Y khoa - Dược - Chapter 4: Drug orders

Math for the Pharmacy Technician: Concepts and CalculationsChapter 4: Drug OrdersEgler • BoothDrug Orders2Learning ObjectivesSummarize the Rights of Medication Administration.Interpret a written drug order. Identify on the information on a medication order needed to dispense medications.When you have successfully completed Chapter 4, you will have mastered skills to be able to:3Learning 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.4Learning 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.5IntroductionIn order to correctly calculate a medication dose, you must be able to read and understand the drug order.This chapter will discuss: Drug ordersPatient’s rightsMedication administration systemsYour responsibilities6The Rights of Medication Administration1. Right patient2. Right drug3. Right dose4. Right route5. Right time6. Right technique7. Right documentationTo prevent errors, check the rights!7Right PatientYou 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.8Right DrugOnly 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.9Right Drug (con’t)Always check medication three times:1. when you take it off the shelf.2. when you prepare it.when you replace it on the shelf.Check it three times even if it is prepackaged, labeled, and ready to be administered.310Right DoseLater 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.11Right RouteA 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 injectionsBe especially careful between ophthalmic and otic routes.12Right TimeSome medications must be given at a specific time.Some medications are given before or after food, depending on food-drug interactions.Other medicines can be spaced over waking hours.13Right TechniqueMedications must be given correctly according to the order. For example:Buccal -- between cheek and gumSublingual -- under the tongueIf unsure, check references materials. Examples:Physicians’ Desk Reference (PDR) Facts and Comparisons Remington: The Science and Practice of Pharmacy 14Right DocumentationBe 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)15Physician’s Orders and PrescriptionsAbbreviations used when writing orders: general abbreviationsform of medicationroutefrequencyYou will be expected to have these memorized. See the next slides for a review of Table 4-216Table 4-2 Abbreviations Commonly Used in Drug Orders17Table 4-2 Abbreviations Commonly Used in Drug Orders (con’t)18Table 4-2 Abbreviations Commonly Used in Drug Orders (con’t)19Table 4-2 Abbreviations Commonly Used in Drug Orders (con’t)20AbbreviationsJoint 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.21Table 4-3 “Do Not Use” Abbreviations22Table 4-4 “Undesirable” Abbreviations23Table 4-4 “Undesirable” Abbreviations (con’t)24General Abbreviationsa, a BP c, cNKANPOp, ps blood pressurewithno known allergiesnothing by mouthafterwithoutbefore25Forms of Medicationcap, capselixgtt, gttsLAsupptr, tinct, tinc.ung, ointcapsuleelixirdrop, dropslong actingsuppositorytinctureointment26RouteIM, I.M.od, O.D., ODos, O.S., OSou, O.U., OUpo, p.o., PO, P.O.Sub-Q or subqintramuscularright eyeleft eyeboth eyesby mouth; orally subcutaneous, beneath the skin27Frequencya.c., ac, AC, acb.i.d., bid, BIDh, hrn, noc, noctp.c., pc, PC, pcp.r.n., prn, PRNbefore mealstwice a dayhournightafter mealswhen necessary, when required28Frequency (con’t) q.___ hrs, q ___hqhs, q.h.s.q.i.d., qid, QIDstatt.i.d., tid, TIDevery ___ hoursevery night, bedtime4 times a dayimmediately3 times a dayNote: Do not use QD or QOD instead write “Daily” or Every other day”29Outpatient SettingsPhysicians’ 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.30Physician’s Drug OrderFull name of the patientFull name of the drugThe doseThe routeThe time The frequencySignature of prescribing physicianThe date PRN order must include the reason 31Physician’s Drug Order (con’t)Outpatient Settings -- written as prescriptionsInpatient Settings -- written on physicians’ order forms32Prescription FormI. Heal, MDBest Medical Clinic123-456-7890Name Anna Versary Date April 19, 2012Address________________________________Rx: Lopressor 50 mgQUANTITY: # 90SIG: i tab po tidRefills: 5AH1234567 I. Heal, MDPrescriber ID #33Controlled SubstancesA 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.34Controlled 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.35Controlled 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.36Controlled 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 six-month period. For example: butalbital, hydrocodone/codeine.37Controlled 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®).38Controlled 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®)39DEA NumbersThe 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.40DEA 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. 41Formula 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. 42Formula 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.43Formula 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 = 9Step 2. Add second, fourth, and sixth numbers and multiply by 2. 2 + 4 + 6 = 12 x 2 = 2444Formula to Verify DEA Numbers (con’t)Step 3. Add the two answers together. 9 + 24 = 33If 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 3.45Detecting 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. 46Detecting 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.47Inpatient SettingFor 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. 48Inpatient 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.49Physician’s Order Forms:Medication OrdersPrescription Order Forms50CAUTION!Never guess what the prescriber meant!If the order is not legible, always contact the prescribing physician to clarify the order.51Verbal Physician’s OrdersIf 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.52Verbal 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.53CAUTION!Always be certain that you are dispensing the correct medication.Many drugs have names that are similar.DarvonDiovan 54Medication Administration SystemsMost 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.55Sample Times for Medication AdministrationFrequency OrderedTimes to Administerqd0800bid0800 – 2000tid0800 – 1400 – 2000qid0800 – 1200 – 1600 – 2000q 12 hrs0800 – 2000q 8 hrs2400 – 0800 – 1600q 6 hrs2400 – 0600 – 1200 – 1800Every night at bedtime200056Medication Administration Records (MAR)Legal documentsHandwritten or computerized printoutsContains same information as a physician’s order formSpecify the actual times to administer the medicationProvide a place to document each medication administrationBy law, after you give a medication you must immediately document it57Medication Administration Records (con’t)An MAR must include the following information:Name of medication, dose, route, frequencyTimes that accurately reflect the frequency specifiedName and identification number of patientDate of orderEnd date of narcotics and antibioticsSpecial instructions, diagnosis, weight, etc.58Review and PracticeIs the following MAR complete? If not, what is missing?59Review and PracticeAnswer: In the previous MAR the order is written correctly and all information is complete.60Is the following MAR complete? If not, what is missing?Review and Practice61Review and PracticeAnswer: 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.62Medication Reference MaterialsYou must be familiar with drug information sourcesResourcesPhysicians’ Desk Reference (PDR)United States Pharmacopeia National FormularyDrug handbooksInternet sitesSoftware programs used with personal digital assistant (PDA) 63Review and PracticeWhich of the Rights of medication administration is not listed?right patientright drugright doseright timeright techniqueright documentationAnswer: right route64Review and PracticeWhat do the following abbreviations mean?pcosqdsuppBPafter mealsleft eyeevery daysuppositoryblood pressure65Drug OrdersTHE ENDYou must be 100 percent accurate in interpreting medication orders. I. Heal, MDBest Medical Clinic123-456-7890Name Anna Versary Date April 19, 2012Address________________________________Rx: Lopressor 50 mgQUANTITY: # 90SIG: i tab po tidRefills: 5AH1234567 I. Heal, MDPrescriber ID #66