CHAPTER FOUR: INTERPRETATION OF

PRESCRIPTIONS AND MEDICATION

ORDERS
Objectives
• Demonstrate an understanding of the format and
components of a typical prescription.

• Demonstrate an understanding of the format and

components of a typical institutional medication order.

• • Interpret correctly standard abbreviations and symbols

used on prescriptions and medication orders.

• • patient adherence calculations

• By definition, a prescription is an order for medication
issued by a physician, dentist, or other properly licensed
medical practitioner.

• A prescription designates a specific medication and

dosage to be prepared by a pharmacist and administered
to a particular patient.
Components of a typical prescription
• (1) Prescriber information and signature
• (2) Patient information
• (3) Date prescription was written
• (4) symbol (the Superscription), meaning ‘‘take thou,’’
• ‘‘you take,’’ or ‘‘recipe’’
• (5) Medication prescribed (the Inscription)
• (6) Dispensing instructions to the pharmacist (the Subscription)
• (7) Directions to the patient (the Signa)
• (8) Special instructions. It is important to note that for any
Medicaid or Medicare prescription and according to
• individual state laws, a handwritten language by the prescriber,
such as ‘‘Brand necessary,’’ may be required
• to disallow generic substitution.
• In hospitals and other institutions, the forms are
somewhat different and are referred to as medication
orders. A typical medication order sheet is shown in
Figure 4.2.
• A prescription or medication order for an infant, child, or
an elderly person may also include the age, weight,
and/or body surface area (BSA) of the patient

• An example of a prescription written for a pediatric

patient is shown in Figure 4.3. This information
• is sometimes necessary in calculating the appropriate
medication dosage.
Generic drug
• It is important to recognize two broad categories of
prescriptions:

• (1) those written for a single component or prefabricated

product and not requiring compounding or admixture by
• the pharmacist, and

• (2) those written for more than a single component and

requiring compounding
extemporaneous compounding
• The extemporaneous compounding of prescriptions is an
activity for which pharmacists are uniquely qualified by
virtue of their education, training, and experience.
• By definition, pharmacy compounding involves the
• mixing,
• assembling,
• packaging, and
• labeling of
• a medication on receipt of a prescription order for a
specific patient.
e-prescribing/e-prescriptions
• In the inpatient or outpatient setting, a medication order,
for a patient is entered into an automated data entry
system as a personal computer (PC) or a handheld
• device loaded with e-prescribing software and sent to a
pharmacy as an e-prescription.

• When received, a pharmacist immediately reduces the

order to a hard copy and/or stores it as a computer
• file.
• Among the advantages cited for e-prescriptions over
traditional paper prescriptions are:
• Reduced errors due to prescription legibility;
• concurrent software screens for drug interactions;
• reduced incidence of altered or forged prescriptions;
• efficiency for both prescriber and pharmacist; and,
• convenience to the patient, whose prescription would likely be ready for
pick-up upon arrival at the pharmacy
Range of Prescription and Medication
Order Calculations
• calculations of the following:
• Doses: including the quantity of a prescribed dose, the total number of
doses prescribed, and the number of days the prescribed medication
will last.
• Adherence: the patient’s or caregiver’s Adherence in meeting the
prescribed directions for dosing. Drug concentration: the quantity of an
active therapeutic ingredient to use to achieve the desired drug
concentration.
• Rate of drug administration: the quantity of drug administered per unit
of time to meet prescribed dosing schedule
• Compounding: the quantities of active and inactive components to use
in the extemporaneous preparation of a pharmaceutical product,
including the use of stock solutions and/or prefabricated dosage units
in the process.
• Chemical-physical factors: including calculations to make solutions
isotonic, iso-osmotic, equimolar, or buffered.
• •Pharmacoeconomics: including medication costs, cost-benefit
analysis, cost-effectiveness analysis, alternative treatment plans, and
medication pricing.
• The quantities of ingredients to be used almost always
are expressed in SI metric units of weight and
measurement.
Prescription and Medication Order
Accuracy
• It is pharmacists responsibility that each medication
should be:
• • therapeutically appropriate for the patient;
• • prescribed at the correct dose;
• • dispensed in the correct strength and dosage form;
• • correctly labeled with complete instructions for the patient or
caregiver; and
• • for the patient in a hospital or other health care facility, each
medication must be administered
• to the correct patient, at the correct time, and by the correct rate
and route of administration.
Use of Roman Numerals on Prescriptions
• 1. A letter repeated once or more, repeats its value (e.g.,
xx 20; xxx 30).
• 2. One or more letters placed after a letter of greater value
increases the value of the greater letter (e.g., vi 6; xij 12;
lx 60).
• 3. A letter placed before a letter of greater value
decreases the value of the greater letter (e.g., iv
• 4; xl 40).
• When Roman numerals are used, the tradition of placing
the numerals after the term or
• symbol generally is followed (e.g., capsules no. xxiv;
fluidounces xij).
Use of Abbreviations and Symbols
Recommendations to decrease errors
Presentation by students
• Medication Scheduling,

• Medication Adherence,

• Errors and Omissions

Homework