Chapter 11: Understanding and Interpreting Medication Orders

Question 1

Types of Medication Orders:

Answer 1

• Standing order: routine order
  >Example: Ampicillin 1 g IV q6h for 4 doses
• prn order: administered as needed
  >Example: Tylenol 650 mg po q4h prn for temp greater than 101° F
• Stat order: administered immediately
  >Example: Ativan 2 mg IM stat
• Single (one-time) order: administered only once
  >Example: Tdap 0.5 mL IM × 1

Question 2

Other Orders

Answer 2

• “Physician’s Order Sheet” or “Order Sheet”
• Noted by nurse and “unit clerk”
• Transcribed to Medication Administration Record (MAR) or faxed to Pharmacy
• Nurse who administers is accountable regardless of who transcribes to MAR
• Some facilities utilize electronically generated MARs

Question 3

VERBAL ORDERS

Answer 3

• Verbal orders (from prescriber to nurse)
• By telephone or in person
• Error prone
• Emergent situations by qualified staff
• WRITE it, READ it back, receive CONFIRMATION
• Prescriber’s signature required within 24 hours
• Errors may be prevented by using computerized physician order entry or fax
  transmission

Question 4

TRANSCRIPTION OF MEDICATION ORDERS

Answer 4

• Memorization of acceptable common symbols and abbreviations is essential
• Refer to Tables 11-1 and 11-2
• Some symbols have double meaning
• ID = intradermal, also means initial dose
• Reminder of TJC and ISMP guidelines
• The nurse who administers an unsafe or incorrect medication shares the liability for injury and is responsible for the medication error

Question 5

CASE STUDY:
You call the physician to alert her that, despite the correct use of the PCA morphine, Mr. Ross is having persistent, uncontrolled pain at a level of 8 out of 10. She gives you new orders to increase the PCA settings. Before hanging up, you need to do what three things?

Answer 5

ANS:
1. Write the order
2. Read it back to the physician
3. Receive confirmation that the order is correct

Question 6

TRANSCRIPTION OF ORDERS

Answer 6

• Before transcribing, nurse must be familiar with reading and interpreting an order
• Nurse must memorize abbreviations and symbols used in medication orders
• Incorrect transcription is one of the main causes of medication orders

Question 7

WRITING MEDICATION ORDERS: 7 essential components

Answer 7

Seven ESSENTIAL components:
1. Client’s full name
2. Date and time written
3. Name of medication
4. Dosage
5. Route
6. Time and frequency
7. Signature of prescriber or proxy
*If parts are missing—order is NOT legal and should NOT be filled!

Question 8

WRITING MEDICATION ORDERS: SPECIAL CONSIDERATIONS

Answer 8

Medication names:
* Trade = proprietary, followed by the registration symbol, ®.
* Generic = “proper” or chemical name
* Caution = look-alike or sound-alike names

Dosage:
* Amount and strength clear
* The abbreviation “U” for units is on TJC’s Official “Do Not Use” List and on ISMP’s
List of Error-Prone Abbreviations, Symbols, and Dose Designations.

Question 9

WRITING MEDICATION ORDERS: SPECIAL CONSIDERATIONS (CONT.)

Answer 9

• Route
• Very important, never assume
• Frequency
• Standard abbreviations and meaning (q.i.d., t.i.d.)
• Signatures
• Legibility and co-signing
• Special instructions
• Hold if …
• ½ hour before …
• For blood pressure greater than …

Question 10

INTERPRETING A MEDICATION ORDER

Answer 10

Written in following order:
1. Name of medication
2. Dosage
3. Route
4. Frequency

Example: Colace 100 mg p.o. t.i.d.

Question 12

Which detail(s) must be included in an order to be considered legal?

Answer 12

• client’s full name
• date the order was written
• drug dosage