Introduction

Medications are ordered by a physician either as a medication order in a patient medical record or on a written prescription for the patient to take to a pharmacy for dispensing. In whatever setting, the order must be read and interpreted exactly so the correct medication and its dosage can be provided for patient safety. Even if the order is a verbal order to a health care professional, the order must be transcribed into writing to create a medication record for legal purposes. Therefore, the ability to understand the components of the prescription, as well as the ability to interpret the order or prescription, is an essential skill for the health occupation professionals who work with medications on a daily basis.

Just as a reminder, because many drugs have similar-sounding or look-alike names, reading the prescription can become much like working a puzzle. If an order should be questioned in any way, the pharmacy technician should bring this to the attention of the pharmacist. The pharmacist is ultimately responsible for dispensing the medication as ordered. As a pharmacy technician, you must be sure that you stay current with new medications and new indications for older medications. As new precautions are found for medicines, you should keep these in mind. You should always remember that the highest level of patient safety is the most important aspect of dispensing medications.

Remember the knowledge of pharmacy includes the action of the medication in the body or pharmacokinetics, the therapeutic uses and effects or pharmacotherapeutics, and the adverse and toxic reactions or toxicology. Each of these must be considered as medications are dispensed to patients. As a pharmacy technician, you must be aware of the usual dosage of a drug and other possible medications being taken concurrently by the patient so that you may assist the pharmacist in attaining a high level of quality control and patient safety and help prevent drug interactions.

What Does a Prescription Indicate?

A prescription is a means for a physician or other health professional to provide the information needed by the pharmacist to dispense the desired medication for a patient in an outpatient setting. It is an order written for a specific person by a medical professional licensed to prescribe for a specific condition. The rules about who may prescribe vary from state to state, so the statutes of the state of practice determine the legalities of prescription writing. As a legal document, the prescription indicates the medication desired and the directions for its use to meet the health needs of the patient. The components of a prescription are included as a review of what is necessary for this legal document.

Figure 6-1 provides short descriptions of the parts of a prescription. The five major components are the superscription, inscription, signa (Sig), subscription and signature of the health care professional. Line A of Figure 6-1 is the preprinted name of the physician or group of physicians, the address, and phone number. Line B includes the patient’s name, address, date of the prescription, and the patient’s age if the patient is a child. Dating the prescription is important because prescriptions must be filled within 12 months of writing except with controlled substances or scheduled medications, and the refilling of prescriptions is dependent on the date. Line C is the superscription or the symbol , meaning “recipe” or “take thou,” from Latin. The inscription, which specifies the name of the medication, its strength, and quantity of drug to be dispensed, appears on line D. If the medication must be compounded or prepared, the ingredients would appear in this location. Line E is the “Sig,” or signa, giving directions for taking the medication. The subscription, line F, tells the pharmacist the drug form, as well as how the medication is be taken. The physician’s signature appears on line G, and the number of allowed refills on Line H. Finally, if the prescription is for a controlled medication, the physician must place his or her U. S. Drug Enforcement Administration (DEA) number either under or beside the signature.

Prescriptions may be written or verbal (except with Schedule II medications, which require a written signed prescription), but the legal implications are the same for both. Both means of communicating a prescription must provide identification of the patient who is to receive the medication and the amount of medicine to be received. It is the responsibility of the pharmacy technician to follow the orders. When the orders are given verbally, the order should always be repeated with the health care professional to verify the drug, the amount, and the directions to avoid errors. If a question about the prescription or medication error is noted, clarification or corrections must occur before the medication is dispensed. This clarification will require further communication with the person prescribing the drug.

Abbreviations are often used in the writing of prescriptions. Only standard abbreviations should be used. Remember that a prescription is a legal document that could appear in a court case. In those instances, “local” or nonstandard abbreviations might become an area of concern for possible misinterpretation. Abbreviations are actually medical shorthand that is used to write clear and concise orders that will be used among health care professionals. For orders to be correctly written and interpreted, the health care professional and the person dispensing the medication must understand the meaning of each abbreviation used. For commonly accepted abbreviations, see the table on the inside front cover and Chapter 1.

What Is a Medication Order?

A medication order is a method of providing the same information as found on a prescription given to the patient, but is used in an inpatient or physician’s office environment (Figure 6-2). An exception with the medication order is that the order is written for either the number of doses or for the specific length of time for the medicine to be taken. With the medication order, the health care professional is told what drug or drugs should be administered, the strength of the medication, and the frequency to be taken. This order is a means of providing drugs at correct frequency in an inpatient setting. The medication order has six parts: date; patient name, which may appear on the patient record; medication name; dose or medication strength/form; route, time, and frequency of administration; and signature of the prescribing professional. Medication orders may be verbally communicated, but for legal purposes, each order should be transcribed onto a written form by the health care professional who accepts the order and the order must be countersigned by the health care professional who communicated the order and is licensed to prescribe medications in the state of practice.

For the pharmacy technician, medication orders have usually been transcribed from the medication order form to a drug administration record and to an order that will be sent to the pharmacy to be filled for the patient. The order to the pharmacy is much like a prescription in that the pharmacist provides the needed medication to the inpatient floor for administration. In some instances medication orders are written in duplicate, and the duplicate copy is sent to the pharmacy for preparation of the medications. Using this type of transmittal of medication orders provides a double-check between the pharmacist and health care personnel on the floor. As with a prescription, the medication order must be written by a health care professional who is licensed to prescribe in the state of employment. Because medicines found in the inpatient setting often can be given by several routes of administration, the route of administration is also added so that the pharmacy provides the correct form of medication to be administered. A route of administration prescribed by the physician or other health care professional cannot be changed without the permission of the prescriber. Once the route has been specified, that route cannot be substituted without obtaining another order for the change by the prescriber.

What Does a Medication Label Indicate?

The label on the medication bottle is the identification of the drug within the container. It indicates the following important information needed to dispense the drug:

One of the most important aspects of patient safety is the careful reading of the medication label. To ensure that the proper medication has been provided for dispensing, the label (i.e., drug name, drug strength, drug form, expiration date, and the NDC number) should be read when taking the medication from the shelf, before preparing the medication, and finally, when returning the medication container to the shelf for storage. By reading medication labels carefully, you can prevent possible errors and avoid confusion, and the therapeutic potential of the drug is maximized. The pharmacy technician must be fully aware of the parts of the label and the information on the label including expiration dates and the need for auxiliary labels to ensure that the medicines dispensed, or the “recipe” (), are at the level of highest quality possible and are the exact medications that have been ordered by the health care professional.

Using Units and Milliequivalents as Measurements for Dosage

Some medications, such as penicillin, heparin, and insulin, as well as others used less often, such as hormones, vitamins, and antitoxins, are measured in units. A unit is a standard of measurement that is set according to a laboratory standard when a biologically based medication contains some product of either plant or animal origin. These may be either USP units or international units. No universal value to a unit is applicable because the value of a unit is measured by the physiological effect a drug has on the body. The effect of a drug varies from medication to medication, so the equivalent given on the label is the guide to the amount of medication that is to be administered to a person. The strength may vary from a few units (less than 100) per milliliter, such as vasopressin and Acthar Gel, to a moderate number of units per milliliter (from 250 to 5000), as is found with heparin and tetanus antitoxin, to 100,000 to 1,000,000 units per milliliter, as is found in the penicillins. Therefore, when working with units, you must be careful interpreting the orders to be sure the correct number of units is indicated on the order or prescription. For example, orders may read as penicillin G 500,000 units, heparin 10,000 units, or NPH insulin 54 units.

As a pharmacy technician, you must be sure to carefully read the label of medications using units as a dosage strength. This is important for obtaining the exact number of units per milliliter, tablet, capsule, or other drug form, because this can vary not only between medications but with the number of units per dosage form found with the same medication. Medications found in vials must be read completely because the potency of the drugs must be stated on the vial, and this is where the differences in potency are seen. Some of the medications that are in injectable form must be given to a hundredth of a milliliter because of potency. Insulin, which also is in units, requires an insulin syringe that matches the potency of the insulin, such as U-100 insulin must be administered with a U-100 syringe.

Milliequivalents (mEq) are used to measure electrolytes that are used as medications, such as potassium (K) and chloride (Cl). A milliequivalent strength represents the amount of electrolyte that is dissolved in a given unit of medication, such as mEq per tablet, milliliter, liter, teaspoon, or tablespoon. In actuality, when using milliequivalents, the amount of medication is a thousandth (1/1000) of an equivalent weight of a chemical.

When using units or milliequivalents, conversions are not necessary because the order will be written in the dosage amount that matches the label strength of the medication to be administered (e.g., insulin is ordered in units, potassium chloride is ordered in milliequivalents). If a prescription is written for KCl 20 mEq and the stock medication is KCl 20 mEq/tablet, a single tablet per dose would be delivered to the patient.

Review

It is absolutely necessary that you read medication orders and prescriptions and correctly interpret orders as written by health care professionals to keep patients safe when they take the medications. There must be checks and balances among the prescriber, the pharmacist, and the person responsible for obtaining the medications for dispensing, such as the pharmacy technician. Any break in this cross-check might result in the patient getting the wrong medication, and, more importantly, the mistake could be lethal.