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Pharmaceutical Services Division Penang State Health Department 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. 2014 Good Prescribing Guideline Quick Reference for Healthcare Providers Good Prescribing Principles B A C A Details Pertaining to Medicines All prescriptions must be written CLEARLY, LEGIBLY, INDELIBLY and ATTRIBUTABLE. Write drug names in full. Drug name4,5 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. 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 Dose4,5 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 2 Good Prescribing Guideline A Quick Reference for Healthcare Providers Details Pertaining to Medicines 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 Dose4,5 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. Frequency MUST always be specified. e.g. Tab. Paracetamol 1g tds / PRN x 10 tablets Frequency4,5 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 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. Duration6 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 B Details Pertaining to Patient’s Data One prescription for one patient. Patient’s data6 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. C Details Pertaining to Prescriber Prescriber’s information7 Prescriber’s signature & name stamp with MMC, department and hospital must be provided. 3 Good Prescribing Guideline Quick Reference for Healthcare Providers 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 µg cc IJ IU q.d. or OD U or ü ung Misinterpretation mg u (units) IV or intrajugular IV (intravenous) or 10 (ten) BD or QID Number 0, number 4 or cc Not universally understood SR Syrup O Number 0 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 1/2 one or two I/I , II/II , III/III e.g. Cap. Cloxacillin II/II QID Trailing zero after decimal point, e.g. 1.0mg ‘Naked’ decimal point, e.g. .5mg Drug name and dose written closely (e.g. Metoprolol50mg; Bisoprolol5mg) Different drug dosage available Correct Term Use ‘mcg’ or ‘microgram’ Use ‘mL’ or ‘ml’ Use ‘Inj’ Use ‘units’ Use ‘daily’ Use ‘units’ Use ‘oint’ SR to be written after a drug name. e.g. Tab. Morphine SR Use ‘T’ or ‘Tab’ for tablet, ‘C’ or ‘Cap’ for Capsule and ‘Syr’ for syrup Use ‘6 hrly’ or ‘QID’ Use ½ Use usual dose in numbers. e.g. Cap. Cloxacillin 250 mg QID 10 mg Write 1 mg instead of 1.0 mg 5 mg Write 0.5 mg instead of .5 mg Metoprolol 150 mg Bisoprolol 15 mg Large doses without properly placed commas e.g. 100000 units; 1000000 units 100000 10,000 or 100,000 Sound alike brand names Losec or Lasix x3d 3 doses Number 1 / (slash mark) e.g. ‘25 units / 10 units’ misread as ‘25 units and 110 units’ @ & + Number 2 Number 2 Number 4 4 Place adequate space between the drug name, dose, and unit of measure. Use commas for dosing units ≥ 1,000 or use words such as ‘100 thousand’ or ‘1 million’ to improve readability. Use generic names except for acceptable brand names. Use ‘x3 days’ or ‘3/7’ Use ‘per’ rather than a slash mark to separate doses Use ‘at’ Use ‘and’ Use ‘and’ Good Prescribing Guideline Quick Reference for Healthcare Providers 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. 1. 2. 3. PRESCRIBING TERM Write in full - avoid using abbreviations wherever possible, including Latin abbreviations. Abbreviations used should be commonly used, understood and universal. Do not use symbols. List of Acceptable BRAND NAMES (Please refer to Appendix 1 in Good Prescribing Guideline for full list) No. Generic Names 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Acetylsalicylic Acid 100mg and Glycine 45mg Tablet Alendronate Sodium 70mg and Cholecalciferol 5600 IU Tablet Amiloride HCl 5mg and Hydrochlorothiazide 50mg Tablet Ammonium Bicarbonate, Tincture Ipecac (Mixture Expect Stimulant) Amoxicillin and Clavulanate Tablet / Injection / Syrup Ampicillin and Sulbactam Tablet / Injection / Syrup Benzalkonium 0.01% Cream Betamethasone 17-valerate Cream/ Ointment Bismuth Subgallate and Benzyl Benzoate Suppository Budesonide 160mcg and Formoterol 4.5mcg Inhalation Cefoperazone Sodium 500mg and Sulbactam Sodium 500mg Injection Chlorpheniramine Maleate Tablet / Injection Choline Salicylate 8.7% and Cetylkonium Chloride 0.01% Dental Gel Clobetasol Propionate 0.05% Cream / Ointment Clobetasone Butyrate 0.05% Cream / Ointment Diosmin 450mg and Hesperidin 50mg Tablet Diphenhydramine 14mg/ 5ml and Ammonium Chloride 135mg/ 5ml Expectorant Syrup Diphenoxylate with Atropine Sulphate Tablet Erythropoietin Human Recombinant Injection (alfa) Essential Phospholipids Capsule 5 Acceptable Brand Names Cardiprin Fosamax Plus Moduretic Expect Stimulant Augmentin Unasyn Drapolene Betnovate Cream/ Oint Anusol Symbicort Sulperazone Piriton Bonjela Dermovate Cr / Oint. Eumovate Cr / Oint. Daflon Benadryl Lomotil Eprex Essentiale Good Prescribing Guideline Quick Reference for Healthcare Providers No. Generic Names 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Estradiol 1mg and Dydrogesterone 5mg Tablet Estradiol Valerate 2mg and Norgestrel 0.5mg Tablet Ezetimibe 10mg and Simvastatin 20mg Tablet Ferrous Fumarate, Folic Acid and B Complex Tablets Framycetin Sulphate 0.5%, Dexamethasone 0.05% and Gramicidin 0.005% Ear Drops Gamma Benzene Hexachloride 0.1 % Lotion Glycerin 25% and Sodium Chloride 15% Enema Hypromellose 0.3% Eye Drops Imipenem 500mg and Cilastatin 500mg Injection Insulin Recombinant Neutral Human, short-acting 100 IU/ml Injection Insulin Recombinant Synthetic Human, intermediate-acting 100 IU/ml Injection Insulin Recombinant Synthetic Human, pre-mixed 100 IU/ml Injection Ipratropium Bromide MDI / Inhalation Solution Ipratropium Bromide and Salbutamol MDI / Inhalation Solution Ipratropium Bromide 20mcg and Fenoterol 50mcg/dose Inhalation Irbersartan and Hydrochlorothiazide Tablet Isosorbide Dinitrate Tablet / Injection Levodopa 100mg and Carbidopa 25mg Tablet Levodopa 100mg and Benserazide 25mg HBS Capsule Losartan and Hydrochlorothiazide Tablet Magnesium Trisilicate Tablet Meclozine HCl and Pyridoxine Tablet Medroxyprogesterone Acetate Tablet / Injection Monobasic Sodium Phosphate 48% and Dibasic Sodium Phosphate 18% Oxytocin 5 units and Ergometrine Maleate 0.5mg/ml Injection Phenoxymethyl Penicillin 125mg Tablet Piperacillin 4g and Tazobactam 500 mg Injection Potassium Chloride 600mg SR Tablet Protein Free Haemodialysate 10% Jelly / Ointment Rifampicin 150mg, Isoniazid 75mg, Pyrazinamide 400mg and Ethambutol HCl 275mg Tablet Salmeterol 25mcg and Fluticasone Propionate 125mcg Inhalation Sodium Biphosphate 16% and Sodium Phosphate 6% Solution Sodium Chloride 0.9% Sodium Cromoglycate 2% Eye Drops Stavudine 30mg, Lamivudine 150mg and Nevirapine 200mg Tablet Sulfadoxine 500mg and Pyrimethamine 25mg Tablet Sulphamethoxazole 400mg and Trimethoprim 80mg Tablet Sulphur 2% and Resorcinol 2% in Calamine Lotion Tar, Coal Tar and Oleyl Alcohol Liquid Telmisartan 80mg and Hydrochlorothiazide 12.5mg Tablet Telmisartan and Amlodipine Tablet Triprolidine HCl 2.5mg and Pseudoephedrine HCl 60mg Tablet Varenicline Tartrate Tablet 50 51 52 53 54 55 56 57 58 59 60 61 62 63 6 Acceptable Brand Names Femoston Conti Progyluton Vytorin Hematinic Sofradex Lindane Ravin enema Artificial tears Tienam Actrapid, Humulin R Insulatard, Humulin N Mixtard, Humulin 30/70 Atrovent Combivent Berodual N CoAprovel Isordil Sinemet Madopar HBS Hyzaar Gelusil Veloxin Provera Fleet Phospho-Soda Syntometrine Penicillin V Tazocin Slow K Solcoseryl Gel / Oint. Akurit-4 Seretide Fleet enema Normal Saline Opticrom SLN 30 Fansidar Bactrim Acne Lotion Polytar Micardis Plus Tywnsta Actifed Champix Good Prescribing Guideline Quick Reference for Healthcare Providers List of Acceptable DRUG NAME ABBREVIATIONS (Please refer to Appendix 2 in Good Prescribing Guideline for full list) No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Acceptable Drug Name Abbreviations Flavin Aq Cream Vit C EBB CMC DF118 Emulsificant Oint. FAC GTN LPC MMT OMS ORS PCM KCl Pot. Citrate KH2PO4 KMNO4 SSD Cream Vit. B Co Vit B1 B6 B12 WSP 60% and LP 40% Generic Names Acriflavine 0.1% Lotion Aqueous Cream Ascorbic Acid Benzyl Benzoate Emulsion Chloramphenicol Dihydrocodeine Bitartrate Emulsifying Ointment Ferric Ammonium Citrate Glyceryl Trinitrate Liquor Picis Carbonis (Coal Tar) Magnesium Trisilicate Mixture Methyl Salicylate Ointment Oral Rehydration Salt Paracetamol Potassium Chloride Potassium Citrate Potassium Dihydrogen Phosphate Injection Potassium Permanganate Silver Sulfadiazine Cream Vitamin B Complex Vitamin B1 B6 B12 White Soft Paraffin 60% and Liquid Paraffin 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 (in the) morning evening or afternoon (at) night once daily twice a day three times a day four times a day every 4 hours every 6 hours every 8 hours every other day hourly once a week three a week when required immediately Acceptable Terms or Abbreviations om pm on daily bd tds qid every 4 hrs or 4 hourly or 4 hrly every 6 hrs or 6 hourly or 6 hrly every 8 hrs or 8 hourly or 8 hrly eod hrly 1x/ week and specify the day in full e.g. 1x / week (Tuesday) 3x/ week and specify the days in full e.g. 3x / week (Mondays, Wednesdays and Saturdays) prn stat 7 Good Prescribing Guideline Quick Reference for Healthcare Providers (b) Route of Administration Intended Meaning Intramuscular Intravenous Acceptable Terms or Abbreviations IM IV Left Left or (L) or L Nebulised Naso-gastric Oral Per vagina Per rectum NEB NG PO PV PR Right Right or (R) or R Subcutaneous Sublingual Topical S/C S/L Topical or LA (c) Units of Measure and Concentration Intended Meaning gram(s) international unit(s) units kilogram(s) litre(s) milligram(s) millilitre(s) microgram(s) percentage millimole Acceptable Terms or Abbreviations g units units kg L mg mL or ml mcg % mmol (d) Dosage Forms Intended Meaning Capsule Controlled Release Eye Drops Eye Ointment Extended Release Immediate Release Injection Metered Dose Inhaler Modified Release Mixture Ointment Suppository Suspension Syrup Slow Release Acceptable Terms or Abbreviations C. or cap. CR Gutt. Eye Oint. or Occ. XR IR Inj MDI MR Mixt. Oint. Supp. Susp. Syr SR Pharmaceutical Services Division, Penang State Health Department Aras 8, Bangunan Persekutuan, Jalan Anson, 10400 Pulau Pinang, Malaysia. Tel: 04 – 2292319 8 Fax: 04 - 2280314 Website: www.jknpenang.moh.gov.my