Transcript Chapter 04 - McGraw Hill Higher Education

Math for the Pharmacy Technician:
Concepts and Calculations
Egler • Booth
Chapter 4: Drug Orders
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Drug Orders
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Learning Objectives
When you have successfully completed Chapter 4, you will
have mastered skills to be able to:
 Summarize the Rights of Medication
Administration.
 Interpret a written drug order.
 Identify on the information on a
medication order needed to dispense
medications.
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Learning Objectives
(con’t)
 Locate on medication administration
records or medication cards the
information needed to administer
medication.
 Recognize incomplete drug orders.
 Select appropriate action for
confusing, incomplete, or illegible
drug orders.
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Learning Objectives
(con’t)
 Identify and verify DEA numbers.
 Recognize classifications of controlled
substances.
 Recognize prescription errors and
forged or altered prescriptions.
 Interpret and use pharmaceutical and
medical abbreviations and
terminology.
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Introduction
 In order to correctly calculate a
medication dose, you must be able
to read and understand the drug
order.
 This chapter will discuss:




Drug orders
Patient’s rights
Medication administration systems
Your responsibilities
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The Rights of Medication
Administration
1.
2.
3.
4.
5.
6.
7.
Right
Right
Right
Right
Right
Right
Right
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patient
drug
To prevent
dose
errors, check
route
the rights!
time
technique
documentation
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Right Patient
You are responsible if an error occurs.
 Name on original order must be exactly the
same as the name on the Medication
Administration Record (MAR), medication
card, or prescription.
 Verify the full name.
 Ask “What is your name?”
 Check the bed number and tag.
 Read the patient’s identification bracelet.
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Right Drug






Only give drugs that you have
prepared yourself.
Or that are clearly and completely
labeled.
Check the expiration date.
If the patient questions a medication,
then recheck it.
A patient always has the right to
refuse a medication.
Dispose of medicine according to
facility guidelines.
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Right Drug
(con’t)
 Always check medication
three times:
1. when you take it off the shelf.
2. when you prepare it.
3. when you replace it on the
shelf.
 Check it three times even if
it is prepackaged, labeled,
and ready to be
administered.
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Right Dose
Later you will learn how to convert from
the dosages ordered by the doctor to
the desired dose.
 Use extreme caution when calculating
dosages.
 Pay special attention to decimal
points.
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Right Route


A drug intended for one route is often
not safe if administered via another
route.
Some medications are produced in
different versions for different routes.
 For example: suppositories, oral
tablets, or injections

Be especially careful between
ophthalmic and otic routes.
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Right Time



Some medications must be given
at a specific time.
Some medications are given before
or after food, depending on fooddrug interactions.
Other medicines can be spaced
over waking hours.
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Right Technique
 Medications must be given correctly
according to the order. For example:
 Buccal -- between cheek and gum
 Sublingual -- under the tongue
 If unsure, check references materials.
Examples:
Physicians’ Desk Reference (PDR)
Facts and Comparisons
Remington: The Science and Practice of Pharmacy
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Right Documentation
 Be sure that the right documentation is
completed.
For example, inpatient facilities
administer medication to the patient.
The health professional who administered
the medication must, immediately after
the patient takes the medication, sign the
medication administration record
(MAR)
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Physician’s Orders and
Prescriptions
Abbreviations used when writing orders:
 general abbreviations
 form of medication
 route
 frequency
 You will be expected to have these
memorized.
 See the next slides for a review of Table 4-2
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Table 4-2 Abbreviations Commonly
Used in Drug Orders
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Table 4-2 Abbreviations Commonly
Used in Drug Orders (con’t)
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Table 4-2 Abbreviations Commonly
Used in Drug Orders (con’t)
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Table 4-2 Abbreviations Commonly
Used in Drug Orders (con’t)
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Abbreviations
Joint Commission on Accreditation of
Healthcare Organization (JCAHO) has
established a list of “Do Not Use” and
“Undesirable” abbreviations.
See Tables 4-3 and 4-4 on the following
slides.
Be certain to check abbreviations carefully
when reading drug orders.
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Table 4-3 “Do Not Use” Abbreviations
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Table 4-4 “Undesirable” Abbreviations
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Table 4-4 “Undesirable” Abbreviations
(con’t)
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General Abbreviations
a, a
before
BP
blood pressure
c, c
with
NKA
NPO
no known allergies
p, p
nothing by mouth
s
after
without
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Forms of Medication
cap, caps
elix
gtt, gtts
LA
supp
tr, tinct, tinc.
ung, oint
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capsule
elixir
drop, drops
long acting
suppository
tincture
ointment
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Route
IM, I.M.
od, O.D., OD
os, O.S., OS
ou, O.U., OU
po, p.o., PO, P.O.
Sub-Q or subq
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intramuscular
right eye
left eye
both eyes
by mouth; orally
subcutaneous,
beneath the skin
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Frequency
a.c., ac, AC, ac
b.i.d., bid, BID
h, hr
n, noc, noct
p.c., pc, PC, pc
p.r.n., prn, PRN
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before meals
twice a day
hour
night
after meals
when necessary,
when required
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Frequency
q.___ hrs, q ___h
qhs, q.h.s.
q.i.d., qid, QID
stat
t.i.d., tid, TID
(con’t)
every ___ hours
every night, bedtime
4 times a day
immediately
3 times a day
Note: Do not use QD or QOD instead
write “Daily” or Every other day”
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Outpatient Settings
 Physicians’ orders are given as
prescriptions that are filled at a
pharmacy or through the mail.
 Prescriptions include all the elements
of a physician’s order as well as the
physician’s name and prescriber
number.
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Physician’s Drug Order









Full name of the patient
Full name of the drug
The dose
The route
The time
The frequency
Signature of prescribing physician
The date
PRN order must include the reason
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Physician’s Drug Order
(con’t)
 Outpatient Settings -- written as
prescriptions
 Inpatient Settings -- written on
physicians’ order forms
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Prescription Form
I. Heal, MD
Best Medical Clinic
123-456-7890
Name Anna Versary
Date April 19, 2012
Address________________________________
Rx: Lopressor 50 mg
QUANTITY: # 90
SIG: i tab po tid
Refills: 5
AH1234567
Prescriber ID #
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I. Heal, MD
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Controlled Substances
 A controlled substance is a drug
that has the potential for addiction,
abuse, or chemical dependency, also
referred to as a narcotic.
 There are five categories of controlled
substances listed by schedule.
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Controlled Substances (con’t)
 Schedule I-Drugs have a high
level for potential abuse and are
unacceptable for medical use in the
United States. These drugs are not
to be prescribed.
For example: marijuana,
heroin.
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Controlled Substances (con’t)
 Schedule II-Drugs have a high level
for potential abuse and dependency.
Drug orders must be on a written or
typed hard copy order and have DEA
number and prescriber signature.
Referred to as narcotics. Quantities are
limited and NO REFILLS are allowed.
For example: opium, morphine,
oxycodone.
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Controlled Substances (con’t)
 Schedule III-Drugs have less
potential for abuse than Schedule I
and II drugs, but still have a moderate
potential for dependency. Drug orders
may be ordered by phone or in writing
and may have five refills in a sixmonth period.
For example: butalbital,
hydrocodone/codeine.
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Controlled Substances (con’t)
 Schedule IV-Drugs have a low level
for potential abuse, and limited
potential for dependency. Drug
orders may be ordered by phone or in
writing and may have five refills in a
six-month period.
For example: alprazolam (Xanax®), diazepam
(Valium®), zolpidem (Restoril®).
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Controlled Substances (con’t)
 Schedule V-Drugs have a low level
for potential abuse, and limited
potential for dependency. Drug
orders may be ordered by phone or in
writing and may have five refills in a
six-month period.
For example: diphenoxylate (Lomotil®),
pregabalin (Lyrica®)
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DEA Numbers
 The Drug Enforcement Administration
(DEA) of the Justice Department passed the
Controlled Substances Act in 1970. It
regulates the distribution of controlled
substances.
 Federal law mandates that any prescriber
that writes a medication order for a
controlled substance must be registered
with the DEA and are given a DEA number
that must be listed on the controlled
substance orders.
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DEA Numbers (con’t)
 A DEA number always consists of two
letters followed by seven numbers.
The second letter is the initial of the
prescriber’s last name.
 An example of a DEA number is
AH1234567.
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Formula to Verify DEA Numbers
 To ensure that a DEA number is
authentic, the following formula is used
for verification. Using the example DEA
number of AH1234567.
 Add the first, third, and fifth digits
together;
 Next add the second, fourth, and sixth
digits together and multiply the sum
by 2.
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Formula to Verify DEA Numbers
(con’t)
 Then add the two answers
together.
 The last number in your answer of
the formula must be the same as
the last number of the DEA
number for it to be authentic.
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Formula to Verify DEA Numbers
(con’t)
Using the formula verify the example DEA
number AH1234567.
 Step 1. Add the first, third, and fifth
numbers.
1+3+5=9
 Step 2. Add second, fourth, and
sixth numbers and multiply by 2.
2 + 4 + 6 = 12 x 2 = 24
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Formula to Verify DEA Numbers
(con’t)
 Step 3. Add the two answers together.
9 + 24 = 33
 If the answer in Step 3 of the formula ends
in the same number as the last number of
the DEA numbers, it may be an authentic
number.
 In working the formula we see that the
example DEA AH1234567 is not an authentic
number; if it were, it would have ended
with the number 3.
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Detecting Errors and Forged or
Altered Prescriptions
 As a pharmacy technician you need to
know federal and state restrictions for
all schedules of controlled
substances.
 You must verify the date, DEA
number, and prescriber’s signature on
all controlled substance drug orders.
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Detecting Errors and Forged or
Altered Prescriptions (con’t)
 On Schedule II drug orders, verify the
allowable quantity limits and that
there are NO refills written.
 Inspect the hard copy for paper type
and the order for consistent
handwriting style.
 If a prescription looks altered or
forged in any way, follow your
facility’s protocol.
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Inpatient Setting
 For inpatient settings, drug orders are
usually written on physicians’ order
forms, with space for multiple orders.
 Orders may also be entered into a
computer. The patient’s name and the
physician’s signature appear once on the
form.
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Inpatient Setting
(con’t)
Under Medication Orders, the physician
writes the components of each
medication requested in the following
sequence:




name of drug
dose route
frequency
any additional instructions.
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Prescription Order Forms
Physician’s
Order
Forms:
Medication
Orders
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CAUTION!
 Never guess what the prescriber meant!
 If the order is not legible, always contact the
prescribing physician to clarify the order.
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Verbal Physician’s Orders



If the physician is unable to write
or personally sign an order, verbal
orders may be used.
These are governed by state laws
as to which personnel may accept
verbal orders.
You must be legally permitted to
accept a telephone order.
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Verbal Physician’s Orders
(con’t)



Write the order carefully and legibly
as you receive it, not after the call.
Identify it as a verbal order.
Read the order back to the
physician.
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CAUTION!
 Always be certain that you are
dispensing the correct
medication.
 Many drugs have names that
are similar.
Darvon
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Medication
Administration Systems



Most facilities have a standard
schedule for administering
medication.
Person who verifies the transcription
ensures that the times listed are
appropriate for the medications.
Times may need to be adjusted
according to mealtimes or conflicting
medication schedules.
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Sample Times for
Medication Administration
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
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Medication Administration
Records (MAR)






Legal documents
Handwritten or computerized printouts
Contains same information as a physician’s
order form
Specify the actual times to administer the
medication
Provide a place to document each
medication administration
By law, after you give a medication you
must immediately document it
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Medication Administration
Records (con’t)
An MAR must include the following information:
 Name of medication, dose, route,
frequency
 Times that accurately reflect the frequency
specified
 Name and identification number of patient
 Date of order
 End date of narcotics and antibiotics
 Special instructions, diagnosis, weight, etc.
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Review and Practice
Is the following MAR complete? If not, what is missing?
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Review and Practice
 Answer: In the previous MAR the
order is written correctly and all
information is complete.
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Review and Practice
Is the following MAR complete? If not, what is missing?
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Review and Practice
 Answer: In the previous MAR:
 Order A is correct.
 Order B dose not include the strength of
the medication.
 Order C contains an error in the times
listed.
 Order D does not include a route.
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Medication Reference
Materials


You must be familiar with drug information
sources
Resources





Physicians’ Desk Reference (PDR)
United States Pharmacopeia National Formulary
Drug handbooks
Internet sites
Software programs used with personal digital
assistant (PDA)
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Review and Practice
 Which of the Rights of medication
administration is not listed?
right
right
right
right
right
right
patient
drug
dose
time
technique
documentation
Answer: right route
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Review and Practice
What do the following abbreviations mean?
pc
os
qd
supp
BP
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after meals
left eye
every day
suppository
blood pressure
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Drug Orders
You must be
100 percent
accurate in
interpreting
medication
orders.
I. Heal, MD
Best Medical Clinic
123-456-7890
Name Anna Versary
Date April 19, 2012
Address________________________________
Rx: Lopressor 50 mg
QUANTITY: # 90
SIG: i tab po tid
Refills: 5
AH1234567
Prescriber ID #
I. Heal, MD
THE END
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