Download Pharmaceutical Services Division Penang State Health Department

Pharmaceutical Services Division
Penang State Health Department
2014
Good Prescribing Guideline
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.
Pharmaceutical Services Division
Penang State Health Department
Ministry of Health Malaysia
i
Good Prescribing Guideline
GOOD PRESCRIBING GUIDELINE
First Edition 2014
This is a publication of the Pharmaceutical Services Division, Penang State Health
Department. Enquiries are to be directed to the address below. Permission is hereby
granted to reproduce information contained herein provided that such reproduction
be given due acknowledgement and shall not modify the text.
This guideline can be downloaded from JKNPP website at
www.jknpenang.moh.gov.my
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
ii
Good Prescribing Guideline
TABLE OF CONTENTS
PAGE
1.
ACKNOWLEDGEMENT
1
2.
FOREWORD BY THE DIRECTOR OF PENANG STATE HEALTH DEPARTMENT
3
3.
FOREWORD BY DEPUTY DIRECTOR (PHARMACY) OF PENANG STATE HEALTH
DEPARTMENT
4
4.
INTRODUCTION
5
5.
GOOD PRESCRIBING PRINCIPLES
6
A. Details Pertaining to Medicines
6
B. Details Pertaining to Patient’s Data
9
C. Details Pertaining to Prescriber
9
6.
ERROR PRONE ABBREVIATIONS, SYMBOLS & DOSE DESIGNATION
10
7.
ACCEPTABLE TERMS AND ABBREVIATIONS
13
A. Drug Name
13
B. Prescribing Term
13
8.
REFERENCES
14
9.
APPENDICES
15
Appendix 1 - List of Acceptable Brand Names
15
Appendix 2 - List of Acceptable Drug Name Abbreviations
19
Appendix 3 - List of Acceptable Terms or Abbreviations
20
(a) Frequency or Timing
20
(b) Route of Administration
21
(c) Units of Measure and Concentration
22
(d) Dosage Forms
23
iii
Good Prescribing Guideline
Acknowledgement
This guideline is an initiative by the Medication Safety Committee of Pharmaceutical Services Division,
Penang State Health Department.
The committee would like to express our heartfelt gratitude to Dato’ Dr. Hj. Lailanor bin Hj. Ibrahim
(former Director of Penang State Health Department), Puan Zainab Md Yusuf (former Deputy Director
(Pharmacy) of Penang State Health Department), members of the reviewers, contributors and all those
involved for their valuable and constructive comments in the completion of this guideline.
Reviewers
Dato’ Dr. Ong Loke Meng
Head of Medical Department
Hospital Pulau Pinang
Dr. Revathy Nallusamy
Head of Paediatric Department
Hospital Pulau Pinang
Dr. Anita Bhajan Manocha
Head of Medical Department
Hospital Seberang Jaya
Dr. Siti Khamariah Ahmad
Family Medicine Specialist
Pejabat Kesihatan Daerah Timur Laut
Pn Noraini Ab. Kadir
Senior Principal Assistant Director
Pharmacy Practice & Development Division
(Penang State)
Cik Nor Hasni Haron
Pharmacist, Hospital Pulau Pinang
Pn Nurazrina Yuzrin
Pharmacist, Hospital Seberang Jaya
Contributors
Oiyammaal M. Chelliah
Pharmacist, Hospital Pulau Pinang
Hafizah Hamad
Pharmacist, Hospital Seberang Jaya
Maryam Omar
Pharmacist, Hospital Bukit Mertajam
Afida Amir Ismet Amir Mohd Idris
Pharmacist, Hospital Kepala Batas
Ong Chiou Ting
Pharmacist, Hospital Sungai Bakap
Chung Sook Meng
Pharmacist, Hospital Balik Pulau
Suraniza Suhaimi
Pharmacist, PKD Seberang Perai Utara
Lee Shi Mun
Pharmacist, PKD Seberang Perai Utara
Nurzawani Mat Yusoff
Pharmacist, PKD Seberang Perai Tengah
Tan Siew Chin
Pharmacist, PKD Seberang Perai Selatan
Kua Wen Chyi
Pharmacist, PKD Timur Laut
Ng Wei Min
Pharmacist, PKD Barat Daya
Tan Pei Ling
Senior Assistant Director
Pharmacy Practice and Development Division
(Penang State)
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Good Prescribing Guideline
Editors
2
Afida Amir Ismet Amir Mohd Idris
Pharmacist, Hospital Kepala Batas
Chua Cheah Chin
Pharmacist, Hospital Kepala Batas
Chung Sook Meng
Pharmacist, Hospital Balik Pulau
Sherene Tan Su Ann
Pharmacist, Hospital Pulau Pinang
Siti Hajar Rosli
Pharmacist, Hospital Balik Pulau
Tan Shu Hwa
Pharmacist, Hospital Kepala Batas
Good Prescribing Guideline
Foreword
Director
Penang State Health Department
Patient safety has become a fundamental priority in healthcare organizations worldwide and
increasing effort is being invested to ensure patient safety. In the year 1999, a landmark report entitled
“To Err is Human” by Institute of Medicine (IOM) triggered healthcare organizations to give serious
consideration in reducing and preventing medication errors. In response to that, studies were actively
conducted at all stages of medication use from prescribing, ordering, dispensing, administering and
monitoring of medications to determine causes and enforce the strategies to reduce the incidence of
medication errors.
The Joint Commission revealed that communication failure was one of the leading causes of
sentinel events from the year 2004 till June 2013. In Malaysia, the incidence of medication errors due to
abbreviations and non-standard nomenclature was the foremost reported error with a prevalence of
95.2% at non-specialist hospitals and 95.1% at specialist hospitals. Generally, this error occurred when
healthcare providers responsible for reading, interpreting and processing medication orders misinterpret
an abbreviation causing the final medicinal outcome to differ from the intended meaning. Education on
good prescribing practice among healthcare providers is essential in reducing medication error and
developing a safe environment in healthcare organizations.
I hope this Good Prescribing Guideline will be a good guide to all healthcare providers who are
involved in each level of medication use process. This will result in safe medication practice that
ensures patients receive the best and safest treatment.
Finally, I would like to thank the committee who have contributed their precious time and effort
in establishing this guide to ensure a safe healthcare practice for Penang state.
Thank you.
With Best Regards,
DATO’ DR. HJH. ZAILAN BINTI DATO’ HJ. ADNAN
Director of Penang State Health Department
3
Good Prescribing Guideline
Foreword
Deputy Director (Pharmacy)
Penang State Health Department
Medication safety is well recognized as a very important element in patient care. It is important
to ensure that medication errors are prevented at all stages of the medication use process which
comprises of prescribing, documenting, dispensing, administering and monitoring.
Ever since Pharmaceutical Services Division of the Ministry of Health introduced the
Medication Error Reporting System, there was a paradigm shift in the healthcare team towards
developing a non-punitive culture. Medication error reports were extensively reported allowing more
preventive actions to be identified and acted upon in all healthcare facilities. Some of which include the
use of Tallman lettering for sound alike medications and the labelling of High Alert Medications in red.
Prescribing is the most initial stage where medication error can occur and it is crucial to
establish safeguards to prevent its occurrence from this point. It has been estimated that 1% of
hospitalized patients suffer adverse events as the result of medical mismanagement and that drug
related complications are the most common type of adverse event. A guideline on safe prescribing
practice is indeed beneficial in reducing prescribing errors. Pharmaceutical Services Division of Penang
has proactively established a Good Prescribing Guide as a reference to all healthcare providers as a
step in creating a safe prescribing practice.
It is hoped that this guide will facilitate healthcare providers in treating patients and to help
them in identifying problem-prone medication in their respective facilities. Monitoring and supervision
must be continuous to ensure sustainability and on-going systems improvements. All drugs listed in this
guideline are the most common drugs used in our healthcare facilities. This list may be edited at the
individual health facility based on localized medication error reports.
With that, I would like to express my appreciation to all members in the working committee and
the reviewers who had taken great effort in establishing this Good Prescribing Guideline. I hope this
guide will serve its purpose well in reducing medication errors and instilling safe medication practice in
the state of Penang.
Thank you.
ZUBAIDAH CHE’ EMBEE
Deputy Director (Pharmacy) of Penang State Health Department
4
Good Prescribing Guideline
Introduction
Patient safety has become a fundamental mission in healthcare organizations worldwide and increasing
effort is being invested to ensure patient safety. In the year 1999, a landmark report “To Err is Human”
by Institute of Medicine (IOM) triggered healthcare organizations in giving serious consideration to
reducing and preventing medication errors1. As part of this response, studies were actively conducted
at all stages of medication use processes, which included the prescribing, ordering, dispensing,
administering and monitoring of medications to determine causes and strategies to reduce the
incidence of medication errors. The Joint Commission revealed that communication failure was one of
the leading causes of sentinel events from 2004 to June 2013 2. In Malaysia, the incidence of
medication errors due to abbreviations and non-standard nomenclature was the foremost reported error
with a prevalence of 95.2% at non-specialist hospitals and 95.1% at specialist hospitals3. This error in
general occurred when healthcare providers responsible for reading, interpreting and processing
medication orders misinterpret an abbreviation causing the final medicinal outcome to differ from
intended meaning. Educating all healthcare providers on good prescribing practice will hopefully reduce
medication error and develop a safe culture in healthcare organizations3.
Objectives
1.
To create and promote awareness of good prescribing practice among healthcare providers.
2.
To minimize medication error due to prescribing error in handwritten prescriptions.
3.
To establish a guide and training module on good prescribing practice for handwritten
prescriptions.
Scope
1.
All handwritten prescriptions or medication orders (including Chemotherapy Request Forms)
from outpatient and inpatient settings.
2.
All hospitals and health clinics under the care of Penang State Health Department.
5
Good Prescribing Guideline
Good Prescribing Principles
A. Details Pertaining to Medicines
All prescriptions must be written CLEARLY, LEGIBLY and INDELIBLY and
ATTRIBUTABLE.
Write drug names in full. DO NOT use abbreviations.
Exception may be made for approved drug name abbreviations.
Refer to Appendix 2 - List of Acceptable Drug Name Abbreviations
DO NOT use chemical names or symbols.
e.g. HCl (hydrochloric acid or hydrochloride) may be mistaken for KCl (potassium
chloride).
Exception may be made for approved drug names abbreviations.
Refer to Appendix 2 - List of Acceptable Drug Name Abbreviations
Drug name4,5
Use generic drug names.
Exception may be made for:
a) Combination products and approved brand names.
b) Drugs where significant bioavailability issues exist.
e.g. Adalat® vs. Nifedipine, Plavix® vs. Clopidogrel
c) Unless otherwise specified, an equivalent generic brand will be dispensed
for any medication ordered by brand name.
e.g. “Please supply Plavix® for stented patient “
Refer to Appendix 1 - List of Acceptable Brand Names
Where different formulations/ strengths /devices of a medication are available, it is
important that details are clearly stated on the prescription.
e.g. Actrapid Penfill or Actrapid Vial
MDI Budesonide or Turbuhaler Budesonide
DO NOT use trailing zeroes.
e.g. Use 5mg, NOT 5.0mg
Dose4,5
Use a leading zero in front of a decimal point for a dose less than 1.
e.g. Use 0.5mg, NOT .5mg
6
Good Prescribing Guideline
A. Details Pertaining to Medicines
Use words or Hindu-Arabic numbers.
e.g. One, Two, Three or 1, 2, 3, etc.
DO NOT use Roman numerals.
e.g. Do not use ‘II’ for two, ‘III’ for three, ‘V’ for five, etc.
Quantities of 1 gram or more should be written in grams
e.g. 1g, 1.5g, etc.
Quantities less than 1 gram should be written in milligrams
e.g. 500mg, NOT 0.5g
Quantities less than 1 miligram should be written in micrograms
e.g. 100mcg, NOT 0.1mg
Where fractions need to be used, circle the dose to denote clearly,
e.g. ‘½ tab’ could be interpreted as ‘half’ or as ‘one to two’ tablets
Therefore, write
Dose4,5
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 at or above 1,000
e.g. Syr. Nystatin 100,000 units qid
For insulin, prescribe as ‘units’ in full with a space in between numbers and dose,
e.g. ‘12 units’
DO NOT abbreviate as this is often associated with ten-fold errors,
e.g. ‘U’ or ‘ü’ can be mistaken for number ‘0’.
For multiple dose insulin, written as:
S/C Actrapid Penfill 12 units am
10 units noon
13 units pm
For combination drugs, specify:
a) Strength
b) Quantity of tablets per dose
e.g. Tab. Glucovance (500mg/5mg) 2 tabs BD
7
Good Prescribing Guideline
A. Details Pertaining to Medicines
Dose4,5
For inhalers, prescribe as number of doses NOT puffs (unless a combination
inhaler is involved).
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. Tab. Clonazepam 1mg ON/ PRN x 7 doses
Dose units4,5
Diagnosis4,5
The term millilitre is abbreviated as mL or ml, NOT cc or cm3.
Avoid acronyms or abbreviations for medical terms (diagnosis) and procedure
names on orders or prescriptions.
Refer to Appendix 3 - List of Acceptable Terms or Abbreviations
Frequency MUST always be specified, even for ‘as required’ medications.
Where appropriate, state the quantity of drug to be given.
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’ as the latter could be confused as
‘every two weeks’
For drugs to be administered only on specific days of the week, then those days
must always be written in full.
e.g. S/C Erythropoietin Beta 2,000 units 3x/ week on Monday, Wednesday and
Friday
Duration should be written clearly on the prescription.
Duration6
If possible, for long term prescriptions (chronic illnesses), the appointment date
(TCA) for the patient to visit the facility again can be written on the TOP RIGHT of
the prescription so that both patient and pharmacist are left with no ambiguity as to
the quantity to be consumed/ dispensed.
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
It can also deter patients from using more or less of the medicine.
8
Good Prescribing Guideline
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 of a patient, their age and gender.
(Age must be stated on all prescriptions)
AGE and WEIGHT must be stated on all PAEDIATRIC prescriptions.
e.g. Age: 2 years (14kg)
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.
9
Good Prescribing Guideline
Error Prone Abbreviations, Symbols and Dose Designation
One of the major causes of medication errors is the ongoing use of potentially dangerous abbreviations
and dose expressions8. The abbreviations, symbols and dose designations found in this table have
been reported as being frequently misinterpreted and involved in harmful medication errors. They
should never be used when communicating medical information. This includes internal
communications, telephone or verbal prescriptions, computer-generated labels, labels for drug storage
bins, medication administration records, as well as pharmacy and prescriber computer order entry
screens.
Abbreviations
µg
Intended Meaning
Microgram
Misinterpretation
Mistaken as ‘mg’.
Correction
Use ‘mcg’ or
‘microgram’
cc
Cubic centimeters
Mistaken as ‘u’ (units).
Use ‘mL or ml’
IJ
Injection
Mistaken as ‘IV’ or
‘intrajugular’.
Use ‘Inj’
IU
International unit
Mistaken as ‘IV’ (intravenous)
or ‘10’ (ten).
Use ‘units’
q.d. or OD
Once daily
Mistaken as ‘BD’ or ‘QID’.
Use ‘daily’
Mistaken as ‘q.i.d.’, especially
if the period after the ‘q’ or the
tail of the ‘q’ is misunderstood
as an ‘i’.
U or ü
Unit
Mistaken as the number ‘0’ or
Use ‘units’
number ‘4’, causing a 10-fold
overdose or greater.
e.g. 4U seen as ‘40’ or 4ü seen
as ‘44’.
Mistaken as ‘cc’ causing the
dose to be dispense in volume
instead of units.
e.g. 4u seen as 4cc
ung
10
Ointment
Latin abbreviation, not
universally understood.
Use ‘oint’
Good Prescribing Guideline
Abbreviations
SR
Intended Meaning
Slow Release
Misinterpretation
Mistaken as Syrup.
e.g. SR Morphine mistaken as
Syrup Morphine.
Correction
‘SR’ to be written after
a drug name.
e.g. T. Morphine SR
O
oral
biweekly
Two possible
meanings, i.e. ‘two
times a week’ or
‘every two weeks’
X (10)
Two possible
meanings, i.e. ‘10
doses’ or ‘10 tablets’
6/24
Every 6 hours
1/2
Half
Mistaken as number ‘0’.
-
Use ‘T’ or ‘Tab’ for
tablet, ‘C’ or ‘Cap’ for
Capsule and ‘Syr’ for
syrup
Use ‘2x/ week’ or ‘every
two weeks’
e.g. “T. Clonazepam 1mg ON x Prescribe as number of
(10) “can be interpreted as ‘10 doses.
tablets’ or ‘10 doses’.
e.g. T. Clonazepam
1mg ON x (10 doses)
Note: T. Clonazepam currently
comes in 2mg strength.
Mistaken as ‘six times a day’.
Use ‘6 hrly’ or ‘QID’
Mistaken as ‘one or two’.
Use ½ and circle it,
i.e.
I/I , II/II , III/III
e.g. Cap.
Cloxacillin II/II
QID
One, two, three
Trailing zero after
decimal point,
e.g. 1.0mg
1 mg
½
Availability of drug dosage
depends on product
purchased. A capsule of
Cloxacillin could be 250mg or
500mg.
Use usual dose in
numbers.
e.g. Cap. Cloxacillin
250mg QID
Mistaken as 10mg if the
decimal point is not seen.
DO NOT use trailing
zeros for doses
expressed in whole
numbers.
Write ‘1mg’ instead of
‘1.0mg’
“Naked” decimal
point,
e.g. .5mg
0.5 mg
Mistaken as 5mg if the decimal
point is not seen.
Write ‘0.5 mg’ instead
of ‘.5mg’
11
Good Prescribing Guideline
Abbreviations
Drug name and
dose written
closely
(especially
problematic for
drug names that
end with letter ‘l’
e.g.
Metoprolol50mg;
Bisoprolol5mg)
Intended Meaning
Metoprolol 50mg
Misinterpretation
Mistaken as Metoprolol 150mg
Bisoprolol 5mg
Mistaken as Bisoprolol 15mg
Large doses
without properly
placed commas
e.g. 100000 units;
1000000 units
100,000 units
100000 has been mistaken as
10,000 or 1,000,000;
1000000 has been mistaken as
100,000.
Sound alike
brand names
e.g. ‘Losec’ and
‘Lasix’
Either one of the
drug
Correction
Place adequate space
between the drug
name, dose and unit of
measure.
Use commas for dosing
units at or above 1,000
or use words such as
‘100 thousand’ or ‘1
million’ to improve
readability.
Omeprazole (Losec) has been Use generic names
mistaken as Frusemide (Lasix). except for acceptable
brand names.
Refer to Appendix 1 List of Acceptable
Brand Names
x3d
/ (slash mark)
12
For three days
Mistaken as ‘3 doses’
Separates two doses Mistaken as the number ‘1‘.
or indicates ‘per’
e.g. ‘25 units / 10 units’
misread as ‘25 units and 110
units’
Use ‘x3 days’ or ‘3/7’
Use ‘per’ rather than a
slash mark to separate
doses
@
at
Mistaken as number ‘2’
Use ‘at’
&
and
Mistaken as number ‘2’
Use ‘and’
+
plus or and
Mistaken as number ‘4’
Use ‘and’
Good Prescribing Guideline
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
Refer to Appendix 1 - List of Acceptable Brand Names
Appendix 2 - List of Acceptable Drug Name Abbreviations
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.
Refer to Appendix 3 - List of Acceptable Terms or Abbreviations
13
Good Prescribing Guideline
References
14
1.
Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building A Safer Health System.
Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine.
National Academy Press; 1999.
2.
The Joint Commission: Sentinel Events Data: Root Causes by Event Type. [cited 2013 Jul 7].
Available from:
http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2Q2013.pdf
3.
Zaiton K., Abd Haniff M.Y., Siti Norlina S., Atia H., Norma A., Fuziah A.R. Medication Error And
Adverse Drug Event Rates Through Medical Records Review. Institute for Health Systems
Research.
4.
National Terminology, Abbreviations and Symbols to be Used in The Prescribing and
Administering of Medicines in Australian Hospitals. Australian Commission on Safety and
Quality in Healthcare; October 2006.
5.
All Wales Prescription Writing Standards. Clinical Pharmacy Sub group of Welsh Chief
Pharmacists Committee; September 2004.
6.
Guidelines for Prescription Writing and Handling of Prescriptions and Prescription Medicines.
The Voluntary Health Association of Goa; April 2011
7.
Laws of Malaysia: Poison Act 1952 (revised 1989).
8.
Sentinel Event Alert - Medication Errors Related to Potentially Dangerous Abbreviations: Joint
Commission on Accreditation of Healthcare Organisations; 2001.
9.
List of Error-Prone Abbreviations, Symbols, and Dose Designations: Institute for Safe
Medication Practices; 2005.
10.
Insulin Errors – Abbreviations Will Get U in Trouble: Medication Safety Alert! Acute Care
Institute for Safe Medication Practices (Edition August 13); 1997.
11.
Drug Formulary Ministry of Health Malaysia; 2013.
Good Prescribing Guideline
Appendices
Appendix 1 - List of Acceptable Brand Names
1
Acetylsalicylic Acid 100mg and Glycine 45mg Tablet
Acceptable Brand
Names
Cardiprin
2
Alendronate Sodium 70mg and Cholecalciferol 5600 IU Tablet
Fosamax Plus
3
All-Trans Retinoic Acid 10mg Capsule
ATRA
4
Amiloride HCl 5mg and Hydrochlorothiazide 50mg Tablet
Moduretic
5
Exforge
7
Amlodipine 5mg / 10mg and Valsartan 160mg Tablet
Ammonium Bicarbonate, Tincture Ipecac (Mixture Expect
Stimulant)
Amorolfine 5% Nail Lacquer
8
Amoxicillin and Clavulanate Tablet / Injection / Syrup
Augmentin
9
Unasyn
12
Ampicillin and Sulbactam Tablet / Injection / Syrup
Anti RhD Gamma Globulin 250mcg/ 2ml Injection (500
units=100mcg)
Antilymphocyte / Antithymocyte Immunoglobulin (from horse)
Injection
Antithymocyte Immunoglobulin (from rabbit) Injection
13
Artemether 20mg and Lumefantrine 120mg Tablet
Riamet
14
Drapolene
16
Benzalkonium 0.01% Cream
Beractant Intratracheal Suspension (200mg phospholipids in 8 ml
vial)
Betamethasone 17-valerate Cream
17
Betamethasone 17-valerate Ointment
Betnovate Oint.
18
Bismuth Subgallate and Benzyl Benzoate Suppository
Anusol
19
Symbicort
24
Budesonide 160mcg and Formoterol 4.5mcg Inhalation
Calcipotriol Hydrate 50mcg/g and Betamethasone Dipropionate
0.5 mg/g Ointment
Cefoperazone Sodium 500mg and Sulbactam Sodium 500mg
Injection
Chlorpheniramine Maleate Tablet / Injection
Choline Salicylate 8.7% and Cetylkonium Chloride 0.01% Dental
Gel
Chorionic Gonadotrophin Human (HCG) 5000 IU Injection
25
Clobetasol Propionate 0.05% Cream / Ointment
Dermovate Cr / Oint.
No.
6
10
11
15
20
21
22
23
Generic Names
Expect Stimulant
Loceryl
Rhogam
Atgam
Thymoglobulin
Survanta
Betnovate Cream
Daivobet
Sulperazone
Piriton
Bonjela
Pregnyl
15
Good Prescribing Guideline
26
Clobetasone Butyrate 0.05% Cream / Ointment
Acceptable Brand
Names
Eumovate Cr / Oint.
27
Clostridium Botulinum Toxin Type A 100 units
Botox
28
Clostridium Botulinum Toxin Type A 500 units
Dysport
29
Coal Tar, Salicylic Acid and Pinetar Liquid
Conjugated Oestrogen 0.625mg and Medroxyprogesterone
Acetate 2.5mg Tablet
Cyclopentolate 0.2% with Phenylephrine 1% Eye Drops
Sebitar
Diane 35
34
Cyproterone Acetate 2mg and Ethinyloestradiol 0.035mg Tablet
Dexamethasone and Neomycin Sulphate and Polymyxin B Eye
Ointment
Dexamethasone Sodium Phosphate 0.1% Eye Drops
35
Dinoprostone (Prostaglandin E2 ) 3mg Vaginal Tablet
Prostin E2
36
Daflon
38
Diosmin 450mg and Hesperidin 50mg Tablet
Diphenhydramine 14mg/ 5ml and Ammonium Chloride 135mg/
5ml Expectorant Syrup
Diphenoxylate with Atropine Sulphate Tablet
39
Dorzolamide HCl 2% Ophthalmic Solution
Trusopt
40
Erythropoietin Human Recombinant Injection (alfa)
Eprex
41
Erythropoietin Human Recombinant Injection (beta)
Recormon
42
Essentiale
44
Essential Phospholipids Capsule
Estradiol 1mg (14 tablet) and Estradiol 1mg with Dydrogesterone
10mg (14 tablet)
Estradiol 1mg and Dydrogesterone 5mg Tablet
45
Estradiol Valerate 2mg and Norgestrel 0.5mg Tablet
Progyluton
46
Ezetimibe 10mg and Simvastatin 20mg Tablet
Vytorin
47
Factor IX Injection
Factor VII - Factor VIIa (Recombinant) Eptacog Alfa (activated)
100 KIU (2 mg) Injection
Ferrous Fumarate, Folic Acid and B Complex Tablets
Octaplex / Replenine
Gonad F
52
Follitropin Alpha (Recombinant Human FSH) 300 IU Injection
Framycetin Sulphate 0.5%, Dexamethasone 0.05% and
Gramicidin 0.005% Ear Drops
Fusidic Acid 2% in Betamethasone Valerate 0.1% Cream
53
Gamma Benzene Hexachloride 0.1 % Lotion
Lindane
54
Gemeprost (Prostagladin E1 Synthetic Analogue) 1mg Pessary
Cervagem
No.
30
31
32
33
37
43
48
49
50
51
16
Generic Names
Premelle 2.5
Cyclomydril
Maxitriol
Maxidex
Benadryl
Lomotil
Femoston 1/10
Femoston Conti
Novoseven
Hematinic
Sofradex
Fucicort
Good Prescribing Guideline
55
Glycerin 25% and Sodium Chloride 15% Enema
Acceptable Brand
Names
Ravin enema
56
Hypromellose 0.3% Eye Drops
Artificial tears
57
Hypromellose 0.3%, Carbomer 980 Ophthalmic Gel
Genteal Gel
58
Tienam
63
Imipenem 500mg and Cilastatin 500mg Injection
Insulin Aspart 30% and Protaminated Insulin Aspart 70% 100
U/ml 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
Interferon Alfa-2b 18 MIU Multidose Injection Pen
64
Interferon Beta-1a 44 mcg Injection
Rebif
65
Ipratropium Bromide MDI / Inhalation Solution
Atrovent
66
Combivent
68
Ipratropium Bromide and Salbutamol MDI / Inhalation Solution
Ipratropium Bromide 20mcg and Fenoterol 50mcg/dose
Inhalation
Irbersartan and Hydrochlorothiazide Tablet
69
Isosorbide Dinitrate Tablet / Injection
Isordil
70
Isorsorbide Mononitrate 50mg SR Capsule
Elantan
71
Isorsorbide-5-Mononitrate 30mg or 60mg SR Tablet
Imdur SR
72
Levodopa 100mg and Carbidopa 25mg Tablet
Sinemet
73
Levodopa 100mg and Benserazide 25mg HBS Capsule
Madopar HBS
74
Levodopa 200mg and Benserazide 50mg Tablet
Madopar
75
Lopinavir 200mg and Ritonavir 50mg Tablet
Kaletra
76
Loratadine 5mg and Pseudoephedrine Sulphate 120mg Tablet
Clarinase
77
Losartan and Hydrochlorothiazide Tablet
Hyzaar
78
Magnesium Trisilicate Tablet
Gelusil
79
Meclozine HCl and Pyridoxine Tablet
Veloxin
80
Medroxyprogesterone Acetate Tablet / Injection
Provera
81
Metformin and Glibenclamide Tablet
Glucovance
82
Metformin and Sitagliptin Tablet
Janumet
83
Metformin and Vildagliptin Tablet
Methoxy Polyethylene Glycol-epoetin Beta 100mcg/ 0.3ml
Injection in Prefilled Syringe
GalvusMet
No.
59
60
61
62
67
84
Generic Names
Novomix
Actrapid,
Humulin R
Insulatard, Humulin N
Mixtard,
Humulin 30/70
Intron A
Berodual N
CoAprovel
Mircera
17
Good Prescribing Guideline
No.
85
Acceptable Brand
Names
Gelafundin
87
Modified Fluid Gelatin 4% Injection
Monobasic Sodium Phosphate 48% and Dibasic Sodium
Phosphate 18%
Oxytocin 5 units and Ergometrine Maleate 0.5mg/ml Injection
88
Paradichlorobenzene, Turpentine Oil and Chlorbutol Ear Drops
Cerumol
89
Peginterferon Alpha-2a 135mcg Prefilled Syringe
Pegasys
90
Pegylated Interferon Alpha-2b 100mcg Injection
Peg-Intron
91
Phenoxymethyl Penicillin 125mg Tablet
Penicillin V
92
Piperacillin 4g and Tazobactam 500 mg Injection
Tazocin
93
Potassium Chloride 600mg SR Tablet
Slow K
94
Solcoseryl Gel / Oint.
97
Protein Free Haemodialysate 10% Jelly / Ointment
Rifampicin 150mg, Isoniazid 75mg and Pyrazinamide 400mg
Tablet
Rifampicin 150mg, Isoniazid 75mg, Pyrazinamide 400mg and
Ethambutol HCl 275mg Tablet
Salicylic Acid, Lactic Acid and Oxypolyethoxy Solution
98
Salmeterol 25mcg and Fluticasone Propionate 125mcg Inhalation
Seretide
99
Sodium Biphosphate 16% and Sodium Phosphate 6% Solution
Fleet enema
100
Sodium Chloride 0.9%
Normal Saline
101
Opticrom
103
Sodium Cromoglycate 2% Eye Drops
Stavudine 30mg, Lamivudine 150mg and Nevirapine 200mg
Tablet
Sulfadoxine 500mg and Pyrimethamine 25mg Tablet
104
Sulphamethoxazole 400mg and Trimethoprim 80mg Tablet
Bactrim
105
Sulphur 2% and Resorcinol 2% in Calamine Lotion
Acne Lotion
106
Tar, Coal Tar and Oleyl Alcohol Liquid
Polytar
107
Telmisartan 80mg and Hydrochlorothiazide 12.5mg Tablet
Micardis Plus
108
Tywnsta
111
Telmisartan and Amlodipine Tablet
Tenofovir Disoproxil Fumarate 300mg and Emtricitabine 200mg
Tablet
Triamcinolone Acetonide, Neomycin Oil, Gramicidin and Nystatin
Ear Drop
Triprolidine HCl 2.5mg and Pseudoephedrine HCl 60mg Tablet
112
Ursodeoxycholic Acid 250 mg Capsule
Ursofalk
113
Varenicline Tartrate Tablet
Champix
114
Zidovudine 300mg and Lamivudine 150mg Tablet
Combivir
86
95
96
102
109
110
18
Generic Names
Fleet Phospho-Soda
Syntometrine
Rimcure 3-FDC
Akurit-4
Collomack Soln
SLN 30
Fansidar
Tenvir-Em
Kenacomb
Actifed
Good Prescribing Guideline
Appendix 2 - List of Acceptable Drug Name Abbreviations
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
Didanosine 250 mg Enteric Coated Capsule
Didanosine EC 250mg
7
Dihydrocodeine Bitartrate
DF118
8
Emulsifying Ointment
Emulsificant Oint.
9
Ferric Ammonium Citrate
FAC
10
Glyceryl Trinitrate
GTN
11
Liquor Picis Carbonis (Coal Tar)
LPC
12
Magnesium Trisilicate Mixture
MMT
13
Methyl Salicylate Ointment
OMS
14
Oral Rehydration Salt
ORS
15
Paracetamol
PCM
16
Paste Bismuth Subnitrate, Iodoform and Liquid Paraffin
BIPP
17
Potassium Chloride
KCl
18
Potassium Citrate
Pot. Citrate
19
Potassium Dihydrogen Phosphate Injection
KH2PO4
20
Potassium Permanganate
KMNO4
21
Silver Sulfadiazine Cream
SSD Cream
22
Vitamin B Complex
Vit. B Co
23
Vitamin B1 B6 B12
Vit B1 B6 B12
24
White Soft Paraffin
WSP
25
White Soft Paraffin 60% and Liquid Paraffin 40%
WSP 60% and LP 40%
19
Good Prescribing Guideline
Appendix 3 - List of Acceptable Terms or Abbreviations
(a) Frequency or Timing
Intended Meaning
(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 6 hours
every 6 hrs or 6 hourly or 6 hrly
every 8 hours
every 8 hrs or 8 hourly or 8 hrly
every other day
eod
hourly
hrly
once a week
three times a week
20
Acceptable Terms or Abbreviations
Once a week and specify the day in full.
e.g. Once a week on Tuesday or 1x / week (Tuesday)
Three times a week and specify the days in full.
e.g. Three times a week on Mondays, Wednesdays and
Saturdays or 3x / week (Mondays, Wednesdays and
Saturdays)
when required
prn
immediately
stat
Good Prescribing Guideline
(b) Route of Administration
Intended Meaning
Acceptable Terms or Abbreviations
Epidural
Epidural
Inhalation
Inhalation
Intraarticular
Intraarticular
Intramuscular
IM
Intrathecal
Intrathecal
Intranasal
Intranasal
Intravenous
IV
Irrigation
Irrigation
Left
Left or ( L ) or
Nebulised
NEB
Naso-gastric
NG
Oral
PO
Percutaneous enteral gastrostomy
PEG
Per vagina
PV
Per rectum
PR
Peripherally inserted central catheter
PICC
Right
Right or ( R ) or
Subcutaneous
S/C
Sublingual
S/L
Topical
Topical or LA
L
R
21
Good Prescribing Guideline
(c) Units of Measure and Concentration
Intended Meaning
22
Acceptable Terms or Abbreviations
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)
microgram or mcg
percentage
%
millimole
mmol
Good Prescribing Guideline
(d) Dosage Forms
Intended Meaning
Acceptable Terms or Abbreviations
Ampule
Amp
Capsule
C. or Cap.
Cream
Cream
Controlled Release
CR
Ear Drops
Ear drops
Eye Drops
Eye drops or Gutt.
Eye Ointment
Eye ointment or Eye Oint. or Occ.
Extended Release
XR
Immediate Release
IR
Injection
Inj
Metered Dose Inhaler
Metered dose inhaler or MDI
Modified Release
MR
Mixture
Mixture or Mixt.
Nasal Spray
Nasal spray
Ointment
Ointment or oint.
Pessary
Pessary
Powder
Powder
Suppository
Supp.
Suspension
Susp.
Syrup
Syr
Slow Release
SR
Tablet
T. or Tab.
Patient Controlled Analgesia
PCA
23
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