Medication Orders and Labeling

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Chapter 4
Medication Orders and
Labeling
2012 Paradigm Publishing

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Learning Objectives
 Gain an awareness of the historical roots of prescriptions, the Rx symbol,
and the signa.
 Recognize the influence of early Greek and Roman healthcare
practitioners on current medical terminology and abbreviations.
 Understand the difference between a prescription and a medication
order.
 Understand common medical and pharmacy terminology, abbreviations,
acronyms, and symbols.
 Identify pharmacy directions written in signa language.
 Recognize physician instructions and other pertinent information on a
medication order.
 Identify the various components of a compounded sterile preparation
label.

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Topics
 Learning Objectives
 Introduction
 Medical Root Words, Prefixes, and Suffixes
 Medical Abbreviations, Acronyms, and Symbols
 Signa Interpretation
 Medication Orders
 Types of Medication Orders
 Medication Order Contents and Processing
 CSP Labeling
 Sterile Compound Label Components
 Sterile Compound Label Verification and Application
 Chapter Summary
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Introduction
 The origin of medical terminology is as old as
medicine itself
approximately 75% of medical terminology has its roots in
the Greek language
the remainder can be traced to Latin

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Medical Root Words, Prefixes, and
Suffixes
 Most medical terminology is based on a combination
of medical morphemes, or root words, prefixes, and
suffixes
 A word’s meaning is derived from the root word
 A combining vowel is sometimes added to the end
of the root word
when a root word contains this combining vowel, the word
is said to be in its combined form

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Medical Root Words, Prefixes, and
Suffixes…/2
 A prefix is a word element attached to the beginning
of a root word
a prefix often indicates time, location, direction, or
number
 A suffix is a word element attached to the end of a
root word
the addition of a suffix further defines the meaning of a
root word

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Medical Abbreviations, Acronyms,
and Symbols
 Approximately 35,000 abbreviations, acronyms, and
symbols are used in medicine and pharmacy
 Collectively, they are referred to as medical
abbreviations, or simply abbreviations
most abbreviations are developed to shorten the length of
words and word combinations related to health, medicine,
laboratory procedures or tests, and pharmacy

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and Symbols…/2
Common Medical Abbreviations
 Indicate specific patient care facilities, units, or
departments or the titles of individual team
members
 Refer to specific medical diagnoses and conditions,
procedures, treatments, patient directives/activities,
equipment/supplies, and tests

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and Symbols…/3
Common Pharmacy Abbreviations
 Typically seen on medication orders or other written
communications between providers and pharmacies
provide important information
might also include abbreviations to communicate specific
compounding directives
common for indicating the route of administration and the
dosing intervals for prescribed medications

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and Symbols…/4
Common Pharmacy Symbols
 In addition to knowing pharmacy abbreviations, you
need to recognize and understand a number of
symbols specific to pharmacy practice
symbols such as ↑ and ↓ are frequently placed on
medication orders to indicate “increase” and “decrease,”
respectively
another common symbol is the Greek delta symbol (Δ),
which is used to indicate a desired change

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and Symbols…/5
The Official “Do Not Use” List of Abbreviations
 In 2004, the Joint Commission was driven to create
The Official “Do Not Use” List of Abbreviations in
response to a number of sentinel events that had
been noted across the United States
list integrated into the Performance Standards for
Healthcare Accreditation
the nonstandard and potentially dangerous abbreviations
should not be used in any healthcare application

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Signa Interpretation
 The signa component is a specialized language that
physicians or other prescribers place on a medication
order
provides the pharmacy with specific directions for
administering the medication order
may include dosage information, the route of
administration, the amount to be dispensed, the time
schedule or dosing interval, and any special instructions

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Signa Interpretation…/2
 Signa language combines an assortment of
abbreviations, acronyms, and symbols
Signa Interpretation of Signa
i packet in 2 oz. OJ PO q.i.d. ut dict Mix one packet in two ounces of orange juice and
give by mouth four times daily as directed.
aaa b.i.d. prn itching Apply to affected area twice daily as needed for
itching.
SSI Sub-Q p.c. and h.s. Sliding scale insulin, inject subcutaneously after
meals and at bedtime.
iii gtts au q8h Instill three drops into both ears every eight
hours.

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Signa Interpretation…/3
 Transcribing or interpreting a signa requires you to
seek the portions of the directive that address the
following questions:
What is the route of administration of the medication?
How much of the medication is the patient supposed to
take and how often?
What special instructions need to be followed when taking
the medication?

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Medication Orders
 Medication orders are similar to prescriptions
exclusive to the institutional or hospital setting
 Medication orders entered directly into a computer
by the physician are often called eMARs (electronic
medication administration records)
 Just like other types of prescriptions, medication
orders are legal documents that must be filed,
usually based on the date the order was written, and
kept on hand for up to two years

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Medication Orders…/2
 Upon receipt of the medication order, the pharmacy
determines what medications and dosages have
been ordered and then interprets the signa
directions
it is then transcribed, or interpreted, and then entered into
the pharmacy’s computer system through a process called
order entry
the pharmacist usually performs order entry, but specially
trained pharmacy technicians may also complete this task
 A label is then prepared for each of the medications

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Your Turn
1) Approximately how many abbreviations, acronyms, and symbols are
used in medicine and pharmacy?
a. 350
b. 3,500
c. 35,000
d. 350,000
2) This component is a specialized language that physicians or other
prescribers place on a medication order.
a. delta
b. signa
c. alpha
d. omega
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 During hospital treatment, a physician examines a
patient and then writes the first medication order on
the patient’s medical chart
the medical chart is commonly called the medication
administration record, the patient’s chart or, simply, the
chart
Types of Medication Orders

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 The physician’s initial
order is called the
admission order and is
often written while the
patient is in the
emergency department
or has just been
admitted to a hospital
room
Types of Medication Orders…/2

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 If applicable, the admission order includes a list of
the medications, including dosages and dosing
intervals, that the patient has been taking at home
 These medications are commonly referred to as
home medications or home meds
in many instances, the physician orders the pharmacy to
continue home meds so that the patient will receive these
same medications while he or she is hospitalized

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 Every time a physician
examines a patient,
new orders, or changes
to existing medication
orders, are written
may be referred to as
daily orders

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 Some physicians whose
specialties involve
commonly prescribed
medical treatments take
advantage of preprinted
order forms called
standing orders, or
routine orders

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 The medical chart contains both patient
identification information and copies of all treatment
orders prescribed during the patient’s stay
 Standard patient identification information is either
handwritten on the order, provided on a computer-
generated patient ID label affixed to the order, or
preprinted at the top of each medication order by
using an addressograph
Medication Order Contents and
Processing

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 Access to protected health information (PHI), such
as that found on a medication order or in a patient
chart, is restricted and the information may be
viewed only by those departments that must see the
data in order to correctly treat the patient
pharmacy
laboratory
nursing
Processing…/2

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 The treatment orders kept in the medical chart are
carbon copies of all medication, diagnostic,
laboratory, dietary, and other orders prescribed
the original copy remains in the chart, while the other
carbon copies are hand-delivered, faxed, scanned
electronically, or sent via pneumatic tube system to the
pharmacy or other relevant hospital departments
may be kept at the nursing station or maintained on a
computer record
Processing…/3

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 Orders are most often written by hand, using a
combination of medical terminology and signa
instructions, but they may also be entered directly
into a hospital computer
facilities that depend on an eMAR system provide
computer terminals at the nursing station or near the
patient’s room
physicians use these terminals for direct order entry,
commonly referred to as computerized physician order
entry (CPOE)
Processing…/4

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 A pharmacist or technician based in either the
central pharmacy or a satellite pharmacy enters the
order into the pharmacy’s computer system
specialized pharmacy software assists with the
identification of patient medication allergies and cross-
sensitivities, drug–drug or drug–food interactions,
appropriate medication dosage, duplicate therapy,
contraindications, and other information
if an issue or potential problem arises, a flashing caution or
warning screen (sometimes called a warning flag) appears
Processing…/5

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CSP Labeling
 Upon completion of sterile compounding and
checking procedures, personnel must appropriately
label the sterile compound in its final container
 Labels will most often be affixed by the IV technician
but may also be affixed by the pharmacist
 Federal laws require that pharmacy labels accurately
identify the ingredients and the amount of each
ingredient in the final sterile compound

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Sterile Compound Label
Components
 The CSP label provides general information
must also contain very specific information about the
product, its administration and storage requirements,
expiration date, and preparer
 Product information on the CSP label specifies the
name, concentration, and amount of each base
solution used to prepare the compound
 The label must also clearly identify each additive, or
medication or ingredient that has been added to the
base solution

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Components…/2
 In general, only IV
push and IVPB
medications require
an administration
time, which is the
length of time over
which the drug is to
be given

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Components…/3
 If the medication’s administration is not ordered by
the physician and the package insert is unavailable,
the pharmacist may find this information by
consulting one of the pharmacy reference manuals,
such as the Handbook on Injectable Drugs, or a
computerized pharmacy reference source, such as
Micromedex

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Components…/4
 In contrast to an
administration time, an
infusion rate is specified
for large-volume
parenteral (LVP)
products, such as IV
bags and TPN solutions

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Components…/5
 The CSP label must
also provide the
physician’s directions
for the medication’s
dosing interval

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Components…/6
 Personnel also add
auxiliary labels to clarify
special instructions or
highlight physician
directions for the nursing
staff

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Components…/7
 Another required component
on the CSP label is the
expiration date of the sterile
compound, sometimes
referred to as the beyond-use
date (BUD)

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Components…/8
 Several factors determine the expiration date,
including the stability of the drug in its
compounded form
storage requirements must also be included on the label
 Every CSP label must also identify the pharmacy
personnel who prepared the compound

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 Verifying the accuracy of the
medication order and the CSP
label is one of the most
important components of
ensuring the Five Patient
Rights
 Sterile product labels must be
legible, pharmaceutically
elegant, and complete
Sterile Compound Label Verification
and Application

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Your Turn
3) The physician’s initial order is called this.
a. start order
b. begin order
c. check-in order
d. admission order
4) The CSP label provides all of the following information except
a. storage requirements of medication
b. administration rate of medication
c. patient diagnosis
d. patient identification number
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Medication Orders and Labeling

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