Math and Dosage Calculations for Health Care Third Edition Booth & Whaley

1. Math and Dosage Calculations for Health CareThird EditionBooth & Whaley Chapter 5: Drug Orders McGraw-Hill

2. Learning Outcomes • Summarize the Rights of Medication Administration. • Interpret a written drug order. • Identify on physicians’ orders and prescriptions the information needed to dispense medication.

3. Learning Outcomes (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.

4. Introduction • 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.

5. Basic Rights Right patient Right drug Right dose Right route Right time Additional Rights Right reason Right to refuse Right to know Right technique Right documentation Rights of Medication Administration

6. Right 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.

7. Right Patient (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.

8. Right Drug • To be sure a patient receives the right drug. • Only give drugs that you prepared yourself or are clearly and completely labeled. • Check the expiration date. • Recheck original order if the patient questions a medication.

9. Right Drug (cont.) • A patient always has the right to refuse a medication. • Dispose of refused medications according to facility guidelines.

10. Right Drug (cont.) Rule 5 – 1Check 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. 3

11. Right 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

12. Right Route • A drug intended for one route may not be safe if administered via another route. • Be especially careful between ophthalmic and otic routes.

13. Right Route (cont.) • Some medications are produced in different versions for different routes. Example aspirin is available as tablets or as suppositories • Check that route listed on drug label matches route ordered.

14. Right 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.

15. Right Reason • Know why a medication is being given. • Check medication record • Check order • Check with prescribing physician

16. Right to Know • Patients must be educated about their medications, including the • Reason for taking the medication • Expected effect of the medication • Side effects of medications

17. Right 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

18. Right 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

19. 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 Roman Numerals

20. Combining Roman Numerals Rule 5 – 2When 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.

21. 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. Combining Roman Numerals (cont.) Examples

22. 1. Convert the following Roman numerals to Arabic numbers: viiss XII XIX ixss 2. Provide the answers to the following in Arabic numbers: V + V xxii – vii XXXV – XIV xvi + xii Practice 10 7½ 15 12 21 19 9½ 28

23. Physician’s Orders and Prescriptions • Abbreviations 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

24. Commonly Used General Abbreviations

25. Abbreviations Commonly Used for Form of Medication

26. Abbreviations Commonly Used for Routes of Administration

27. Abbreviations Commonly Used for Frequency

28. Joint Commission on Accreditation of Healthcare Organization (JCAHO) “Do Not Use” abbreviations “Undesirable” abbreviations Check abbreviations carefully in drug orders. Abbreviations Q.O.D

29. “Do Not Use” Abbreviations

30. Undesirable Abbreviations

31. Undesirable Abbreviations (cont.)

32. Undesirable Abbreviations (cont.)

33. 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 Physician’s Drug Order

34. Outpatient Settings • Physicians’ orders are given as prescriptions. • Prescriptionsinclude 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

35. Patient’s full name Date Drug and dose Quantity to dispense Instructions to appear on the label Number of refills permitted Physician name Prescription Form

36. Inpatient Settings • Physicians’ 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

37. Physician’sOrder Form

38. Error Alert! • Never guess what the prescriber meant! • If the order is not legible, always contact the prescribing physician to clarify the order.

39. Verbal 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

40. Error Alert! • Always be certain that you are dispensing the correct medication. • Many drugs have names that are similar. Examples Acular—Ocular Benadryl—Bentyl Cafergot—Carafate Darvon—Diovan Digitoxin—Digoxin Eurax—Urex Iodine—Lodine Nicobid—Nitrobid

41. Practice Allen Capsella, MD Westtown 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 What, if anything, is wrong with this prescription?

42. Click to return to prescription Practice 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.

43. Medication Administration Systems • Standard 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

44. Sample Times for Medication Administration

45. Medication Administration 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

46. Medication Administration Records (MAR)(cont.) 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

47. Practice Is the following MAR complete? If not, what is missing? ANSWER The order is transcribed correctly and all information is complete.

48. Practice Is the following MAR complete? If not, what is missing?

49. Click to return to MAR 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.

50. Medication Cards • Rarely used • One drug per card • Disadvantages • Easily misplaced • Increased potential for omitting a medication • Do not list allergies or diagnoses