medication orders and labeling

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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.


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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


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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


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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


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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


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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


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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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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


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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


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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


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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


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Signa Interpretation…/2

Signa language combines an assortment of abbreviations, acronyms, and symbols


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?


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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


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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


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Your Turn


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


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


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



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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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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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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


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


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



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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)



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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



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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


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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


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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


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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


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In contrast to an administration time, an infusion rate is specified for large-volume parenteral (LVP) products, such as IV bags and TPN solutions


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The CSP label must also provide the physician’s directions for the medication’s dosing interval


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Personnel also add auxiliary labels to clarify special instructions or highlight physician directions for the nursing staff


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Another required component on the CSP label is the expiration date of the sterile compound, sometimes referred to as the beyond-use date (BUD)


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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


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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


Sterile Compound Label Verification and Application

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Your Turn


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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medication orders and labeling

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