Math and Dosage Calculations for Health Care Third Edition Booth & Whaley McGraw-Hill 5- Chapter 5: Drug Orders Edited by B. Holmes MSN/Ed, RN
Summarize the Rights of Medication Administration.
Interpret a written drug order.
Identify on physicians’ orders and prescriptions the information needed to dispense medication.
Learning Outcomes (cont.)
Locate on medication administration records or electronic medication records the information needed to administer medication.
Recognize drug orders that do not contain all of the necessary information to carry out the orders safely.
Select appropriate action for confusing, incomplete, or illegible drug orders.
It is important to be able to read and understand a drug order to correctly calculate medication dosages.
You can be held responsible for medication errors regardless of the source.
Rights of Medication Administration
Right to refuse
Right to know
Before giving a medication to a patient
Check for two identifiers.
Patient’s full name
Another identifier – date of birth, SSN, or medical record number
Ask the patient state his/her full name and second identifier.
Right Patient (cont.)
Check that the name on medication order is exactly the same as the name of the patient.
Outpatient – photographic identification
Inpatient – identification number, identification bracelet, bar code scanning
Check the bed number.
To be sure a patient receives the right drug.
Only give drugs that you prepared yourself
Check the expiration date.
Check original order before administration
If the patient questions a medication, make sure you are able explain the drug, purpose, and side effect
Right Drug (cont.)
A patient always has the right to refuse a medication.
Dispose of refused medications according to facility guidelines.
Right Drug (cont.)
Rule 5 – 1 C heck medication three times:
1. when you take it off the shelf
2. when you prepare it
when you replace it on the shelf
Check it three times even if it is prepackaged, labeled, and ready to be administered.
Preparing and administering the right dose may require calculations.
Conversion from dosage ordered to desired dose
Amount to administer
Use extreme caution when calculating dosages.
Pay special attention to decimal points
A drug intended for one route may not be safe if administered via another route.
Be especially careful between ophthalmic and otic routes.
Right Route (cont.)
Some medications are produced in different versions for different routes.
Example aspirin is available as tablets or as suppositories
Check that route listed on drug label matches route ordered.
Most often within 30 minutes of schedule
Absolute time – 9:00 a.m.
Relative time – before breakfast
Drug order should identify special timing considerations if needed.
Given when needed with a specified time interval.
Check when previous dose was given.
Sign the medication administration record (MAR) immediately after the patient takes the medication.
Do not document prior to giving the medication.
If documentation not done, medication administration is not complete
Also document if the patient
Refuses a medication
Consumes only part of the dose
Vomits after taking the drug
Know why a medication is being given.
Check medication record
Check with prescribing physician
Right to Know
Patients must be educated about their medications, including the
Reason for taking the medication
Expected effect of the medication
Side effects of medications
Medications must be given correctly according to the order.
Buccal -- between cheek and gum
Sublingual -- under the tongue
If unsure of technique
Physicians’ Desk Reference (PDR)
Facility policy or procedure manual
Valid Internet source
Are used sometimes in drug orders.
Calculating dosages may involve changing Roman numerals to Arabic numbers.
Letters represent numbers.
Commonly used Roman numerals
ss = ½
I = 1
V = 5
X = 10
Combining Roman Numerals
Rule 5 – 2 When reading a Roman numeral containing more than 1 letter, follow these two steps:
1. If any letter with a smaller value appears before a letter with a larger value, subtract the smaller value from the larger value.
2. Add the value of all the letters not affected by Step 1 to those that were combined.
Combining Roman Numerals (cont.)
IX = 10 –1 = 9
XIV = 10 + (5-1) = 14
XXVIII = 20 + (5+3) = 28
Doctor’s orders are most likely to contain Roman numerals from 1 to 30.
Most common Roman numerals are: V & X
1. Convert the following Roman numerals to Arabic numbers:
2. Provide the answers to the following in Arabic numbers:
V + V
xxii – vii
XXXV – XIV
xvi + xii
7½ 12 19 9½ 10 15 21 28
Physician’s Orders and Prescriptions
Abbreviations used when writing orders:
Form of medication
Approved abbreviations vary among facilities
Memorize commonly used abbreviations
Keep facility's approved list available
Commonly Used General Abbreviations
Abbreviations Commonly Used for Form of Medication
Abbreviations Commonly Used for Routes of Administration
Abbreviations Commonly Used for Frequency
Joint Commission on Accreditation of Healthcare Organization (JCAHO)
“ Do Not Use” abbreviations
“ Undesirable” abbreviations
Check abbreviations carefully in drug orders.
“ Do Not Use” Abbreviations
Undesirable Abbreviations (cont.)
Undesirable Abbreviations (cont.) Do Not Use Potential Problem Use Instead > (greater than) < (less than) Misinterpreted as the number “7” (seven) or the letter “L” Confused for one another Write “greater than” Write “less than” Abbreviations for drug names Misinterpreted due to similar abbreviations for multiple drugs Write drug names in full Apothecary units Unfamiliar to many practitioners Confused with metric units Use metric units @ Mistaken for the number “2” (two) Write “at” cc Mistaken for U (units) when poorly written Write "mL" or “milliliters” µg Mistaken for mg (milligrams) resulting in one thousand-fold overdose Write "mcg" or “micrograms”
Physician’s Drug Order
Full name of the patient
Full name of the drug
Signature of prescribing physician
PRN order must include the reason
Physicians’ orders are given as prescriptions.
Prescriptions include all the elements of a physician’s order plus
Physician’s name and prescriber number
Quantity to be dispensed
Number of refills
Instructions for the label
Prescription Form Drug and dose Quantity to dispense Instructions to appear on the label Number of refills permitted Patient’s full name Date Physician name
Physicians’ order form
Multiple orders on one form
Essential elements of a medication order
Patient’s name and physician signature appear once
Orders may be entered into a computer
Physician’s Order Form
Never guess what the prescriber meant!
If the order is not legible, always contact the prescribing physician to clarify the order.
Acceptable if the physician is unable to write an order that must be carried out quickly
Governed by state laws
If permitted to accept a telephone order
Write it carefully and legibly as you receive it
Read the order back to the physician
Ask for clarification of spelling if unsure
Always be certain that you are dispensing the correct medication.
What, if anything, is wrong with this prescription?
Allen Capsella, MD Westtown Medical Clinic 989-555-1234 Name: M Ward Date: 8/15/2008 Address: Rx: Lopressor QUANTITY: SIG: 1 tab BD Refills: 2 MD398475 A Capsella, MD Prescriber ID # Physician Signature
1. It does not include patient’s full name.
2. There is no dosage strength for the lopressor.
3. There is no quantity to be dispensed.
4. No route is given.
Click to return to prescription
Medication Administration Systems
Standard schedule for administering medication
Varies by facility
Ensures that the times listed for administration are appropriate
Adjust times as necessary
Conflicting medication schedule
Sample Times for Medication Administration Frequency Ordered Times to Administer qd 0800 bid 0800 – 2000 tid 0800 – 1400 – 2000 qid 0800 – 1200 – 1600 – 2000 q 12 hrs 0800 – 2000 q 8 hrs 2400 – 0800 – 1600 q 6 hrs 2400 – 0600 – 1200 – 1800 Every night at bedtime 2000
Medication Administration Records (MAR)
Legal documents that may be handwritten or computerized
Contain same information as the order form
Specify the times to administer the medication
Provide a place to document each medication administration
Medication Administration Records (MAR) (cont.)
Rule 5-3 MARs must include the following information:
1. Name of medication, dose, route, frequency
2. Times that accurately reflect the frequency specified
3. Name and identification number of patient
4. Date order was written (including start and end dates as necessary)
5. Special instructions or information required by the facility
Is the following MAR complete? If not, what is missing?
ANSWER The order is transcribed correctly and all information is complete. Date init. Medication, dose, duration, frequency, route D/C date init Admin time 2/5 CS Vasotec 10 mg po BID hold for systolic BP < 100 0800 x 2000 x
Practice Is the following MAR complete? If not, what is missing? Date init. Medication, dose, duration, frequency, route D/C date init Admin time 2/5 CS Synthroid 50 mcg PO Bid 0800 x x x 2/5 CS Erythromycin tab i po q6h 0800 x 2000 x 2/5 CS Persantine 75 mg po q6h 2400 0800 1600 x 2/5 CS heparin 10,000 units q 8 hr 2400 0800 1600
1. Order A is correct.
2. Order B does not include the strength of the medication and there is an error in the times listed. The “hours” reflect only a q 12 hr dosing rather than a q 6 hr dosing.
3. Order C contains an error in the times listed. There are only 3 times listed and it should be q 6 hours (4 times).
4. Order D does not include a route.
Click to return to MAR
One drug per card
Increased potential for omitting a medication
Do not list allergies or diagnoses
Medication Card (cont.)
Full name of drug
Dose, route, frequency
Computerized Medical Records
Patient information is entered directly into a computer.
Information is easily updated and accessible.
Computerized Medical Record
Computerized Medical Records (cont.)
Electronic Medication Administration Records (eMARs)
Ongoing working document
Records medications as they are administered
Users must log into system using secure passwords
Medication Reference Materials
To dispense or administer medications
Know effects of the drugs
Be familiar with drug information sources
Medication Reference Materials (cont.)
Physicians’ Desk Reference (PDR)
United States Pharmacopeia National Formulary
Reputable Internet sites
Software programs used with personal digital assistant (PDA)
Apply Your Knowledge
Which of the basic rights of medication administration is not listed?
Answer right route
Apply Your Knowledge
What do the following abbreviations mean?
pc Bid hs supp BP Click for each answer. after meals Twice a day At bedtime suppository blood pressure
Apply Your Knowledge Even though these are inappropriate abbreviation, what do they mean? Qd Au MSO4 cc ug
Apply Your Knowledge
Qd = daily
Au = both ears
MSO4 = Morphine
cc = milliliters
ug = microgram
End of Chapter 5 You must motivate yourself EVERYDAY! ~Matthew Stasior