Chapter 11

Question 1

• written to indicate a medication is to be given for a specified number of doses
• can also indicate that a medication should be administered until it is discontinued or is replaced by another order
• automatic cancellation after a certain period of time; 72 hours for narcotics, 30 days for standing orders

Answer 1

Standing Order (routine order)

Question 2

• administered as needed

- allows for the nurse to exercise their judgment on when a medication should be administered based on the clients needs

Answer 2

PRN order

Question 3

-medication is to be immediately given, but only once, unless it is reordered

Answer 3

STAT order

Question 4

• specifies a medication to be given only once at a specified time
• “on call to the operating room”

Answer 4

Single (one time/on call) order

Question 5

• used by the healthcare providers to communicate to the nurse or designated healthcare worker which medication or medications to administer to a client
• indicates treatment plan or medication the healthcare provider has ordered for a client

Answer 5

Medication Orders

Question 6

• interpreting the order
• selecting the correct medication and dosage
• administering the mediation by the correct route at the correct time to the right client
• educating the client regarding the medication
• monitoring the clients response to the medication and documenting the medication administered

Answer 6

Nurse responsibilities in medication administration

Question 7

• discouraged, except for certain situations or emergencies
• they can be particularly error prone for several reasons:
  
  • the order being misheard
  • poor phone reception
  • sound alike drug names
  • nurse assuming the intended order when the order given is incomplete

Answer 7

Verbal Orders

Question 8

1) write it down in the pts chart or enter it into the computer record
2) read it back to the prescriber
3) receive confirmation from the prescriber who gave the order to ensure it is correct
- any questions or concerns relating to the order should be clarified with the prescriber during the conversation
- must include date of the order, name and dosage of the medication, route, frequency, any special instructions, and the name of the individual giving the order
- must be noted that it was a VO or TO
- signature of the nurse taking the order is required

Answer 8

Preventing errors in Verbal Orders (VO)

Question 9

• after an order is written the nurse records the order in the MAR
• incorrect transcription of med orders is one of the main causes of med errors; illegible handwriting
• nurse must be familiar with reading and interpreting an order, must know the components of a med order, and the standard abbreviations and symbols used in writing a med order
  
  • memorize the abbreviations and symbols commonly used in med orders

Answer 9

Transcription of Medication orders

Question 10

• could prevent many problems that occur with written orders as well as clearly communicating med orders, avoiding common mistakes
• helps in preventing serious drug interactions and monitoring and documenting adverse events and therapeutic outcomes
• allow the physicians to make changes if needed

Answer 10

Computer Physician Order Entry (CPOE)

Question 11

Must contain 7 important parts

1) clients full name-helps prevent confusion between one client and another, preventing administration of the wrong medication to a client
2) date and time the order was written-include the month, day, year, and time the order was written, help in determining the start and stop of the med order; include the length of time the medication is to be given
3) name of the medication-may be ordered by the generic or brand name, the name of the medication should be written clearly and spelled correctly
- trade name: brand/proprietary name; name under which a manufacturer markets the medication; starts with a capital letter or is all uppercase on the label; generally largest printed information on the label; some meds may have several trade names, some meds may not have trade names
- generic name: proper/chemical/nonproprietary name; name given by the manufacturer that first created the medication, in lowercase or different typeface, sometimes placed in parentheses, usually found under the brand/trade name, each medication has only ONE generic name, licensed under generic name, must appear on ALL med labels, not specific to the manufacturer
- crosscheck names of meds even when they are generic (prevent errors), NEVER assume
4) Dosage of the medication-amount and strength of the medication should be written clearly to avoid confusion, indicates the amount or weight provided in the form (per tablet, per mL)
5) Route of administration-very important part of med order because meds can be administered by serval routes (NEVER assume), standard and acceptable abbreviations should be used to indicate the route (PO,ID, IM,IV)
6) Time and frequency-standard abbreviations should be used to indicate when and what times a mediation is to be administered (QID-4 times a day, TID-3 times a day, BID-2 times a day. Time intervals at which a med is administered are determined by the institution (routine times). Factors such as the purpose of the medication, medication interactions, absorption of the medication, and side effects should be considered when med times are scheduled. Frequency indicates the dosage given at one single time.
7) Signature of the person writing the order-must be signed by the healthcare provider, should be legible

Answer 11

Components of a Med Order

Question 12

• should be written following a specific sequence
  1) name of the medication
  2) the dosage, expressed in standard abbreviations or symbols
  3) route
  4) frequency
• follows this order when an order is written correctly
• interpret the order in this manner; avoid “scrambling the order”

Answer 12

Interpreting a Medication Order