Interpretation of the Licensed Prescriber’s Orders Chapter 9 Interpretation of the Licensed Prescriber’s Orders

Written Orders Physician’s signature Date Name and dosage of drug Requirements: Physician’s signature Date Name and dosage of drug Route and frequency What are the requirements for a physician’s written order? A physician’s written order requires the physician’s signature, the date the order was written, the name and dosage of the drug, the route and frequency of administration, and any special instructions. For drugs ordered as needed, the purpose is also listed. The time that the order was written is often included, but it is not required. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Written Orders 6/15/18 2100 Morphine 4 mg IV q2 h prnfor pain For example: 6/15/18 2100 Morphine 4 mg IV q2 h prnfor pain Dr. Joseph M. Jones 6/15/11 2100 Morphine 4 mg IV q2 h prn for pain Dr. Joseph M. Jones   Physician’s signature: Dr. Joseph M. Jones Date: 6/15/11 Name of drug: morphine Dosage of drug: 4 mg Route: intravenous Frequency: every 2 hours, as needed Purpose: for pain Time order was written: 2100 hours (9:00 pm) Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Verbal Orders Extra requirements: Verbal order read back (VORB) Physician’s name Nurse’s signature Order repetition for verification Who generally initiates verbal orders? The nurse generally initiates verbal orders. Other than the same required information for written orders, what are the extra requirements of verbal orders? A notation must be made to the order to indicate that it is a verbal order (VORB). The physician’s name and the nurse’s signature also are required. The order must be repeated to the physician for verification. The physician should sign the verbal order as soon as possible. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Verbal Orders 8/25/18 2100 Demerol 100 mg IM q4 h prn for pain VORB For example: 8/25/18 2100 Demerol 100 mg IM q4 h prn for pain VORB Dr. Marc D. Ryan/ Juliann Kennedy, RN 8/25/11 2100 Demerol 100 mg IM q4 h prn for pain VORB Dr. Marc D. Ryan/Juliann Kennedy, RN   Physician’s signature: Dr. Marc D. Ryan Date: 8/25/11 Name of drug: Demerol Dosage of drug: 100 mg Route: intramuscular Frequency: every 4 hours, as needed Purpose: for pain Time order was written: 2100 hours (9:00 pm) T.O. notation: T.O. Physician’s name: Dr. Marc D. Ryan Nurse’s signature: Juliann Kennedy, RN Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Scheduling the Administration of Medications Most hospitals use 24-hour clock time for the scheduling of medication administration. Convert these examples: 5:00 pm 11:00 pm Abbreviations are commonly used in the scheduling of medication administration. Examples: STAT ac What do the abbreviations STAT and ac mean? STAT means immediately, and ac means before meals. Most hospitals have routine times for administering medications. The nurse should review the medication administration policy for each health care facility where he or she is employed to determine the appropriate schedule. However, it is the nurse’s responsibility to always administer medications at the times that will provide the optimal therapeutic effect.    Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Introduction to Drug Dosages The nurse is ethically and legally responsible for the medications administered to the patient. Packaging of Medications-Stock, Unit, Blister packs Before preparing the drug, the nurse must know: Maximum drug dosage Minimum drug dosage Drug actions Drug contraindications Patient allergies If the pharmacy prepares the wrong medication, who is responsible? The nurse who administers the medication is responsible. What are unit dosages? Unit dosages are prepared in individual doses by the manufacturer or hospital pharmacy. They are available in a form that is ready for the nurse to administer.

Medication Administration Record (MAR) MAR required information: Drug Dose Patient Route Time Nurses are required to do the following with MARs: Verify the transcription using the physician’s order. Place their initials on the form. The medical administration record is the legal document that verifies that the five rights of medication administration and its documentation are correct. In healthcare, if a medication is not documented, it is considered not given. Therefore, it is very important for the patient’s safety that these five “rights” be documented. Why are nurses required to verify the patient’s MAR using the physician’s order? Most transcriptions of the physician’s orders to the patient’s MAR are done by personnel other than nurses. Nurses must always verify the physician’s order to see that the transcription was correctly completed. Nurses also must place their initials on the MAR form to indicate that the transcription was completed correctly. Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.