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What’s In A Script? Common prescribing practices for NPs

Breakdown of a perscription

Recently, I called to make an appointment with my physician, I was given the option to see her next month or the nurse practitioner the next day.  If I did not have a dire concern, I would have chosen the former but I could not stand the wait.  I am not alone. Many consumers lack confidence in NPs because the role is unfamiliar. And as the primary care physician gap increases, NPs are becoming the front line of primary care.  Now with this power comes great responsibilities. The NP profession is progressively growing and many are the provider of choice in primary care settings.  They have a central role in disease prevention, management, and prescribing.

Prescribing is one of the most complex challenges NPs in training face. With the recent data stating that Seventy percent of medication errors that are a direct result of adverse events were due to prescription errors, it is important for future NPs to be equipped with the proper way to prescribe.

The National Association of Medicine, formerly known as the Institute of Medicine, estimated that between 44,000 and 98,000 persons die in US hospitals annually as a result of these errors. Whether errors of omission or commission, an error in prescription writing is the most common form of preventable errors.  In this series, I will share what’s in a script.  By the end of this series, I hope that you transcribing prescriptions improves. Thus, preventing errors and ensuring safe and quality care.

Let’s first start with how to write a prescription.

A prescription can be broken down into 3 parts:  The superscription, inscription, and subscription. The superscription includes the date the prescription is written and all patient information such as name, date of birth, height, weight, and address.  While the address and weight may not be required on all prescriptions, it does save a lot of time for some.  In many states scripts for controlled substances are required to not only have the address of the doctor’s office but also the patient’s home address before they are valid.  A patient’s weight also saves clarification calls when writing for those medications that require weight-based dosing.

The body containing the name and the strength of the drug to be dispensed is the inscription and instructions to the pharmacist are known as the subscription.  These instructions usually let us know how many tablets to dispense and how to translate the signa or “Sig” which are the instructions for the patient.  All three parts are required to transcribe a valid prescription.  Given the complexity of the prescribing process, it is unsurprising that there is clear evidence of poor prescribing in all areas of healthcare.

Two basic questions to ask yourself when writing prescriptions:

  1. Are you aware of the medication you’re prescribing?
    This may sound ridiculous but errors often occur from the lack of knowledge about medications, their indications, contraindications, dosage, route and drug-drug interactions.
  2. How well do you know your patients?
    Studies have shown that lack of information about hospitalized patients was the second leading cause of prescribing errors resulting in adverse drug event (ADE).  Are you aware of the patient’s past medical history, drug history, allergies?

The answer to these questions will ultimately determine your success in prescribing and reducing adverse events.  Not only is citing the proper drug, dose, route, and frequency important in prescription writing but knowing how the patient’s age, gender, genetics, medical and drug history interact with the medication prescribed.   Knowledge of medications and the patient’s history are necessary for competent prescription writing.

Join me in the next issue as we continue to discuss What’s in a Script?