What are the guidelines for preparing IPD (In-Patient Department) and OPD (Out-Patient Department) prescriptions for common medical conditions in Indian clinical practice?

IPD and OPD Prescription Writing in Indian Clinical Practice

Essential Components of Every Prescription

All prescriptions in India must include specific mandatory elements to ensure legal compliance, patient safety, and proper medication dispensing. 1

Header Information (Required on All Prescriptions)

• Doctor's details: Full name, qualification (MD Medicine), registration number with Medical Council of India/State Medical Council, clinic/hospital name, address, and contact number 1
• Date of prescription: Always write the complete date (DD/MM/YYYY format) 1
• Patient demographics: Full name, age, gender, weight (especially important for dose calculations), and contact information 1

Clinical Documentation

• Diagnosis: Write the primary diagnosis clearly using standard medical terminology or ICD-10 codes when available 2
• Comorbidities: Document all relevant comorbid conditions that may affect medication choice or dosing 2
• Allergies: Clearly document any known drug allergies or adverse reactions at the top of the prescription 1

OPD (Outpatient) Prescription Format

Structure and Organization

• Use the Rx symbol before writing medications to clearly demarcate the prescription section 1
• List medications systematically: Write each medication on a separate line with complete details 1

Medication Details (For Each Drug)

• Generic name first: Write the generic name in capital letters, followed by brand name in parentheses if needed 1
• Dosage form: Specify tablet, capsule, syrup, injection, etc. 1
• Strength: Write the exact strength (e.g., 500 mg, 10 mg) 1
• Frequency: Use standard abbreviations (OD = once daily, BD = twice daily, TDS = three times daily, QID = four times daily) 1
• Duration: Specify total duration (e.g., "for 7 days," "for 1 month") 1
• Route: Specify if not oral (e.g., IV, IM, SC) 1
• Timing instructions: Before/after food, morning/evening as relevant 1

Additional OPD Elements

• Investigations ordered: List any laboratory tests, imaging, or other investigations with clear instructions 2
• Follow-up instructions: Specify when the patient should return (e.g., "Review after 2 weeks with reports") 1
• Lifestyle modifications: Document specific dietary advice, activity restrictions, or other non-pharmacological interventions 2
• Warning signs: Note specific symptoms that should prompt immediate medical attention 3

IPD (Inpatient) Prescription Format

Daily Prescription Sheet Requirements

• Date and time: Each prescription order must be dated and timed 1
• Admission diagnosis: Primary and secondary diagnoses clearly documented 2
• Current clinical status: Brief note on patient's condition, vital signs if relevant 2

Medication Orders (More Detailed Than OPD)

• Regular medications: List all scheduled medications with exact timing (e.g., "8 AM, 2 PM, 8 PM") 1
• PRN (as needed) medications: Specify indication, maximum dose, and minimum interval between doses 1
• IV fluids: Specify type, rate, and duration (e.g., "NS 1000 mL over 8 hours") 1
• Monitoring parameters: Document what needs to be monitored (e.g., "Monitor BP 4 hourly," "Check blood glucose before meals") 3

Critical IPD Documentation

• Stop orders: Clearly document when medications should be discontinued 1
• Medication review: Daily review and documentation of ongoing medications 2
• Dose adjustments: Document any changes with rationale (e.g., renal function, drug levels) 2
• Allergy documentation: Must be prominently displayed on every prescription sheet 1

Special Considerations for Indian Practice

Medication Assessment and Review

• Conduct medication reconciliation: Review all current medications including over-the-counter drugs, herbal supplements, and medications from other providers 2
• Assess for drug-drug interactions: Particularly important in patients with multimorbidity receiving polypharmacy 2
• Document medication-related problems: Including adverse effects, non-adherence, and therapeutic failures 2
• Review medication appropriateness: Use clinical judgment to assess benefit-risk ratio for each medication 2

Patient-Centered Prescribing

• Assess treatment burden: Consider the impact of the medication regimen on the patient's daily life and quality of life 2
• Discuss patient preferences: Explore patient's expectations, concerns, and treatment goals before prescribing 2
• Consider cost implications: In Indian practice, medication affordability significantly affects adherence; discuss generic alternatives when appropriate 1
• Provide clear instructions: Use simple language for patient counseling notes, consider language barriers 1

Specific Clinical Scenarios

For Patients with Chronic Kidney Disease

• Adjust doses based on renal function: Calculate eGFR and adjust medications accordingly 4
• Avoid nephrotoxic medications: Particularly NSAIDs and aminoglycosides when possible 2
• Monitor electrolytes closely: Especially potassium in patients on ACE inhibitors or ARBs 4

For Patients with Multiple Comorbidities

• Prioritize based on mortality and morbidity: Focus on conditions with highest impact on survival and quality of life 2
• Simplify regimen when possible: Increase dose or frequency before adding new medications to minimize pill burden 2
• Schedule regular medication reviews: At least annually, more frequently if clinically indicated 2

During Acute Illness (Sick Day Rules)

• Temporarily stop certain medications: Including SGLT2 inhibitors, NSAIDs, ACE inhibitors/ARBs, and diuretics during vomiting, diarrhea, or significant fluid losses 1
• Resume medications appropriately: Within 24-48 hours of normal eating and drinking 1
• Provide clear instructions: Document trigger symptoms and duration of medication hold (typically up to 3 days) 1

Legal and Safety Requirements

Prescription Validity and Storage

• Maintain prescription copies: Keep records for minimum 3 years as per Indian medical regulations 1
• Use prescription pads with security features: Pre-printed letterhead with registration details 1
• Sign and stamp every prescription: Both are mandatory for legal validity 1

Controlled Substances

• Use separate prescription forms: For Schedule H, H1, and X drugs as per Drugs and Cosmetics Rules 1
• Document indication clearly: Especially for narcotics and psychotropic substances 1
• Limit quantity prescribed: Follow state-specific regulations for controlled substances 1

Common Pitfalls to Avoid

• Never use ambiguous abbreviations: Avoid "U" for units (write "units"), "μg" (write "mcg"), or trailing zeros 1
• Don't assume normal glucose excludes problems: In patients on SGLT2 inhibitors, euglycemic diabetic ketoacidosis can occur with normal blood glucose 3
• Never discontinue insulin based on single reading: Insulin requirements fluctuate; single normal glucose does not indicate insulin is unnecessary 5
• Avoid prescribing cascades: When new symptoms appear, consider whether they might be medication side effects before adding new drugs 2
• Don't ignore drug-disease interactions: Certain medications may worsen comorbid conditions 2

Documentation Best Practices

• Write legibly or use electronic prescriptions: Illegible prescriptions are a major source of medication errors 1
• Use standard medical abbreviations only: Avoid creating personal shorthand that others cannot interpret 1
• Document clinical reasoning: Brief note on why specific medications were chosen, especially for complex cases 2
• Include contact information: Provide phone number for pharmacist or patient queries 1