Chapter 4 Medication Orders and Labeling 2012 Paradigm

Chapter 4 Medication Orders and Labeling 2012 Paradigm Publishing 2 Topics

Learning Objectives ü Gain an awareness of the historical roots of prescriptions, the Rx symbol, and the signa. ü Recognize the influence of early Greek and Roman healthcare practitioners on current medical terminology and abbreviations. ü Understand the difference between a prescription and a medication order. ü Understand common medical and pharmacy terminology, abbreviations, acronyms, and symbols. ü Identify pharmacy directions written in signa language. ü Recognize physician instructions and other pertinent information on a medication order. ü Identify the various components of a compounded sterile preparation label. 2012 Paradigm Publishing 3 Topics

Topics Learning Objectives Introduction Medical Root Words, Prefixes, and Suffixes Medical Abbreviations, Acronyms, and Symbols Signa Interpretation Medication Orders In Slide Show view, click Types of Medication Orders the desired topic to the left to link directly to the Medication Order Contents and Processing related slide. To return to this slide at any point CSP Labeling in the presentation, click the Topics button below. Sterile Compound Label Components Sterile Compound Label Verification and Application Chapter Summary 2012 Paradigm Publishing 4 Topics

Introduction Ø The origin of medical terminology is as old as medicine itself vapproximately 75% of medical terminology has its roots in the Greek language vthe remainder can be traced to Latin 2012 Paradigm Publishing 5 Topics

Medical Root Words, Prefixes, and Suffixes Ø Most medical terminology is based on a combination of medical morphemes, or root words, prefixes, and suffixes Ø A word’s meaning is derived from the root word Ø A combining vowel is sometimes added to the end of the root word vwhen a root word contains this combining vowel, the word is said to be in its combined form 2012 Paradigm Publishing 6 Topics

Medical Root Words, Prefixes, and Suffixes…/2 Ø A prefix is a word element attached to the beginning of a root word va prefix often indicates time, location, direction, or number Ø A suffix is a word element attached to the end of a root word vthe addition of a suffix further defines the meaning of a root word 2012 Paradigm Publishing 7 Topics

Medical Abbreviations, Acronyms, and Symbols Ø Approximately 35, 000 abbreviations, acronyms, and symbols are used in medicine and pharmacy Ø Collectively, they are referred to as medical abbreviations, or simply abbreviations vmost abbreviations are developed to shorten the length of words and word combinations related to health, medicine, laboratory procedures or tests, and pharmacy 2012 Paradigm Publishing 8 Topics

Medical Abbreviations, Acronyms, and Symbols…/2 Common Medical Abbreviations Ø Indicate specific patient care facilities, units, or departments or the titles of individual team members Ø Refer to specific medical diagnoses and conditions, procedures, treatments, patient directives/activities, equipment/supplies, and tests 2012 Paradigm Publishing 9 Topics

Medical Abbreviations, Acronyms, and Symbols…/3 Common Pharmacy Abbreviations Ø Typically seen on medication orders or other written communications between providers and pharmacies vprovide important information vmight also include abbreviations to communicate specific compounding directives vcommon for indicating the route of administration and the dosing intervals for prescribed medications 2012 Paradigm Publishing 10 Topics

Medical Abbreviations, Acronyms, and Symbols…/4 Common Pharmacy Symbols Ø In addition to knowing pharmacy abbreviations, you need to recognize and understand a number of symbols specific to pharmacy practice vsymbols such as ↑ and ↓ are frequently placed on medication orders to indicate “increase” and “decrease, ” respectively vanother common symbol is the Greek delta symbol (Δ), which is used to indicate a desired change 2012 Paradigm Publishing 11 Topics

Medical Abbreviations, Acronyms, and Symbols…/5 The Official “Do Not Use” List of Abbreviations Ø 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 States vlist integrated into the Performance Standards for Healthcare Accreditation vthe nonstandard and potentially dangerous abbreviations should not be used in any healthcare application 2012 Paradigm Publishing 12 Topics

Signa Interpretation Ø The signa component is a specialized language that physicians or other prescribers place on a medication order vprovides the pharmacy with specific directions for administering the medication order vmay include dosage information, the route of administration, the amount to be dispensed, the time schedule or dosing interval, and any special instructions 2012 Paradigm Publishing 13 Topics

Signa Interpretation…/2 Ø 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 q 8 h Instill three drops into both ears every eight hours. 2012 Paradigm Publishing 14 Topics

Signa Interpretation…/3 Ø Transcribing or interpreting a signa requires you to seek the portions of the directive that address the following questions: v. What is the route of administration of the medication? v. How much of the medication is the patient supposed to take and how often? v. What special instructions need to be followed when taking the medication? 2012 Paradigm Publishing 15 Topics

Medication Orders Ø Medication orders are similar to prescriptions vexclusive to the institutional or hospital setting Ø Medication orders entered directly into a computer by the physician are often called e. MARs (electronic medication administration records) Ø 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 2012 Paradigm Publishing 16 Topics

Medication Orders…/2 Ø Upon receipt of the medication order, the pharmacy determines what medications and dosages have been ordered and then interprets the signa directions vit is then transcribed, or interpreted, and then entered into the pharmacy’s computer system through a process called order entry vthe pharmacist usually performs order entry, but specially trained pharmacy technicians may also complete this task Ø A label is then prepared for each of the medications 2012 Paradigm Publishing 17 Topics

Your Turn 1) Approximately how many abbreviations, acronyms, and symbols are used in medicine and pharmacy? In Slide Show view, a. 350 click here to see the b. 3, 500 answer to Question 1. Then c. 35, 000 click again to advance to d. 350, 000 Question 2. 2) This component is a specialized language that physicians or other prescribers place on a medication order. a. delta In Slide Show view, click here to see the b. signa answer to Question 2. c. alpha d. omega 2012 Paradigm Publishing 18 Topics

Types of Medication Orders Ø During hospital treatment, a physician examines a patient and then writes the first medication order on the patient’s medical chart vthe medical chart is commonly called the medication administration record, the patient’s chart or, simply, the chart 2012 Paradigm Publishing 19 Topics

Types of Medication Orders…/2 Ø 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 2012 Paradigm Publishing 20 Topics

Types of Medication Orders…/3 Ø If applicable, the admission order includes a list of the medications, including dosages and dosing intervals, that the patient has been taking at home Ø These medications are commonly referred to as home medications or home meds vin 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 2012 Paradigm Publishing 21 Topics

Types of Medication Orders…/4 Ø Every time a physician examines a patient, new orders, or changes to existing medication orders, are written vmay be referred to as daily orders 2012 Paradigm Publishing 22 Topics

Types of Medication Orders…/5 Ø Some physicians whose specialties involve commonly prescribed medical treatments take advantage of preprinted order forms called standing orders, or routine orders 2012 Paradigm Publishing 23 Topics

Medication Order Contents and Processing Ø The medical chart contains both patient identification information and copies of all treatment orders prescribed during the patient’s stay Ø Standard patient identification information is either handwritten on the order, provided on a computergenerated patient ID label affixed to the order, or preprinted at the top of each medication order by using an addressograph 2012 Paradigm Publishing 24 Topics

Medication Order Contents and Processing…/2 Ø 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 patient vpharmacy vlaboratory vnursing 2012 Paradigm Publishing 25 Topics

Medication Order Contents and Processing…/3 Ø The treatment orders kept in the medical chart are carbon copies of all medication, diagnostic, laboratory, dietary, and other orders prescribed vthe 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 vmay be kept at the nursing station or maintained on a computer record 2012 Paradigm Publishing 26 Topics

Medication Order Contents and Processing…/4 Ø 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 computer vfacilities that depend on an e. MAR system provide computer terminals at the nursing station or near the patient’s room vphysicians use these terminals for direct order entry, commonly referred to as computerized physician order entry (CPOE) 2012 Paradigm Publishing 27 Topics

Medication Order Contents and Processing…/5 Ø A pharmacist or technician based in either the central pharmacy or a satellite pharmacy enters the order into the pharmacy’s computer system vspecialized pharmacy software assists with the identification of patient medication allergies and crosssensitivities, drug–drug or drug–food interactions, appropriate medication dosage, duplicate therapy, contraindications, and other information vif an issue or potential problem arises, a flashing caution or warning screen (sometimes called a warning flag) appears 2012 Paradigm Publishing 28 Topics

CSP Labeling Ø Upon completion of sterile compounding and checking procedures, personnel must appropriately label the sterile compound in its final container Ø Labels will most often be affixed by the IV technician but may also be affixed by the pharmacist Ø Federal laws require that pharmacy labels accurately identify the ingredients and the amount of each ingredient in the final sterile compound 2012 Paradigm Publishing 29 Topics

Sterile Compound Label Components Ø The CSP label provides general information vmust also contain very specific information about the product, its administration and storage requirements, expiration date, and preparer Ø Product information on the CSP label specifies the name, concentration, and amount of each base solution used to prepare the compound Ø The label must also clearly identify each additive, or medication or ingredient that has been added to the base solution 2012 Paradigm Publishing 30 Topics

Sterile Compound Label Components…/2 Ø 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 2012 Paradigm Publishing 31 Topics

Sterile Compound Label Components…/3 Ø 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 2012 Paradigm Publishing 32 Topics

Sterile Compound Label Components…/4 Ø In contrast to an administration time, an infusion rate is specified for large-volume parenteral (LVP) products, such as IV bags and TPN solutions 2012 Paradigm Publishing 33 Topics

Sterile Compound Label Components…/5 Ø The CSP label must also provide the physician’s directions for the medication’s dosing interval 2012 Paradigm Publishing 34 Topics

Sterile Compound Label Components…/6 Ø Personnel also add auxiliary labels to clarify special instructions or highlight physician directions for the nursing staff 2012 Paradigm Publishing 35 Topics

Sterile Compound Label Components…/7 Ø Another required component on the CSP label is the expiration date of the sterile compound, sometimes referred to as the beyond-use date (BUD) 2012 Paradigm Publishing 36 Topics

Sterile Compound Label Components…/8 Ø Several factors determine the expiration date, including the stability of the drug in its compounded form vstorage requirements must also be included on the label Ø Every CSP label must also identify the pharmacy personnel who prepared the compound 2012 Paradigm Publishing 37 Topics

Sterile Compound Label Verification and Application Ø Verifying the accuracy of the medication order and the CSP label is one of the most important components of ensuring the Five Patient Rights Ø Sterile product labels must be legible, pharmaceutically elegant, and complete 2012 Paradigm Publishing 38 Topics

Your Turn 3) The physician’s initial order is called this. a. start order b. begin order c. check-in order d. admission order In Slide Show view, click here to see the answer to Question 3. Then click again to advance to Question 4. 4) The CSP label provides all of the following information except a. storage requirements of medication b. administration rate of medication In Slide Show view, click here to see the c. patient diagnosis answer to Question 4. d. patient identification number 2012 Paradigm Publishing 39 Topics