Prescription

PRESCRIPTION (from Latin receptum - taken, from the verb recipere - to take back, to take), a written order by a physician (praescriptio medica), a document according to which a) the physician prescribes a medicine from the pharmacy for a patient, indicating to the pharmacy the method of preparing the medicine, and to the patient the order and method of taking the medicine; b) the patient demands from the pharmacy the therapeutic agent prescribed by the physician, and c) the pharmacy prepares and dispenses to the patient the medicine prescribed by the physician. A prescription as a document is written according to a strictly established form, which facilitates the writing and reading of the prescription, and consists of the following seven parts: 1) the inscription (inscriptio); 2) the heading (praepositio, or invocatio); 3) the designation of medicinal ingredients (designatio materiarum) with an indication of their quantities; 4) the subscription (subscriptio); 5) the indication of the method of use of the prescribed medicine (signatura); 6) the surname of the patient for whom the medicine is prescribed (nomen aegroti), and 7) the surname of the physician who prescribed the prescription (nomen medici). 1) The inscriptio precisely indicates the date (year, month, and day) when the prescription was written, and also usually designates the address, name, patronymic, and surname of the physician and his telephone number, if available. If the prescription is prescribed in a medical-sanitary institution, then in the inscriptio, instead of the physician's address, the address of this medical institution is indicated. 2) Praepositio, or invocatio, consists of the physician's address to the pharmacy worker; the physician proposes to take the medicinal ingredients, which is expressed in Latin as "Recipe" (take), abbreviated as "Rp.". In former times, in the first centuries of Christianity, the invocatio was addressed to God, beginning the prescription with the words "Cum Deo" (with God) or "Juvante Deo" (with God's help); among the Romans in pagan times, prescriptions were begun with the phrase "In nomine Jovis" (in the name of Jupiter), which was not written out fully later, but was replaced by the symbolic sign ★ (the astronomical symbol of Jupiter). In current prescriptions, we encounter this same sign, but in a modified outline # and with a completely different meaning: at present, the sign # is used to separate one prescription from another, if two or more are written on the same sheet of paper. Also, this sign is often placed at the head of a single prescription to prevent the addition to the prescription of any other ingredient not specified by the physician. In the latter case, however, this traditional sign is superfluous, because its latter purpose can be fulfilled by the inscription (inscriptio). Rp. is written on the left of the prescription, as seen in the sample prescription provided here. Sample prescription: Polyclinic of the Medical Section of the KSU Moscow, Arbat, Gagarin Lane, No. 37, Tel. 3-65-40. 15/VIII-1933. Rp.................. Praepositio (s. invocatio)

Chlorali hydrati 8,0

Natrii bromati 6,0 \ Mucil. Gummi arab. 12,0 \ Designatio Sir. cort. Aurantii 30,0 materiarum Aq. destill. ad 120,0 / M. f. Mixtura. Da . . . Subscriptio S. Take internally by 1 tablespoon before sleep, washing down with 1/4 glass of water

) Signatura to Medvedev.......Nomen aegroti Nikolayev.......Nomen medici 3) The request (Rp.) is followed by a list of medicinal substances (designatio materiarum) from which the prescribed medicine is to be prepared; at the same time, the quantities of the prescribed ingredients are indicated. Each medicinal substance in a prescription must be written on a separate line with a capital letter. The names of preparations are designated according to the nomenclature used in the latest pharmacopoeia (State Pharmacopoeia of the USSR). The use of synonyms is permitted, but only the most well-known ones. The part of the prescription known as designatio materiarum is usually written in Latin because the Latin nomenclature of medicinal substances is much more precise than the Russian one and is uniform for all civilized countries of the world, which greatly facilitates the understanding of prescriptions in foreign literature. Only the French and Italians write prescriptions in their native language, but their nomenclature of medicinal substances is very similar to the Latin one. The Latin language is expedient for us in the Union because in this way the discord is eliminated that would arise if prescriptions were to be written in different republics and autonomous regions only in their native language: a prescription written in the Tatar language would be incomprehensible to a Russian doctor, a pharmacy in the Mari Oblast would not be able to prepare a medicine prescribed by an Udmurt doctor, and so on. To shorten the time spent on writing prescriptions and to facilitate the writing and use of prescriptions, abbreviations of various words are permitted in them, provided that no doubt remains regarding the accuracy of the prescribed text (circular of the People's Commissariat of Health No. B 141/64 of April 16, 1929). Therefore, one cannot abbreviate as follows: Natr. arsenic., Bar. sulfur., because under such an abbreviation one can read with equal right Natrii arsenicici and Natrii arsenicosi, Barii sulfurici and Barii sulfurati, and the pharmacy will not know what the doctor actually prescribed to prepare the medicine. For abbreviations permitted in prescriptions, see below. The designated medicinal substances in the designatio materiarum are written in the genitive case, and their quantities in the accusative, since the entire construction of the phrase depends on the verb to take — recipe (praepositio): Rp. Herbae Adonis vernalis 5.0 [take five (accusative case) grams of the herb (genitive case) of the spring pheasant's-eye (genitive case)]. A prescription may indicate one or several medicinal substances serving for the preparation of the required remedy. If there are several medicinal ingredients, they are arranged in the following order according to their significance: a) the main substance (remedium cardinale, s. basis) upon whose favorable action on the patient the doctor primarily relies is written first; b) an auxiliary agent, one or perhaps several, that contribute to the influence of the main one (remedia adjuvantia), reinforcing its action or eliminating or weakening its undesirable side effect, are placed second; c) further, medicinal substances that correct or eliminate the bad taste or smell of the medicine (remedia corrigentia), as well as impart a pleasant color to the prescribed medicine, are placed; d) then, agents that impart a definite constitution to the prescribed medicine (remedia constituentia) are written; for example, in obtaining the medicinal form of a solution, water or alcohol can serve as the constituens, while in the preparation of powders, sugar, magnesia, and the like. The vehicle for a solid medicinal form may be called in Latin, besides constituens, also excipiens or vehiculum, and for a liquid medicinal form, menstruum. In the designatio materiarum, following each medicinal ingredient, its quantity is indicated in units of weight of the metric system (see Apothecary weight), with the name of the units of weight omitted. In cases where two, three, or more medicinal substances are prescribed in a prescription in the same quantity and if the list of these substances in the prescription is given consecutively, the designation of the quantity is made only once following the name of the last of the prescribed ingredients, by writing before the indicated quantity the word

ana

or abbreviated aa, which means “equally”; thus the doctor indicates that the preceding medicinal substances, written without a mark of their quantities, must each be taken in the same quantity as the one after which ana stands and the dose is indicated. Instead of ana, one can write utriusque (of each of two) if only two ingredients are prescribed in equal quantities; if there are more, then ana can be replaced by the word singulorum (of each of them). According to the requirement of the State Pharmacopoeia, the prescribed quantities of ingredients must be designated in the prescription by weight; however, with respect to liquid substances, this requirement is often violated when the quantity of the liquid substance prescribed for the preparation of the medicine does not exceed 1.0–1.5; in such cases, the quantity of the medicinal substances is shown in drops (guttas, abbreviated as gtt.), and sometimes also in volumetric measures. 4) In the next part of the prescription (subscriptio), the doctor indicates the method of preparing the medicine from the ingredients he has prescribed and the form in which the medicine is to be prepared, and very often the pharmaceutical operations that must be performed on the prescribed medicinal substances when preparing the medicine from them are also indicated, and it is also often designated in what glassware or packaging the medicine should be dispensed from the pharmacy in order to better preserve it from spoilage. Both the previous part of the prescription and the subscriptio are set forth in the Latin language. Subscriptio usually begins with the requirement Misce (mix), or Detur (let it be given), or Fiat (let it be made), or Da (give, dispense), usually expressed in abbreviated form: M., M. D., M. F., D., M. F. D. 5) In the next part of the prescription, called signatura, an indication of the method of use of the prescribed medicine is placed. This part of the prescription is written in Russian (except for the first word “signa”, abbreviated as S.; see below) so that the instructions given orally by the doctor on how to use the medicine can be established at home by means of the signatura. The People's Commissariat of Health, with the aim of bringing medical aid closer to the population in autonomous republics and regions, as well as in other places of residence of individual groups of national minorities, permitted by circular (July 13, 1929) that the signaturas of medicines dispensed on prescriptions of doctors should be written for national minorities also in the local language. In the signatura, the doctor indicates to the patient 1) the size of a single dose of the medicine: “one tablespoonful”, “15 drops”, and the like; 2) how often to take the medicine: “every hour”, “every three hours”, “three times a day”; 3) the time of taking the medicine: “morning and evening”, “before bedtime”, “before meals”, “after dinner”, and the like; 4) the method of administration when introducing the medicine into the body: “take internally, washing it down with water”, “for subcutaneous administration”, “for gargling”, and the like. In the interests of the patient and the rationalization of medical aid, it is urgently required that the method of application of the medicine be precisely designated in the signatura of the prescription and that there be no such general expressions as “method of use is known”, “take as told”, “for known use” (usui noto), and the like, because with such stereotyped expressions the doctor limits the control over the assignment of doses of medicines to patients, which is essential in substance and important for the patient, and deprives the attending personnel of the opportunity to verify or ascertain the method of use of the medicine from the signatura, as a result of which serious errors can occur during the use of medicines. Therefore, the People's Commissariat of Health granted the pharmacy the right not to dispense medicines on prescriptions in which there are no precise instructions on the method of application of the prescribed remedy. The part of the prescription called the signatura begins in it with the abbreviated Latin letter S., under which we understand the requirement of the doctor addressed to the pharmacy: “Signa” (mark), or “Signetur” (let it be marked), after which follows the corresponding instruction of the doctor on the use of the prescribed medicine. Frequently, this part of the prescription begins not with S., but with D. S. or M. D. S., and thus the subscriptio and signatura of the prescription are combined into one if the method of preparation of the medicine does not require special instructions on the details of manufacture. According to the name signatura of the described part of the prescription, the copy of the prescription dispensed by the pharmacy together with the prepared medicine to the patient began to be called the signatura (see) or more often the signaturka. 6) After the signatura, the surname of the patient (nomen aegroti) for whom the medicine is prescribed is written further. If the remedy is intended for a minor, “child” is written before the surname with an indication of the age so that the pharmacy can check the correctness of the dosage of the medicine. The surname of the patient is written in the prescription on a separate line, in its second half. 7) On the next line below the patient's surname, the doctor signs his surname, thereby certifying the prescribed prescription, thereby giving the prescription the value of a document. After the prescription is written, the doctor is obliged to read everything he has written in order to control the correctness and accuracy of the prescription, since every error in the prescription may ultimately turn out to be fatal for the patient, causing either poisoning of the patient or deterioration of his condition. In such cases, the doctor, besides moral responsibility, can also incur punishment by court, bringing to trial besides that the pharmacy workers who prepared the medicine prescribed according to the prescription.

A prescription must be written clearly, distinctly, and legibly, without any blots or corrections, so that the pharmacy worker can read everything written in the prescription without any difficulty. An illegibly written prescription easily leads to errors in the preparation of the medicine if the pharmacy worker is placed before the necessity not to read, but to "guess" what has been prescribed by the physician in the prescription. The decoding and reading of a carelessly written prescription usually takes a lot of time and effort for those working in the pharmacy before the true content of the prescription is finally established; the dispensing of medicine from the pharmacy is delayed, the patient does not receive timely medicinal assistance; pharmacy work suffers in its intensity. Therefore, the People's Commissariat of Health proposes (circ. of 16/IV 1929) to pharmacies, in case of non-observance by the physician of any rule of prescribing a prescription and the impossibility for the pharmacy to clarify regarding the prescription with the physician, to obligatorily return such a prescription to the patient with a mark on the back "medicine not dispensed due to non-observance of the rules on prescribing prescriptions." Abbreviations are permitted in prescriptions, as was partly mentioned above. Usually, the spelling of ingredients is abbreviated by dropping the endings of words as much as possible (see above); there are even more abbreviations in the subscriptio section and in other parts of the prescription when it concerns the following words and expressions (see table). In former times, not only abbreviations but even special signs, similar to hieroglyphs, were used in prescriptions to make the prescription understandable only to the physician and pharmacist. Medicines containing poisonous or potent substances in their composition, marked in the apothecary tax with a cross sign, as well as complex medicines, are dispensed exclusively upon a prescription. The right to prescribe prescriptions for medicinal agents is held by medical and veterinary physicians registered with the health department. Prescriptions may also be written for simple medicines that do not contain substances marked with a cross sign in the apothecary tax. Medical assistants serving in state service as heads of medical posts and outpatient clinics have the right, by virtue of their official duties, to prescribe from pharmacies under their signature, with the designation of their medical rank, all necessary agents for the patients they treat in quantities not exceeding the maximum dose. In institutions headed by physicians, middle medical personnel are granted the right, in cases of necessity, to prescribe medicinal agents both when treating patients within the medical institution itself and when providing emergency and urgent care or when making house calls to a patient, with the obligation of subsequent recording of the prescription in the outpatient book or the patient's personal card. Dentists have the right to prescribe prescriptions for medications authorized for dispensing from pharmacies (circ. of the People's Commissariat of Health of 2/I 1924 g.) at the request of dentists for the needs of their offices, but only those specified in a special list. Midwives have the right to prescribe medicinal agents by prescription: all agents permitted for over-the-counter sale, and of other agents only medications authorized (circ. of the People's Commissariat of Health of 2/I 1924 g.) for dispensing from pharmacies according to a special list. "All prescriptions upon receipt at the pharmacy are entered into a logbook with the designation therein of the date of receipt of the prescription, its number, the surname of the physician who prescribed the medicine, the surname of the patient, the form of the medicine, and the cost of the latter. The original prescription bearing the signature of the pharmacist who prepared the medicine and the person who checked it is left and kept in the pharmacy; on the label issued with the medicine, the signature of the pharmacist who dispensed the medicine is affixed. The logbook and original prescriptions are kept in the pharmacy for three years."

What was just cited was mandatory for every pharmacy in the pre-revolutionary period and was confirmed by the circular of the People's Commissariat of Health of March 4, 1926, No. 28, for Soviet pharmacies; however, since the abolition of prescription labels upon the dispensing of medications from pharmacies (circular of the People's Commissariat of Health of June 21, 1929), the above-mentioned rule for dispensing medications on prescriptions has lapsed, and the pharmacy, having dispensed what was prescribed, hands over the original prescription along with the medication, placing on the back of the original prescription the stamp of the pharmacy, the names of the persons who prepared, checked, and dispensed the medication, and the date the medication was dispensed.