HUC-Transcribe Medication Orders helping the nurses help patients

content Objectives & criteria Review of transcription steps Standard Administration times Types of medication orders with examples Placement on Kardex Placement on MARS Mini in-class group assignment

Objectives Demonstrate your ability to transcribe medication orders to the appropriate locations in the chart and the Kardex with 100% accuracy

Review of transcription steps Identify orders to be transcribed Identify urgent orders Transcribe orders Sign off orders following protocol

Medication administration times You cant just give meds willy nilly Medications need to build up and maintain a therapeutic dose in the body in order to be effective If you give them too close together they might build up and become toxic but If too far apart they will all be excreted from the body and never make it to the therapeutic range It’s a fine balancing act

Medication administration times 1. Daily = 0900 (exception: for anti-infectives – time doses from the closest 9 o'clock – either 0900 or 2100) 2. HS = 2100 3. BID = 0900 … 2100 a. Exception anticoagulants – time to be specified by physician, i.e. 0300—1500. b. If time is not specified standard times will be used. 4. Q 12 Hours = 0900 … 2100 5. TID = 0900 … 1400 … 2100 6. 15 minutes AC = 0645 … 1145 … 1645 7. AC or 1 Hour AC = 0600 … 1100 … 1600 8. PC or 2 Hours PC = 0900 … 1400 … 1900 9. Q 8 Hours = 0600 … 1400 … 2200 10. QID = 0900 … 1300 … 1700 … 2100 11. Q 6 Hours = 0600 … 1200 … 1800 … 2359 12. Q 4 Hours = 0200 … 0600 … 1000 … 1400 … 1800 … 2200

Respiratory Therapy Drug Administration Times 1. BID = 0700 … 1900 2. TID = 0700 … 1300 … 1900 3. QID = 0700 … 1100 … 1500 … 1900 4. Q 6 Hours = 0700 … 1300 … 1900 … 0100 5. Q 4 Hours = 0700 … 1100 … 1500 … 1900 … 2300 … 0300 ** remember for brevity and learning we use abbreviations but the WRHA has banned the use of abbreviations such as bid, tid. However doctors have been slow to comply*****

Types of medication orders Routine PRN One dose Loading dose

Types of medication orders Routine medications have regularly scheduled times PRN are given as needed and you need to look for “qualifying phrases” such as “as needed, for pain, for nausea, for constipation”, for fever “

Types of medication orders One time only means just that . For example Demerol 50 mg and droperidol 1.25mg IV one hour pre-op pre-op Loading dose – is a larger than normal dose of a medication to “kick start” the effect. Then you begin regular doses Amoxicillin 1000 mg now then amoxicillin 250 IV g4 h Say “ahhhh”

Placement on kardex; on this kardex ( the one you have supplied- routine drugs are on the left and prn on the right ; follow facility for one time dose

MARS; note routine drugs on MARS have times written in while PRN times are written by nurse

MARS( medication administration record sheet)-screen shot HUC

Practice assignments transcription of the orders: transcribe the medication to the kardex and MARS Before beginning: Refer slide 5 for the basic steps and chapter 8 of the text for help Review the difference between scheduled or routine medication orders and PRN, one-time and STAT orders and their location on the Kardex and MARS Remember to use pencil in the Kardex & pen in the chart  

Working in pairs: Read the orders for March 23 and select the medication orders . Using the Internet or any other resources, research these drugs and write down usual doses and indications for the drugs. Brainstorm with your partner, the relationship between the drugs and the diagnosis. HUC Practical order Processing In - class Assignment one: use the paper kardex and practice sheets-. students to work in pairs. Patient demographics: remember to fill in the demographics in the appropriate spots on the kardex Mr. Alexander Murray , 77, suffered a massive anterior atrial myocardial infarction. He suffers from emphysema, diabetes, CHF, and is 5 days post-op from an AKA, right. His doctor is F. Smith.   March 23/2013 Admit to ICU Portable chest and EKG - phone results O2 @ 3 l per N/P ABGs today Inderal 40 mg tid; withhold if BP < 120/70 Digoxin 0.25 mg po od; withhold if pulse <60 Nitro spray for chest pain prn Morphine 10 mg IV q 4 h with 5 mg per IV prn for breakthrough pain Metformin 500 mg bid Theophylline 400mg per face mask q8h Lasix 40 mg od per IV  

Extra learning links Preoperative medications Doctors order processing http://www.slideshare.net/pamelaveroy/transcribing-doctors-order http://www.slideshare.net/cardiacinfo/preoperative-medications-goals-of-preop-medication

References LaFleur Brooks' Health Unit Coordinating, 6e Saunders Chapters ,9 ( order processing) ,13 ( medication orders) , 14 lab orders) Workbook to accompany LaFleur Brooks' Health Unit Coordinating, 6e Administrative and Clinical Procedures for the Canadian Health Professional –chapters, 6 &16-21