The Hieroglyphics of Prescriptions or “Just how do we do it?”

We often get asked how pharmacists read those uniquely written little pieces of medication hieroglyphics commonly referred to as prescriptions. With all due respect to the cursively challenged (no names will be mentioned so as to protect Dr. Bob and Cathy) we’ll give you a behind the scenes peek at how we do what we do.

Prescriptions have an obscure language all their own, kind of like one of the Northwest Native dialects – you know one of those that have only four native speakers remaining. This is to keep you from having a clue what we are doing. Actually prescription directions are written using abbreviations based on Latin phrases that deal with frequency (once daily, twice daily, etc.), specific dosing time (before meals, after meals, at bedtime, etc.) and route of administration (in the eye, in the ear, by mouth, etc.). This is really a throwback to a much earlier time when all prescriptions were compounded by pharmacists before there were any manufactured tablets. Amounts of each ingredient were given in small pharmaceutical quantities such as drams and scruples and both ingredients and instructions were given in Latin. For the uninitiated, scruples are very, very small amounts of an ingredient – ask any politician that voted for the “donut hole” in your Medicare Part D benefits how small scruples can be.

But how do we READ prescriptions? It’s really not so difficult with practice. The abbreviations are much easier to distinguish when you know what they are. The same goes for the drug names – those are familiar to us. The hardest things to read on a prescription are the “unfamiliar” – i.e. the signature of an unfamiliar doctor (especially if the doctor or clinic name isn’t on the prescription blank) and your name if you would be someone unknown to us. Some of our problems with poorly scrawled prescriptions (and this only refers to off-island docs as Dr. Bob and Cathy print their prescriptions quite legibly) have been eliminated by a new Washington law requiring doctors to type, print or computer generate all prescriptions. Hand-written prescriptions are no longer allowed. This has been done to help eliminate a source of potential errors and miscommunication between your doctors and pharmacists.

Do we ever get one we just can’t read? Heck yes! Then we contact the prescriber for clarification. Sometimes we can read it just fine but we don’t particularly like what we are reading. This can happen when we see a potential drug interaction with something you are already taking, or a drug allergy, or a possible dosing error – any of these would be another cue for us to contact the prescriber. A lot of this happens before you even pick up your prescription. We get the job done without you even knowing there may have been a blip on the radar screen. In some ways we shouldn’t be so efficient – some folks don’t see the value in what we do because they aren’t really aware of all that we are doing behind that tall pharmacy counter. Just as our three branches of government provide for a system of “checks and balances”, ideally your pharmacist should be the “check and balance” in your medication healthcare – working with you and your doctors in reviewing your prescription care on a regular basis.

In the 8 month time span from January thru August 2006, we completed 110 documented Drug Utilization Reviews that involved contacting the doctor for some problem (and this doesn’t count the many informal times we catch a problem while the doctor is calling the prescription in and are able to fix it on the spot), we interviewed 672 new patients (to obtain a drug history, allergy information, etc.), we complied with 62 patient requests for medication history, we contacted insurance companies (either with billing or questions) over 15,700 times and we counseled patients on new prescriptions thousands of times.

So although you may see us change watch batteries, give directions to tourists, tell you which bandaid sticks the best, give information on Medicare Part D options, act crazy in the Fourth of July parade, or a host of other things – the most important things we do you may never see. We monitor you medication needs - your doses, possible drug interactions, watch for medication allergies, consult with your doctors, make recommendations for less costly therapy, fight with your insurance on your behalf, etc. all while reading those hieroglyphic-like prescriptions.

So if you see us standing behind the pharmacy counter, staring at the computer screen and apparently lost in thought – we’re not reading e-mail, really we’re not – we’re checking for drug interactions.