Talk:Medical prescription

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Contents

Definition of Prescriptions

The definition of prescription is taken from the referenced article. —Preceding unsigned comment added by Sbelknap (talk • contribs) 01:24, 12 September 2008 (UTC)

Self-prescribed medication?

Don't know if this is relevant enough to include in the article, but I was wondering if an MD can write a prescription for his or herself. Are there any limitations as to what can be self-prescribed?

My Jurisdiction (New Zealand), makes it clear that although legal, this is unwise and may produce questions about a doctor's practice. The medical council (regulatory body) has a policy that strongly discourages Doctors from prescribing for themselves and their families, and points out that if they do, then their care must be of the same standard as care of any other patient in terms of keeping notes, appropriate knowledge and experience etc. Egmason 20:46, 3 January 2007 (UTC)

The paper vs the drugs & regions

I removed the following section from this article because the article is about the piece of paper that is the prescription, not about the prescription drugs themselves. Prescription drugs is a much larger subject. Samw 03:27, 8 May 2004 (UTC)

==National Health Service Prescriptions==
In England a patient visits a doctor (usually a General practitioner in the first instance) who is able to prescribe medicines. Each item on the prescription is liable to a prescription charge of £6.40 (as of April 2004). Those requiring regular prescriptions may make a saving by purchasing a pre-payment certificate which covers the cost of all prescriptions required for four months (at a cost of £33.40) or the year (at a cost of £91.80).
The money is used to help fund the National Health Service.
The devolved legislatures of Scotland and Wales were examining, in 2004, proposals to scrap the charge and provide free prescriptions for all.


I disagree with your move of the content I added to prescription to prescription drug. It mentions no drugs in particular. It is more about charging. How can we resolve this amicably? Assuming you still feel you were right to move it, who should we ask to decide? I do not feel particularly passionate about this. But I know that, as a British national, if I were looking for more information on my prescription I would look under the article of that name, not prescription drug. --bodnotbod 12:20, May 8, 2004 (UTC)

The issue is that "prescription" can mean different things: the piece of paper, the drugs themselves or the whole system of controlling drugs. I don't have a strong opinion either on whether to include this material. I moved it because the "medical prescription" article itself is already quite long. Perhaps "medical prescription" itself could be a index/disambiguation page that links to "medical prescription - the document" for the current contents; "prescription drugs" and "prescription practices" for your material? If we're looking for a second opinion, Kpjas contributed to the original article. Samw 15:07, 8 May 2004 (UTC)
Cheers. I've asked him to take a look. I take your point. I would be tempted to start a third article if another nationality wades in with material along my lines about their country. At the moment it seems a bit overkill to have 3 articles. Let's see what Kpjas says. --bodnotbod 15:22, May 8, 2004 (UTC)

People I really don't feel entitled to be a judge in your debate. I think you have done a good job and this helpful information stays within Wikipedia. That's a good thing. My comment: it would be fine to include and compare prescription systems and regulations in other countries (healthcare systems).

The matter where the information is going to be placed seems to me relatively unimportant.

Best wishes,
Kpjas 08:36, 9 May 2004 (UTC)

Oh well... I leave it as it is, mainly because I'm very tired right now  ;o) If somebody else comes along who feels it should be changed, they'll go ahead and do it I guess. --bodnotbod 14:06, May 9, 2004 (UTC)

Origination of Rx?

So where did this term come from, and what is its literal meaning? Thanks.

See the second paragraph under format and definition; there are several explanations. I'm not aware of a definitive answer. Samw 00:49, 5 Jan 2005 (UTC)

mg/ug mixup

For the mixup between microgram and milligram, I couldn't find a reference for "unbelievably, deaths have resulted from pharmacists blindly following such a misreading". If you have a reference, I would love to put such a dramatic statement back in. Samw 02:15, 16 Mar 2005 (UTC)

Here's a few references. I have a bit of a flu, and was about to go sleep, but feel free to add them to the article or I will tomorrow. [1] [2]. I couldn't find a specific cite for deaths resulting from that error, but [3] refers to medical error as a leading cause of death (though presumably fairly little of that is due to perscription misreading). I guess there's no really sold proof, sorry. Feel free to leave the remark out, or tone it down to "this is likely to cause potentially fatal misunderstandings..." Pakaran 02:56, 16 Mar 2005 (UTC)
Added compromise commentary back in Samw 14:06, 16 Mar 2005 (UTC)

The sentence "The symbol "Rx" meaning "prescription" is a transliteration of a symbol resembling a capital R with a cross on the diagonal (℞)." doesn't make any sense to me. The last symbol looks like an upside-down square U. It is not a diagonal. What is it supposed to be? 71.32.109.22 21:51, 6 April 2007 (UTC)

how would you write rx for 90 percocet at 1 to 2 tablets per every 6 10 hrs as needed for pain

Percocet 1-2 tab every 6-10hrs prn for pain, mitte90
The words 'every' & 'for' are perhaps redundant, 'mitte' is often abbreviated to just 'm' or just enclosing the quantity within a circle, and sometimes the number of tablets ('tab') is abbreviated to a series of 'T' (latter abbreviation is discouraged as easy to cause confusion). Hence Rx can be abbreviated to:
Percocet T-TT 6-10hrs prn pain (90) - David Ruben Talk 03:22, 19 February 2006 (UTC)

Lot's of good stuff to think about in this prescription. I bet most pharmacists would fill it as written and most patients would use it more or less as intended. Still, I would take a different route:

  1. As David says, the old fashioned lower case Roman numerals (above represented by "T-TT") are a source of confusion and are now dis-preferred in favor of Arabic numerals.
  2. Percocet is a brand name for a generic combination of acetaminophen and oxycodone. For philosophical and cost-containment reasons, I avoid brand names.
  3. This drug comes in multiple strengths, so the above scripts could not be filled without a call back from the pharmacist.
  4. Abbreviations are a major source of confusion, so I avoid "prn" and "po" and especially "qd."
  5. The route is a required element in all prescriptions, although the pharmacist will often deduce it from the preparation.
  6. Ranges on frequency (6-10 hours) are confusing as they imply that the patient should take at least 1 every 10 hours. "As needed" covers the idea well enough.
  7. Refills should always be specified even if none are desired or allowed by law.
  8. "mitte" is not a phrase I've seen. Is it German?

I would write:

acetaminophen 325 mg / oxycodone 10 mg
1-2 tabs by mouth every 6 hours as needed for pain
dispense 90
no refills

Finally, have we just helped some criminal falsify a prescription for a controlled substance? Ben 02:21, 7 April 2007 (UTC)

  • My thoughts precisely. --Younmm23 17:12, 30 October 2007 (UTC)

NPO

Are there any Latin experts out there? What does "NPO" stand for? I've seen:

  • nil per os
  • non per os
  • nihil per orem
  • nil per oris
  • nulla per os

All translate to English as "nothing by mouth" but it would be good to get the Latin right. Thanks! Samw 15:40, 8 October 2005 (UTC)

But irrelevant to article on prescribing, as not taking anything by mout does not form part of any prescribing instruction abbreviation (but will of course be an abbreviation in teh medical record, sign placed above patient's bed etc). David Ruben Talk 12:10, 15 April 2006 (UTC)
nil per os, per os Tkjazzer 14:23, 31 July 2007 (UTC)
why isn't NPO listed? Tkjazzer 14:54, 31 July 2007 (UTC)

re List Abbreviations

This article is about prescriptions, yet the list abbreviations includes terms never found on a prescription (at least none I have ever seen) but rather in the medical notes. Examples are CHF,GI,GU,NKA,SOB,URI,UTI,VS,WBC. Would these be better moved to a new article on medical abbreviations ? David Ruben Talk 03:33, 19 February 2006 (UTC)

That this article has pretensions to a complete list of prescription abbreviations is ludicrous. I have in front of me a 470-page book of such abbreviations that does not claim to be complete. - Montréalais 06:32, 15 April 2006 (UTC)
Agreed. It's absurd to call that a complete list. It's also extremely arrogant and American-centric. Sarah Ewart (Talk) 06:54, 15 April 2006 (UTC)

Can't this material be merged with the existing article List of medical abbreviations? Ben 15:32, 8 April 2007 (UTC)

It's my understanding that abbreviations on prescriptions are a subset and possibly different than those on general medical reports. Note also that section has been cleaned up since the discussion from a year ago. Samw 00:17, 9 April 2007 (UTC)

Legal Regulation "Exhibits"

These sections should I believe be deleted, although being bold resulted in a revertion. My reasons in increasing importance are:

  • This is a worldwide encyclopaedia, not just US-centric. This is obviously not an absolute contraindication for including a specific item, but it is worth remembering to try to keep aricles "balanced"
  • Choice of the word "Exhibit" is troubling - wikipedia is not a legal court for protagonists to present their "exhibits" of evidence. Instead wikipedia may present a few choice examples to illustrate points being made.
  • With only 5 exhibits given, it is hardly applicable to even most Americans; i.e. those that live in the other 45 states.
  • However the main problems are that it is just awful encyclopedia making:
    • It is incomprehensible (to the majority) legal-speak & listing of regulation rules, rather than this a general encyclopaedia's summarisation of knowledge. So if the purpose of these "Exhibits" is to add to the article specific information, then I think this should be done by a clear summary in general English. As an example of how other articles do this, see Murder#The United States which gives a clear explanation.
    • Verification & Citing - if however the "exhibits" are being provided more as material to which discussion in the main article may refer to, in order to verify (as this revert comment suggests), then wikipedia need not reproduce the material but rather merely provide citation details within a footnote. David Ruben Talk 13:36, 15 April 2006 (UTC)

As an example of this, Exhibit C is referred to in the text as an example of regulation setting out "... the size of the piece of paper - see Exhibit C paragraph 10" and also "... security measures may be mandated by law - see Exhibit C for sample legal specifications". Yet Exhibit C section starts, as they all do, with a reference for its own source [4] (this link nolonger seems to exist, after quick search refound as this one). So why not in the text have used:

"... the size of the piece of paper.[1]"
"... security measures may be mandated by law.[1]"

and then in a Footnotes & References section have included the desired citation details:

1 Indiana State Board of Pharmacy. "Rule 34. Security Features for Prescriptions". Indiana Professional Licensing Agency.

David Ruben Talk 14:25, 15 April 2006 (UTC)

Sorry Didn't mean to be rude; I thought you were done with the deletions and left the article in an inconsistent state. Reverting seemed the quickest fix. Yes, I'm fine with any reasonable changes. When I added these exhibits 3 years ago there were no established conventions for references and certainly none of the templates in Wikipedia today. These examples were readily available on the net at the time; if a more representative, international selection is available now, by all means use them. On the topic of descriptions versus examples, I'm a big fan of examples, especially real-life examples. Descriptions are needed to make the explanation generically applicable, but there's nothing like specifics. Finally, I'm not an American, never lived in the US and am not in the medical professional. That said, I don't think articles should be "dumbed down" for a general audience. I do agree progressive disclosure should apply to make the article as accessible as possible. Wikipedia has articles on the most obscure technical subjects (c.f. voigt notation) and there's no reason why this article (or a refactored article) can't covered legal details of prescriptions in gory detail. Samw 15:54, 15 April 2006 (UTC)
  • Thanks for comments, yes I think I too may have acted similarly if positions reversed :-) Certainly don't intend for "dumbing down" - I'm discussing issues of encyclopedia layout and certainly not of article/subject description, which I think is good in this article. All of description re features that get specified (form size, security measures, prescription information, patient details, pharmacist handling) should be included. It is just that having described a particular feature, the example given (as required by WP:Cite and WP:Verify) can be provided now by linking to a footnote that cites a source and provides a relevant web link (as is possible for all 5 'Exhibits'). I appreciate the problems prior to footnotes, external links and citation templates being introduced into wikipedia - must have made citing sources very hard to have to find, select & copy appropriate segments and markup accordingly :-) David Ruben Talk 03:16, 16 April 2006 (UTC)
I, too, dislike the word "Exhibit" being used in this context. And I agree it would be far better dealt with as footnotes rather than copy and pasting in the actual text.
Above comment posted by User:Sarah Ewart 03:01, 16 April 2006
Yes, I know it's policy to sign talk page comments and I'm pretty sure that's the first time I've ever forgotten to do it. Sorry. Sarah Ewart (Talk) 03:00, 16 April 2006 (UTC)


I've removed the "legal exhibits". This is not the right way to present this information. I'll paste them below in case anyone wants to use specific details to add encyclopedic information back to the article. WhatamIdoing (talk) 21:47, 3 August 2008 (UTC)

Aargh, I didn't notice what a message that makes of the article, which refers to these exhibits repeatedly. Ick. WhatamIdoing (talk) 05:30, 4 August 2008 (UTC)

Removed material

Exhibit A: sample legal definition of a prescription

Taken from California's Business and Professions Code Section 4040 [5]:

4040. (a) "Prescription" means an oral, written, or electronic transmission order that is both of the following:
(1) Given individually for the person or persons for whom ordered that includes all of the following:
(A) The name or names and address of the patient or patients.
(B) The name and quantity of the drug or device prescribed and the directions for use.
(C) The date of issue.
(D) Either rubber stamped, typed, or printed by hand or typeset, the name, address, and telephone number of the prescriber, his or her license classification, and his or her federal registry number, if a controlled substance is prescribed.
(E) A legible, clear notice of the condition for which the drug is being prescribed, if requested by the patient or patients.
(F) If in writing, signed by the prescriber issuing the order, or the certified nurse-midwife, nurse practitioner, or physician assistant who issues a drug order pursuant to Section 2746.51,2836.1, or 3502.1.
(2) Issued by a precribing medical practitioner if a drug order is issued pursuant to Section 2746.51, 2836.1, or 3502.1.
(b) Notwithstanding subdivision (a), a written order of the prescriber for a dangerous drug, except for any Schedule II controlled substance, that contains at least the name and signature of the prescriber, the name and address of the patient in a manner consistent with paragraph (3) of subdivision (b) of Section 11164 of the Health and Safety Code, the name and quantity of the drug prescribed, directions for use, and the date of issue may be treated as a prescription by the dispensing pharmacist as long as any additional information required by subdivision (a) is readily retrievable in the pharmacy. In the event of a conflict between this subdivision and Section 11164 of the Health and Safety Code, Section 11164 of the Health and Safety Code shall prevail.
(c) "Electronic transmission prescription" includes both image and data prescriptions. "Electronic image transmission prescription" means any prescription order for which a facsimile of the order is received by a pharmacy from a licensed prescriber. "Electronic data transmission prescription" means any prescription order, other than an electronic image transmission prescription, that is electronically transmitted from a licensed prescriber to a pharmacy.
(d) The use of commonly used abbreviations shall not invalidate an otherwise valid prescription.
(e) Nothing in the amendments made to this section (formerly Section 4036) at the 1969 Regular Session of the Legislature shall be construed as expanding or limiting the right that a chiropractor, while acting within the scope of his or her license, may have to prescribe a device.

Exhibit B: sample legal requirement for storage of prescriptions

From the Mississippi Board of Pharmacy [6]:

ARTICLE XIII PRESCRIPTIONS TO BE FILED
1. All prescriptions shall be filed in one of the following ways:
A. Three separate files may be maintained; a file for Schedule II prescriptions dispensed; a file for Schedule III, IV and V prescriptions dispensed; and a file for all other prescriptions dispensed.
B. Two files may be maintained; a file for all Schedule II prescriptions dispensed and another file for all other prescriptions dispensed, including those in Schedule III, IV and V. If this method is used, the prescriptions for Schedule III, IV and V substances must be stamped with the letter "C" in red ink, not less than one inch high, in the lower right-hand corner. This distinctive marking makes the records readily retrievable for inspection. Pharmacies with automatic data processing systems are exempted from marking Schedule III, IV and V controlled substance prescriptions with the red "C".
2. A hard copy of original prescriptions, whether records are maintained manually or in a data processing system, shall be assigned a serial number and maintained by the pharmacy in numerical and chronological order. All prescriptions shall be maintained for at least five years from the date of original dispensing.
3. If a pharmacy utilizes a data processing system for record keeping, all computer generated labels should be affixed to the prescription document in such a manner as not to obscure information on the face of the document.

Exhibit C: sample legal requirements for security and format

From Indiana Board of Pharmacy [7]:

856 IAC 1-34-2 Security feature requirements
Authority: IC 35-48-7-8
Affected: IC 16-42-19-5
Sec. 2. (a) All controlled substance prescriptions written by licensed Indiana practitioners, as defined by IC 16-42-19-5, must contain the following security features:
(1) A latent, repetitive "void" pattern screened at five percent (5%) in reflex blue must appear across the entire face of the document when the prescription is photocopied.
(2) There shall be a custom artificial watermark printed on the back side of the base paper so that it may only be seen at a forty-five (45) degree angle. The watermark shall consist of the words "Indiana Security Prescription", appearing horizontally in a step-and-repeated format in five lines on the back of the document using 12-point Helvetica bold type style.
(3) An opaque RX symbol must appear in the upper right-hand corner, one-eighth (1/8) of an inch from the top of the pad and five-sixteenths (5/16) of an inch from the right side of the pad. The symbol must be three-fourths (3/4) inch in size and must disappear if the prescription copy is lightened.
(4) Six (6) quantity check-off boxes must be printed on the form and the following quantities must appear and the appropriate box be checked off for the prescription to be valid:
(A) 1-24
(B) 25-49
(C) 50-74
(D) 75-100
(E) 101-150
(F) 151 and over.
(5) No advertisements may appear on the front or back of the prescription blank.
(6) Logos, defined as a symbol utilized by an individual, professional practice, professional association, or hospital, may appear on the prescription blank. The upper left one (1) inch square of the prescription blank is reserved for the purpose of logos. Only logos, as defined by this subdivision, may appear on the prescription blank.
(7) Only one (1) prescription may be written per prescription blank. The following statement must be printed on the bottom of the pad: "Prescription is void if more than one (1) prescription is written per blank.".
(8) Refill options that can be circled by the prescriber must appear below any logos and above the signature lines on the left side of the prescription blank in the following order: Refill NR 1 2 3 4 5 Void after_____.
(9) Practitioner name and state issued professional license number must be preprinted, stamped, or manually printed on the prescription.
(10) All prescription blanks printed under this rule shall be four and one-fourth (4-1/4) inches high and five and one-half (5-1/2) inches wide.
(b) Nothing in this rule shall prevent licensed Indiana practitioners from utilizing security paper prescriptions for the prescribing of any legend drug. (Indiana Board of Pharmacy; 856 IAC 1-34-2; filed Jul 5, 1995, 9:45 a.m.: 18 IR 2782, eff Jan 1, 1996)

Exhibit D: sample requirements on information added by the pharmacist

Taken from the Ontario's Drug and Pharmacies Regulation Act [8], paragraph 156.

(1) Every person who dispenses a drug pursuant to a prescription shall ensure that the following information is recorded on the prescription,
(a) the name and address of the person for whom the drug is prescribed;
(b) the name, strength (where applicable) and quantity of the prescribed drug;
(c) the directions for use, as prescribed;
(d) the name and address of the prescriber;
(e) the identity of the manufacturer of the drug dispensed;
(f) an identification number or other designation;
(g) the signature of the person dispensing the drug and, where different, also the signature of the person receiving a verbal prescription;
(h) the date on which the drug is dispensed;
(i) the price charged. R.S.O. 1990, c. H.4, s. 156 (1).

Exhibit E: New Jersey requirements for prescription blanks

From New Jersey official statutes:[9]

45:14-55 Use of New Jersey Prescription Blanks.
16. a. A practitioner practicing in this State shall use non-reproducible, non-erasable safety paper New Jersey Prescription Blanks bearing that practitioner's license number whenever the practitioner issues prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety.
b. A licensed practitioner practicing in this State shall maintain a record of the receipt of New Jersey Prescription Blanks. The practitioner shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the practitioner's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action, including notification to the Department of Human Services and the Attorney General.
45:14-56 Health care facility prescriptions.
17. a. Prescriptions issued by a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall be written on non-reproducible, non-erasable safety paper New Jersey Prescription Blanks. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety. The New Jersey Prescription Blanks shall bear the unique provider number assigned to that health care facility for the issuing of prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items.
b. A health care facility shall maintain a record of the receipt of New Jersey Prescription Blanks. The health care facility shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the facility's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action including notification to the Department of Human Services and the Attorney General.
45:14-57 Requirements for prescription to be filled.
18.A prescription issued by a practitioner or health care facility licensed in New Jersey shall not be filled by a pharmacist unless the prescription is issued on a New Jersey Prescription Blank bearing the practitioner's license number or the unique provider number assigned to a health care facility.
45:14-59 Format for New Jersey Prescription Blanks.
20.The Division of Consumer Affairs in the Department of Law and Public Safety shall establish the format for uniform, non-reproducible, non-erasable safety paper prescription blanks, to be known as New Jersey Prescription Blanks, which format shall include an identifiable logo or symbol that will appear on all prescription blanks. The division shall approve a sufficient number of vendors to ensure production of an adequate supply of New Jersey Prescription Blanks for practitioners and health care facilities statewide.

Split out Appendix 1?

It might be more convenient to split out Appendix 1 into a subsidiary article. This would be partially to facilitate linking to it from the Latin medical phrases category, such that people looking for the translations of these abbreviations don't have to find this page. It seems inelegant to link to the main article from the category page. What do you think? Octopod 10:26, 16 November 2006 (UTC)

hi

Is splitting out such related content common in Wikipedia? I haven't seen much of that. My only concern is whether or not it would it make it more difficult to find the Appendix if it were moved? I guess if linked prominently it wouldn't hurt. ---J-Mac

  • I recommend splitting out appendix 1 and linking it for better categorization and a direct link to the talbe instead of linking to a long article when only really wanting to link to the table. Tkjazzer 13:55, 31 July 2007 (UTC)

Globalize tag

There's plenty this can apply to, and the article does have a very strong US flavour (flavor?) but one little thing that doesn't often get mentioned is that the abbreviation "Rx" is not in everyday colloquial use in the UK. I don't know about within the medical profession, but if you wrote "Rx drugs" you'd get a lot of blank looks from the general population. 86.136.250.133 04:05, 21 July 2007 (UTC)

That's true, but Rx is widely used in pharmacies and healthcare companies and by doctors in the UK, myself working for one at the moment. Josh 22:56, 30 April 2008 (UTC)

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BetacommandBot 19:38, 3 December 2007 (UTC)

Change redirect?

I'm not sure how to change it, or even if I can, but I think that prescription medicine should redirect to Prescription drugs rather than Medical prescription.58.104.18.126 (talk) 07:44, 29 May 2008 (UTC)

Done. Thanks for flagging. Samw (talk) 00:57, 30 May 2008 (UTC)

Physician or other medical practitioner

Physicians are not the only class of healthcare worker to write prescriptions. Even if you use "prescription" to mean "orders to take a drug", there are many non-physicians that are allowed to write such orders. Dentists, for example, routinely order painkillers and antibiotics. This article should not exclude non-physicians. WhatamIdoing (talk) 01:55, 16 September 2008 (UTC)

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