According to the International Monetary Systems (IMS) Health Report, 4 billion prescriptions were written and dispensed in the United States in 2011. This reflects a need for prescribers and dispensers to fully understand prescriptive privileges and rational prescribing.1 The following outlines principles of pharmacotherapy, including general considerations of prescribing, rational prescribing of medications, types of prescription orders, safe prescribing practices including the importance of handwriting, adverse event reporting, and medication education.
It is essential that the prescriber and dispenser familiarize themselves with the professional guidelines, state laws, and federal laws. In addition, they must also understand the components of rational prescribing. Table D–1 below provides key elements a prescriber should understand as well as useful resources.
Table D–1Pharmacotherapy Principles |Favorite Table|Download (.pdf) Table D–1Pharmacotherapy Principles
|Pharmacotherapy Principle ||Description ||Online Resources |
|Prescriptive privileges ||Dictated by federal and state law || |
| ||Scope of practice and formularies vary by profession. Physicians, nurse practitioners, physician assistants, and dentists all have varying scopes of practice, which may include formularies or supervising prescribers. Each provider must become familiar with his or her profession’s scope of practice. || |
| ||Pharmacology courses in program of study and Continuing Education required || |
| ||Prescribing legend drugs requires board examination and National Provider Identifier (NPI) ||https://nppes.cms.hhs.gov/NPPES/Welcome.do |
| ||Prescribing controlled substances requires DEA registration number ||http://www.dea.gov/index.shtml |
|Rational prescribing ||Ensure necessity of medication || |
| || |
Obtain pertinent history
Health history: comorbidities or contraindications (ie, pregnancy, hepatic failure, or renal failure)
Medication history: prior and current prescription, OTC, or herbal use; drug allergies or sensitivities; compliance issues
Family and social history
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Select correct medication
It is important to know the following components of each medication when prescribing or dispensing:
Interdisciplinary collaboration when necessary
TYPES OF PRESCRIPTION ORDERS
Prescription orders can be provided in a variety of ways by authorized prescribers. Outpatient prescriptions may be written, verbally authorized by phone, faxed, or provided via electronic means. All outpatient prescriptions are subject to federal regulations and contain the same basic components. Laws and regulations for outpatient prescription requirements can vary from state to state, so prescribers should be knowledgeable of all applicable laws. The basic components of a prescription are listed below as well as numbered in Figure D–1.2
Example of a prescription.
Prescriber information: name, address, and phone number
Prescriber’s signature and prescriptive authority number or Drug Enforcement Administration (DEA) number (if applicable)
Patient information: full name and address, and weight and age if appropriate
Date the prescription was written
Superscription (Rx symbol), meaning “you take” or “recipe”
Inscription: medication being prescribed (name of medication, strength, and dose)
Signa, sig, or signature: ...