PrescribingPractical Lab Work

8/10/2019 PrescribingPractical Lab Work

1/24

PRESCRIBINGPharmaceutical Medicine Department

Medical Faculty of Udayana University


2/24

PROCESS THERAPYDIAGNOSE

Non DrugTherapy

Drug

Therapy

Choose drug

Writing Prescription

skills

Rational

Pharmacotherapy


3/24

Rational Prescribing Skills

BiomedicalScience

Basic andClinical

Pharmacology

PharmaceuticalMedicine

Writing Prescriptions Skills as amedical competence

Clinical

features


4/24

Objective:to comprehend What is a prescribing error?

Analyze

Why do errors occur? Different drug charts

Examples of common errors

High risk drugs

Applied

Good prescribing principles

Outline Prescribing

Parts of prescription

Good prescribing

How to use drug


5/24

Wrong drug (e.g. drugs that sound alike) Clotrimazole/Co-trimoxzasole, Carbimazole/Carbamazepine

Inappropriate Units Insulin mixtard 10IU read by 101 unit

Poor/illegible prescriptions

Failure to take account of drug interactionsDigoxin/Warfarin-Amiodaron

OmissionWrong route/multiple routes (IV/SC/PO)

Calculation errors (important in Paediatrics)

Poor cross referencing

Infusions with not enough details of diluent, rate etc.Poor cross-referencing between charts

Once weekly drugs

Multiple dose changes

Wron dose

Commonprescribing errors


6/24

Rational Pharmacotherapy?

The rational use of drugs requires that

patients receive medicines appropriate to

their clinical needs, in doses that meet

their own individual requirements, for an

adequate period of time, and at the lowest

cost to them and the community.

Rational prescribing is rational therapy also

World Health Organization, 1988


7/24

WHY Rational Prescribing must beapplied?

Irrational DrugTherapy as global

issues and Medicaleducation have many

important roles inreducing the problem

Drugpromot

ion

Knowledge<

DrugsTechnology >

Irrationaldrug

therapy

Attitude

Patien

pressure

Drug

FormularyStandar d

Therapy

>> Length of stay>>Therapeutic Cost


8/24

The Process of Rational Prescribing

Evaluation, monitor or stop therapy

Give information, instruction and warningFarmakodinamik,farmakokinetik and advice when they come back

Start the therapyadvice an explanation of the drug

Verify whether the P drugs suitable for patientsthe effectivity, safety, acceptability, and cost, clinical reasoning

Specify the therapeutic objectiveEstablish the diagnose

Define the patients problemsEstablish the working diagnose

WHO, Guide to Good Prescribing


9/24

How to prevention medication error?

Indicationappropriate

Drugappropriate

Doseregimentappropriate

Frequency and theamount ofadministrationAppropriate

to thePatient

(Dosage form)

Be aware todrugs sideeffect

Affordablecost


10/24

P drug Physician/Health provider need 40-70 kinds of

medicines

Know the pharmacology entity, effectivity, safety,

rute of administration and cost

P drug:Need therapeutic experience

-Consider all essential information DrugList ( Standard Therapy, DrugFormularies) including existingtreatment guidelines

- Scientific data,evidence based >>


11/24

Principles of Good Prescribing

1. Use addressograph for patient details

2. Complete allergy box and alert label3. Use brand name/generic product4. State drug, dose, strength, route and frequency5. State dose as grams, mg, mcg.6. Make administration of once weekly drugs clear7. Avoid abbreviations8.

Give a sign when prescribe the emergency or critical caremedicines9. Inform when prescribe the drugs that the patient can not apply the

medicines by themselves10. Be careful to prescribe ethical drugs and opiates contents (depend

on each country)11. Prescribe Opthalmic preparation/ Nasal/ otic/Rectal, vaginal

preparation or topical preparation clearly or Avoid multiple routeprescribing (i.e. im/sc/po)12. Prescribe when the drug usage unregularly (pain relieves) and

educate the patient13. Repeat prescription, to amend a prescribed drug draw a line

through it, date and initial, then rewrite as new prescription.


12/24

Sources of Prescribing Info

Trust Prescribing Policy

Farmakope IndonesiaBNF/eBNF IV guides/monographs

Trust FormularySpecialist references (e.g. Paediatric)Summary of Product Characteristics ISO,

MIMS

PharmacistMedicines InformationElectronic access to central library of Trust

approved guidelines.


13/24

Prescribing

Use Latin Language or international language

Name of drug dosage form product with the

dose, preparation form which is available inthe market

The amount

How to use

Patient identity


14/24

dr Made Satrya Wirana

Jl Mawar No.7, Denpasar

Telp. (0361)222881

SIK:Denpasar, 23 November 2007

Rx

Amoxicilin 125 mg

Paracetamol 125 mg

Vit B Complex tab 1/3

M f l a pulv dtd No XVS 3 d d Pulv No I

#

Pro: Anne (2th) BB: 14 kg

Alamat: Jl Kamboja 6, Dps

aper Work of Rational rescribing

Physician Identity .............. ...Name

...Address

...Registration no

City/Date........ ...................

Superscription.................

Inscription............................ ...Primary drugs

...Adjuvant

...How to use/apply?

Subscription........................

Signatura.............................

Sign ..................................

Patient Identity Name

Age/Body weight

Address/Telp no


15/24

Latin Abbreviation

Purpose of Latin Language:

Standard language in medical, dead languagebecause it is not use daily

English also can be used in prescription


16/24

Abbreviations

1 gram (g)

1 milligram (mg) (1 x 10~3 g)

1 microgram3 (1 x 10-6 g)1 nanogram3 (1 x 10-9 g)

1 decilitre (dL) (1 x 10-11)

1 millilitre (mL) (1 x 10-31)

Home/domestic measures. A standard 5 ml

spoon and a graduated oral syringe are

available.Otherwise the following approximations will

serve:

1 tablespoonful = 14 ml (or mL)

1 dessertspoonful = 7 ml (or mL)

1 teaspoonful = 5 ml (or mL)


17/24

Latin Abbreviation


18/24

EXAMPLES


19/24

Examples

R/ Paracetamol mg 120

Amoxycillin mg 200

Actifed tab 1/3

Sl qs.

m. fpulv.dtd No XIIS t d d pulv


20/24

brand and generic name

R/ Parasetamol tab No X

S t d d tab I prn

===============

R/ Amoxil 500 mg cap No XVS 4 d d cap I

===============


21/24

Brand name

R/ Amoxyl 500 cap No XII

S 3 dd cap I

Generic name

R/ Amoxyllin syr fl.No I

S t d d Cth (5 cc) I


22/24

R/ Otopain ear drop fl. No I

S tdd gtt II a d s

R/ Cendostatrol eye drop fl No I

S 6 dd gtt I od et s

R/ WF zalp 10 g

s u eR/ Bioplacenton tube I

S u e


23/24

R/ OBH 250 cc

S 4 dd C I

R/ OBH 140 cc

S 3 dd C I


24/24

Thank you

PrescribingPractical Lab Work

Documents