How to know if a medical prescription is correct?

Many of the handwritten prescriptions received at pharmacies come from the hospital and correspond to treatments prescribed by the specialist. And although generalizing is very ugly, in my experience, in the two autonomous communities where I have worked, prescriptions that come from hospitals tend to contain proportionally more misprints than those from health centers. Among the reasons occurs to me the fact that specialists are less used to making recipes and therefore are less familiar with the regulations since they usually make the same mistakes. But as I say, they are just assumptions not to sleep.

What happens when a recipe is poorly completed?

The great drama. The patient goes to the pharmacy in search of his medication with his brand new document called prescription as guarantor and finds that an unfriendly pharmacist (at that precise moment it is as if in the eyes of the world we are all uglier than usual) He says that he is very sorry, the prescription is invalid and that he should return to his doctor to amend it or to prescribe a new one.

I insist, it is the great drama. At this moment a conflict is generated in which, as usually happens, the two parties have their reasons:

– The patient expresses (generally annoyed) that he is not to blame for the fact that the recipe lacks the signature, the dose or that he has a date stud . What is usually clear to the patient is that, for example, he has been in the hospital all morning, that he needs his medication (or his son or his husband or father needs it) and that now he has to make an appointment again and probably miss another morning of work to fix it.

– The pharmacist is also not to blame for the fact that the prescription lacks the signature, the dose or that it has a stud on the date . He knows that the recipe is not valid and that for Social Security it is a piece of paper. It is not that he is a picky eater and “wants to make trouble.” Pharmacists really do not like to put problems, among other things, because it is a waste of time and significant wear and tear, but it turns out that:

  1. a) For security reasons we cannot venture to give in to a “give me the one you see best” or “give me the weakest and that’s it, I’m not too bad either”, as some patients request when the prescription is not clear or incomplete .
  2. b) Nor can we “scribble”, as requested by other patients when the doctor’s signature is missing. This is called counterfeiting.
  3. c) For sustainability reasons, we cannot assume the errors in the recipes since, although their dispensing may be relatively safe, Social Security does not pay for them. There are gentlemen whose job is to review recipes and detect errors retroactively for up to a few months. When this occurs, recipes are not paid in full or in a percentage depending on the reason.

What happens to the third party involved, the doctor? Well, as a human being, it is within the normality that it can be wrong. And even more so when, as many doctors have told me, they have not received specific and updated training during their work to fill prescriptions. However, it is still your responsibility to actively inform yourself of how to make a prescription correctly with the current legislation in each autonomous community (because beware, this changes) and to be receptive to the patient’s requests for amendment.

What is crashing down?

A system in which, existing electronic prescription, the patient is forced to physically go to the doctor in search of an amendment with his seal and his doodle is a prehistoric system and what happens to us we have deserved. With the appropriate effective communication tools between the doctor and the pharmacist, which we have “half-hearted”, we would not only avoid walking the patient, but also improve compliance.

All this, in addition to a few cans of omeprazole for the ulcer that has just been generated in patients and apothecaries in this regard.

What can the patient do on his part?

It is true that the errors in the prescriptions are not the fault of the patient, but it is also true that there are four basic rules that can be known to avoid taking the walk back.

For years standing in line at the bank and watching older people withdraw money from their pension (in my town it was normal), I never observed anyone leaving the counter without counting and counting the bills despite having come out of a machine or have been told by the banker. In the same way, nothing would happen if we took a quick look at the recipe before leaving the office to check that the four rules are OK, especially if the recipes are made by hand.

 

What are the four basic rules in a recipe?

My colleagues, especially the most rigorous ones, will find many more essential requirements. For the record, I know and I have the concert as a bedside book  and even the BOE . But the basics, what any patient can easily review to avoid the most recurring failures is:

1. Medication data: 

Mainly must include the name of the medicine (brand name or active ingredient), the dose, the pharmaceutical form and the number of units per container.

Example: 

Paracetamol 1000 mg 40 tablets

The question is logical: if you only put “paracetamol” you would not know if it refers to the 500 mg, 650 mg or 1000 mg. And no, it is not worth that we always use the 650 mg or that the doctor has told us and has forgotten to put it . It must be recorded. Also logically, if only “Paracetamol 1000 mg” were indicated, it would not be possible to know if the appropriate pharmaceutical form is sachets, tablets or even effervescent tablets. This is important and causes displeasure in those who have a particular preference for a pharmaceutical form because, for example, they are unable to swallow the tablets.

 

An important fact is that when the number of units per container is not mentioned and there are several sizes, the legislation requires giving the smallest container (unless the dosage indicates otherwise and I am not going to enter the dosage because it is a garden ). In hospitals, this is usually done so that the patient “gets out of the way” with the small package and then goes to check and follow up by their primary care doctor. That yes, when it happens by “absent-mindedness” it is a real task since the patient is forced to return to consultation earlier than usual.

Medicines, one by one: another important fact is that with few exceptions (antibiotics, narcotics …) in general, no more than one container is allowed per prescription. Even if you put “2 containers” in the box, you can never dispense two containers of paracetamol.

2. Date

The recipe has a valid duration of ten days from the next day. That is, if the recipe is for today, May 10, it can be used until May 2. After May 20 it will not be valid.

There are recipes that are “delayed”. This is common in the summer when the doctor writes prescriptions “in advance” and prescribes for a couple of months. Let’s imagine that the doctor prescribed them a month ago because we were going on vacation but the expected date of dispensation is May 20. In this case, they can be withdrawn five days before the dispensation: specifically in the period from May 16 to May 30.

3. Physician information 

  1. Name and two last names.
  2. Registerednumber or, in the case of medical prescriptions of the National Health System, the identification code assigned by the competent Administrations and, where appropriate, the officially accredited specialty that they exercise. And I smelled. If anyone is curious to know what each digit is in a doctor’s collegiate number, you can check this WTO link .
  3. Signature. The scribble is still essential except in some communities such as the Valencian where the signature can be electronic.

4. Patient data 

First of all, clarify that it is mandatory that the patient present the health card at the pharmacy before any dispensing with a paper or electronic prescription. In the case of electronics, it is expressly forbidden to make a dispensation without it.

In the paper recipe, the following information must appear (although there are schools that are permissive only with entering name and surname):

  1. Name and two last names.
  2. Year of birth.
  3. CIPA And what is this? Well, the patient’s personal identification codeis on the cards where the red circle marks.

 

The Apothecary’s advice

Knowing these 4 basic points (data of the medicine, the patient, the doctor and the date) can be considered “general culture” and is very useful to avoid having to make a return trip from the pharmacy. In the case of having to make any correction to the prescription, it is important to remember that the doctor must endorse each amendment with his signature and his seal . That is, if you cross out and rewrite but do not put the stamp and signature, the patient will have to return to the consultation again in a loop that is not recommended for everyone.

Hopefully administrations are aware that these small contingencies are a waste of time and money for the system. And above all, they generate a terrible and unnecessary waste in the relationship with patients who literally end up remembering the mother of all of us. The solution is to enable pharmaceutical-medical communication channels that make life easier for everyone. Especially the life of the patient who really, and once and for all, deserves to be at the center.

 

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