Hospital Pharmacy Lecture 2 part 1

Question 1

How are orders placed in the hospital? There are a lot of similarities to retail so there’s a ____________ (CPOE) so this is done with an electronic health record for example the Umass system uses Epic…orders can be placed electronically via through that…via computer

Answer 1

computer physician order entry

Question 2

Orders in the hospital are not only used for medications they are also used to order other things within the hospital

Question 3

Medication order has to be placed through outpatient setting and through same type of electronic health records system

Question 4

We can take verbal and telephone orders in the hospital as well

Question 5

An order is used _________ setting

Answer 5

inpatient

Question 6

A prescription is used in an _______setting

Answer 6

outpatient

Question 7

We can take verbal and telephone orders in the hospital as well

Question 8

Its always preferred that the computer physician order entry is used if possible but if we are in an emergency situation or a lot of times in the emergency department if the doctor is at bedside and asks the nurse for something those types of orders can be placed verbally or if physician doesn’t have access to order a certain medication.

Question 9

Can do a telephone order and say I would like to order this medication on this patient and pharmacist can take a telephone order that way and place order for the physician

Question 10

There are paper and handwritten orders nowadays this is less and less frequent but every once in a while there’s an issue with the electronic health record or it goes down or there’s downtime and in that gap Paper and handwritten orders still need to be used so even though there are less common that is still our backup nowadays

Question 11

The orders is what is used ___________ and the requirements are for a medication they have the drug name, the dose, the route, the dosage form, frequency, duration so a start and stop time and then the ordering provider

Answer 11

inpatient

Question 12

Prescription which is used _________ setting

Answer 12

outpatient

Question 13

For prescription in the outpatient setting
5 R’s: right drug, right dose, right frequency, right route (also has to have an ordering provider and they both need to have patient names but some of the things that are little bit different

Question 14

An inpatient order has to specify the dosage form which would need to be specified on an outpatient prescription as well there’s just less dosage form to choose from in that outpatient setting but the duration so we need to specify that the medication needs to start today so…the doctor could and say I want this medication to start tonight at 9pm and continue for 10 days so its going to have a start time, a stop time, and that duration of 10 days

Question 15

Fluid order that is placed in the hospital so the provider can say I want to run normal saline at 100mL per hour for x patient and I want that to start at 9am and run for 12 hours till 9pm this evening so that’s the big different in these systems when we are placing these orders they need a start and a stop time so nurse knows when to give that medication and when to stop that medication

Question 16

If a doctor is writing medication by hand they are not to use any of these abbreviations and the same would go if they are using the computerized physician order entry system and free handing the script

Question 17

A lot of computer physician order entry systems (CPOEs) have things that are already ready to go for the physician so they have buttons that they can click and this medication should be oral and there’s a button for that so they are able to click through real quick and have order entered without much need for freehand but if there is need for free text…its also important we are making sure as pharmacist that we are doing our due diligence that these error prone abbreviations are not being used to avoid confusion for example we can see that OD might be used to mean once daily can be mistaken for right eye. OD is the correct abbreviation for right eye and this might need to an oral medication being administered in the eye which would not be what we want and the same thing goes for the reason we don’t use the abbreviation QD for everyday so the correct way to write that would be just to use daily to avoid misinterpretation