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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.

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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.

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Core Components

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Prescription Details Element

The main element for prescription events: 
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

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Prescription Workflow

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1. Creating a Prescription

1

Select Patient

Navigate to the patient record for whom you’re prescribing
2

Create Event

Click “Add Event” and select “Prescription”
3

Add Medications

Use the medication search to add drugs to the prescription
4

Specify Details

For each medication, specify:
  • Route of administration (both eyes, right eye, left eye, oral, etc.)
  • Dose and frequency
  • Duration of treatment
  • Specific instructions
5

Review Warnings

Check for allergy alerts and drug interactions
6

Save

Save the prescription (may require authorization depending on configuration)

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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

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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)

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4. Electronic Distribution

Modern installations may support:
  • Electronic Prescription Service (EPS) integration
  • Direct pharmacy messaging
  • Patient portal access
  • GP system integration

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Medication Management

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Formulary Integration

The prescription module integrates with the OpenEyes medication formulary:

Drug Database

Comprehensive ophthalmic medication database with standard preparations, doses, and frequencies

Local Formulary

Institution-specific formulary customization and restrictions

Usage Tracking

Frequently prescribed items appear first for quick selection

Tapers & Sets

Common medication regimens saved as sets (e.g., post-op cataract drops)

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Prescription Items

Each prescription can contain multiple items: 
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)

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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.

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Safety Features

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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:
auditAllergicDrugEntries($target, $action = "allergy_override")

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Drug Interaction Warnings

Check for interactions between:
  • Newly prescribed medications
  • Existing patient medications
  • Recent prescriptions

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Duplicate Detection

Prevents duplicate prescriptions: 
public $check_for_duplicate_entries = true;
System alerts if:
  • Same medication already prescribed
  • Similar medications in same class
  • Active prescription already exists

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Controlled Drugs

Special handling for controlled substances:
  • Additional authorization requirements
  • Quantity limits
  • Enhanced audit trail
  • Special printing format
  • Destruction records

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Medication Sets & Tapers

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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

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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

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Integration with Examination

The prescription module integrates with OphCiExamination:

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Medication Management Element

use \OEModule\OphCiExamination\models\MedicationManagement;
Links between:
  • Current medications recorded in examination
  • New prescriptions generated
  • Medication changes documented
  • Adherence tracking

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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

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Patient Group Directions (PGD/PSD)

Integration with the OphDrPGDPSD module: 
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

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Reporting & Audit

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Prescription Reports

Prescribing Patterns

Analyze medication usage by prescriber, clinic, or diagnosis

Formulary Compliance

Track adherence to local formulary guidelines

Controlled Drugs

Audit trail for controlled substance prescribing

Allergy Overrides

Review cases where allergy alerts were overridden

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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)

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Administration

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Configuration

Module registration: 
'modules' => [
    'OphDrPrescription' => [
        'class' => 'application.modules.OphDrPrescription.OphDrPrescriptionModule',
    ],
],

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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
Customizable print templates for:
  • NHS FP10 prescriptions
  • Private prescriptions
  • Hospital pharmacy requisitions
  • Patient information leaflets
  • Clinic medication charts

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Best Practices

Check Allergies

Always review patient allergies before prescribing - the system will alert but clinical review is essential

Verify Current Medications

Review existing medications to avoid duplicates and check for interactions

Specify Laterality

Always specify which eye(s) for topical medications - never assume

Clear Instructions

Provide clear dosing instructions, especially for tapers and PRN medications

Document Indication

Use comments field to document indication, especially for off-label use

Print Promptly

Print prescriptions promptly after creation to ensure patient receives medications

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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

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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)

Examination

Record findings that inform prescribing decisions

PGD/PSD

Protocol-based prescribing and administration

Correspondence

Include prescription information in letters

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Further Information

User Guide

Step-by-step prescribing workflows

Admin Guide

Formulary management and configuration

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