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Appendix A: Prescription Writing Principles

Kim Hawkins; Jill Isaacs; Emily Knezevich; Jon Knezevich

Approximately 4 billion prescriptions are written and dispensed in the United States annually, with 80% of those prescribed digitally.1 This reflects a need for prescribers and dispensers to fully understand prescriptive privileges and rational prescribing.2 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 and electronic prescribing, adverse event reporting, and medication education.

It is essential that the prescriber and dispenser familiarize themselves with professional guidelines, state laws, and federal laws. In addition, they must understand the components of rational prescribing. Table A–1 provides key elements a prescriber should understand as well as useful resources.

Table A–1Pharmacotherapy Principles
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Table A–1 Pharmacotherapy 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.justice.gov/dea/
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

  
 

Select correct medication

  • It is important to know the following components of each medication when prescribing or dispensing:

    • Pharmacokinetics

    • Pharmacodynamics

    • Drug interactions

    • Drug–disease interactions

    • Interdisciplinary collaboration when necessary

 http://www.jointcommission.org/

DEA, Drug Enforcement Administration; OTC, over the counter.

TYPES OF PRESCRIPTION ORDERS

Prescription orders can be provided in a variety of ways by authorized prescribers. Outpatient prescriptions may be generated in a format that is handed to the patient directly. For example, prescriptions can be handwritten, typed, or computer generated and printed. A verbal format could also be used, making the prescription available for retrieval at the pharmacy without a physical prescription in hand. This can be accomplished by verbally authorizing the prescription with a phone call to the pharmacy staff or leaving a message on the pharmacy voicemail, which must be immediately reduced to written format when received. A fax could also be used to generate the prescription. Most commonly, the prescription can be provided electronically through e-prescribing. This allows the prescription to be communicated directly from the provider’s electronic medical record to the pharmacy’s database for dispensing. 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 ...

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