> ## Documentation Index > Fetch the complete documentation index at: https://mintlify.com/appertafoundation/openeyes/llms.txt > Use this file to discover all available pages before exploring further. # OphDrPrescription Module > Electronic prescribing and medication management in OpenEyes # OphDrPrescription - Prescriptions The **OphDrPrescription** module provides comprehensive electronic prescribing functionality for ophthalmic medications. It handles the complete prescription lifecycle from creation through authorization, printing, and administration tracking. ## Overview OphDrPrescription is designed for prescribing medications in ophthalmic practice, with particular support for: * Topical eye medications (drops, ointments, gels) * Systemic medications related to eye conditions * Post-operative medication regimens * Controlled drug prescriptions * Patient Group Directions (PGD) and Patient Specific Directions (PSD) This module is separate from but integrates with the OphCiExamination medication management element and the OphDrPGDPSD module for protocol-based prescribing. ## Core Components ### Prescription Details Element The main element for prescription events: ```php theme={null} Element_OphDrPrescription_Details ``` **Properties:** * `event_id`: Links to the prescription event * `comments`: General prescription notes * `printed_by_user`: User who printed the prescription * `printed_date`: Timestamp of printing * `authorised_by_user`: Authorizing prescriber * `authorised_date`: Authorization timestamp **Relations:** * `items[]`: Collection of prescription items (medications) * `printedByUser`: User who printed * `authorisedByUser`: User who authorized ## Prescription Workflow ### 1. Creating a Prescription Navigate to the patient record for whom you're prescribing Click "Add Event" and select "Prescription" Use the medication search to add drugs to the prescription For each medication, specify: * Route of administration (both eyes, right eye, left eye, oral, etc.) * Dose and frequency * Duration of treatment * Specific instructions Check for allergy alerts and drug interactions Save the prescription (may require authorization depending on configuration) ### 2. Authorization Workflow Depending on institutional policy, prescriptions may require authorization: **When Required:** * Prescriptions by non-prescribers * Controlled substances * High-risk medications * Medications outside formulary **Authorization Steps:** 1. Initial prescription saved as "pending" 2. Authorized prescriber reviews 3. Authorizer approves (or rejects) 4. System records authorizer and timestamp 5. Prescription becomes active ### 3. Printing Prescriptions Prescriptions can be printed for: * Patient to take to pharmacy * Hospital pharmacy dispensing * Clinic medication room * GP information **Print Features:** * Standard NHS prescription format support * Private prescription templates * Batch printing for multiple patients * Reprint functionality with audit trail * Digital signatures (where configured) ### 4. Electronic Distribution Modern installations may support: * Electronic Prescription Service (EPS) integration * Direct pharmacy messaging * Patient portal access * GP system integration ## Medication Management ### Formulary Integration The prescription module integrates with the OpenEyes medication formulary: Comprehensive ophthalmic medication database with standard preparations, doses, and frequencies Institution-specific formulary customization and restrictions Frequently prescribed items appear first for quick selection Common medication regimens saved as sets (e.g., post-op cataract drops) ### Prescription Items Each prescription can contain multiple items: ```php theme={null} OphDrPrescription_Item ``` **Item Properties:** * Medication/drug * Dose * Route (both eyes, right eye, left eye, oral, IM, IV, etc.) * Frequency (QDS, TDS, BD, OD, PRN, etc.) * Duration * Quantity to dispense * Special instructions * Taper schedule (if applicable) ### Laterality Support Ophthalmic medications often require laterality specification: * **Both Eyes (OU)**: Medication to both eyes * **Right Eye (OD)**: Right eye only * **Left Eye (OS)**: Left eye only * **Systemic**: Oral, injection, or other non-topical routes The system automatically calculates quantities based on laterality and duration. ## Safety Features ### Allergy Checking Automatic allergy screening against patient allergy records: **Alert Types:** * **Critical**: Direct allergy to prescribed medication * **Warning**: Cross-reactivity or class allergy * **Information**: Related medication sensitivity **Workflow:** 1. System checks each medication against patient allergies 2. Alerts displayed prominently if matches found 3. Prescriber must acknowledge alert to proceed 4. Override rationale documented in audit trail **Audit Method:** ```php theme={null} auditAllergicDrugEntries($target, $action = "allergy_override") ``` ### Drug Interaction Warnings Check for interactions between: * Newly prescribed medications * Existing patient medications * Recent prescriptions ### Duplicate Detection Prevents duplicate prescriptions: ```php theme={null} public $check_for_duplicate_entries = true; ``` System alerts if: * Same medication already prescribed * Similar medications in same class * Active prescription already exists ### Controlled Drugs Special handling for controlled substances: * Additional authorization requirements * Quantity limits * Enhanced audit trail * Special printing format * Destruction records ## Medication Sets & Tapers ### Predefined Sets Create standard medication bundles for common scenarios: **Post-Cataract Surgery:** * Prednisolone 0.5% QDS tapering over 4 weeks * Chloramphenicol 0.5% QDS for 2 weeks * Ketorolac 0.5% TDS for 2 weeks **Post-Trabeculectomy:** * Prednisolone 1% 2-hourly tapering protocol * Chloramphenicol 0.5% QDS * Atropine 1% BD **Acute Anterior Uveitis:** * Prednisolone 1% hourly initially * Cyclopentolate 1% TDS * Glaucoma medications as required **Glaucoma Initiation:** * First-line agent (prostaglandin analog) * Optional second-line combination * Monitoring instructions ### Tapering Schedules Support for complex tapering regimens: ``` Week 1: QDS (4 times daily) Week 2: TDS (3 times daily) Week 3: BD (twice daily) Week 4: OD (once daily) Then stop ``` Tapers can be: * Time-based (weekly reductions) * Symptom-based (with review points) * Custom schedules ## Integration with Examination The prescription module integrates with OphCiExamination: ### Medication Management Element ```php theme={null} use \OEModule\OphCiExamination\models\MedicationManagement; ``` Links between: * Current medications recorded in examination * New prescriptions generated * Medication changes documented * Adherence tracking ### Workflow Integration 1. **During Examination**: Review current medications in MedicationManagement element 2. **Treatment Decision**: Decide on medication changes in management plan 3. **Create Prescription**: Generate prescription event with new/changed medications 4. **Link Events**: Prescription linked to examination event 5. **Update Record**: Medication list automatically updates ## Patient Group Directions (PGD/PSD) Integration with the OphDrPGDPSD module: ```php theme={null} use OEModule\OphDrPGDPSD\models\OphDrPGDPSD_PGDPSD; ``` **Patient Group Directions (PGD):** * Protocol-based prescribing for defined patient groups * Non-prescribers can administer under PGD * Specific inclusion/exclusion criteria * Limited medication list per PGD **Patient Specific Directions (PSD):** * Individual prescription by prescriber * Administration by non-prescriber * Specific to named patient and occasion **Use Cases:** * Diagnostic mydriasis by technicians * Post-injection medications by nurses * Emergency medications in clinic * Screening program medications ## Reporting & Audit ### Prescription Reports Analyze medication usage by prescriber, clinic, or diagnosis Track adherence to local formulary guidelines Audit trail for controlled substance prescribing Review cases where allergy alerts were overridden ### Audit Trail Complete audit trail captures: * Prescription creation (user, timestamp) * Modifications (before/after values) * Authorization (authorizer, timestamp) * Printing events (user, timestamp, number of copies) * Allergy alert acknowledgments * Destruction records (for controlled drugs) ## Administration ### Configuration Module registration: ```php theme={null} 'modules' => [ 'OphDrPrescription' => [ 'class' => 'application.modules.OphDrPrescription.OphDrPrescriptionModule', ], ], ``` ### Formulary Management Administrators can: * Add/edit medications in formulary * Set local restrictions * Define standard doses and frequencies * Create medication sets * Configure allergy checking rules * Set authorization requirements ### Print Templates Customizable print templates for: * NHS FP10 prescriptions * Private prescriptions * Hospital pharmacy requisitions * Patient information leaflets * Clinic medication charts ## Best Practices Always review patient allergies before prescribing - the system will alert but clinical review is essential Review existing medications to avoid duplicates and check for interactions Always specify which eye(s) for topical medications - never assume Provide clear dosing instructions, especially for tapers and PRN medications Use comments field to document indication, especially for off-label use Print prescriptions promptly after creation to ensure patient receives medications ## Common Medications Frequently prescribed ophthalmic medications include: * Latanoprost 0.005% (Xalatan) - OD * Timolol 0.25%/0.5% - BD * Dorzolamide 2% - TDS * Brinzolamide 1% - BD * Brimonidine 0.2% - BD/TDS * Fixed combinations (e.g., Cosopt, Ganfort, DuoTrav) * Prednisolone acetate 1% - hourly to QDS * Dexamethasone 0.1% - QDS * Ketorolac 0.5% - TDS/QDS * Diclofenac 0.1% - QDS * Fluorometholone 0.1% - BD to QDS * Chloramphenicol 0.5% drops - QDS * Chloramphenicol 1% ointment - ON * Fusidic acid 1% gel - BD * Ofloxacin 0.3% - QDS * Aciclovir 3% ointment - 5x daily * Tropicamide 1% - for diagnostics * Cyclopentolate 1% - for uveitis or cycloplegia * Atropine 1% - for severe uveitis * Phenylephrine 2.5%/10% - for mydriasis * Hypromellose 0.3% - PRN * Carbomer 0.2% gel - QDS * Sodium hyaluronate - PRN * Paraffin ointment - ON * Preservative-free preparations for frequent use ## Troubleshooting **Solution:** * Contact system administrator to add medication * Use "Other" category for unlisted medications * Provide full drug details in free text * Request formulary update for future use **Process:** * Carefully review the allergy alert * Consult patient about reaction details * Consider alternative medications * If override necessary, document clear rationale * System maintains audit trail **Check:** * Prescription is saved and authorized * Printer connection and status * Print template configuration * User has printing permissions * Browser pop-up settings (for PDF generation) ## Related Modules Record findings that inform prescribing decisions Protocol-based prescribing and administration Include prescription information in letters ## Further Information Step-by-step prescribing workflows Formulary management and configuration