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Chapter 4
Medication Orders and Labeling
2012 Paradigm Publishing
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Learning Objectives Gain an awareness of the historical roots of prescriptions, the Rx symbol,
and the signa. Recognize the influence of early Greek and Roman healthcare
practitioners on current medical terminology and abbreviations. Understand the difference between a prescription and a medication
order. Understand common medical and pharmacy terminology, abbreviations,
acronyms, and symbols. Identify pharmacy directions written in signa language. Recognize physician instructions and other pertinent information on a
medication order. Identify the various components of a compounded sterile preparation
label.
2012 Paradigm Publishing
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Topics Learning Objectives Introduction Medical Root Words, Prefixes, and Suffixes Medical Abbreviations, Acronyms, and Symbols Signa Interpretation Medication Orders Types of Medication Orders Medication Order Contents and Processing CSP Labeling Sterile Compound Label Components Sterile Compound Label Verification and Application Chapter Summary
2012 Paradigm Publishing
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Introduction
The origin of medical terminology is as old as medicine itselfapproximately 75% of medical terminology has its roots in
the Greek languagethe remainder can be traced to Latin
2012 Paradigm Publishing
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Medical Root Words, Prefixes, and Suffixes
Most medical terminology is based on a combination of medical morphemes, or root words, prefixes, and suffixes
A word’s meaning is derived from the root word A combining vowel is sometimes added to the end of
the root wordwhen a root word contains this combining vowel, the word
is said to be in its combined form
2012 Paradigm Publishing
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Medical Root Words, Prefixes, and Suffixes…/2
A prefix is a word element attached to the beginning of a root worda prefix often indicates time, location, direction, or number
A suffix is a word element attached to the end of a root wordthe addition of a suffix further defines the meaning of a
root word
2012 Paradigm Publishing
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Medical Abbreviations, Acronyms, and Symbols
Approximately 35,000 abbreviations, acronyms, and symbols are used in medicine and pharmacy
Collectively, they are referred to as medical abbreviations, or simply abbreviationsmost abbreviations are developed to shorten the length of
words and word combinations related to health, medicine, laboratory procedures or tests, and pharmacy
2012 Paradigm Publishing
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Medical Abbreviations, Acronyms, and Symbols…/2
Common Medical Abbreviations Indicate specific patient care facilities, units, or
departments or the titles of individual team members
Refer to specific medical diagnoses and conditions, procedures, treatments, patient directives/activities, equipment/supplies, and tests
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Medical Abbreviations, Acronyms, and Symbols…/3
Common Pharmacy Abbreviations Typically seen on medication orders or other written
communications between providers and pharmaciesprovide important informationmight also include abbreviations to communicate specific
compounding directivescommon for indicating the route of administration and the
dosing intervals for prescribed medications
2012 Paradigm Publishing
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Medical Abbreviations, Acronyms, and Symbols…/4
Common Pharmacy Symbols In addition to knowing pharmacy abbreviations, you
need to recognize and understand a number of symbols specific to pharmacy practicesymbols such as ↑ and ↓ are frequently placed on
medication orders to indicate “increase” and “decrease,” respectively
another common symbol is the Greek delta symbol (Δ), which is used to indicate a desired change
2012 Paradigm Publishing
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Medical Abbreviations, Acronyms, and Symbols…/5
The Official “Do Not Use” List of Abbreviations In 2004, the Joint Commission was driven to create
The Official “Do Not Use” List of Abbreviations in response to a number of sentinel events that had been noted across the United Stateslist integrated into the Performance Standards for
Healthcare Accreditationthe nonstandard and potentially dangerous abbreviations
should not be used in any healthcare application
2012 Paradigm Publishing
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Signa Interpretation
The signa component is a specialized language that physicians or other prescribers place on a medication orderprovides the pharmacy with specific directions for
administering the medication ordermay include dosage information, the route of
administration, the amount to be dispensed, the time schedule or dosing interval, and any special instructions
2012 Paradigm Publishing
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Signa Interpretation…/2
Signa language combines an assortment of abbreviations, acronyms, and symbols
2012 Paradigm Publishing
Signa Interpretation of Signa
i packet in 2 oz. OJ PO q.i.d. ut dict Mix one packet in two ounces of orange juice and give by mouth four times daily as directed.
aaa b.i.d. prn itching Apply to affected area twice daily as needed for itching.
SSI Sub-Q p.c. and h.s. Sliding scale insulin, inject subcutaneously after meals and at bedtime.
iii gtts au q8h Instill three drops into both ears every eight hours.
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Signa Interpretation…/3
Transcribing or interpreting a signa requires you to seek the portions of the directive that address the following questions:What is the route of administration of the medication?How much of the medication is the patient supposed to
take and how often?What special instructions need to be followed when taking
the medication?
2012 Paradigm Publishing
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Medication Orders
Medication orders are similar to prescriptionsexclusive to the institutional or hospital setting
Medication orders entered directly into a computer by the physician are often called eMARs (electronic medication administration records)
Just like other types of prescriptions, medication orders are legal documents that must be filed, usually based on the date the order was written, and kept on hand for up to two years
2012 Paradigm Publishing
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Medication Orders…/2
Upon receipt of the medication order, the pharmacy determines what medications and dosages have been ordered and then interprets the signa directionsit is then transcribed, or interpreted, and then entered into
the pharmacy’s computer system through a process called order entry
the pharmacist usually performs order entry, but specially trained pharmacy technicians may also complete this task
A label is then prepared for each of the medications
2012 Paradigm Publishing
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Your Turn
2012 Paradigm Publishing
1) Approximately how many abbreviations, acronyms, and symbols are used in medicine and pharmacy?a. 350b. 3,500c. 35,000d. 350,000
2) This component is a specialized language that physicians or other prescribers place on a medication order.a. deltab. signac. alphad. omega
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During hospital treatment, a physician examines a patient and then writes the first medication order on the patient’s medical chartthe medical chart is commonly called the medication
administration record, the patient’s chart or, simply, the chart
2012 Paradigm Publishing
Types of Medication Orders
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The physician’s initial order is called the admission order and is often written while the patient is in the emergency department or has just been admitted to a hospital room
2012 Paradigm Publishing
Types of Medication Orders…/2
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If applicable, the admission order includes a list of the medications, including dosages and dosing intervals, that the patient has been taking at home
These medications are commonly referred to as home medications or home medsin many instances, the physician orders the pharmacy to
continue home meds so that the patient will receive these same medications while he or she is hospitalized
2012 Paradigm Publishing
Types of Medication Orders…/3
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Every time a physician examines a patient, new orders, or changes to existing medication orders, are writtenmay be referred to as
daily orders
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Types of Medication Orders…/4
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Some physicians whose specialties involve commonly prescribed medical treatments take advantage of preprinted order forms called standing orders, or routine orders
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Types of Medication Orders…/5
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The medical chart contains both patient identification information and copies of all treatment orders prescribed during the patient’s stay
Standard patient identification information is either handwritten on the order, provided on a computer-generated patient ID label affixed to the order, or preprinted at the top of each medication order by using an addressograph
2012 Paradigm Publishing
Medication Order Contents and Processing
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Access to protected health information (PHI), such as that found on a medication order or in a patient chart, is restricted and the information may be viewed only by those departments that must see the data in order to correctly treat the patientpharmacylaboratorynursing
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Medication Order Contents and Processing…/2
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The treatment orders kept in the medical chart are carbon copies of all medication, diagnostic, laboratory, dietary, and other orders prescribedthe original copy remains in the chart, while the other
carbon copies are hand-delivered, faxed, scanned electronically, or sent via pneumatic tube system to the pharmacy or other relevant hospital departments
may be kept at the nursing station or maintained on a computer record
2012 Paradigm Publishing
Medication Order Contents and Processing…/3
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Orders are most often written by hand, using a combination of medical terminology and signa instructions, but they may also be entered directly into a hospital computerfacilities that depend on an eMAR system provide
computer terminals at the nursing station or near the patient’s room
physicians use these terminals for direct order entry, commonly referred to as computerized physician order entry (CPOE)
2012 Paradigm Publishing
Medication Order Contents and Processing…/4
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A pharmacist or technician based in either the central pharmacy or a satellite pharmacy enters the order into the pharmacy’s computer systemspecialized pharmacy software assists with the
identification of patient medication allergies and cross-sensitivities, drug–drug or drug–food interactions, appropriate medication dosage, duplicate therapy, contraindications, and other information
if an issue or potential problem arises, a flashing caution or warning screen (sometimes called a warning flag) appears
2012 Paradigm Publishing
Medication Order Contents and Processing…/5
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CSP Labeling
Upon completion of sterile compounding and checking procedures, personnel must appropriately label the sterile compound in its final container
Labels will most often be affixed by the IV technician but may also be affixed by the pharmacist
Federal laws require that pharmacy labels accurately identify the ingredients and the amount of each ingredient in the final sterile compound
2012 Paradigm Publishing
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Sterile Compound Label Components
The CSP label provides general informationmust also contain very specific information about the
product, its administration and storage requirements, expiration date, and preparer
Product information on the CSP label specifies the name, concentration, and amount of each base solution used to prepare the compound
The label must also clearly identify each additive, or medication or ingredient that has been added to the base solution
2012 Paradigm Publishing
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Sterile Compound Label Components…/2
In general, only IV push and IVPB medications require an administration time, which is the length of time over which the drug is to be given
2012 Paradigm Publishing
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Sterile Compound Label Components…/3
If the medication’s administration is not ordered by the physician and the package insert is unavailable, the pharmacist may find this information by consulting one of the pharmacy reference manuals, such as the Handbook on Injectable Drugs, or a computerized pharmacy reference source, such as Micromedex
2012 Paradigm Publishing
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Sterile Compound Label Components…/4
In contrast to an administration time, an infusion rate is specified for large-volume parenteral (LVP) products, such as IV bags and TPN solutions
2012 Paradigm Publishing
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Sterile Compound Label Components…/5
The CSP label must also provide the physician’s directions for the medication’s dosing interval
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Sterile Compound Label Components…/6
Personnel also add auxiliary labels to clarify special instructions or highlight physician directions for the nursing staff
2012 Paradigm Publishing
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Sterile Compound Label Components…/7
Another required component on the CSP label is the expiration date of the sterile compound, sometimes referred to as the beyond-use date (BUD)
2012 Paradigm Publishing
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Sterile Compound Label Components…/8
Several factors determine the expiration date, including the stability of the drug in its compounded formstorage requirements must also be included on the label
Every CSP label must also identify the pharmacy personnel who prepared the compound
2012 Paradigm Publishing
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Verifying the accuracy of the medication order and the CSP label is one of the most important components of ensuring the Five Patient Rights
Sterile product labels must be legible, pharmaceutically elegant, and complete
2012 Paradigm Publishing
Sterile Compound Label Verification and Application
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Your Turn
2012 Paradigm Publishing
3) The physician’s initial order is called this. a. start orderb. begin orderc. check-in orderd. admission order
4) The CSP label provides all of the following information excepta. storage requirements of medicationb. administration rate of medicationc. patient diagnosisd. patient identification number
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