DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

1884 >750 pairs of potentially confusing names that
could lead to harmful prescribing or dispensing
errors. Alliterative drug names can be particularly
problematic when giving verbal orders to pharmacists
or other healthcare providers.
• Provide the patient’s diagnosis on the prescription
order. This is the single most important measure to
prevent dispensing errors based on sound-alike or
look-alike drug names. For instance, an order for
administration of magnesium sulfate must not be
abbreviated “MS,” as this may result in administration
of morphine sulfate. Including the therapeutic
purpose and/or the patient’s diagnosis can prevent
this error.
• Write clearly. Poor handwriting is a well-known and
preventable cause of dispensing errors. Both physician
and pharmacist share in the responsibility for
preventing adverse drug events by writing prescriptions
clearly (When in doubt, write it out!) and questioning
intent whenever an order is ambiguous
(When in doubt, check it out!).
• Think.
APPENDIX I
PRINCIPLES OF PRESCRIPTION ORDER WRITING AND PATIENT COMPLIANCE
CONTROLLED SUBSTANCES
In the U.S., the DEA within the Department of Justice
is responsible for the enforcement of the Federal
Controlled Substances Act (CSA). The DEA regulates
each step of the handling of controlled substances from
manufacture to dispensing (21 U.S.C. § 811). The law
provides a system that is intended to prevent diversion
of controlled substances from legitimate uses.
Substances that come under the jurisdiction of the CSA
are divided into five schedules (Table AI–1), but practitioners
should note that individual states may have
additional schedules. Physicians must be authorized to
prescribe controlled substances by the jurisdiction in
which they are licensed, and they must be registered
with the DEA or exempted from registration as defined
under the CSA. The number on the certificate of registration
must be indicated on all prescription orders for
controlled substances. Criminal prosecution and penalties
for misuse generally depend on the schedule of a
substance as well as the amount of drug in question.
State agencies may impose additional regulations,
such as requiring that prescriptions for controlled substances
be printed on triplicate or state-issued prescription
pads or restricting the use of a particular class of
drugs for specific indications. Some U.S. states, such
as California, have placed marijuana, classified by the
FDA as a schedule I substance, in a special category by
decriminalizing its possession and sale for medical use.
Under California’s medical marijuana laws, patients
and caregivers are exempt from prosecution by the state
of California, notwithstanding contrary federal law.
This legal difference of opinion between state and federal
regulation is the source of considerable controversy.
Generally, the most stringent law takes
precedence, whether it is federal, state, or local.
Prescription Orders for Controlled
Substances
To be valid, a prescription for a controlled substance
must be issued for a legitimate medical purpose by an
individual practitioner acting in the usual course of his
or her professional practice. An order that does not
meet these criteria, such as a prescription issued as a
means to obtain controlled substances for the doctor’s
office use or to maintain addicted individuals, is not
considered a legitimate prescription within the meaning
of the law, and thus does not protect either the
physician who issued it or the pharmacist who dispensed
it. Most states prohibit physicians from prescribing
controlled substances for themselves; it is
prudent to comply with this guideline even if it is not
mandated by law.
Execution of the Order
Prescriptions for controlled substances should be dated
and signed on the day of their issuance and must bear
the full name and address of the patient and the printed
name, address, and DEA number of the practitioner and
should be signed the way one would sign a legal document.
Preprinted orders are not allowed in most states,
and pre-signed blanks are prohibited by Federal law.
When oral orders are not permitted (schedule II), the
prescription must be written with ink or typewritten.
The order may be prepared by a member of the physician’s
staff, but the prescriber is responsible for the signature
and any errors that the order may contain.
Oral Orders
Prescriptions for schedule III, IV, and V medications
may be telephoned to a pharmacy by a physician or
by trusted staff in the same manner as a prescription
for a noncontrolled substance, although it is in the
physician’s best interest to keep his or her DEA
number as private as reasonably possible (see
“Preventing Diversion”). Schedule II prescriptions