1. Bendigo Health Pharmacy Department
Inpatient prescribing

2. Patient identification
Patient identification is essential for safe drug prescribing and administration
Patient identification must be visible on all sections on the drug chart – FRONT & BACK
111111
BLOGGS, Mr. Joe /10/1939
1 Cumming St Male, 69 years, 3 months
Bendigo VIC, Ward: MED
Ph: MC:
Public- Eligible
AMU- Acute Medical unit
Adm: Thursday 7th January 2016
GP: dr SMITH John, Medcial medical Clinic
Only 28% of charts
had correctly
completed
patient ID
Patient must have the identification labels on all drug drug charts (front and back)
Prescribe must print the patient’s name underneath the label to verify that both the ID label & drug orders relate to the correct patient. This will reduce risk of wrong ID label being placed on the chart. Needs to be completed front & back of drug charts
Weight should be documented here. It is important clinical information, vital to calculating and confirming doses of certain medicines, particularly for paediatrics and chemotherapy patients as the BSA is needed for accurate dose calculation. Patients should have their weight recorded on at least 1 of their current drug charts (if there are multiple charts).
21% of drug charts incomplete – not filling in the back of chart – or not hand writing the name under the label
75kg
Joe Bloggs

3. Allergies and Adverse Drug Reaction (ADR) Alerts
Medical officers, registered nurses and pharmacists are obliged to complete ADR details for patients – when asking a patient use terms such as ‘allergy or side effects’
Once information has been verified and documented, the person documenting the information must SIGN, DATE and PRINT THEIR NAME
When documenting any additional information – the person adding the information must initial the designated area
If a previous ADR exists, list the following:
Drug name
Reaction details (e.g. rash, diarrhoea, anaphylaxis)
Date of reaction (if possible)
Who recorded the information
If the patient is not aware of any perivious ADRs, then the nil known box should be ticked.
If the patient is unable to communicate this information, the unknown box should be ticked.
The person documenting the information must sign, print their name, and date the entry
37.36% - failed as ADR either hasn’t been signed and printed, or failed to include reaction type

4. Allergies and Adverse Drug Reaction (ADR) Alerts
Ibuprofen GI bleed (2014) T.Smith
T.Smith
07/01/2016
Medical officers, registered nurses and pharmacists are obliged to complete ADR details for patients – when asking a patient use terms such as ‘allergy or side effects’
Once information has been verified and documented, the person documenting the information must SIGN, DATE and PRINT THEIR NAME
When documenting any additional information – the person adding the information must initial the designated area
If a previous ADR exists, list the following:
Drug name
Reaction details (e.g. rash, diarrhoea, anaphylaxis)
Date of reaction (if possible)
Who recorded the information
If the patient is not aware of any perivious ADRs, then the nil known box should be ticked.
If the patient is unable to communicate this information, the unknown box should be ticked.
The person documenting the information must sign, print their name, and date the entry
37.36% - failed as ADR either hasn’t been signed and printed, or failed to include reaction type
35% OF ADRS WERE
NOT completed properly

5. Regular Medication orders
A drug order is only valid if:
All patient identification is completed
The prescriber enters all of the following:
Date
Generic name (active ingredient name)
Slow release box is ticked when applicable
Route
Dose
Dose calculation (paediatric charts only)
Frequency and administration times
Indication
Prescriber signature, print name and contact (pager number)
FILL IN ALL THE BOXES

6. 32% of drug orders had some sort of error prone abbreviation
DANGEROUS ABBREVIATIONS DO NOT USE IN MEDICATION ORDERS ROMAN NUMERALS ARE NOT PERMITTED
Large lists of abbreviations can be hard to memorise. This is a short list of the DANGEROUS abbreviations which we should NOT use
Error Prone Abbreviation
Intended
meaning
Misinterpretation
Correct Abbreviation
Ug, mcg or μg
microgram
Mistaken for milligram when handwritten 
microgram or microg 
U or u
unit
Mistaken as the numbers ‘0’ or ‘4’, causing a 10-fold overdose or greater (e.g. 4U seen as ‘40’ or 4u seen as ‘44’).
unit(s)
OD, od or d
Once a day
Once daily
Mistaken for twice a day
d is easily missed
daily or the specific time
QD or qd
Every day
Mistaken as qid (four times a day)
daily
Q4h
Every 4 hours
Every 4 hrs, 4 hourly, 4 hrly SC
subcutaneous
Mistaken for sublingual
subcut or subcutaneous
SL or S/L
sublingual
Mistaken for SC &
interpreted as subcutaneous
subling or sublingual
No zero before decimal point
(e.g. .5mg) 
0.5mg
Misread as 5mg 
0.5 mg or write 500 microgram or 500 microg
Trailing zero after decimal point (e.g. 5.0mg)
5mg
Misread as 50mg
Do not use trailing zero after decimal points or after whole numbers
32% of drug orders had some sort of error prone abbreviation

7. VTE Prophylaxis Guide to accessing IDEA3S
Printed Version th May 2012
Guide to accessing IDEA3S
MEDICAL ADULT VTE Risk Screening Tool (see full policy on PROMPT)
LMWH = low molecular weight heparin UFH = low dose unfractionated heparin
IPC = intermittent pneumatic compression GCS = graduated compression stockings
Acute on chronic lung dis.
Acute on inflammatory dis.
Cancer
Decompensated heart failure
Acute spinal cord injury
History of VTE
Active cancer
Age > 60years
Myocardial infarct
Until resolution of acute medical illness or hospital discharge
LMWH or UFH
Withhold 1st dose 24 hours post thrombolysis
LMWH
DURATION
PROPHYLAXIS
FEATURES
Ischaemic stroke
Moderate
High
RISK
Immobility
Thrombophilia
Oestrogen therapy
Obesity
Medical conditions with additional VTE risk factors:
Acute inflammation
Pregnancy or puerperium
Acute infection
Family history of VTE
Consider
Pharmacy Department tel: Printed version 1. 01/05/2014
SURGIAL ADULT VTE Risk Screening Tool (see full policy on PROMPT)
Until discharge
Consider LMWH or UFH
Consider GCS
Pregnancy/ puerperium
5 – 10 days or fully mobile
GCS +/- IPC
Any surgery with prior VTE &/or active cancer
5 – 10 days or fully mobile (cancer surgery consider 28 days)
Major surgery and age > 40 years
Major surgery definition:
All intraabdominal including laparoscopic
Duration >45 mins
See Orthopaedic
VTE Policy
Major orthopaedic trauma
Hip fracture surgery
Hip or knee arthroplasty
Major trauma
Other surgery with additional VTE risk factors:

8. VTE Prophylaxis 11% OF charts had vte risk assessment completed 14/01
The VTE prophylaxis section in the medication chart is designed to improve the documentation of VTE risk assessment and increase the prescription of VTE prophylaxis (pharmacological and mechanical) in patients at risk of developing a VTE and in whom prophylaxis is indicated
The VTE prophylaxis section is in the regular medications section and is highlighted in red to remind clinicians to assess VTE Risk and Prescribe VTE prophylaxis if indicated
11% OF charts had vte risk
assessment completed
14/01
14/01 Enoxaparin
0800
S/Cut mg Daily
T.Smith
200

9. Joe Bloggs’ Medication orders
Pre-admission meds
Seretide 250/25 ii puffs inh bd
Metformin XR 1000mg i tab o morning
Hospital initiated meds:
Benzylpenicillin 1.2g IV every 6 hours
Prednisolone 30mg for 2/7, then 25mg for 2/7
Enoxaparin 40mg sc daily
Paracetamol 500mg ii tabs o every 6 hours prn

10. Regular Medication orders
Seretide 250/25 inhale ii puffs bd
If the order is recharted –the date on which the order is re-written should be entered on the new order (not the date it was originally prescribed)
Seretide 250/25
7/1
08:00
20:00
inh
2 puffs
12 hrly
Dose: must be written using metric (e.g. grams, litres and Arabic system (e.g. 1, 2, 3).
Always use a zero (0.) before a decimal point but never after the decimal point.
If possible it is preferable to state the dose in whole numbers and not decimal ( write 500mg instead of 0.5g or write 125 microg instead of 0.125mg)
Don’t use U or IU for units – they can be misread as 0 or 10. always write units in full
pneumonia
EVERY order must have a signature & NAME PRINTED
T Smith
154
Medicine – to be done in generic name.
With the exception of combination products – Targin, Seretide, coveram.
Be cautious that some combination products (i.e. relatively new ones) aren’t stocked by the hospital – and you may be asked to write them out individually.
If you do prescribe in brand name – make sure you know what is in it. Occasionally you see duplicates of orders – Somac vs Pantoprazole
Route – avoid dangerous abbreviations – SC vs subcut
Dose – to be written out avoid using dangerous abbreviations microg and units
Frequency – avoid dangerous abbreviations OD/QD for daily - D
Indication – ideally to be written -
Prescriber sign & print name – contact details
Timing it is the doctors resposnisbility to fill in the timing of the doses – not the nurses
– sometimes the nurse fills it in and misses the times. Writing only 8am for bd doses, or specific timing required.
Diuretics bd – writing it up at 800 and 2000 when we they are normally 800 and 1200

11. Slow Release Drugs Metformin XR 1000mg i tab orally morning
The red Tick if Slow Release box is a prompt to prescribers to consider whether or not the standard release form of the drug is required
Good practice to also write out the SR, MR, XR, CD
7/ Metformin XR
08:00
PO mg mane
T2DM
T.Smith
154
The box must be ticked to indicate a sustained, modified or controlled release form of an oral drug.
If it not ticked it is assumed that the standard release form is to be given

12. Regular Medication orders
Benzylpenicillin 1.2g IV every 6 hours
Benzylpenicillin
7/1
06:00
12:00
24:00
18:00 IV
1.2 gram
6 hrly
pneumonia
T Smith
154
Medicine – to be done in generic name.
With the exception of combination products – Targin, Seretide, coveram.
Be cautious that some combination products (i.e. relatively new ones) aren’t stocked by the hospital – and you may be asked to write them out individually.
If you do prescribe in brand name – make sure you know what is in it. Occasionally you see duplicates of orders – Somac vs Pantoprazole
Route – avoid dangerous abbreviations – SC vs subcut
Dose – to be written out avoid using dangerous abbreviations microg and units
Frequency – avoid dangerous abbreviations OD/QD for daily - D
Indication – ideally to be written -
Prescriber sign & print name – contact details
Timing it is the doctors resposnisbility to fill in the timing of the doses – not the nurses
– sometimes the nurse fills it in and misses the times. Writing only 8am for bd doses, or specific timing required.
Diuretics bd – writing it up at 800 and 2000 when we they are normally 800 and 1200

13. Variable Dose O once daily
For drugs that require drug concentration monitoring document the following for each day of therapy
Drug level result
Time drug level taken
10/1 15
7/1
8/1 9/1
7/01 Prednisolone
For each dose the prescriber must document:
Dose
Prescriber initials
Time to be given
30mg 30mg 25mg 25mg
O once daily
Pneumonia
T.Smith
154

14. PRN medication order Paracetamol 500mg ii tabs every 6 hours prn
O g hrly g
Pain
T.Smith
154
Charting an as required ‘PRN’ medication order
Ensure all patient id sections are complete
Remember an incomplete order is invalid so ensure you document all of the follwoign
Date
Generic name (active ingredient name)
Route
Dose
Maximum dose in 24 hours
Hourly frequency
Indication
Prescriber signature and print name
The prescriber must check the rest of the chart to ensure that the maximum prn dose, combined with other orders does not exeed the safety limit for the patient
The prescriber must write the dose and hourly frequency. “PRN” alone is not sufficient as there is a risk of overdosing and the drug being administered at inappropriate intervals (if the patient is continuously in pain).
The indication must be charted so the staff known when it is appropriate to administer that particular drug to the patient
The frequency should document the intervals between doses rather than the number of doses per day ( e.g. 6 hrly not 4 times a day)

15. Changing/Ceasing orders
7/1 benzylpenicillin
IV grams every 6 hours
pneumonia
J. Hibbert
154
06:00
12:00
24:00
18:00
1.8 grams
NOT ONE order wAS
Ceased/changed correctly

16. Changing/Ceasing orders
7/1 benzylpenicillin
IV grams every 6 hours
pneumonia
T.Smith
154
06:00
12:00
24:00
18:00
increased dose
8/1/16 J.Vu
8/1 benzylpenicillin
06:00
12:00
24:00
18:00
IV grams every 6 hours
pneumonia
J.Vu
200
Ceasing and order the prescriber must:
Draw a clear line through both the prescription and the administration record sections, taking care that the line does not impinge on other orders
– only charting a line from the administration order sometimes leads to drugs being charted up for discharge
Write the date the order is to be ceased
Write the reason for changing the order (increased dose, written in error or ceased) at an appropriate place in the administration record cessation
Included a not to see new order 9if there is one)
Sign or initial the ceased order (so we know who ceased it)
Do not alter the original order as it is important to know when the change was made to monitor the impact of the change and identify who made the changed. Always cease the original order first before writing a new order (avoids duplicates)

17. Other examples Intermittent Orders
7/1 Thyroxine
X X X X O
100microg alt days
0730
Hypothyroidism
Empty stomach , ½ hr before breakfast
T.Smith
154
When a drug is not administer daily, the prescriber must clearly indicate this on the chart by using crosses to block out the days that the drug is not to be given

18. Warfarin Prescribing For each day of therapy document:
INR result (if ordered)
Warfarin dose
Prescriber’s initials
2.3 7
14/01
Warfarin is an anticoagulant ( and a high risk drug) the Warfarin section is printed in read as an extra alert
Because of the well-documented risk associated with the use of warfarin, all patients should receive counselling about the use of warfarin and be given written information on warfarin (warfarin book)
This section is included as a record that these risk mitigation activities have been completed
Completion of this drug order will vary slightly from the Regular Medication order in these ways
Warfarin brand must be circled as the two brands are not interchangeable
The target INR should be included when warfarin is initially ordered
A standard dose time of 1600hours (4pm) is recommended as this allows the medical team caring of the patient to order the next dose based on INR results rather than leaving for after-hours staff to do it
2 – 3 O
Atrial fibrilation
T.Smith
154

19. Once only and Nurse initiated medicine orders
The Once Only, Pre-medication, Telephone Orders and Nurse initiated Medicine sections are found on the front page of the drug chart. These orders are separate from regular medications so as to reduce the risk of continued administration.