1. Do the orders limit abbreviations to a minimum and never use unapproved abbreviations (e.g., QD or U)? |
Abbreviations are time-saving measures when handwriting orders. But, since preprinted orders can be readily reproduced by electronic or printed means, abbreviations are no longer a shortcut. They should be used rarely. Abbreviated medication names should be avoided. 7The risk of dosing errors can also be reduced by avoiding the use of leading zeros before a decimal point and the use of trailing zeros after a decimal point. 8
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2. Are medication orders numbered? | This is not a recommended practice because the order number may be confused with the medication dose. |
3. Are all medications listed together under the title, “Medications”? |
This makes it easier to take these orders off and lessens the possibility of overlooking a medication order. It also helps the pharmacy in completing the medication administration record. (Remember to include “Saline flush every 8 hours and as needed to maintain patency” under “Medications” when a nursing order calls for a saline lock.)
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4. Are blanket or multiple-range orders used? (e.g., 1–2 tablets every 3–4 hours) | Blanket orders can be confusing or imprecise and are not permitted, for example:
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5. Do orders always list indications for PRN medications? | Listing the indication helps verify that the medication and dosing are correct.6 |
6. Is “tall-man lettering” used for look-alike medication names? |
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7. If salts are used as part of medication names, do they follow the drug name? |
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8. Do orders use the word “thousand” and “million” for large doses? | Write “1 million units” or “150 thousand units” rather than 1,000,000 or 150,000 units |
9. Do orders use commas for dosage numbers expressed in thousands? | Write “5,000,” NOT “5000”.6 |
10. Is there a space between the name of the medication and the dosage or unit of measure? | Write “propranolol 20 mg,” NOT “propranolo l20 mg,” which may be misread as 120 mg.6 |
11. Do orders contain a total dose warning for appropriate medications? | For example, many medications contain acetaminophen. The warning, “Maximum total dose of acetaminophen not to exceed 4,000 mg per 24 hours” (for adults)” should be included in all orders with any medication(s) containing acetaminophen. |
12. Do paper orders contain a medication warning above the physician signature line as appropriate? e.g., “Adverse Reaction/Allergy Alert! These orders contain [aspirin, NSAIDS, antibiotic, narcotic, sulfonamides or MAO] medications?” | This warning serves as a reminder for physicians to check adverse reactions or allergies prior to signing preprinted orders. |
13. Do medication orders include drug name, strength, dose, route, and frequency? | ☑ Furosemide (Lasix®) 40 mg. Take one tablet by mouth one time daily.11 |
14. Are generic and trade names, if applicable, used? |
Just as patients are identified in two ways, so should medications. List the generic name first followed by trade name in parentheses; e.g., bumetanide (Bumex®). Some literature recommends placing the trade name in ALL CAPS. Consider including the drug’s purpose for high-risk, easily confused, or problematic drugs. 6
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15. Do medication orders contain criteria for determining the route of administration to be used, if multiple routes are possible? | Give IV until patient is able to tolerate liquids by mouth. |
16. Are medication doses written in MILLIgram (mg) when possible and not just in tablets or milliLITER (mL) doses? | ☑ Acetaminophen (Tylenol) 500 mg. Take one tablet by mouth every 6 hours as needed for mild pain. |
17. Is a timeframe included for IV bolus and IV push medications? | ☑ Diazepam (Valium) 5 mg/mL. Give 5 mg IV push, over at least 1 minute, every 4 hours, as needed for muscle spasm. |
18. Do the orders refer to all medications (from different specialists, OTC, etc.) as appropriate? | ☑ Refer to Medication Reconciliation Sheet for further medication orders. (Safety measure)
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19. Do the scheduled times for medication administration promote patient safety? |
The schedule (and stacking) of medications can contribute to falls in the elderly. Something as simple as changing scheduled medication times for every-12-hour diuretic medications from 9 am and 9 pm to 9 am and 5 pm can decrease nighttime falls in patients trying to get to the restroom.
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20. Do orders consider potential errors within the local cultural setting? |
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