The Prescription
Who May Write a Prescription
Filling the Prescription

Verification
Check for Accuracy
Prescription Labeling

Prescription Files
Where and Why Prescriptions Go Wrong
Eyewear Prescription
References

As you advance in rate to Hospital Corpsman First Class and eventually Chief Hospital Corpsman, your work will become more and more specialized, and your responsibilities will involve more supervision and training of others. Not only will you probably head a department, but you will also have more people working under your supervision in various capacities. One of these departments for which you might con- ceivably become responsible is the pharmacy, the service that fills prescriptions.

This section is a continuation of the chapter on pharmacy in the HM 3 & 2 training course. Review of that chapter at this time is advisable.

The key instrument used in the pharmacy is the prescription-the written order from the prescriber directing the pharmacy to compound and dispense a drug or medication for the use of the patient. To accomplish this correctly, you must thoroughly understand prescription writing and filling.

Any information pertaining to the prescription is confidential and shall not be made known to persons not involved.

Another important point to remember is that a prescription or any part of it cannot be applied or transferrd to any person other than the patient specified.

Because regulations and policies sometimes change, it is important that you are familiar with Chapter 21 of the Manual of the Medical Department (MANMED). Chapter 21, MANMED is the basic guide to pharmacy operations.

The Prescription

For proper use, the prescription must contain certain information written legibly in ink on a bonafide prescription blank (DD Form 1289, fig. 4-1) or a polyprescription blank (NAVMED 6710/6, fig. 4-2). The prescription shall contain the name of the ship or station where it was written. This is important if the source of prescribing has to be traced.

To avoid errors, make sure that the patient's full name, rate, address, and age if under 12 is written clearly on the prescription. This will aid in getting the right medication to the patient for whom it is intended.

The superscription "Rx" means take or take thou or in effect, "I want this patient to have the following medication."

The inscription is that part of the prescription that lists the names and quantities of the ingredients to be used. Legibility here is of utmost importance, since the spelling of a great many unrelated drugs is quite similar. Whenever there is doubt as to the drugs or their amounts listed in the inscription, always double-check with the prescriber. Use the metric system to list amounts.

The subscription follows the inscription and is that part of the prescription that gives directions to the compounder.

The signa, not to be confused with the prescriber's signature, is that part of the prescription that gives the directions for the patient. This portion is preceded by the abbreviation "Sig."

Finally, all prescriptions must be signed by the prescriber. Ensure that the prescriber's full name signature is legible and that the rate or rank, corps, and service are included. Mimeographed, preprinted, or rubber-stamped prescriptions may be used, but signatures must be original, in the handwriting of the prescriber. Facsimiles are not acceptable.

Who May Write a Prescription

According to chapter 21, MANMED, the following persons are authorized to write prescriptions: officers of the Medical and Dental Corps, Medical Service Corps podiatrists, civilian physicians employed by the Navy, and independent duty Hospital Corps personnel. Qualified military nurse practitioners and military physician assistants may write prescriptions when authorized in writing by the commanding officer. Prescriptions written by civilian prescribers for eligible beneficiaries are allowed, but medical and dental students prior to internship are not allowed to write prescriptions for substances listed in schedules II and III.

With the exception of the polyprescription, prescriptions will be limited to one item per prescription. (It goes without saying that it will also be restricted to one patient.) Avoid the use of brand names of drugs and medical stores in prescription writing. Whenever possible, use generic names.

The quantity of the drug prescribed will be a reasonable amount needed for the patient. Excessive or unrealistic quantities will not be prescribed. Erasures are prohibited, and interlineations must be initialed.

And remember, persons authorized to prescribe drugs cannot write prescriptions for themselves or members of their immediate families.

Filling the Prescription

When you, as the compounder in the pharmacy, receive a prescription for filling, you should follow certain basic steps to make sure that the right patient gets the right medicine in the right amount in the right way. There are no shortcuts-in pharmacy things are done right or not at all!

Verification

First of all, satisfy yourself that the prescription you have received is a bonafide one and that the person you have received it from is in fact entitled to having it filled by your pharmacy. You don't need to be tedious about verification- the simplest and best way is to ask for an ID card. Verify the date on the ID card.

Check for Accuracy

Study the prescription carefully and ensure that the drug prescribed is in fact reasonable, that its amount or dosage is realistic as compared to the patient's age, and that the quantity of the medication is a practical one. A prescription calling for 1,000 tetracycline tablets or a pint of paregoric, for instance, warrants further inquiry.

If, in this process of verification, you feel that there is a discrepancy, an ambiguity, or an incompatibility, or if for any reason it is necessary to consult the prescriber, never allow the patient to suspect that anything is amiss. You should never fill a prescription you do not completely understand or you feel is incorrect. What appears to be an overdose may be the desired dose for a specific patient, but the prescriber will appreciate being called for verification of the dose.

When you are sure you understand the prescription and are satisfied that it is in all respects correct, you should give its filling your undivided attention. Most mistakes are made when the person filling the prescription is either interrupted while doing so or is trying to accomplish more than one chore at a time.

Always type the label before you fill the prescription, since it affords more time for considering the manner of compounding and the doses involved. Read the labels on the containers used in filling the prescriptions three times:

When the container is taken from the shelf
Before the contents are removed from the container
Before the container is returned to the shelf

Prescription Labeling

The proper labeling of a prescription is as important as filling it correctly. It is reasonable to assume that if a great deal of accuracy is necessary to properly compound a prescription, it is just as important that the patient take the correct amount of medication in the right manner to receive its maximum benefits. Improperly written or misunderstood directions on a prescription label can be disastrous. Ensure that all labels are typed clearly and their directions translated into simple layman's language. Keep in mind that the prescription label serves two purposes. First and most important, it gives the patient directions pertaining to the medication; second, in case of misuse or error, it is the quickest means by which the contents of the prescription container, the person who wrote the prescription, and the person who filled it can be traced. Consequently, always include the following information on the label (fig. 4-3):

The name and phone number of the dispensing facility
The prescription number (must correspond to the number on the prescription)
The date the prescription is filled
The patient's name-in sufficient detail for identification
The directions to the patient, transcribed accurately from the prescription, in clear, concise layman's language
The prescriber's name and rate or rank-in sufficient detail for identification
The initials of the compounder
Authorized refills, if any
The expiration date, if applicable
Name, strength, and quantity of medication dispensed

Other information that may need to be attached to the prescription container are labels reading "Shake Well Before Using" or "For External Use Only." "Poison" labels are best omitted when a preparation is intended for external use, as many physicians prefer the "For External Use Only" labels.

After the prescription is labeled, check the ingredients again by some systematic method to ensure accuracy.

As an added precaution and to aid expeditious identification of drugs, in case of undesirable effects, note the manufacturer and the lot number of the proprietary drug dispensed on the prescription. This procedure does not apply when the medication consists of a mixture of several ingredients. The initials or the code of the person filling the prescription must be on the prescription blank.

Prescription Files

Prescriptions that have been filled must be maintained in one of several separate files:

Schedule II and III narcotics-Prescriptions containing narcotics are numbered consecutively, preceded by the letter "N," and filed separately.
Alcohol (alcoholic beverages are no longer dispensed)-These prescriptions are numbered consecutively, preceded by the letter "A," and filed separately.
Schedule III (non-narcotic), IV, and V drugs-These prescriptions are numbered in the same manner as and are part of the general files; however, they are maintained separately.
General files-All other prescriptions are numbered consecutively and filed together.

Make sure that all prescriptions are written in black or blue-black ink or indelible pencil, or typewritten, and are kept on file for at least 2 years after the date of issue.

Where and Why Prescriptions Go Wrong

Contrary to common belief, errors in prescription filling are seldom due to gross negligence or ignorance of technical aspects. The vast majority of errors are due to human mistakes that could be avoided. The following are some major causes of error, and you should pay particular attention to them.

Giving the prescription to the wrong person. Occasionally, especially during rush hours, prescriptions go to the wrong person, either through misunderstanding or inattention. Make absolutely sure that you have the right patient, both when you receive the prescription and when you dispense the finished product.
Switching labels. Often when a patient has more than one prescription, or when the compounder is filling several prescriptions at a time, the label of one prescription is inadvertently fastened to the container of another, with consequent conflict of directions. It is absolutely imperative that the right label go with the right medication.
Overconfidence. Statistics show that the majority of mistakes are made by the "experts"- those who have been doing things for so long they have become overconfident and have begun to take shortcuts. Whenever you feel that you have become so good at filling prescriptions that you no longer need to double-check your work, stop and think-you may be inviting disaster.
Dishonesty or cheating. A person who becomes so involved in tampering with drugs and their quantities to make up for those pilfered or misappropriated cannot possibly avoid tragic mistakes. Personnel with low integrity, disciplinary problems, and moral shortcomings should not be allowed to work in the pharmacy.
Failure to double-check. All too often the belated excuse for error is "I thought it was thus and so" or "I didn't want to bother the prescriber with this" or, worse still, "I didn't want the prescriber to think I was stupid for asking." When in doubt, always double-check and ask. Failing to do so can be tragic.

Eyewear Prescription

Whether on independent duty, on duty in a dispensary, or at a major medical center, there exists a critical need for the hospital corpsman to perform the basic functions necessary to transcribe information from a patient's health record onto an eyewear prescription (DD Form 771, fig. 4-4). Since all of the necessary calculations for an effective prescription have already been done, the task then becomes one of effectively recording that information in the proper place and manner.

There are three major areas of consideration in completing a DD Form 771. They are patient information, prescription information, and miscellaneous information, all of which are critical areas and will be discussed in length.

The first area of consideration is that of patient information. The specific information required is the patient's name, rate, social security number, duty station, mailing address, and military status. This information is required in order to establish eligibility and provide the requesting activity with an address for the patient upon receipt of the completed spectacles.
The spectacle prescription itself is the technical portion of the order form and as such should be completed with great care, ensuring that the prescription is transferred in its entirety. The essential elements are interpupillary distance, frame size, temple length, plus and minus designators for both sphere and cylinder powers, segment powers and heights, prism, and prism base. It is not necessary to calculate decentration in the single vision or multifocal portions of the order. It is also unnecessary to try to transpose any prescription into plus or minus cylinder form. Leave the prescription as is, copy it onto the DD Form 771, and note in the remarks section that the prescription has been copied as is from the record.
The final area to consider is that of miscellaneous information. This area is reserved for any information you may feel will be helpful in either fabrication or determining eligibility for your patient. Items that are normally entered in the space labeled "special lenses or frames" are types of multifocal lenses requested, any type of nonstandard lens or frame, verification of flight status for aviation spectacles, and justification for any request for unusual prescription items. Standard issue items can be determined from BUMEDINST 6810.4G.

All DD Form 771s should be typewritten whenever possible. This practice eliminates any errors by misreading an individual's handwriting. Remember, if you are not underway, help is only as far away as your phone.

To ensure that the spectacle prescription that the physician has carefully determined to be necessary to satisfy the patient's visual need is provided, it is critical that you, as the corpsman, take the time to correctly order the spectacles. Any omission of information or erroneous information will result in delays at the fabricating facility or a patient receiving an incorrect pair of spectacles or both. If individuals requiring spectacles are either without or wearing inappropriate spectacles, they are not going to be as effective as possible. This could have a detrimental effect on the readiness of that individual's command.

As a last effort to interpret a prescription that a physician has written, always make a photostatic copy of the prescription and send it to the fabricating facility, rather than try to copy over some information you are unsure of. Make sure that the copy of the prescription is accompanied by a completed DD Form 771.

References:

NAVMED P-117, Manual of the Medical Department, Chapter 21
BUMEDINST 6810.4G, Ophthalmic Services

Naval Education and Training Command: Hospital Corpsman 1 & C: August 1986

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Operational Medicine 2001

Health Care in Military Settings

Bureau of Medicine and Surgery
Department of the Navy
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Operational Medicine
Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
January 1, 2001

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*This web version is provided by The Brookside Associates Medical Education Division. It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

Hospital Corpsman 1 & C Chapter 4: Prescriptions

Health Care in Military Settings

Hospital Corpsman 1 & C
Chapter 4: Prescriptions