1. Writing Orders and Prescriptions

2. Educational Objectives
The student will be able to write standard admission orders
The student will be able to write correct medication orders
The student will be able to write complete discharge orders
The student will be able to write clear and legible prescriptions

3. Outline Admission Orders Medication Orders Discharge Orders
Prescription Writing

4. Admission Orders
All patients need a standard conventional set of orders when they are admitted or transferred between floors within the hospital
Gives direction to nurses on patient care
Useful phase to remember is:
ADC VANDALISM or ADC VAAN DISML
-These are orders used to admit the patient to the hospital

5. ADC VANDALISM Admit to Internal Medicine service under Dr. ____
Diagnosis: list in order of priority
Condition: good, stable, fair, guarded, critical
Vitals: every 4 hours, every shift, routine
Allergies: List medication and food allergies

6. ADC VANDALISM
Nursing: I/O’s, daily weight, neuro-check, seizure precautions
Diet: regular, low sodium, clear liquid, nothing per oral (NPO), diabetic
Activity: bed rest, up to chair, ambulate 3 times daily
Labs/Imaging: CBC and chemistry every morning

7. ADC VANDALISM IV Fluids: Normal saline 100 cc/hr x 24 hrs
Special request: example commode to bedside
Medications: List the medications that you want patient on for example antibiotics, DVT prophylaxis
Always put parameters for the nurse to call you
House officer calls: Notify house officer if BP > 150/100, temperature > 101°F

8. Other Important Things for Admission Orders
Can also place on the admission orders:
Consults: Consult specific specialty services (Cardiology)
Code status: Full code, Do not resuscitate (Country specific)
Write legible orders as others have to read them !
You must sign your name, the service you are with and your phone number (attending should co-sign in 24 hrs)

9. Admit to: Internal Medicine Service under Dr. Siadi, resident Dr. ____
Diagnosis: Congestive Heart Failure
Condition: Stable
Vitals: q 4 hours
Allergies: Penicillin
Nursing: Please record I/O’s, record daily weights, Fluid restrict to 1.5 liters per day
Diet: Low sodium
Activity: Out of bed as tolerated
Labs: CBC, Chemistry panel, Chest X-ray now; Chemistry panel twice daily
IV Fluids: None
Medications:
Furosemide 40 mg IV q 12
Coreg 6.25 mg q 12
Lipitor 80 mg po daily
ASA 325 mg po daily
Lisinopril 20 mg po daily
Instructions: Please call house officer if BP < 100/50 > 150/00, Temp > 101.4°F, RR <10 >20, HR <55 > 100
Consult: Cardiology
Dr. John Smith
Internal Medicine Resident
Phone number:

10. A Medication Order
Always place the patients name, patient identification number if one is available (hospital, service number etc.)
Place weight of patient and allergies on the order sheet
Drug name, strength, dose, route, frequency
Lisinopril 20 mg po (by mouth) daily
Sign your name, service and phone number
Date and time your order

11. Writing Proper Medication Orders
Always, always write the drug name (generic), strength, route, and frequency of use
Most medications have an indefinite duration unless you specify otherwise
You need to write if a medication is as needed (PRN) and qualify the order (Tylenol 650 mg po q 4 hrs as needed for pain or temp > 101.4°F
Antibiotics need to have a duration of time associated with them

12. Writing Proper Medication Orders
Changes to prior orders should be written on a new order sheet
Do not use trailing zeros (e.g. 1.0 mg)
Always write preceding zeros (e.g. 0.1 mg)
Always be specific with what you want done and if any questions call the nurse or pharmacist

13. Discharge Orders - Sample Orders
Discontinue: all lines and tubes
Discharge home with: Instruction on what the patient leave the hospital with for example the discharge narrative
Discharge diagnosis: What was the final diagnosis?
Condition: What is the patient’s condition at discharge?
Activity: Describe what kind of activity they are able to do?

14. Discharge Orders - Sample Orders
Diet: Make recommendations on diet such as low sodium
Medications: List all the medications that you want the patient to take
Make sure the new medications are identified for the patient !!
Follow-up: Specify whom you want the patient to follow-up and when
Instructions: Specify and special instructions for the patient

15. Abbreviations with Medication Orders
PO= per oral, PR = per rectal, gtt = drops, IV = Intravenous
qd = once a day
Abbreviation is no longer allowed on charts
Should write out the word daily or qDay instead
bid = twice a day
tid = three times a day
qid = four times a day

16. Abbreviations with Medication Orders
q12 = every 12 hours (not the same as bid)
q12 means midnight and noon
Bid means you give the medication when the patient wakes up and prior to bed
qAM = every morning
qHS = every evening
qAC = before every meal
prn = as needed

17. Medication Writing Examples
Furosemide 40 mg po bid
Ceftriaxone 1 gram IV q 12° x 14 doses – first dose stat
Prednisone 40 mg po daily x 2 days, then 20 mg po daily x 2 days
Maalox 30 ml q 4-6° prn dyspepsia

18. Prescription Writing
Should be written on an appropriate prescription pad
Controlled substances, including narcotics and benzodiazepines should be prescribed by attending or licensed physicians

19. Prescription Writing Example
Patient’s name: Date:
Drug Name: Lisinopril 20 mg
Sig(Instructions): 1 tab by mouth daily
Disp (dispense): # 90 (ninety) tabs
Refills: 3

20. Any Questions ??