Which elements of the medication prescription will the nurse specifically check?

A medication order is written by a practitioner for a medication that will be administered. Medication orders are required before a nurse may administer medications.

A medication order must include specific information before the medication order can be carried out. As with other orders, the medication order becomes a permanent part of the patient record.

A medication order may be written, typed, or it may be given verbally or by telephone to a licensed nurse or pharmacist.

Remember: Student nurses are not able to receive a verbal or telephone order, only licensed practitioners.

Some healthcare facilities may use electronic prescribing systems called computer prescriber order-entry systems or CPOEs. These systems were put in place to prevent medication errors due to illegible handwriting resulting in illegible drug names. Each healthcare facility has a policy on how orders may be written by the practitioner at that facility. Always check the facility’s policy.

Medication Administration Record or MAR

Once a medication order is given, the information is transcribed to a medication administration record (MAR). The medication administration record is a record of all medications administered to a specific patient during hospitalization. The medication administration record is a part of the patient’s legal chart.

Depending on the facility the information is either handwritten on the MAR or the information is entered directly into the computer by the prescribing practitioner or unit secretary. When the information is entered into the system, the medication information is transferred to the MAR. The MAR is then printed and added to the patient’s chart for the nurse to use.

Medication Order Requirements

As mentioned earlier, whether the MAR is handwritten or printed out the medication order must include specific information. Below is a list of the information that should be included in a medication order.

• Patient’s name
• Date and time the order is written
• Name of medication to be administered
• Dose of the medication
• Route by which the medication is to be administered
• Frequency of administration of the medication
• Signature of person writing the order

Patients Name

The medication order should always include the patient’s full name. You should also be aware of the patient’s middle name or initial if they have one. This can help you avoid any confusion with another patient that has the same last name.

The patient’s name is not only located on the patient’s chart but, also on individual documents including the MAR. You must be careful when administering medications when there is more than one person with the same last name on your unit. Even if you are not caring for both patients, you should still be extremely cautious.

Date and Time the Medication Order is Written

The date and time the order is written should always be included in the medication order. This information helps the medication from being overlooked. Not only will you know exactly when the medication was ordered, but you will also know when the first dose is due.

There is more than one shift in a 24 hr period. It can get busy and there may be oversight with medication orders. Especially when a medication order is written close to or during shift change. The date and time will help prevent medication errors. It also helps prevent missed doses.

The date and time are also important for medications given over a specific time period and needs to be discontinued on a specific day. When the medication order is dated and time you will know which dose will be the last dose.

Name of the Medication to be Administered

It goes without saying that the name of the medication should be on the medication order. The name of the medication may be written as the brand name or the generic name. Generic medications are well-known and used by many healthcare facilities.

It is important for a nurse to be familiar with the brand name and the generic name of a medication. Many facilities offer online medication information for nurses to use. Also, a nurse can use a drug handbook or a Physicians’ Desk Reference which are sometimes available on the unit.

Dosage of the Medication

Thedosage of a medication is normally stated using the metric system. However, sometimes medication orders are written using the household system. The metric system is the most widely used system. It is also considered to be the safest system for the measurement of medication dosage. You are more likely to see household measurements in the community setting.

There are certain abbreviations used to indicate medication amounts. These common abbreviations are used on the medication order. There are also some abbreviations that the Joint Commission has identified as unsafe to use. These medications are on The Joint Commission Official “Do Not Use” List.

Route the Medication is to be Administered

The route of medication administration is included in the medication order. Specifying the route is important because some medications can be given via more than one route.

Some medications may be safe for administration to a patient via one route and not safe for a different patient via the same route.

Frequency of Administration of the Medication

The frequency a medication is to be administered is included in the medication order. Most time the frequency is written using medication dosage abbreviations.

The Institute for Safe Medication Practices (ISMP) has a List of Error-Prone Abbreviations, Symbols, and Dose Designations.This is a great source for the prevention of medication errors.

The healthcare facility’s policy or the pharmacy department determines the frequency and times for routine medications.

Also, healthcare facilities use military time or the 24-hour clock. Midnight is 0000 hours and counts till 2400 hrs. So 9 AM will be 0900 hours and 9 PM will be 2100 hours.

For medications given before a particular meal such as before breakfast, the administration time will vary depending on the time meals are served at that facility.

For medications given once or twice a day, the time of day will depend upon the medication and the patient’s plan of care. Also, some facilities may have standard times for the administration of medications once a day (QD) or twice a day (BID).

Sometimes a patient may have a preference about the time they want to take a particular medication. Consider the patient’s choice as long as it falls within the guidelines of safe practice.

If you have more than one patient you cannot administer every patient medication on the hour indicated. Most facilities give you one-half (1/2) hour before a medication is due and one-half (1/2) hour after a medication is due to give the medication.

Signature of Person Writing the Order

The medication order must include the signature of the prescribing practitioner.

When a facility uses a computerized system, the prescriber has a username and password that identifies them as the prescriber. Their information is automatically added to the medication record. There is no need for a handwritten signature with these systems.

The signature whether handwritten or computer-generated makes this order a legal part of the patient’s chart.

Types of Medication Orders

There are several types of medication orders. They are based on when the medication must be given and the urgency of the dose.

There are also different policies for medication administration that affect medication orders. Some facilities discontinue all medications when a patient goes and to surgery and the medications have to be reordered. We will take a look at five types of medication orders.

Standing Medication Orders

First, we will look at standing medication orders. A standing medication order is a set of prewritten orders that a nurse can use to administer treatments and medications.

These are usually written by a specific practitioner and allows the nurses to administer certain medication without a physician order. In a way, these are the physician orders. Standing orders are approved by the practitioner.

Standing orders are used until they are canceled or until the number of days has passed for the standing order. These orders usually contain the number of treatments to be given and how long the treatments should last.

PRN Medication Orders

Secondly, there are PRN medication orders. These medications are only given when the patient requires them. Medications for pain relief, sleep, and nausea can be written as PRN orders. Sometimes you will find medications for blood sugar and high blood pressure given as a PRN medication order.

PRN medication orders usually have instructions and guidelines for when, what dose, and how often the medication should be administered. With PRN medication you must use assessment and discretion when administering.

Single One-Time Medication Orders

Thirdly, there are single one-time medication orders. These medications are given only once at a specific time. Medications given preoperatively are usually single one-time medication orders.

Medications used to treat an acute symptom may be given as a single one-time order. And medications used for diagnostic procedures are given as a single one-time dose.

Once the dose is given the order is no longer active. If the patient needs another dose of the same medication another order must be written.

Stat Medication Orders

Fourthly, there are stat medication orders. These orders are for a medication that must be given immediately. These orders are also for a single dose of medication.

A stat order may be written and another order to continue the same medication for a specific time at a specific dose. This medication order must include all the requirements of any medication order. Stat orders are usually written in emergent situations.

Now Medication Orders

Finally, there are now medication orders. These orders are written when the patient needs the medication quickly but not immediately. The now medication order is also a single one-time dose of medication. There is usually an hour window of time to give a now order medication, but as always check your facility’s policy.

Conclusion

Each health care facility has a system for the writing of medication orders and the distribution of medication. As a nursing student, it is helpful to know what should be included in a medication order and to be able to distinguish between the types of medication orders. This article covers the requirements of medication orders and the types of medication orders.

Sources

Taylor, Ph.D. MSN, RN, Carol, et al. Fundamentals of Nursing: The Art and Science of Person-Centered Nursing Care. 8th ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015.

Potter RN, MSN, PhD, FAAN, Patricia A., and Anne G. Perry RN, EdD, FAAN. Fundamentals of Nursing. 9th ed., St. Louis, Mosby Elsevier, 2017.

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