PRESCRIPTION AND MEDICATION ORDER
A physician usually determines the client’s medication needs and orders medication.
A prescription is a legal order for preparation and administration of medication.
Usually a physician writes a prescription and in certain countries, the nurse practitioners carry it out.
· Prescription pad
· Handheld electronic device
· Computerised physician order entry(CPOE)
Types of orders
1. Stat order: Indicates that the medication to be given immediately and only once. (Inj Lasix 20mg IV stat).
2. Single order (one time order): it is for the medication to be given once at a specified time. (Pre-operative medications).e.g. Ativan 1 mg IV on call to MRI
3. Standing order: It may or may not carry a termination date. A standing order may carried out indefinitely (multiple vitamin), until an order written to cancel it. A standing order may carried out for a specific number of days.
4. PRN orders (as needed order): It permits the nurse to give a medication when the condition of the client demands. It requires a keen nursing judgment, (Painkillers and laxatives). E.g. Morphine sulphate 2mg IV q2h prn.
5. Telephone, verbal and fax orders: Some times after discussion with the doctor about the clients condition over the phone, the nurse may write the ordered medication on the physician’s order sheet, which is designated as ‘T.O’. The physician must countersign the order at a specified time-period, which is usually 24 hours. In certain cases physician gives the reply by a return fax indicating the needed charge. Fax order is also considered as telephonic order so it should be countersigned at specified time period.
6. Telephonic order-An order for a medication or medical treatment made over the telephone .
7. Verbal order -If order is given verbally it is called a verbal order. While writing- indicate the time and name of prescriber.
8. Now order: more specific than one time order and used when a patient needs a medication quickly but not right away. Up to 90 minutes to administer the medication E.g. Vancomycin 1g IV now.
Essential parts of a Drug order
· Client’s name.
· Date and time, the order is written,
· Name of the drug to be administered.
· Dosage of the drug.
· Frequency of administration,
· Route of administration.
· Signature of the person writing the order.
Essential parts of a prescription
· Descriptive information about the client, (name, age, address).
· Date of prescription.
· The symbol which ‘take thou’.
· Medication name dosage and strength.
· Route of administration.
· Dispensing instruction to the pharmacist.
· Direction for administration to be given to the client.
· Prescriber’s signature.
ADMNISTER MEDICATION SAFELY
· A nurse should always assess a client’s health status and obtain a medication history prior to giving any medication.
· It is important to determine whether the route of administration is suitable.
· The medication history which includes information about the drugs that the client taking currently or has taken recently.
· Note down the intake of vitamins, herbs, and food supplements, and or folk remedies that have used by the patient. Note its compatibility with the current medication.
· Client’s knowledge about their drug allergy is an important factor of a medication history.
· During history, the nurse tries to elicit the information about drug dependency.
· Include the eating habit of the client, sometimes the medication should need to be coordinated with the mealtime and ingestion food.
· Certain medication are incompatible with some kind of food. (Milk and tetracycline).
· Also, identify any problem that the client has in self-administration of medication.
· Obtain the information about the storage of medication is also needed. Socioeconomic factors are also be considered for all patients.
Medication error in the administration of drugs
· Which is given not according to the order.
· Is administered as per order, but is unsafe or inappropriate for client.
· Medication was given but not recorded.
· Administration of IV medication at a wrong rate.
· Administering medication in the wrong route.
· Administering extra dose
· Administration of medication at a wrong time.
· Administration of wrong medication.
· Charting medication that was not given.
· Administering substitution medication.
· Medication within the prescribed time interval.
· Administering medication by wrong route.
· Inaccurate preparation of a drug.
· Administering medication to a client with known allergy to that medicine.
· Improper technique while administering a drug.
· Administering medication to a wrong client.
· Giving a drug that has deteriorated.
When a medication error occurs, it should be documented exactly as it has occurred. First asses client, notify health care provider. Once patient stable write incident report.