Week 2Week 2

Medication Orders Medication Ordersandand

Measurement SystemsMeasurement SystemsChapters 5 and 7Chapters 5 and 7

Presented by: Dr. S

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Medication Order IssuesMedication Order Issues

Are you expected to know everything?Are you expected to know everything?– No healthcare professional isNo healthcare professional is

TipTip Obtain a good, current referenceObtain a good, current reference When in doubt askWhen in doubt ask

– No silly questions related to patient safetyNo silly questions related to patient safety

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JCAHO (Joint Commission on (Joint Commission on

Accreditation of Healthcare Accreditation of Healthcare Organizations)Organizations)

Created an Official “Do Not Use” ListCreated an Official “Do Not Use” List– Why?Why?

easily misinterpreted abbreviationseasily misinterpreted abbreviations

increased risk of errorsincreased risk of errors

compromised patient safetycompromised patient safety

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““Do Not Use” List ExamplesDo Not Use” List Examples

DON’TDON’T

1. “u” or “IU” for units

2. “q.d." "qd" "Q.D." "QD“

3. “Q.O.D.”

DODO

1. Spell out the word “units”

2. Spell out the word “daily”

3. Spell out “every other day”

The Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission on Accreditation of Healthcare Organizations. The The Official “Do Not Use Official “Do Not Use List”.Retrieved September 29, 2007, List”.Retrieved September 29, 2007, http://www.jointcommission.orghttp://www.jointcommission.org

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““Do Not Use” List ExamplesDo Not Use” List Examples DON’TDON’T

1. Trailing zero – “5.0 mg”

1. Decimal point without a leading zero

– “.5” can be mistaken for “5”

DODO

1. Avoid the use of a zero after a decimal point

– “5”

2. Use a leading zero before a decimal

– “0.5”

The Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission on Accreditation of Healthcare Organizations. The The Official “Do Not Use Official “Do Not Use List”.Retrieved September 29, 2007, List”.Retrieved September 29, 2007, http://www.jointcommission.orghttp://www.jointcommission.org

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Common Medical Common Medical Abbreviations:Abbreviations:

RouteRoute RouteRoute

– IMIM intramuscularintramuscular Example: Depo-Provera Example: Depo-Provera ® 150 mg/mL, # ® 150 mg/mL, #

1mL 1mL

150 mg IM q 3 months150 mg IM q 3 months

– SCSC subcutaneoussubcutaneous Example:Example: Lantus 100 units/mL, # 1 vialLantus 100 units/mL, # 1 vial

Inject 10 units SC q Inject 10 units SC q hshs

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Common Medical Common Medical Abbreviations:Abbreviations:

RouteRoute RouteRoute

– SLSL sublingual (under the tongue)sublingual (under the tongue) Example: nitroglycerin 0.4 mg SL tabs, Example: nitroglycerin 0.4 mg SL tabs,

#25#25i tab SL q 5 min x 3 doses prn i tab SL q 5 min x 3 doses prn

chest painchest pain

– POPO by mouthby mouth Example: atenolol 25 mg, # 30Example: atenolol 25 mg, # 30

i tab po q ami tab po q am77

Common Medical Common Medical Abbreviations:Abbreviations:

RouteRoute IVIV intravenousintravenous p.r.p.r. per rectumper rectum p.v.p.v. per vaginaper vagina

O.D. Right eye

O.S. Left eye

O.U. Both eyes

A.D. right ear

A.S. left ear

A.U. both ear

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Common Medical Common Medical Abbreviations:Abbreviations:

FrequencyFrequency

a.c.a.c. before mealsbefore meals p.c.p.c. after mealsafter meals prnprn as needed; as needed;

as needed foras needed for– prn painprn pain– prn HAprn HA

h.s.h.s. at bedtimeat bedtime statstat immediatelyimmediately

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Common Medical Common Medical Abbreviations:Abbreviations:

FrequencyFrequency

q 2hq 2hevery 2 hoursevery 2 hours q 4-6hq 4-6h every 4-6 hoursevery 4-6 hours

b.i.d.b.i.d. twice a daytwice a day t.i.d.t.i.d. three times a daythree times a day q.i.d.q.i.d. four times a day four times a day

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Questions?Questions?

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Required InfoRequired Info

Manufacturer’s LabelManufacturer’s Label

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Parts of a Manufacturer’s Parts of a Manufacturer’s Medication LabelMedication Label

Generic and Trade NamesGeneric and Trade Names National Drug CodeNational Drug Code Controlled Substances Drug SchedulesControlled Substances Drug Schedules Dosage StrengthDosage Strength PrecautionsPrecautions Administration Instructions Administration Instructions Storage RequirementsStorage Requirements Lot Numbers and Expiration DatesLot Numbers and Expiration Dates

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Generic and Trade NamesGeneric and Trade Names

FDA recognizes the United States FDA recognizes the United States Pharmacopoeia/National Formulary Pharmacopoeia/National Formulary (USP/NF) as official registrar of all FDA (USP/NF) as official registrar of all FDA approved drugs. approved drugs.

USP/NF contains over 3700 medications USP/NF contains over 3700 medications and dietary supplements. and dietary supplements.

Generic is drug’s official name in USP.Generic is drug’s official name in USP. Brand or Trade names that have a U.S. Brand or Trade names that have a U.S.

patent and have ® example Motrin®patent and have ® example Motrin®

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How are drugs named?How are drugs named? Chemical name – based on structureChemical name – based on structure

– N-acetyl-p-aminophenolN-acetyl-p-aminophenol Generic/nonproprietary name – Generic/nonproprietary name –

USP/NF official nameUSP/NF official name– acetaminophen (note it is lowercase)acetaminophen (note it is lowercase)

Trade/brand/proprietary name – Trade/brand/proprietary name – manuf registered name while under manuf registered name while under patentpatent– Tylenol (note it is uppercase like a Tylenol (note it is uppercase like a

proper name)proper name)1515

National Drug CodeNational Drug Code

All drugs assigned NDC codeAll drugs assigned NDC code Helps identify the manufacture, the Helps identify the manufacture, the

product, and container size.product, and container size. Always 11 digits. Always 11 digits. Divided into 5 -4-2 Divided into 5 -4-2 Manufacture is first 5 digitsManufacture is first 5 digits Product code is 4Product code is 4 Package size is 2Package size is 2

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NDC 00006-0543-61NDC 00006-0543-61

00006 is the code for manufacturer. 00006 is the code for manufacturer. In this case Merck & Co, IncIn this case Merck & Co, Inc

0543 is the specific drug in this case 0543 is the specific drug in this case simvastatin generic name.simvastatin generic name.

61 is the size of the bottle, in this 61 is the size of the bottle, in this case 60 tablets.case 60 tablets.

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Storage, Lot Numbers and Storage, Lot Numbers and Expiration DatesExpiration Dates

Storage information (Room Temp, Storage information (Room Temp, Refrigeration)Refrigeration)

Lot Numbers-Important for recallsLot Numbers-Important for recalls Expiration Dates-can be affected if Expiration Dates-can be affected if

not stored properly. not stored properly.

Other things that effect Other things that effect expiration dates type of container expiration dates type of container and humidity. and humidity.

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The controlled substance The controlled substance drug scheduledrug schedule

There are 5 schedulesThere are 5 schedules Labeled with a C and roman number Labeled with a C and roman number Which schedule is determined based Which schedule is determined based

on potential for dependency and on potential for dependency and abuse.abuse.

The lower the number the higher the The lower the number the higher the potential for dependency and abuse. potential for dependency and abuse.

Good examples on pg 83 in your text.Good examples on pg 83 in your text.

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Week 2 SeminarWeek 2 SeminarMeasurement Systems and Their Measurement Systems and Their

EquivalentsEquivalents

Week 2 SeminarWeek 2 SeminarMeasurement Systems and Their Measurement Systems and Their

EquivalentsEquivalents

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Assignment HintsAssignment Hints

Show your work, so I can give partial Show your work, so I can give partial creditcredit

Utilize resources – seek help earlyUtilize resources – seek help early Don’t forget about the Math Center if Don’t forget about the Math Center if

you need helpyou need help Save files with your name first, then Save files with your name first, then

assignment assignment Msmith_caclulations_Unit3Msmith_caclulations_Unit3

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Metric SystemMetric System

Based on the decimal system Based on the decimal system Is the international standard for Is the international standard for

scientific and industrial scientific and industrial measurementsmeasurements

Used in more than 90% of Used in more than 90% of developed countriesdeveloped countries

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Three Basic Units of Three Basic Units of MeasurementMeasurement

Weight – gram (g, gm)Weight – gram (g, gm)

Volume – liter (L)Volume – liter (L)

Length – meter (m) Length – meter (m)

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Common PrefixesCommon Prefixes

Deci- = 0.1 (one-tenth of one unit)Deci- = 0.1 (one-tenth of one unit) Centi- = 0.01 (one-hundredth of Centi- = 0.01 (one-hundredth of

one unit)one unit) Milli- = 0.001 (one-thousandth of Milli- = 0.001 (one-thousandth of

one unit)one unit) Micro- = (one-millionth of one unit)Micro- = (one-millionth of one unit) Kilo- = 1000 unitsKilo- = 1000 units

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Metric PrefixesMetric PrefixesMetric PrefixesMetric Prefixes

Figure 6-2. The basic units of measure–gram, liter, and meter–with prefixes indicating larger or smaller measures. Thus, deka- (“ten”) refers to ten basic units, and deci- (“tenth”) refers to one-tenth of the basic unit. Chart on page 131

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Sliding Mnemonic Sliding Mnemonic ConversionsConversions

KiloKilo hecto dekahecto deka METER(m)METER(m) decideci centicenti milli milli * ** * micro(µ) micro(µ)

LITER(L)LITER(L)

GRAM(g)GRAM(g)1010-3-3 1010-2-2 10 10-1-1 < <<base>><base>> 101011 10 1022 10 1033 * * 10 * * 1066

EX: EX: ..0045kg0045kg<= <= 4.5g4.5g => => 4,500mg4,500mg = = 4,500,000mcg (4,500,000mcg (µ)µ)

EX: EX: .075km.075km <= <= 75m75m => =>7500cm7500cm = =75,000mm75,000mm

Metric RulesMetric Rules

Zero ALWAYS placed before decimal Zero ALWAYS placed before decimal ex: 0.78 ex: 0.78 (not .78)(not .78)

****If not included on assignments it If not included on assignments it will be counted as incorrectwill be counted as incorrect

Zero NEVER added to the end Zero NEVER added to the end ex: 1.01 ex: 1.01 (not 1.0100)(not 1.0100)

No fractions ex: 0.1 No fractions ex: 0.1 (not 1/10)(not 1/10)

Which is correct?Which is correct?

2.0 g2.0 g 0.2g0.2g ¼ g¼ g

What are the “zero” rules?What are the “zero” rules?

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Length Measurement Length Measurement Conversion FactorsConversion Factors

1 Meter = 39.37 inches1 Meter = 39.37 inches

2.5 cm = 1 inch2.5 cm = 1 inch

1 m = 1000 mm1 m = 1000 mm

1 m = 100 cm1 m = 100 cm

1 cm = 10 mm1 cm = 10 mm

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Meter Conversion Factors Meter Conversion Factors

= 1,000,000 micrometers= 1,000,000 micrometers

1 meter= 1000 millimeters1 meter= 1000 millimeters= 100 centimeters= 100 centimeters

= 10 decimeters= 10 decimeters

= 0.1 dekameters= 0.1 dekameters

= 0.01 hectometers= 0.01 hectometers

= 0.001 Kilometers= 0.001 Kilometers

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Let’s learn to convert units!Let’s learn to convert units!

Really just a 4 step process….Really just a 4 step process…. 1. What units are we converting to and 1. What units are we converting to and

from?from? 2. What is our conversion factor?2. What is our conversion factor? 3. Set up equation so units cancel. Start 3. Set up equation so units cancel. Start

with what you are given.with what you are given. 4. Carry out the math.4. Carry out the math. 5. Review – does our answer make 5. Review – does our answer make

sense?sense?3131

Length Conversion FactorsLength Conversion Factors How many cm is 75 mm?How many cm is 75 mm?

1.First determine the units you are 1.First determine the units you are converting to and from – mm to cmconverting to and from – mm to cm

2. Our conversion factor is 1 cm = 10 mm2. Our conversion factor is 1 cm = 10 mm3. Then use your conversion factor setting 3. Then use your conversion factor setting

up so units cancel. Start with what you are up so units cancel. Start with what you are given.given.75mm x 1cm/10mm =75mm x 1cm/10mm =

4. Carry out the math4. Carry out the math 75 x 1/10 = 7.5 cm75 x 1/10 = 7.5 cm5. Does our answer make sense? Should we have a 5. Does our answer make sense? Should we have a

smaller number for cm? smaller number for cm? 75 mm = 7.5 cm (remember 1 cm = 10 mm)75 mm = 7.5 cm (remember 1 cm = 10 mm)

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Let’s go through it again…Let’s go through it again…

75mm =75mm =________ cm cm Remember 1cm = 10mm from page Remember 1cm = 10mm from page

133133 75mm x 75mm x 1cm1cm or or 75mm x 1cm 75mm x 1cm

10mm10mm 10mm10mm mm cross each other out leaving cmmm cross each other out leaving cm 75/10= 7.5cm75/10= 7.5cm

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Let’s try another length Let’s try another length exampleexample

How many mm in 2.5 m? _____mm = 2.5 mHow many mm in 2.5 m? _____mm = 2.5 m

1. We are given m and want mm as our answer 1. We are given m and want mm as our answer 2. What is our conversion factor (page 133)?2. What is our conversion factor (page 133)?

1 m = 1000 mm1 m = 1000 mm

3. Set up equation so units cancel3. Set up equation so units cancel2.5m x 1000mm/1m =

4. Carry out math4. Carry out math2.5 x1000/1 = 2500 mm2.5 x1000/1 = 2500 mm

5. Review – does our answer make sense?5. Review – does our answer make sense?look at conversion factor 1m = 1000 mmlook at conversion factor 1m = 1000 mm

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What would happen if we What would happen if we set it up like this?set it up like this?

2.5 m x 1m/1000mm =2.5 m x 1m/1000mm =

Can you tell why it is wrong? Should our Can you tell why it is wrong? Should our final answer be larger or smaller than our final answer be larger or smaller than our original number?original number?

conversion factor is 1 m = 1000 mmconversion factor is 1 m = 1000 mm

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Try this on your ownTry this on your own

How many mm in 3.6 m?How many mm in 3.6 m?

1.1. I am converting from ……….I am converting from ……….

2.2. My conversion factor is…….My conversion factor is…….

3.3. My equation set – up is……My equation set – up is……

4.4. My answer is……My answer is……

5.5. My answer makes sense!My answer makes sense!

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How did you do?How did you do?How many mm in 3.6 m?How many mm in 3.6 m?

1.1. I have m and want to convert to mm.I have m and want to convert to mm.

2.2. My conversion factor is found on page 133 and is 1 m = My conversion factor is found on page 133 and is 1 m = 1000 mm1000 mm

3.3. My set up is: 3.6 m x 1000 mm/1 m (m cancel out!)My set up is: 3.6 m x 1000 mm/1 m (m cancel out!)

4.4. When I solve it I get 3600 mmWhen I solve it I get 3600 mm

5.5. Based on the conversion factor and the fact that mm are Based on the conversion factor and the fact that mm are smaller than m, my answer makes sense!smaller than m, my answer makes sense!

3600 mm = 3.6 m3600 mm = 3.6 m

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Metric Volume Conversion Metric Volume Conversion Factors based on Liter Factors based on Liter

=1,000,000microliters=1,000,000microliters 1 Liter (L) = 1,000 milliliters1 Liter (L) = 1,000 milliliters

= 100 centiliters= 100 centiliters

=10 deciliters=10 deciliters

=0.1 dekaliter=0.1 dekaliter

=0.01 hectoliter=0.01 hectoliter

=0.001 kiloliter=0.001 kiloliter

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Volume Conversion Volume Conversion FactorsFactors

1 mL = 1cc1 mL = 1cc1 teaspoonful=5mL or 5cc’s1 teaspoonful=5mL or 5cc’s1 tablespoon=3 tsp = 15mL or 15cc’s1 tablespoon=3 tsp = 15mL or 15cc’s1 L = 32 ounces (approx)1 L = 32 ounces (approx)1L = 1000 mL=1000cc1L = 1000 mL=1000cc1L = 1qt (approx)1L = 1qt (approx)

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Metric Weight Conversion Metric Weight Conversion Factors based on GramFactors based on Gram

=1,000,000micrograms=1,000,000micrograms

1 gram= 1000 mg1 gram= 1000 mg= 100 centigrams= 100 centigrams

= 10 decigrams= 10 decigrams

= 0.1 dekagram= 0.1 dekagram

= 0.01 hectogram= 0.01 hectogram

= 0.001 kilogram= 0.001 kilogram

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Most Commonly UsedMost Commonly Used

MilligramMilligram GramGram KilogramKilogram 1000mg (mg)=1 gram (g)1000mg (mg)=1 gram (g) 1000gms (g)1000gms (g) = 1 kilogram (kg. or kilo)= 1 kilogram (kg. or kilo)

Mark pages in text where common Mark pages in text where common conversions are found – better yet – conversions are found – better yet – make your own list! (you’ll thank make your own list! (you’ll thank yourself!)yourself!)

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Weight Measurement Weight Measurement Conversion FactorsConversion Factors

1 kg = 2.2 pounds1 kg = 2.2 pounds

1 kg = 1000 g1 kg = 1000 g

1 mg = 0.001g1 mg = 0.001g

1 mg = 1000 mcg or µg 1 mg = 1000 mcg or µg

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Let’s practice with weight Let’s practice with weight conversionsconversions

How many mg in 8 g?How many mg in 8 g?

1.1.I want to go from g to mg.I want to go from g to mg.2.2.My conversion factor is 1000 mg = 1 My conversion factor is 1000 mg = 1

gg3.3.My set up is My set up is

8 g x 1000mg/g =8 g x 1000mg/g =4.4.When I solve it I get 8000 mgWhen I solve it I get 8000 mg5.5.My answer makes sense because I am My answer makes sense because I am

going from a larger unit to a smallergoing from a larger unit to a smaller

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Your turnYour turn

How many mg in 635 mcg?How many mg in 635 mcg? 1. What units are we going to and from?1. What units are we going to and from? 2. What is my conversion factor? 2. What is my conversion factor?

1 mg = 1000mcg or µg1 mg = 1000mcg or µg 3. Set up equation. Start with what you 3. Set up equation. Start with what you

are given.are given. 4. Solve.4. Solve. 5. Does it make sense?5. Does it make sense?

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How did you do?How did you do?

How many mg in 635 mcg?How many mg in 635 mcg? 1. I have mcg and want to convert to 1. I have mcg and want to convert to

mg.mg. 2. 1 mg = 1000 mcg2. 1 mg = 1000 mcg 3. 635 mcg x 1 mg/1000 mcg3. 635 mcg x 1 mg/1000 mcg 4. 0.635 mg4. 0.635 mg 5. Mcg are smaller than g so my 5. Mcg are smaller than g so my

answer makes sense! answer makes sense!

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Apothecary System Apothecary System Conversion FactorsConversion Factors

Old measurement system for Old measurement system for calculating drug orderscalculating drug orders

1 drop (gtt) of water = 1 minim (ɱ)1 drop (gtt) of water = 1 minim (ɱ) 60 minims(=60gtts) = 1 fluid dram 60 minims(=60gtts) = 1 fluid dram

(f(fӠӠ)) 1 grain = approximately the weight 1 grain = approximately the weight

of 1 grain of wheat or rice = 60mgof 1 grain of wheat or rice = 60mg

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Household System Conversion Household System Conversion FactorsFactors

VolumeVolume– 1 cup (c) = 8 oz1 cup (c) = 8 oz– 1 pint (pt) = 2 c = 16 oz1 pint (pt) = 2 c = 16 oz– 1 quart (qt) = 2 pt = 4 c =32 oz1 quart (qt) = 2 pt = 4 c =32 oz– 1 gallon (gal)= 4 qt= 8 pt = 16c = 128oz1 gallon (gal)= 4 qt= 8 pt = 16c = 128oz

Weight or massWeight or mass– 1 pound = 16 oz1 pound = 16 oz

LengthLength– 1 foot = 12 in1 foot = 12 in– 1 yard = 3ft 36in 1 yard = 3ft 36in

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You are doing great!You are doing great!

Keep practicing!Keep practicing!

Resources include:Resources include:

Quiz ReviewQuiz Review

Workbook (answers in doc sharing)Workbook (answers in doc sharing)

Math Resource CenterMath Resource Center

Me!Me!

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