Superscription - this includes
* Patient Information - Name of the patient, age, and sex with address The full name and address of the patient is necessary on the prescription for identification purposes. Names and addresses written illegibly should be clarified on acceptance of the prescription. The physician should always place it at the top of the prescription and the name of the patient should be transferred to the label by the compounder for identification purpose. In case of emergency, it is possible to identify or contact the patient with the help of the address. Names and addresses written illegibly should be clarified on acceptance of prescription.
The word 'For' is written before the name of the patient.
* The symbol 'Rx'
It has been stated that this sign was originally employed as the sign of Jupiter in the days when Medicine was thought to be under astrological influence. Gradual distortion through the years has led to the symbol currently used. It is now used as an abbreviation for the Latin word 'recipe' - 'receive'. Similarly French prescriptions have the superscription 'P' as an abbreviation of 'prenez'.
2. Inscription - this is the body of the prescription, which includes
* Name of the medicine, its potency and its quantity This is the actual treatment, decided by the physician, as the similimum for the disease at that point of time. The name of the remedy together with its potency in the desired scale is written in this part of the prescription in that order. The quantity of the medication as well its form is also noted.
* Nature and quantity of the various vehicles to be employed Name of the medicine with potency and its quantity should be written first and then the name and quantity of the vehicle is written.
3. Subscription - this includes
* Instructions and directions for the dispenser This part of the prescription contains the directions to the dispenser or pharmacist regarding the mode of preparation of the dosage form of the medication desired by the physician and dispensing of the medication with the vehicle.
4. Signature - this includes
* Directions to the patient
The prescriber indicates the directions for the patient's use of the medication in the portion of the prescription called the 'Signatura', abbreviated 'signa' and means 'mark thou'.
This should be short, simple, comprehensible and complete regarding
- How to take the medicine, route of administration and the time of intake of the medicine;
- When to report;
- Advice regarding diet and regimen to be followed;
- Any other instructions or caution to the patient.
These directions are to be transferred by the pharmacist onto the label of the container of dispensed medication.
* Signature of the physician with date and the registration number The signature of the physician with his registration number, from the official registration authority is essential as this makes the prescription valid and authentic.
Prescriptions are dated at the time they are written and also when they are received and filled in the pharmacy. The 'date' helps the pharmacist to find out cases where prescription is brought for dispensing, a long time after it is issued. The date is important in establishing record of the patient. A lapse of time should be questioned and determined whether the needs of the patient can still be met.
PRESCRIPTION GUIDELINES
* Prescriptions must always be written in a definite pattern, as detailed. Proper arrangement of the form of prescription is to be maintained for uniformity and standard, as it is universal.
* It should be legible and neatly written, so as to be easily interpreted.
* The information should be complete, accurate and unambiguous.
* The homoeopathic physician should avoid prescribing inimical homoeopathic medicines as also those medications that are not homoeopathic.
* Prescriptions may be written in simple form or in Latin.
The use of Latin words, phrases and abbreviations in prescriptions is a carryover from the time that Latin was considered the international language of medicine. Latin was used extensively in writing prescription orders until the early part of the 20th century. Although its use has gradually diminished, it is still widely used in the form of abbreviations in the subscription and signa portion of prescriptions.
There has been a simplification in the language of prescription writing. Nowadays prescriptions are frequently written in English. There are a number of Latin terms and phrases that have been traditionally used and which continue to find a place in prescription writing. The arguments for the continued use of Latin are
- Pharmacists in all countries understand it.
- Latin forms a healthy shorthand for the busy practitioner.
- It is argued that it is advisable, the patient should not learn the nature of remedies prescribed for him.
Hence the Latin names should be used for the directions to the dispenser. The dispenser must write the directions on the label either in English or in the local language. But, when in doubt, write in simple form.
HOSPITAL PRESCRIPTIONS
In hospitals too, the principles underlying dispensing of prescriptions for out-patients are essentially the same as those in routine dispensing. The main difference in the form of hospital prescriptions is that, generally the length of time and duration of the treatment is specified rather than the actual quantity of the medicine that is to be supplied.
For in-patients, supply of drugs in hospital has a different form of dispensing. Prescriptions for in-patients are written on the in-patient case-sheets under the follow-up record and on a sheet where the daily record of medicines administered to the patient is kept. This is called the 'Physician's Order Sheet'. This in turn is sent to the hospital pharmacy for dispensing.
PROCESSING THE PRESCRIPTION ORDER
A strict dispensing routine is essential to ensure safety, speed, neatness and efficiency. Proper procedures are reading and checking, numbering and dating, labeling, preparing, packaging, rechecking, delivering and counseling, recording, filing and pricing the prescriptions.
i. Reading and Checking the prescription
The prescription order should be first read completely and carefully. There should be no doubt as to the nature and quantity of the prescription. If something is illegible or confusing or if it appears that an error has been made, the concerned prescriber should be consulted. The dispenser should never attempt to guess. While dispensing, it is essential for the dispenser to take every precaution so as to eliminate mistakes in interpreting the prescription. It is the responsibility of the pharmacist to detect prescriptions that have been forged by the patient.
ii. Numbering and Dating
It is advisable to number and date the prescription order and to place the same on the label. This serves to identify the prescription for future reference.
iii. Labeling
A prescription should have an aesthetic and a professionally appearing label, the size of which should be in conformance with the size of the container. Prepare the labels for internal and external use properly and distinctly. A separate label should be made for each medication.
iv. Preparing the prescription
Adequate care and precautions should be taken by the dispenser in preparing the prescription, as per the physician's directions. Carry the prescription always, if it is necessary to go to a distant part of the dispensary. It serves as a constant reminder of the name and potency of the medicine and helps in avoiding mistakes. If the prescription involves weighing, the dispensing scales should be ready and clean before use. Replace all apparatus, ingredients and medicines in their proper positions after use.
v. Rechecking
Every prescription should be rechecked and verified. All details on the label should also be rechecked against the prescription order to verify the minutest details. Before the medications are handed over to the patient, check again that the correct preparation for the correct patient has been supplied and correct directions have been stated on the label.
vi. Delivering and Patient Counseling
When presenting the medication to the patient, the dispenser should draw attention to any auxiliary labeling instructions. It is advisable for the dispenser to reinforce the directions to the patient, while dispensing the medication, as the patient may be uncertain or confused as to the proper method of use. Written directions outlining the proper use of the prescribed medication may be given. These directions frequently include the best time and manner to take the medicine, importance of adhering to the prescribed dosage schedule, permitted use of food, drink and other medicines with respect to the medication.
vii. Recording and Filing
A proper record and filing of the prescription is to be carried out for records, reference and research.
viii. Pricing and Receipt preparation The prescription is ultimately priced and receipt delivered to complete the processing of the prescription
GUIDELINES FOR A GOOD PRESCRIPTION AND PATIENT COMPLIANCE
In order to gain maximum benefit from the prescription, there has to be an effective communication amongst the prescriber, dispensing pharmacist and the patient. The instructions and directions for drug use, which prescribers indicate on prescription orders and which dispensing pharmacists transfer to prescription labels are important for effective cure.
For effective patient compliance, the following guidelines may be followed.
Guidelines for Prescribers
* Name and strength of the dispensed medication should be recorded on the prescription label unless otherwise directed by the prescriber.
* Whenever possible, specific times of the day for drug administration should be indicated.
* Use of potentially confusing abbreviations should be discouraged.
* Vague instructions that are confusing to patient are to be avoided.
* Metric system of weights should be used.
Guidelines for the Dispensing Pharmacist
* When a prescription is presented for dispensing, it should be received by the pharmacist without any discussion or comment over it regarding the merits and demerits of its therapeutic efficiency. The pharmacist should not even show any expression of alarm or astonishment, as such things may cause anxiety in the patient.
* It is not within the privilege of a pharmacist to add, omit or substitute the composition and nature of the prescription without the consent of the prescriber
* Pharmacists should indicate the following information on the prescription label: name, address, telephone number of the pharmacy, name of prescriber, strength and quantity of the dispensed medication (unless otherwise directed by the physician), directions for use, prescription number, date on which the prescription is dispensed, full name of the patient or any other information as felt necessary.
* Instructions to patient regarding directions for use of medication should be concise, precise and easily understandable by the patient.
* Directions for storage of the dispensed medication should also be mentioned.
ABBREVIATIONS USED IN PRESCRIPTION WRITING Refer Appendix B
SAMPLE PRESCRIPTION
001
For, Mrs. Sherry Dastur
Age - 35 yrs
Dastur Villa, Carter Rd., Mumbai h (superscription)
Merc sol 200, 2 drops Distilled water 30 ml (inscription)
Mix and stir well.
Put six marks. (subscription)
To be taken every two hours, on empty Stomach. Stop when improvement starts.
Have a liquid diet.
Report tomorrow.
Dr. ABCD, B.H.M.S.(Bom)
Reg no. 000
Dt - Jan 4, 2000
(signature)
SELF ASSESSMENT
* What is a Prescription? Describe the parts of a prescription.
QUIZ
1. A complete prescription consists, in definite order
(a) Superscription, subscription, inscription, signature
(b) Superscription, inscription, signature, subscription
(c) Superscription, inscription, subscription, signature
(d) Superscription, subscription, signature, inscription
2. Directions to the dispenser regarding the mode of preparation of the dosage form is included in
(a) Superscription
(b) Subscription
(c) Inscription
(d) Signature
3. The abbreviation b.i.d. signifies
(a) Twice in a day
(b) Every two hours
(c) At bed time
(d) Alternate day
4. 'Immediately' is represented as
(a) s.o.s.
(b) stat
(c) ante
(d) h.s.
5. Name of the medicine, its potency and its quantity is included in
(a) Signature
(b) Subscription
(c) Superscription
(d) Inscription
ANSWERS: 1 (c); 2 (b); 3 (a); 4 (b); 5 (d).
In prescribing, a homoeopathic physician first uses his knowledge of homoeopathic therapeutics to select the drug that is most suitable for the treatment of the patient. He then decides on the right potency, dose and mode of administration of the similimum. Prescribing must be based on an accurate diagnosis, but the importance of the whole process is lost, if at the end of the process, the physician is unable to summarize his requirements in the form of an intelligent prescription.
Dispensing is the part of clinical pharmacy in which the physician himself or the dispenser (compounder or the pharmacist) interprets the physician's requirement and delivers the medicine to the patient. The physician may do so himself or may give oral or written instructions to the dispenser, his compounder or a homoeopathic pharmacist.
A prescription is a written document (order) given by a physician to the dispenser for the preparation of the required medication as well as instructions about the mode of intake, for a particular patient, at a particular time.
'Prescription' is derived from the Latin word 'praescripto' (pre - before; scripto - write).
The physician may choose to dispense the medication himself, where he needs to record the details of the prescription in his case record. But when directions are given to the dispenser, it becomes a valuable document and must be properly written and preserved by the pharmacist, compounder or the patient after it has been served.
The prescription order is a part of the professional relationship between the prescriber, pharmacist and the patient. It is the pharmacist's responsibility in this relationship to provide the medication needs of the patient. Pharmacists should maintain the trust of the prescriber and the patient. This includes maintaining confidentiality. The medicine being taken by a patient and the nature of the illness is a private matter, which must be respected.
FORM OF THE PRESCRIPTION
Prescriptions are usually written on printed forms, usually in the form of a pad and imprinted with the name, address, telephone number, registration number and other relevant information.
A complete prescription must consist of the following information, in definite order.
1. Superscription - this includes
* Patient Information - Name of the patient, age, and sex with address The full name and address of the patient is necessary on the prescription for identification purposes. Names and addresses written illegibly should be clarified on acceptance of the prescription. The physician should always place it at the top of the prescription and the name of the patient should be transferred to the label by the compounder for identification purpose. In case of emergency, it is possible to identify or contact the patient with the help of the address. Names and addresses written illegibly should be clarified on acceptance of prescription.
The word 'For' is written before the name of the patient.
* The symbol 'Rx'
It has been stated that this sign was originally employed as the sign of Jupiter in the days when Medicine was thought to be under astrological influence. Gradual distortion through the years has led to the symbol currently used. It is now used as an abbreviation for the Latin word 'recipe' - 'receive'. Similarly French prescriptions have the superscription 'P' as an abbreviation of 'prenez'.
2. Inscription - this is the body of the prescription, which includes
* Name of the medicine, its potency and its quantity This is the actual treatment, decided by the physician, as the similimum for the disease at that point of time. The name of the remedy together with its potency in the desired scale is written in this part of the prescription in that order. The quantity of the medication as well its form is also noted.
* Nature and quantity of the various vehicles to be employed Name of the medicine with potency and its quantity should be written first and then the name and quantity of the vehicle is written.
3. Subscription - this includes
* Instructions and directions for the dispenser This part of the prescription contains the directions to the dispenser or pharmacist regarding the mode of preparation of the dosage form of the medication desired by the physician and dispensing of the medication with the vehicle.
4. Signature - this includes
* Directions to the patient
The prescriber indicates the directions for the patient's use of the medication in the portion of the prescription called the 'Signatura', abbreviated 'signa' and means 'mark thou'.
This should be short, simple, comprehensible and complete regarding
- How to take the medicine, route of administration and the time of intake of the medicine;
- When to report;
- Advice regarding diet and regimen to be followed;
- Any other instructions or caution to the patient.
These directions are to be transferred by the pharmacist onto the label of the container of dispensed medication.
* Signature of the physician with date and the registration number The signature of the physician with his registration number, from the official registration authority is essential as this makes the prescription valid and authentic.
Prescriptions are dated at the time they are written and also when they are received and filled in the pharmacy. The 'date' helps the pharmacist to find out cases where prescription is brought for dispensing, a long time after it is issued. The date is important in establishing record of the patient. A lapse of time should be questioned and determined whether the needs of the patient can still be met.
PRESCRIPTION GUIDELINES
* Prescriptions must always be written in a definite pattern, as detailed. Proper arrangement of the form of prescription is to be maintained for uniformity and standard, as it is universal.
* It should be legible and neatly written, so as to be easily interpreted.
* The information should be complete, accurate and unambiguous.
* The homoeopathic physician should avoid prescribing inimical homoeopathic medicines as also those medications that are not homoeopathic.
* Prescriptions may be written in simple form or in Latin.
The use of Latin words, phrases and abbreviations in prescriptions is a carryover from the time that Latin was considered the international language of medicine. Latin was used extensively in writing prescription orders until the early part of the 20th century. Although its use has gradually diminished, it is still widely used in the form of abbreviations in the subscription and signa portion of prescriptions.
There has been a simplification in the language of prescription writing. Nowadays prescriptions are frequently written in English. There are a number of Latin terms and phrases that have been traditionally used and which continue to find a place in prescription writing. The arguments for the continued use of Latin are
- Pharmacists in all countries understand it.
- Latin forms a healthy shorthand for the busy practitioner.
- It is argued that it is advisable, the patient should not learn the nature of remedies prescribed for him.
Hence the Latin names should be used for the directions to the dispenser. The dispenser must write the directions on the label either in English or in the local language. But, when in doubt, write in simple form.
HOSPITAL PRESCRIPTIONS
In hospitals too, the principles underlying dispensing of prescriptions for out-patients are essentially the same as those in routine dispensing. The main difference in the form of hospital prescriptions is that, generally the length of time and duration of the treatment is specified rather than the actual quantity of the medicine that is to be supplied.
For in-patients, supply of drugs in hospital has a different form of dispensing. Prescriptions for in-patients are written on the in-patient case-sheets under the follow-up record and on a sheet where the daily record of medicines administered to the patient is kept. This is called the 'Physician's Order Sheet'. This in turn is sent to the hospital pharmacy for dispensing.
PROCESSING THE PRESCRIPTION ORDER
A strict dispensing routine is essential to ensure safety, speed, neatness and efficiency. Proper procedures are reading and checking, numbering and dating, labeling, preparing, packaging, rechecking, delivering and counseling, recording, filing and pricing the prescriptions.
i. Reading and Checking the prescription
The prescription order should be first read completely and carefully. There should be no doubt as to the nature and quantity of the prescription. If something is illegible or confusing or if it appears that an error has been made, the concerned prescriber should be consulted. The dispenser should never attempt to guess. While dispensing, it is essential for the dispenser to take every precaution so as to eliminate mistakes in interpreting the prescription. It is the responsibility of the pharmacist to detect prescriptions that have been forged by the patient.
ii. Numbering and Dating
It is advisable to number and date the prescription order and to place the same on the label. This serves to identify the prescription for future reference.
iii. Labeling
A prescription should have an aesthetic and a professionally appearing label, the size of which should be in conformance with the size of the container. Prepare the labels for internal and external use properly and distinctly. A separate label should be made for each medication.
iv. Preparing the prescription
Adequate care and precautions should be taken by the dispenser in preparing the prescription, as per the physician's directions. Carry the prescription always, if it is necessary to go to a distant part of the dispensary. It serves as a constant reminder of the name and potency of the medicine and helps in avoiding mistakes. If the prescription involves weighing, the dispensing scales should be ready and clean before use. Replace all apparatus, ingredients and medicines in their proper positions after use.
v. Rechecking
Every prescription should be rechecked and verified. All details on the label should also be rechecked against the prescription order to verify the minutest details. Before the medications are handed over to the patient, check again that the correct preparation for the correct patient has been supplied and correct directions have been stated on the label.
vi. Delivering and Patient Counseling
When presenting the medication to the patient, the dispenser should draw attention to any auxiliary labeling instructions. It is advisable for the dispenser to reinforce the directions to the patient, while dispensing the medication, as the patient may be uncertain or confused as to the proper method of use. Written directions outlining the proper use of the prescribed medication may be given. These directions frequently include the best time and manner to take the medicine, importance of adhering to the prescribed dosage schedule, permitted use of food, drink and other medicines with respect to the medication.
vii. Recording and Filing
A proper record and filing of the prescription is to be carried out for records, reference and research.
viii. Pricing and Receipt preparation The prescription is ultimately priced and receipt delivered to complete the processing of the prescription
GUIDELINES FOR A GOOD PRESCRIPTION AND PATIENT COMPLIANCE
In order to gain maximum benefit from the prescription, there has to be an effective communication amongst the prescriber, dispensing pharmacist and the patient. The instructions and directions for drug use, which prescribers indicate on prescription orders and which dispensing pharmacists transfer to prescription labels are important for effective cure.
For effective patient compliance, the following guidelines may be followed.
Guidelines for Prescribers
* Name and strength of the dispensed medication should be recorded on the prescription label unless otherwise directed by the prescriber.
* Whenever possible, specific times of the day for drug administration should be indicated.
* Use of potentially confusing abbreviations should be discouraged.
* Vague instructions that are confusing to patient are to be avoided.
* Metric system of weights should be used.
Guidelines for the Dispensing Pharmacist
* When a prescription is presented for dispensing, it should be received by the pharmacist without any discussion or comment over it regarding the merits and demerits of its therapeutic efficiency. The pharmacist should not even show any expression of alarm or astonishment, as such things may cause anxiety in the patient.
* It is not within the privilege of a pharmacist to add, omit or substitute the composition and nature of the prescription without the consent of the prescriber
* Pharmacists should indicate the following information on the prescription label: name, address, telephone number of the pharmacy, name of prescriber, strength and quantity of the dispensed medication (unless otherwise directed by the physician), directions for use, prescription number, date on which the prescription is dispensed, full name of the patient or any other information as felt necessary.
* Instructions to patient regarding directions for use of medication should be concise, precise and easily understandable by the patient.
* Directions for storage of the dispensed medication should also be mentioned.
ABBREVIATIONS USED IN PRESCRIPTION WRITING Refer Appendix B
SAMPLE PRESCRIPTION
001
For, Mrs. Sherry Dastur
Age - 35 yrs
Dastur Villa, Carter Rd., Mumbai h (superscription)
Merc sol 200, 2 drops Distilled water 30 ml (inscription)
Mix and stir well.
Put six marks. (subscription)
To be taken every two hours, on empty Stomach. Stop when improvement starts.
Have a liquid diet.
Report tomorrow.
Dr. ABCD, B.H.M.S.(Bom)
Reg no. 000
Dt - Jan 4, 2000
(signature)
SELF ASSESSMENT
* What is a Prescription? Describe the parts of a prescription.
QUIZ
1. A complete prescription consists, in definite order
(a) Superscription, subscription, inscription, signature
(b) Superscription, inscription, signature, subscription
(c) Superscription, inscription, subscription, signature
(d) Superscription, subscription, signature, inscription
2. Directions to the dispenser regarding the mode of preparation of the dosage form is included in
(a) Superscription
(b) Subscription
(c) Inscription
(d) Signature
3. The abbreviation b.i.d. signifies
(a) Twice in a day
(b) Every two hours
(c) At bed time
(d) Alternate day
4. 'Immediately' is represented as
(a) s.o.s.
(b) stat
(c) ante
(d) h.s.
5. Name of the medicine, its potency and its quantity is included in
(a) Signature
(b) Subscription
(c) Superscription
(d) Inscription
ANSWERS: 1 (c); 2 (b); 3 (a); 4 (b); 5 (d).
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