pharmaceutical services division penang state health...

Pharmaceutical Services Division

Penang State Health Department

2014

This is a general guide for good prescribing practice within

MOH facilities in Penang State. Users are advised to refer to

the policy currently used at the respective facilities and

update accordingly.

Quick Reference for Healthcare Providers

2

Good Prescribing Guideline

Good Prescribing Principles

Details Pertaining to Medicines

Drug name4,5

All prescriptions must be written CLEARLY, LEGIBLY, INDELIBLY and ATTRIBUTABLE.

Write drug names in full.

DO NOT use chemical names or symbols.

Use generic drug names.

Specify formulations/ strengths /devices needed when various forms of a medication are available. e.g. Actrapid Penfill or Actrapid Vial

DO NOT use trailing zeroes Use 5mg, NOT 5.0mg Leading zero in front of a decimal point for dose less than 1 Use 0.5mg, NOT .5mg

Use words or Hindu-Arabic numbers. DO NOT use Roman numerals. e.g. One, Two, Three or 1, 2, 3.

Dose4,5

Dose ≥ 1 gram should be written in grams E.g. 1g, 1.5g, etc. Dose ≤ 1 gram should be written in milligrams E.g. 500mg, NOT 0.5g Dose ≤ 1 mg should be written in micrograms E.g. 100mcg, NOT 0.1mg

Where fractions need to be used, circle the dose to denote clearly.

Write ½ if the intended meaning is ‘half a tablet’.

For figures above 100, a) Use words to express intent. e.g. One thousand, one million, six million, etc b) Use commas for dosing units ≥ 1,000 e.g. Syr. Nystatin 100,000 units qid

For insulin, prescribe as ‘units’ in full, e.g. ‘12 units’, NOT 12 u. For multiple dose insulin, write as: S/C Actrapid Penfill 12 units am 10 units noon 13 units pm

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Details Pertaining to Medicines

Dose4,5

For combination drugs, specify strength and quantity of tablets per dose. e.g. Tab. Glucovance (500mg/5mg) 2 tabs BD

For inhalers, prescribe as number of doses NOT puffs (except for combination inhaler). e.g. MDI Budesonide 200mcg BD Accuhaler Seretide (50mcg/250mcg) 1 puff BD

For psychotropic drugs, prescribe as number of doses NOT number of tablets. e.g. T. Clonazepam 1mg ON/ PRN x 7 doses

Dose units4,5 Milliliter is abbreviated as mL or ml, NOT cc or cm3.

Diagnosis4,5 Avoid acronyms or abbreviations for medical terms (diagnosis) and procedure names on orders or prescriptions.

Frequency4,5

Frequency MUST always be specified. e.g. Tab. Paracetamol 1g tds / PRN x 10 tablets

Express dosage frequency unambiguously. e.g. Use ‘two times a week’, NOT ‘biweekly’ (confused as ‘every two weeks’)

For drugs to be administered only on specific days of the week, those days must always be written in full. e.g. S/C Erythropoietin Beta 2,000 units I.V. 3x/ week on Monday,Wednesday and Friday

Duration6

Duration should be written clearly on the prescription.

For long term prescriptions, the appointment date (TCA) can be written on the TOP RIGHT of the prescription.

For short term / PRN usage, the number of tablets to be given should be written. e.g. Tab. Paracetamol 1g tds / PRN x 10 tablets

Details Pertaining to Patient’s Data

Patient’s data6

One prescription for one patient.

Patient's full name, full I.C. number (12 digits) or Hospital RN must be stated on all

prescriptions for proper identification, age and gender.

AGE and WEIGHT must be stated on all PAEDIATRIC prescriptions.

The DATE when the prescription is written must be stated.

Details Pertaining to Prescriber

Prescriber’s

information7 Prescriber’s signature & name stamp with MMC, department and hospital must be provided.

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Error Prone Abbreviations, Symbols and Dose Designation

The abbreviations, symbols and dose designations found in this table have been reported as being frequently misinterpreted and involved in harmful medication errors.

Abbreviations Misinterpretation Correct Term

µg mg Use ‘mcg’ or ‘microgram’

cc u (units) Use ‘mL’ or ‘ml’

IJ IV or intrajugular Use ‘Inj’

IU IV (intravenous) or 10 (ten) Use ‘units’

q.d. or OD BD or QID Use ‘daily’

U or ü Number 0, number 4 or cc Use ‘units’

ung Not universally understood Use ‘oint’

SR Syrup SR to be written after a drug name. e.g. Tab. Morphine SR

O Number 0 Use ‘T’ or ‘Tab’ for tablet, ‘C’ or ‘Cap’ for Capsule and ‘Syr’ for syrup

biweekly Ambiguous two times a week or

every two weeks Use ‘2x/ week’ or ‘every two weeks’

X (10) Ambiguous 10 tabs or 10 doses Prescribe as number of doses.

6/24 six times a day Use ‘6 hrly’ or ‘QID’

1/2 one or two Use

I/I , II/II , III/III e.g. Cap. Cloxacillin II/II QID

Different drug dosage available Use usual dose in numbers. e.g. Cap. Cloxacillin 250 mg QID

Trailing zero after decimal point, e.g. 1.0mg

10 mg Write 1 mg instead of 1.0 mg

‘Naked’ decimal point, e.g. .5mg

5 mg Write 0.5 mg instead of .5 mg

Drug name and dose written closely

(e.g. Metoprolol50mg; Bisoprolol5mg)

Metoprolol 150 mg

Bisoprolol 15 mg

Place adequate space between the drug name, dose, and unit of measure.

Large doses without properly placed commas e.g. 100000

units; 1000000 units 100000 10,000 or 100,000

Use commas for dosing units ≥ 1,000 or use words such as ‘100 thousand’ or ‘1 million’ to improve readability.

Sound alike brand names Losec or Lasix Use generic names except for acceptable brand names.

x3d 3 doses Use ‘x3 days’ or ‘3/7’

/ (slash mark) Number 1

e.g. ‘25 units / 10 units’ misread as ‘25 units and 110 units’

Use ‘per’ rather than a slash mark to separate doses

@ Number 2 Use ‘at’

& Number 2 Use ‘and’

+ Number 4 Use ‘and’

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Acceptable Terms and Abbreviations

Abbreviations should be avoided at all if possible, but in the event of abbreviations being utilised, only those approved and contained within this document are permitted to be used within MOH facilities in Penang State. A. DRUG NAME 1. Drug names must always be written in full generic names. 2. It may sometimes be appropriate to use the brand name (innovator drug) to avoid confusion, such as in:

Insulins

Combination products

Multi-ingredient preparations

Overly long and complicated drug names 3. Drug names MUST NEVER be abbreviated under any circumstance.

Exceptions:

Modified release products - slow release, controlled release, continuous release or other modified release products, the description used in the brand name to denote the release characteristics should be included with the generic drug name, for example tramadol SR, carbamazepine CR

B. PRESCRIBING TERM 1. Write in full - avoid using abbreviations wherever possible, including Latin abbreviations. 2. Abbreviations used should be commonly used, understood and universal. 3. Do not use symbols.

List of Acceptable BRAND NAMES (Please refer to Appendix 1 in Good Prescribing Guideline for full list)

No. Generic Names Acceptable Brand

Names

1 Acetylsalicylic Acid 100mg and Glycine 45mg Tablet Cardiprin

2 Alendronate Sodium 70mg and Cholecalciferol 5600 IU Tablet Fosamax Plus

3 Amiloride HCl 5mg and Hydrochlorothiazide 50mg Tablet Moduretic

4 Ammonium Bicarbonate, Tincture Ipecac (Mixture Expect Stimulant) Expect Stimulant

5 Amoxicillin and Clavulanate Tablet / Injection / Syrup Augmentin

6 Ampicillin and Sulbactam Tablet / Injection / Syrup Unasyn

7 Benzalkonium 0.01% Cream Drapolene

8 Betamethasone 17-valerate Cream/ Ointment Betnovate Cream/ Oint

9 Bismuth Subgallate and Benzyl Benzoate Suppository Anusol

10 Budesonide 160mcg and Formoterol 4.5mcg Inhalation Symbicort

11 Cefoperazone Sodium 500mg and Sulbactam Sodium 500mg Injection Sulperazone

12 Chlorpheniramine Maleate Tablet / Injection Piriton

13 Choline Salicylate 8.7% and Cetylkonium Chloride 0.01% Dental Gel Bonjela

14 Clobetasol Propionate 0.05% Cream / Ointment Dermovate Cr / Oint.

15 Clobetasone Butyrate 0.05% Cream / Ointment Eumovate Cr / Oint.

16 Diosmin 450mg and Hesperidin 50mg Tablet Daflon

17 Diphenhydramine 14mg/ 5ml and Ammonium Chloride 135mg/ 5ml Expectorant Syrup Benadryl

18 Diphenoxylate with Atropine Sulphate Tablet Lomotil

19 Erythropoietin Human Recombinant Injection (alfa) Eprex

20 Essential Phospholipids Capsule Essentiale


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No. Generic Names Acceptable Brand

Names

21 Estradiol 1mg and Dydrogesterone 5mg Tablet Femoston Conti

22 Estradiol Valerate 2mg and Norgestrel 0.5mg Tablet Progyluton

23 Ezetimibe 10mg and Simvastatin 20mg Tablet Vytorin

24 Ferrous Fumarate, Folic Acid and B Complex Tablets Hematinic

25 Framycetin Sulphate 0.5%, Dexamethasone 0.05% and Gramicidin 0.005% Ear Drops Sofradex

26 Gamma Benzene Hexachloride 0.1 % Lotion Lindane

27 Glycerin 25% and Sodium Chloride 15% Enema Ravin enema

28 Hypromellose 0.3% Eye Drops Artificial tears

29 Imipenem 500mg and Cilastatin 500mg Injection Tienam

30 Insulin Recombinant Neutral Human, short-acting 100 IU/ml Injection Actrapid, Humulin R

31 Insulin Recombinant Synthetic Human, intermediate-acting 100 IU/ml Injection Insulatard, Humulin N

32 Insulin Recombinant Synthetic Human, pre-mixed 100 IU/ml Injection Mixtard, Humulin 30/70

33 Ipratropium Bromide MDI / Inhalation Solution Atrovent

34 Ipratropium Bromide and Salbutamol MDI / Inhalation Solution Combivent

35 Ipratropium Bromide 20mcg and Fenoterol 50mcg/dose Inhalation Berodual N

36 Irbersartan and Hydrochlorothiazide Tablet CoAprovel

37 Isosorbide Dinitrate Tablet / Injection Isordil

38 Levodopa 100mg and Carbidopa 25mg Tablet Sinemet

39 Levodopa 100mg and Benserazide 25mg HBS Capsule Madopar HBS

40 Losartan and Hydrochlorothiazide Tablet Hyzaar

41 Magnesium Trisilicate Tablet Gelusil

42 Meclozine HCl and Pyridoxine Tablet Veloxin

43 Medroxyprogesterone Acetate Tablet / Injection Provera

44 Monobasic Sodium Phosphate 48% and Dibasic Sodium Phosphate 18% Fleet Phospho-Soda

45 Oxytocin 5 units and Ergometrine Maleate 0.5mg/ml Injection Syntometrine

46 Phenoxymethyl Penicillin 125mg Tablet Penicillin V

47 Piperacillin 4g and Tazobactam 500 mg Injection Tazocin

48 Potassium Chloride 600mg SR Tablet Slow K

49 Protein Free Haemodialysate 10% Jelly / Ointment Solcoseryl Gel / Oint.

50 Rifampicin 150mg, Isoniazid 75mg, Pyrazinamide 400mg and Ethambutol HCl 275mg Tablet

Akurit-4

51 Salmeterol 25mcg and Fluticasone Propionate 125mcg Inhalation Seretide

52 Sodium Biphosphate 16% and Sodium Phosphate 6% Solution Fleet enema

53 Sodium Chloride 0.9% Normal Saline

54 Sodium Cromoglycate 2% Eye Drops Opticrom

55 Stavudine 30mg, Lamivudine 150mg and Nevirapine 200mg Tablet SLN 30

56 Sulfadoxine 500mg and Pyrimethamine 25mg Tablet Fansidar

57 Sulphamethoxazole 400mg and Trimethoprim 80mg Tablet Bactrim

58 Sulphur 2% and Resorcinol 2% in Calamine Lotion Acne Lotion

59 Tar, Coal Tar and Oleyl Alcohol Liquid Polytar

60 Telmisartan 80mg and Hydrochlorothiazide 12.5mg Tablet Micardis Plus

61 Telmisartan and Amlodipine Tablet Tywnsta

62 Triprolidine HCl 2.5mg and Pseudoephedrine HCl 60mg Tablet Actifed

63 Varenicline Tartrate Tablet Champix


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List of Acceptable DRUG NAME ABBREVIATIONS (Please refer to Appendix 2 in Good Prescribing Guideline for full list)

No. Generic Names Acceptable Drug Name

Abbreviations

1 Acriflavine 0.1% Lotion Flavin

2 Aqueous Cream Aq Cream

3 Ascorbic Acid Vit C

4 Benzyl Benzoate Emulsion EBB

5 Chloramphenicol CMC

6 Dihydrocodeine Bitartrate DF118

7 Emulsifying Ointment Emulsificant Oint.

8 Ferric Ammonium Citrate FAC

9 Glyceryl Trinitrate GTN

10 Liquor Picis Carbonis (Coal Tar) LPC

11 Magnesium Trisilicate Mixture MMT

12 Methyl Salicylate Ointment OMS

13 Oral Rehydration Salt ORS

14 Paracetamol PCM

15 Potassium Chloride KCl

16 Potassium Citrate Pot. Citrate

17 Potassium Dihydrogen Phosphate Injection KH2PO4

18 Potassium Permanganate KMNO4

19 Silver Sulfadiazine Cream SSD Cream

20 Vitamin B Complex Vit. B Co

21 Vitamin B1 B6 B12 Vit B1 B6 B12

22 White Soft Paraffin 60% and Liquid Paraffin 40% WSP 60% and LP 40%

List of Acceptable TERMS or ABBREVIATIONS (Please refer to Appendix 3 in Good Prescribing Guideline for full list)

(a) Frequency or Timing

Intended Meaning Acceptable Terms or Abbreviations

(in the) morning om

evening or afternoon pm

(at) night on

once daily daily

twice a day bd

three times a day tds

four times a day qid

every 4 hours every 4 hrs or 4 hourly or 4 hrly



every other day eod

hourly hrly

once a week 1x/ week and specify the day in full e.g. 1x / week (Tuesday)

three a week 3x/ week and specify the days in full e.g. 3x / week (Mondays, Wednesdays and Saturdays)

when required prn

immediately stat


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(b) Route of Administration


Intramuscular IM

Intravenous IV

Left Left or (L) or

Nebulised NEB

Naso-gastric NG

Oral PO

Per vagina PV

Per rectum PR

Right Right or (R) or

Subcutaneous S/C

Sublingual S/L

Topical Topical or LA

(c) Units of Measure and Concentration


gram(s) g

international unit(s) units

units units

kilogram(s) kg

litre(s) L

milligram(s) mg

millilitre(s) mL or ml

microgram(s) mcg

percentage %

millimole mmol

(d) Dosage Forms


Capsule C. or cap.

Controlled Release CR

Eye Drops Gutt.

Eye Ointment Eye Oint. or Occ.

Extended Release XR

Immediate Release IR

Injection Inj

Metered Dose Inhaler MDI

Modified Release MR

Mixture Mixt.

Ointment Oint.

Suppository Supp.

Suspension Susp.

Syrup Syr

Slow Release SR

R

L

Pharmaceutical Services Division, Penang State Health Department

Aras 8, Bangunan Persekutuan, Jalan Anson,

10400 Pulau Pinang, Malaysia.

Tel: 04 – 2292319 Fax: 04 - 2280314

Website: www.jknpenang.moh.gov.my

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