Interpreting Drug Orders Chapter 7 Interpreting Drug Orders Review: 4 t = ? mL …can be measured in what? insulin can be measured in a TB or 1 mL syring T or F are medications calibrated from the top or bottom of the syringe? medications are measured by what part of the plunger tip? (Top ring) how can 1.27 be measured in a 3 mL syringe? The 3 mL syringe is calibrated in _____________of an mL? The 1 mL syringe calibrated in _________of an mL? You need to give a pediatric pt a volume dose of 0.765…what syringe? What is final volume?

Objectives Read and write correct medical notation Write the standard medical abbreviation from a list of common terminology Interpret medicine orders of MD’s /prescribers Interpret medication administration records The prescription or medication order conveys the therapeutic drug plan for the patient ASK…what do you think are the nurses responsibility for medications???

These are the responsibility of the nurse: Interpret order Gather information about drug Prepare exact dosage of prescribed drug Identify patient Administer dosage by prescribed route at prescribed time intervals There are many responsibilities a nurse has when administration of a drug is involved

Nursing Responsibilities Educate patient regarding medication Record administration of prescribed drug Monitor patient’s response for desired and adverse effects Before you can prepare the correct dosage of the prescribed drug, you must learn to interpret or read the written drug order. For speed purposes healthcare profesessions have adopted certain standards and common abbreviations for use in notation

Medical Abbreviations Used frequently with drug orders Must commit to memory Page 144, fourth Edition of classroom book Student activity? Show a typical drug order: Zithromax 250 mg po daily; gentamycin 80 mg iv q 8 h; singulair 10 mg po q noct; insulin Humulin-R regular 10 units subcut ac and hs; cxr ap/lat stat OR USE NEXT SLIDE AS EXAMPLES

Example of a medication order Rocephin 750 g IV q 12 hours Acetaminophen 500 mg p.o. q 4 h prn mild pain EES 250 mg p.o. a.c. and h.s. Nitro-Bid 0.3 mg SL prn, may repeat q 5 min for 2 additional doses for acute attack

Seven Parts of a Drug Order Patient name Name of drug Dosage Route of administration Frequency, time, and special instructions Date and time of order Signature and licensure of person writing order Parts 1-5 of the drug order are known as the original Five Rights of safe medication administration. ESSENTIAL!! The first five of these must be checked faithfully every time a medication is prepared and administered.

Caution If any of the seven parts of the order is missing or unclear, the order is incomplete Therefore, it is not a legal drug order if ever in doubt, ask writer to clarify If it is a phone order, must write down, read back Show example from pink index card

Six Rights of Medication Administration Right patient Right drug Right dose Right route Right time Right documentation After checking the 5 rights of medication administration, it is the responsibility of the nurse to DOCUMENT that s/he administered the medication. This makes it 6 Rights of Med. Admin and is a patient right.

Six Rights of Medication Administration Right patient must receive right drug in right amount by right route at right time, followed by right documentation

Drug Orders Sequence: Name of drug Dosage Route Frequency Each drug should follow a specific sequence… The name of the drug is written first, followed by the dose, route, time WRITE EXAMPLE ON BOARD BEFORE NEXT SLIDE: metronidazole 300 mg p.o. t.i.d.

Drug Orders Example: metronidazole 300 mg p.o. t.i.d. Name of drug = brand name: Flagyl Dosage = 300 mg Route = oral Frequency = three times daily This order means: Give 300 mg of flagyl three times a day Brand name of drug is CAPITALIZED….Trade name is lower case

Drug Orders The p.r.n. frequency designates the minimum time allowed between doses. There is no maximum time other than automatic stops as defined by hospital or agency policy. Example: hydromorphone 3 mg IM q4h p.r.n., severe pain This order means: Give 3 milligrams of hydromorphone intramuscularly every 4 hours when necessary for moderate to severe pain. Ask what prn is

What’s Wrong? Heparin 5,000 units IV Lasix b.i.d. Depakene 250 mg by mouth Demerol 50 mg IV as needed for pain

LET’S PRACTICE have class do Review Set 18 pg. 146 1-13. go over the rest with class

Medication Administration Record (MAR) May be paper form or electronic Used to record drug orders Health care professional must verify and initial each order

MAR Used by nurse as guide to: Check drug order Prepare correct dosage Record drug administration Ask: HOW DO YOU THINK NURSES CAN PREVENT MEDICATION ERRORS?

Preventing Medication Errors Nurse can prevent medication errors by: Clarifying incomplete orders Correctly scheduling doses Current example: February 2019

Preventing Medication Errors Verify MD medication order Read entire MAR at beginning of shift Verify times scheduled with ordered frequency Review all medications to indentify any potential drug interactions or patient allergy

Quick Review Drug orders are prescribed on the physician’s order form. The person who administers a drug records it on the MAR, either handwritten or computerized. All parts of the drug order must be stated clearly for accurate, exact interpretation. If you are ever in doubt as to the meaning of any part of a drug order, ask the writer to clarify.

Critical Thinking What is the role of a nurse in medication administration?

Critical Thinking What are the legal implications related to medication administration?

Critical Thinking What are some potential outcomes of unsafe medication administration? Have class do Review Set 19 pt 151 and we will review as a class

Patients are entitled to these: