Erick Ochieng

The origin of prescription genre can be traced back to 1550 BC during the Egyptian Papyrus Ebers era. At the time, medical information’s were written in hieroglyphics while health professionals shared information among each other in Greek or Latin since the standard practice required medical terminologies to be described in either of the two languages. The Egyptian medical documents then listed about 811 prescriptions for various ailments and described their treatment protocol. This way, health professional had a means of discussing a diagnosis with patients before writing a treatment plan commonly referred as prescription order. For this reason, a prescription order or otherwise known as medication order gained its popularity. According to the University of Florida College of Medicine Jacksonville (2007) prescription order is defined as “a written medication order by the doctor, dentist, surgeon, veterinarian or any other registered medical prescriber to the pharmacist, for the supply of a medicine, dressing or surgical appliances to the patient.” Note that a prescription order here is used as a link between the health professionals and the patient. So, the emphasis on its setting, context and content guides both the pharmacist and patient purpose. For example, a prescription for narcotics is designed not to be refilled, therefore prescription order details a setting for no medication refills. Likewise, in extemporaneous preparations prescription, the prescriber provides a recipe for all ingredients based on the specific context of therapy. In this essay, I will shade light on the common features of prescription order to junior health professional and patients using prescription medicines.

The general goal for writing a prescription order is for the doctors to offer: legal documentation, source of record, means of communication, treatment modality, means of medical control of therapy and establish means of clinical trial. In conjunction to these goals mentioned above, doctors typically followed a laid procedure that has existed for several years in the health fraternity. The parts of prescription I am referring to here include: superscription, inscription, subscription and transcription. You will realize that new terminologies have emerged in attempt to replace the above four parts of prescription, however, they still lack the appeal in health sector. For example, in prescription the term superscription is described by Pendicheva and Stavreva (2014) “… include the abbreviation Rx, meaning ‘take thou’” (p. 2). Where the symbol Rx comes from R abbreviation for the Latin word meaning recipe. This basically made more sense in the past because there was no blister packed medicine. So, pharmacists were obligated to prepare prescription orders from start to end and deliver medication fresh from a list of medicinal ingredients. It is in the list that a recipe is generated in a prescription order.

Despite all parts of a prescription conveying important information to various players in healthcare setting, I believe the second part of prescription order, inscription, offer more content than any other part of a prescription order. Inscription contain information that is pertaining to the patient drug, dose and dosage form. Most often the prescribers will ensure that the medication prescribed in a prescription order is correct and is within the policy guideline for disease management. On the other hand, at the pharmacy store, the pharmacist ensures that they dispense the correct medication considering individual client’s age, body mass index and disease condition as a means of titrating dosage significant for an individual patient before dispensing is actually done. An example of this is shown in General Principle of Pharmacology (2008) “for children, the age and weight should be noted so that pharmacist can monitor the dose prescribed, as a double check to reduce errors in prescribing” (p.26). Registered prescribers may prescribe medication as an official preparation, or a proprietary product, or as a special formula in which the quantities of each ingredient is stated together with adjuvant added in the preparation.

The third part of prescription order is Subscription. In this part, instructions are written to the pharmacist/chemist on how to prepare prescription order. The details include among other things the number of doses or medicinal form to be supplied to the patient. For example, in Bulgarian prescription order, Pendicheva and Stavreva (2014) writes, “Rp/Tab Paracetamoli 0,5 Da Scatulam No.2 (D. scat. No 2) = Give 2 blisters” (p.3). Is a direction to pharmacist to prepare the order as mentioned and has nothing to do with a patient. The instruction may include additional flavor to the product, special label and quantity to be dispensed. If the pharmacy believes it is risky dispensing the prescription order as such in one setting, they may offer refill services in later days upon clarification to the patient.

The last major component in the part of prescription order is the signature. The signature provides the patient with instructions that include: the method of medicine administration or application, the dose if the preparation is for internal consumption, the time of administration or application and the diluent be to use while administering the medication since not all diluents favor all medicinal preparations. This information must be elaborate enough to allow the patients to understand fully what is required of them after receiving medication. In many cases it has been noted that patients confuse and consume topical preparations meant for external use leading to unintended drug adverse reaction. For example, in “Principles of Prescription writing and Other Pharmacotherapeutic Considerations” Bowen (2008) writes “… sig: take 1tab po Ciprofloxacin 500mg bid X 7 days …” (p. 18) here po means take one tablet by mouth while bid refers to use twice a day. Normally this may be confused by many patients to mean take two tablets by mouth two times in a day.

In conclusion, it is important to acknowledge that prescription orders have existed for several years. Since the Egyptian Papyrus era to this date, the concept has remained principally the same. Healthcare professionals use prescription order to relate to their patient while they offer medical services. The patients also depend on a well written prescription order to comply with therapeutic modality. This is partly because prescription orders are well regulated, and the design earlier discussed speaks for itself. It should not be forgotten that numerous attempts have been made to change the past format of classifying part of prescription. Notably, names such a heading, body and closing have been used to describe parts of a prescription order. However, none of these terms have been able to explain the symbol Rx, recipe and signature as noted in the previous parts of prescription orders. Therefore, as I said earlier the major function of a prescription order is to offer legal documentation, record sources, means of communication, therapy modality, means of medical control of therapy and means of clinical trial is true.

Reference List

Bowen, J. F. (n.d.) Prescription and Medication order (pp 1-14). Retrieved from    https://jbpub.com/9781284035667/9781449685362_CH02_Sample.pdf

Dr. Pendicheva, D., Dr. Stavreva, G., (2014) Structure of The Medical Prescription. Prescription      Writing. Medical University – Pleven Department of Pharmacology.

Johnson M. (2014). The Pharmaceutical Journal. The history of Prescription. A Royal             Pharmaceutical Society Publication.

NHS Education for Scotland (2012). A guide to Prescribing Practice for Prescribing Pharmacist           in NHSScotland (p. 1-13). Retrieved from https://www.nes.scot.nhs.uk/media/1457463/nesd0061_goodprescribingpractice.pdf

Principles of prescription Writing and Other Pharmacotherapeutic Considerations, General         Principle of Pharmacology (p. 25 – 32). China: R.R Donnelley.

World Health Organization Action Program on Essential Drugs. Guide to Prescribing: A             Practice Manual (p.1-142). Retrieved from             https://who.int/medicinedocs/pdf/whozip23e/whozip23e.pdf