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Chapter 4, Drug orders. This chapter begins with the seven rights of medication administration, abbreviations, and controlled substances. This chapter shows the various ways in which drug orders may be written and how to interpret physicians’ orders and prescriptions. It emphasizes safety and shows how drug orders and prescriptions can easily be misread, giving added detail to detecting errors and forged or altered prescriptions.
Math for the Pharmacy Technician: Concepts and Calculations Egler • Booth Chapter 4: Drug Orders McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights Reserved 4-2 Drug Orders McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-3 Learning Objectives When you have successfully completed Chapter 4, you will have mastered skills to be able to: Summarize the Rights of Medication Administration Interpret a written drug order Identify on the information on a medication order needed to dispense medications McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-4 Learning Objectives (con’t) Locate on medication administration records or medication cards the information needed to administer medication Recognize incomplete drug orders Select appropriate action for confusing, incomplete, or illegible drug orders McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-5 Learning Objectives (con’t) Identify and verify DEA numbers Recognize classifications of controlled substances Recognize prescription errors and forged or altered prescriptions Interpret and use pharmaceutical and medical abbreviations and terminology McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-6 Introduction In order to correctly calculate a medication dose, you must be able to read and understand the drug order This chapter will discuss: Drug orders Patient’s rights Medication administration systems Your responsibilities McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights The Rights of Medication Administration Right Right Right Right Right Right Right McGraw-Hill patient drug To prevent dose errors, check route the rights! time technique documentation ©2010 by the McGraw-Hill Companies, Inc All Rights 4-7 4-8 Right Patient You are responsible if an error occurs Name on original order must be exactly the same as the name on the Medication Administration Record (MAR), medication card, or prescription Verify the full name Ask “What is your name?” Check the bed number and tag Read the patient’s identification bracelet McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-9 Right Drug Only give drugs that you have prepared yourself Or that are clearly and completely labeled Check the expiration date If the patient questions a medication, then recheck it A patient always has the right to refuse a medication Dispose of medicine according to facility guidelines McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-10 Right Drug (con’t) Always check medication three times: when you take it off the shelf 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 McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights Verbal Physician’s Orders 4-52 If the physician is unable to write or personally sign an order, verbal orders may be used These are governed by state laws as to which personnel may accept verbal orders You must be legally permitted to accept a telephone order McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights Verbal Physician’s Orders 4-53 (con’t) Write the order carefully and legibly as you receive it, not after the call Identify it as a verbal order Read the order back to the physician McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-54 CAUTION! Always be certain that you are dispensing the correct medication Many drugs have names that are similar Darvon McGraw-Hill Diovan ©2010 by the McGraw-Hill Companies, Inc All Rights Medication Administration Systems 4-55 Most facilities have a standard schedule for administering medication Person who verifies the transcription ensures that the times listed are appropriate for the medications Times may need to be adjusted according to mealtimes or conflicting medication schedules McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 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 hrs 2400 – 0800 – 1600 q hrs 2400 – 0600 – 1200 – 1800 Every night at bedtime 2000 McGraw-Hill 4-56 ©2010 by the McGraw-Hill Companies, Inc All Rights Medication Administration Records (MAR) 4-57 Legal documents Handwritten or computerized printouts Contains same information as a physician’s order form Specify the actual times to administer the medication Provide a place to document each medication administration By law, after you give a medication you must immediately document it McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights Medication Administration Records (con’t) 4-58 An MAR must include the following information: Name of medication, dose, route, frequency Times that accurately reflect the frequency specified Name and identification number of patient Date of order End date of narcotics and antibiotics Special instructions, diagnosis, weight, etc McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights Review and Practice 4-59 Is the following MAR complete? If not, what is missing? McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-60 Review and Practice Answer: In the previous MAR the order is written correctly and all information is complete McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights Review and Practice 4-61 Is the following MAR complete? If not, what is missing? McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-62 Review and Practice Answer: In the previous MAR: Order A is correct Order B dose not include the strength of the medication Order C contains an error in the times listed Order D does not include a route McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights Medication Reference Materials 4-63 You must be familiar with drug information sources Resources Physicians’ Desk Reference (PDR) United States Pharmacopeia National Formulary Drug handbooks Internet sites Software programs used with personal digital assistant (PDA) McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-64 Review and Practice Which of the Rights of medication administration is not listed? right right right right right right patient drug dose time technique documentation Answer: right route McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4-65 Review and Practice What the following abbreviations mean? pc os qd supp BP McGraw-Hill after meals left eye every day suppository blood pressure ©2010 by the McGraw-Hill Companies, Inc All Rights 4-66 Drug Orders You must be 100 percent accurate in interpreting medication orders I Heal, MD Best Medical Clinic 123-456-7890 Name Anna Versary Date April 19, 2012 Address Rx: Lopressor 50 mg QUANTITY: # 90 SIG: i tab po tid Refills: AH1234567 Prescriber ID # I Heal, MD THE END McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights ... McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4- 23 Table 4- 4 “Undesirable” Abbreviations McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4- 24 Table 4- 4 “Undesirable”... name of the patient Full name of the drug The dose The route The time The frequency Signature of prescribing physician The date PRN order must include the reason McGraw-Hill ©2010 by the McGraw-Hill... Tables 4- 3 and 4- 4 on the following slides Be certain to check abbreviations carefully when reading drug orders McGraw-Hill ©2010 by the McGraw-Hill Companies, Inc All Rights 4- 22 Table 4- 3 “Do