Medication Order and Medication

1. Medication Order
Medication is prescribed as part of the treatment plan for many medical diagnoses. The
prescription is a medication order that is sometimes referred toas a physician’s order.
Today medication orders are typically electronically written using a computerized
practitioner order entry (CPOE) system.

Medication orders can be written on paper in urgent situations when there is no time
to enter the order into the CPOE system. The practitioner may give a verbal
medication order to a registered nurse (RN) such as in the emergency department.
The practitioner might also telephone a medication order to the nurse or pharmacist
if the practitioner is not on premises and the patient requires the medication
immediately. The practitioner must sign the order within 24 hours depending on the
health care facility’s policy.

Medication orders are transcribed from the medication order to the patient’s
medication administration record (MAR). The MAR is a schedule for administering
medication to the patient and documenting when and by whom the medication was
administered.

Many health care facilities use an electronic medication administration record

(eMAR). CPOE medication orders are automatically transmitted to the pharmacy. A
pharmacist electronically transcribes the medication order to the eMAR. This is
referred to as taking off the order. The nurse then reviews and verifies medication
orders on the eMAR in a process called cosigning the transcription of the order to the
eMAR. Some health care facilities use a paper MAR. Medication orders are
transcribed by hand to the paper MAR by a nurse. Another nurse reviews and verifies
the transcriptions and initializes the entry into the MAR.

Parts of a Medication Order

Patient Identification

The patient must be clearly identified on the medication order to prevent the medication from being
administered to the wrong patient. The patient is identified by patient’s number, patient’s full name, and
date of birth. This information must be identical to the information on the patient’s wrist band.
Furthermore, the patient must tell the nurse verbally his or her name and date of birth to confirm the
identity.

Date and Time of the Medication Order

Each medication order must specify the month, day, year, and time that the practitioner wrote
the medication order, which is referred to as the time stamp. Do not confuse the time stamp of
the order with the time to administer the medication. The medication order will specify when to
administer the medication.

Depending on the medication, some health care institutions have a policy that specifies when a
medical order expires. This is commonly called a cutoff time and is used frequently for antibiotics.
The date and time of the medical order is used to determine when this time period begins.

Furthermore, a practitioner might want the medication administered for a specific number of
days that begins from when the medication order is written.

Medication Name

The practitioner must clearly write either the brand name or generic drug on the medication
order. A brand name drug is a medication protected by a patent usually held by a company that
discovered, tested, and received approval from the Food and Drug Administration (FDA) to sell
the drug.

After the patent expires, other pharmaceutical companies can manufacture a bioequivalent
medication referred to as a generic drug. Bioequivalent means that the generic is in identical
dose, strength, route of administration as the brand name medication. For example, CIPRO is the
brand name of a synthetic antibiotic sold by Bayer AG, the generic name being ciprofloxacin.

Medication Dose

The medication dose specifies the strength of the medication and is the amount of the
medication that the patient is to receive. The dose in the medication order includes a value
followed by a unit of measurement such as 250 milligrams, which is abbreviated as mg.

Errors can occur when abbreviations are used for the unit of measurement because the
abbreviation can be misread as part of the value. For example, U was used as the abbreviation
for units, which is the measurement used for insulin. A practitioner could write the following as
the dose.

The handwritten U is poorly written. However, the error is easily detected by the nurse because
if the value of the dose is 20, as it can be interpreted, then the medication order is missing the
unit of measurement for the value and therefore isn’t a valid medication order.

A similar problem occurs with the abbreviation for international units, which is IU. A poorly
written U can be misread as a V resulting the abbreviation being read as IV instead of IU. This too
can be caught because the medication order would be missing the unit of measurement.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) developed a list of

abbreviations that should not be used, which are illustrated in Table 1–1. Some health care
facilities have policies that add to this do-not-use list of abbreviations and instead require
practitioners to write out the complete word.

Another common error occurs with decimal values. It is easy to miss the decimal point. For
example, .2 mg could be misread as 2 mg or 5.0 mg can be misinterpreted as 50 mg. Practitioner
must use a leading zero for decimal values such as 0.2 mg and drop values and exclude the
decimal point and zero if no decimal value is used such as 5 mg.

Medication Route

The practitioner must specify the way the medication is to be administered to the patient, which
is referred to as the route. The route is typically identified by the common abbreviations given.
Medication Administration Time and Frequency

The practitioner prescribes the time and frequency of drug administration based on a number of
factors including absorption, side effects, interactions with other medication, and the desired
effect of the drug on the patient.

The time when the medication is given to the patient is usually at fixed hours according to the
health care facilities policy such as 6 PM meds. Sometimes practitioners will prescribe a specific
time to administer the medication, but many times the practitioner specifies the frequency. The
eMAR system automatically determines times to administer the medication based on the health
care facility’s policy if the practitioner uses CPOE. The nurse determines the medication
administration time based on the health care facility’s policy if a paper MAR is in use.

PRN Medication Order

A PRN medication order directs the nurse to administer the medication as needed by the patient
based on criteria established by the practitioner. The criteria are referred to as parameters, such
as range of blood pressure, a range of temperature, or a range of pain.
The practitioner must specify the patient identity, date and time of the medication order, name
of the medication, dose, and route, parameters, and sign the order. Without any of these, the
medication order is invalid.

Medication Order Renewal

Although, the practitioner determines when to discontinue a medication order based on the
patient’s condition, health care facilities have a medication order renewal policy that requires
certain medication orders automatically discontinued after a specified period of time. The
practitioner must write a new medication order if the medication is to be continued. A common
practice is to have all medication orders discontinued after 14 days.

The Medication Administration Record (MAR)

The MAR is used to schedule when patients are to receive medication and record when the
medication is administered and who administered it. Many health care facilities use an eMAR.
Although the form differs among health care facilities, each has the same information.

• Patient Information: This includes the patient’s name, identification number, room number,
diagnosis, and allergies.
 • Schedule Medications: These are medications that are given regularly to the patient to maintain
a therapeutic level such as once a day for seven days.
• Single Orders: These are medications that are administered once for an immediate effect such
as epinephrine given STAT for anaphylactic shock.
• PRN Medications: These are medications given as needed such as nonsteroidal anti-
inflammatory drug for pain relief.
• Signature: The name of each nurse who administers medication to the patient is identified by the
nurse’s name, which corresponds to the nurse’s ID and password that is used to log onto the eMAR

Information About Medication

The MAR is a time-saving tool because it contains information needed to administer medications to a
patient, except for orders that are cancelled or have not been taken off as yet. It is for this reason that
you must always review the latest medical orders before administering any medication.

For each medication, the MAR contains the following:

• Order Date: This is the date that the practitioner ordered the medication.
• Expiration Date: The order is no longer valid on or after the expiration date.
• Medication Name: This is usually the brand name of the medication.
• Dose: The amount of the medication the patient receives.
• Frequency: The number of doses the patient receives.
• Route of Administration: The route in which the medication is given to the patient.
• Site of Administration: Where was the medication administered if medication was
administered in an injection?
• Date and Time: The day and hour that the medication must be administered.

Reading the Medication Label

The pharmacy delivered Dilantin to the unit. The following is a portion of the information contained on
the label.

Dilantin suspension 125 mg/5 mL

What information on this order do you need to calculate the dose for your patient? Let’s take apart this
label.
• The name of the medication is Dilantin.
• The dose is 125 mg in 5 mL.

The information needed for the formula is the dose on hand, which is 125 mg, and the quantity, which is
5 mL. The name of the medication isn’t required by the formula.
Calculating the Formula
There are two mathematical operations that must be performed to calculate the dose. These are division
and multiplication.

1. First divide the dose on hand into the dose ordered.

100 mg
125 mg
= 0.8

2. Next, multiply by 5 mL to calculate the dose to administer to the patient.

0.8 x 5 mL = 4 mL

You will administer 4 mL of Dilantin to the patient.

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