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Math and Dosage Calculations Math and Dosage Calculations for Health Carefor Health Care Third EditionThird Edition
Booth & WhaleyBooth & Whaley
McGraw-Hill 5-1
Chapter 5: Drug OrdersEdited by B. Holmes MSN/Ed, RN
Learning OutcomesLearning Outcomes
Summarize the Rights of Medication Administration.
Interpret a written drug order.
Identify on physicians’ orders and prescriptions the information needed to dispense medication.
Learning Outcomes Learning Outcomes (cont.)(cont.)
Locate on medication administration records or electronic medication records the information needed to administer medication.
Recognize drug orders that do not contain all of the necessary information to carry out the orders safely.
Select appropriate action for confusing, incomplete, or illegible drug orders.
IntroductionIntroduction
It is important to be able to read and understand a drug order to correctly calculate medication dosages.
You can be held responsible for medication errors regardless of the source.
Rights of Medication Rights of Medication AdministrationAdministration
Basic Rights
Right patient
Right drug
Right dose
Right route
Right time
Right
documentation
Additional Rights
Right reason
Right to refuse
Right to know
Right technique
Right PatientRight Patient
Before giving a medication to a patient
◦Check for two identifiers.
Patient’s full name
Another identifier – date of birth, SSN, or medical record number
◦Ask the patient state his/her full name and second identifier.
Right Patient Right Patient (cont.)(cont.)
◦Check that the name on medication order is exactly the same as the name of the patient.
Outpatient – photographic identification
Inpatient – identification number, identification bracelet, bar code scanning
◦Check the bed number.
Right DrugRight Drug
To be sure a patient receives the right drug.◦Only give drugs that you prepared
yourself◦Check the expiration date.◦Check original order before
administration◦If the patient questions a medication,
make sure you are able explain the drug, purpose, and side effect
Right Drug Right Drug (cont.)(cont.)
◦A patient always has the right to refuse a medication.
Dispose of refused medications according to facility guidelines.
Right Drug Right Drug (cont.)(cont.)
Rule 5 – 1Rule 5 – 1 Check medication three times:
1. when you take it off the shelf2. when you prepare it3. when you replace it on the shelf
Check it three times even if it is prepackaged, labeled, and ready to be administered.
Right DoseRight Dose
Preparing and administering the right dose may require calculations.◦ Conversion from dosage
ordered to desired dose◦ Amount to administer
Use extreme caution when calculating dosages.◦ Pay special attention to decimal
points
Right RouteRight Route
A drug intended for one route may not be safe if administered via another route.
◦ Be especially careful between ophthalmic and otic routes.
Right Route Right Route (cont.)(cont.)
Some medications are produced in different versions for different routes.
ExampleExample aspirin is available as tablets or as suppositories
Check that route listed on drug label matches route ordered.
Right TimeRight Time
Most often within 30 minutes of schedule◦ Absolute time – 9:00 a.m.◦ Relative time – before breakfast
Drug order should identify special timing considerations if needed.
PRN medications ◦ Given when needed with a specified time
interval.◦ Check when previous dose was given.
Right DocumentationRight Documentation
Sign the medication administration record (MAR) immediately after the patient takes the medication.◦ Do not document prior to giving the
medication.◦ If documentation not done, medication
administration is not complete
Also document if the patient◦ Refuses a medication◦ Consumes only part of the dose ◦ Vomits after taking the drug
Right ReasonRight Reason
Know why a medication is being given.
◦ Check medication record
◦ Check order
◦ Check with prescribing physician
Right to KnowRight to KnowPatients must be educated about
their medications, including the
◦Reason for taking the medication
◦Expected effect of the medication
◦Side effects of medications
Right TechniqueRight Technique
Medications must be given correctly according to the order. ◦ For example:
Buccal -- between cheek and gum Sublingual -- under the tongue
If unsure of technique◦ Physicians’ Desk Reference (PDR)◦ Facility policy or procedure manual◦ Valid Internet source
Roman NumeralsRoman Numerals
Are used sometimes in drug orders.
Calculating dosages may involve changing Roman numerals to Arabic numbers.
Letters represent numbers.
Commonly used Roman numerals◦ ss = ½◦ I = 1◦ V = 5◦ X = 10
Combining Roman Combining Roman NumeralsNumerals
Rule 5 – 2Rule 5 – 2 When reading a Roman numeral containing more than 1 letter, follow these two steps:
1. If any letter with a smaller value appears before a letter with a larger value, subtract the smaller value from the larger value.
2. Add the value of all the letters not affected by Step 1 to those that were combined.
Combining Roman Numerals Combining Roman Numerals (cont.)(cont.)
IX = 10 –1 = 9
XIV = 10 + (5-1) = 14
XXVIII = 20 + (5+3) = 28
Doctor’s orders are most likely to contain Roman numerals from 1 to 30.
Most common Roman numerals are: V & X
ExamplesExamples
Practice Practice
1. Convert the following Roman numerals to Arabic numbers:
a. viiss
b. XII
c. XIX
d. ixss
2. Provide the answers to the following in Arabic numbers:
a. V + V
b. xxii – vii
c. XXXV – XIV
d. xvi + xii
7½
12
19
9½
10
15
21
28
Physician’s Orders and Physician’s Orders and PrescriptionsPrescriptionsAbbreviations used when writing orders:
◦ General abbreviations◦ Form of medication◦ Route◦ Frequency
Approved abbreviations vary among facilities◦ Memorize commonly used abbreviations◦ Keep facility's approved list available
Commonly Used General Commonly Used General AbbreviationsAbbreviations
Abbreviations Commonly Used for Abbreviations Commonly Used for Form of MedicationForm of Medication
Abbreviations Commonly Used Abbreviations Commonly Used for Routes of Administrationfor Routes of Administration
Abbreviations Commonly Used Abbreviations Commonly Used for Frequencyfor Frequency
AbbreviationsAbbreviations
Joint Commission on Accreditation of Healthcare Organization (JCAHO) ◦“Do Not Use” abbreviations◦“Undesirable” abbreviations
Check abbreviations carefully in drug orders.
““Do Not Use” Abbreviations Do Not Use” Abbreviations
Undesirable AbbreviationsUndesirable Abbreviations
Undesirable Abbreviations Undesirable Abbreviations (cont.)(cont.)
Do Not Use Potential Problem Use Instead
> (greater than) < (less than) Misinterpreted as the number “7” (seven) or the letter “L” Confused for one
another
Write “greater than” Write “less than”
Abbreviations for drug names Misinterpreted due to similar abbreviations for
multiple drugs
Write drug names in full
Apothecary units Unfamiliar to many practitioners
Confused with metric units
Use metric units
@ Mistaken for the number “2” (two)
Write “at”
cc Mistaken for U (units) when poorly written
Write "mL" or “milliliters”
µg Mistaken for mg (milligrams) resulting in one
thousand-fold overdose
Write "mcg" or “micrograms”
Undesirable Abbreviations Undesirable Abbreviations (cont.)(cont.)
Physician’s Drug OrderPhysician’s Drug Order
Essential elements◦ Full name of the
patient
◦ Full name of the
drug
◦ Dosage
◦ Route
◦ Time
◦ Frequency
◦ Signature of prescribing physician
◦ Date
◦ PRN order must include the reason
Outpatient SettingsOutpatient SettingsPhysicians’ orders are given as
prescriptions.
Prescriptions include all the elements of a physician’s order plus ◦Physician’s name and prescriber
number◦Quantity to be dispensed◦Number of refills◦Instructions for the label
Prescription Prescription FormForm
Drug and dose Quantity to
dispense
Instructions to appear on the label
Number of refills permitted
Patient’s full
name
Date
Physician name
Inpatient SettingsInpatient SettingsPhysicians’ order form
◦Multiple orders on one form◦Essential elements of a medication
order◦Patient’s name and physician
signature appear once
Orders may be entered into a computer
Physician’sOrder Form
Error Alert!Error Alert!
Never guess what the prescriber meant!◦If the order is not legible, always
contact the prescribing physician to clarify the order.
Verbal OrdersVerbal Orders
Acceptable if the physician is unable to write an orderthat must be carried out quickly
Governed by state laws
If permitted to accept a telephone order◦ Write it carefully and legibly as you receive it
◦ Read the order back to the physician
◦ Ask for clarification of spelling if unsure
Error Alert!Error Alert!Always be certain that you are
dispensing the correct medication.
◦Many drugs have names that are similar.
Acular—Ocular Benadryl—BentylCafergot—Carafate Darvon—DiovanDigitoxin—Digoxin Eurax—UrexIodine—Lodine Nicobid—Nitrobid
ExamplesExamples
PracticePractice
What, if anything, is wrong with this prescription?
Allen Capsella, MDWesttown Medical Clinic
989-555-1234
Name: M Ward Date: 8/15/2008
Address:
Rx: Lopressor
QUANTITY:
SIG: 1 tab BD
Refills: 2
MD398475 A Capsella, MD Prescriber ID # Physician Signature
PracticePractice
ANSWER 1. It does not include patient’s full
name.2. There is no dosage strength for the
lopressor.3. There is no quantity to be dispensed.4. No route is given.
Click to return to prescription
Medication Administration Medication Administration SystemsSystemsStandard schedule for
administering medication ◦Varies by facility
Verifier ◦Ensures that the times listed for
administration are appropriate ◦Adjust times as necessary
Mealtimes Conflicting medication schedule
Sample Times for Medication Sample Times for Medication AdministrationAdministration
Frequency Ordered Times to Administer
qd 0800
bid 0800 – 2000
tid 0800 – 1400 – 2000
qid 0800 – 1200 – 1600 – 2000
q 12 hrs 0800 – 2000
q 8 hrs 2400 – 0800 – 1600
q 6 hrs 2400 – 0600 – 1200 – 1800
Every night at bedtime 2000
Medication Administration Medication Administration Records (MAR)Records (MAR)
Legal documents that may be handwritten or computerized
Contain same information as the order form
Specify the times to administer the medication
Provide a place to document each medication administration
Medication Administration Medication Administration Records (MAR)Records (MAR)(cont.)(cont.)
Rule 5-3 Rule 5-3 MARs must include the following information:
1. Name of medication, dose, route, frequency
2. Times that accurately reflect the frequency specified
3. Name and identification number of patient
4. Date order was written (including start and end dates as necessary)
5. Special instructions or information required by the facility
PracticePractice
Is the following MAR complete? If not, what is missing?
Dateinit.
Medication, dose, duration,frequency, route
D/Cdateinit
Admin time
2/5
CS
Vasotec 10 mg po BID
hold for systolic BP < 100
0800x
2000x
ANSWER The order is transcribed correctly and all information is complete.
Is the following MAR complete? If not, what is missing?
PracticePractice
Dateinit.
Medication, dose, duration,frequency, route
D/Cdateinit
Admin time
2/5
CS
Synthroid 50 mcg
PO Bid
0800xxx
2/5
CS
Erythromycin tab i
po q6h
0800x
2000x
2/5
CS
Persantine 75 mg
po q6h
240008001600
x
2/5
CS
heparin 10,000 units
q 8 hr
240008001600
Practice Practice
ANSWER 1. Order A is correct.
2. Order B does not include the strength of the medication and there is an error in the times listed. The “hours” reflect only a q 12 hr dosing rather than a q 6 hr dosing.
3. Order C contains an error in the times listed. There are only 3 times listed and it should be q 6 hours (4 times).
4. Order D does not include a route.Click to return to MAR
Medication CardsMedication CardsRarely used
One drug per card
Disadvantages◦Easily misplaced◦Increased potential for omitting a
medication◦Do not list allergies or diagnoses
Medication Card Medication Card (cont.)(cont.)
Patient’s nameRoom numberFull name of drugDose, route, frequencySpecial instructionsAdministration timesDate ordered
Computerized Medical Computerized Medical RecordsRecords Patient information is entered directly into a
computer. Information is easily updated and accessible. Includes
Orders Lab resultsAllergies Appointments Discharge plans
Computerized Computerized Medical Medical RecordRecord
Computerized Medical Computerized Medical Records Records (cont.)(cont.)Electronic Medication Administration Records (eMARs)
◦Ongoing working document
◦Records medications as they are
administered
◦Users must log into system using
secure passwords
eMAR
Medication Reference Medication Reference MaterialsMaterialsTo dispense or
administer medications◦ Know effects of the
drugs
◦ Be familiar with drug information sources
Medication Reference Medication Reference Materials Materials (cont.)(cont.)Resources
◦ Package inserts
◦ Physicians’ Desk Reference (PDR)
◦ United States Pharmacopeia National Formulary
◦ Drug handbooks
◦ Reputable Internet sites
◦ Software programs used with personal digital assistant (PDA)
Apply Your KnowledgeApply Your Knowledge
Which of the basic rights of medication administration is not listed?Right patientRight drugRight doseRight timeRight techniqueRight documentation
Answer right route
Apply Your KnowledgeApply Your Knowledge
What do the following abbreviations mean?
pcBidhssuppBP
after meals
Twice a day
At bedtime
suppository
blood pressure
Click for each answer.
Apply Your KnowledgeApply Your Knowledge
Even though these are inappropriate abbreviation, what do they mean?
QdAuMSO4ccug
Apply Your KnowledgeApply Your KnowledgeQd = dailyAu = both earsMSO4 = Morphinecc = millilitersug = microgram
End of Chapter 5End of Chapter 5
You must motivate yourself EVERYDA
Y!~Matthew
Stasior