1. Ch.5: Reading and Interpreting Medical Labels and Orders and Documents Appropriately
By Dr. Kevin Perrino

2. Background Assessment
Q. What are the advantages of using the same pharmacy for all of your medication needs?

3. Background Assessment
A: If you use the same pharmacy for all the prescriptions you need filled, all of your medications will be on file at that pharmacy. That way the pharmacist can monitor for medication interactions. The pharmacist also keeps track of all your allergies to food or previously taken medications.

4. Labels for Stock Medications
Parts of the stock medication label
A. Trade (proprietary, brand) name
B. ??????????
C. Drug strength or weight
D. ??????????
E. ??????????
F. Amount of medication in container

5. Labels for Stock Medications
B. Generic name D. Form of Medication E. Route of administration

6. Labels for Stock Medications
G. ????????????????
H. ????????????????
I. Manufacturer’s name
J. Expiration date
K. ????????????????
L. Auxiliary Labels
NDC
What do these numbers represent?

7. Labels for Stock Medications
G. Directions for reconstitution
H. National Drug Code
K. Label for controlled drugs
NDC
What do these numbers represent?

8. Common Abbreviations Used in Medication Orders/Prescriptions
Abbreviations come from Greek and Latin
Shorthand for writing medical orders
Use only standard abbreviations
TJC “Do Not Use List”

9. Medical orders vs. Prescription
What is the difference between medical orders and a prescription?

10. Medical orders Should be written but may be verbal
Used in in-patient facilities for medication administration
Are not given to patients for dispensing
May be
Standing order
Standard protocol

11. Medical orders
What are the six components of medication orders?

12. Medical orders

13. Prescription
A prescription is a written order for a medication for a particular patient by a person licensed to prescribe medications.
Prescriptions may be written for therapy (physical, occupational, speech) and ultrasound.
Those licensed to prescribe medications vary from state to state
What is the purpose of prescription?

14. Prescriptions Order written for:
compounding or mixing of medications
dispensing of medication
dedication administration
Use blue or black permanent ink for filling out prescriptions.
A physician must sign a computer-generated prescription.
Single- or multiple-line forms may be used for prescriptions.

15. Multiple-Line Prescription
What would make this prescription complete?

16. Prescription Components
B: Patient heading
Date determines when prescription is no longer valid.
Most prescriptions must be filled within ____ months of writing.
Some prescriptions may be refilled for ____ months after initial filing.
Schedule III, IV, V substances must be within what time frame?

17. Prescription Components
B: Patient heading
Date determines when prescription is no longer valid.
Most prescriptions must be filled within 12 months of writing.
Some prescriptions may be refilled for 12 months after initial filing.
Schedule III, IV, V substances must be within what time frame?
6 months

18. Prescription Components (cont’d.)
E: What is “E” and what does it stand for?

19. Prescription Components (cont’d.)
E: What is “E” and what does it stand for?
Directions should include instructions on when to start and stop taking medication and the appropriate administration route.

20. Prescription Components (cont’d.)
F: What is “F” and what does it stand for? What directions are included here?

21. Prescription Components (cont’d.)
F: What is “F” and what does it stand for? Subscription—directions to pharmacist for filling prescription (number of doses, quantity to dispense, form of drug).

22. Question
A patient calls you at the office to report that he is out of refills for his medication. He asks you to call in the prescription refills to his pharmacist. When you ask him to make an appointment with the physician first, the patient says he does not have time. How would you handle this situation?

23. Answer
A refill prescription should be handled in the same manner as a new prescription. Because the physician is the only person who may approve a refill request, you should consult with the physician first. Also check the patient’s medical record for any allergies, adverse reactions, or other prescription issues. If the physician approves the request, tell the patient that you will call in the prescription. Record the refill in the patient’s medical record. If the physician denies the request, tell the patient that he needs to make an appointment to see the physician before the prescription can be refilled.

24. Patient Compliance
Why is it important to encourage patients to fill all prescriptions at one pharmacy?
How might financial issues be barriers to compliance?
How might you assist patients with remembering to take their medications?

25. Patient Compliance In order to increase patient compliance:
Provide written instructions.
Ensure patient/caregiver thoroughly understands medication directions.
Encourage using one pharmacy to fill all prescriptions.
Confirm that patients understand why they are taking a medication.
Take time to answer questions.

26. Review Exercises Interpret this order:
Keflex 250 mg #20, Sig: cap I po qid with food

27. Review Exercises (cont’d.)
Keflex 250 mg #20, Sig: cap I po qid c food
Answer:
Keflex 250 mg. Dispense 20 capsules. Take 1 capsule by mouth 4 times a day with food.

28. Review Exercises (cont’d.)
Interpret this order:
Brethine 5 mg #30, Sig: tab i po tid

29. Review Exercises (cont’d.)
Interpret this order:
Brethine 5 mg #30, Sig: tab i po tid
Answer:
Brethine 5 mg. Dispense 30 tablets. Take 1 tablet by mouth 3 times a day.

30. Review Exercises (cont’d.)
Interpret this order:
Restoril 15 mg #30, Sig: cap I hs prn sleep

31. Review Exercises (cont’d.)
Interpret this order:
Restoril 15 mg #30, Sig: cap I hs prn sleep
Answer:
Restoril 15 mg. Dispense 30 tablets. Take 1 capsule at bedtime as needed for sleep.

32. Review Exercises (cont’d.)
Interpret this order:
furosemide 20 mg tabs #90, Sig: 40 mg qam and 20 1 pm

33. Review Exercises (cont’d.)
Interpret this order:
furosemide 20 mg tabs #90, Sig: 40 mg qam and 20 1 pm
Answer:
furosemide 20 mg tablets. Dispense 90 tablets. Take 2 tablets every morning and 1 tablet at 1:00 pm

34. Documentation Exercises
Document the following using abbreviations: Lopressor 50 milligrams, 1 tablet taken at breakfast and again at bedtime

35. Documentation Exercises
Document the following using abbreviations: Lopressor 50 milligrams, 1 tablet taken at breakfast and again at bedtime Answer: Lopressor 50 mg tab i am and hs

36. Documentation Exercises
Document the following using abbreviations:
indomethacin 25 milligrams, taken 3 times daily with meals

37. Documentation Exercises
Document the following using abbreviations:
indomethacin 25 milligrams, taken 3 times daily with meals
Answer:
indomethacin 25 mg tid with meals

38. Documentation Exercises
Document the following using abbreviations: Phone an order for Zithromax 250 mg (Z-Pak), 2 tablets to be taken on the first day, followed by 1 tablet on days 2 to 5, 24 hours apart, on an empty stomach

39. Documentation Exercises
Document the following using abbreviations: Phone an order for Zithromax 250 mg (Z-Pak), 2 tablets to be taken on the first day, followed by 1 tablet on days 2 to 5, 24 hours apart, on an empty stomach Answer: Zithromax (Z-Pak) 250 mg; tab ii today then tab i on days 2 to 5, 24 hours apart on an empty stomach

40. Ch. 7 Measurement System & Their Equivalents

41. Question
The international Bureau of Weights and Measures adopted the International System of Units in 1960 to standardize the notation used in measurements. Why is this standardization especially important in medical applications?

42. Answer
When medicine is prescribed, it is important that the physician’s instructions for dosage be followed precisely. Without a standard notational system, there can be room for confusion regarding dosage administration.

43. Metric System

44. Weight Conversion Factors
Given Smaller number to find Larger number = division = moving decimal to the left
I.e mcg = ___________ mg (0.635 mg)
5.5 cm = ____________ m (0.055 m)
1427 mL = ___________ L (1.427 L)

45. Weight Conversion Factors
Given Larger number to find Smaller number = multiply = moving decimal to the right
I.e. 8g= ___________ mg (8000mg)
5m = __________ mm (5000mm)
1.6L= _________ mL (1600mL)

46. Weight Conversion Factors
______ mg = 8 g
8 x 1000 = 8000 mg
8000 mg = 8 g
______ mg = 635 mcg
635 ÷ 1000 = mg
0.635 mg = 635 mcg
______ g = 4.5 kg
4.5 x 1000 = 4500
4500 g = 4.5 kg

47. Household Measurement System
Also called United States Customary System of Measurement
uses common kitchen measuring devices
not recommended for measurements in a medical facility because of different sizes of measuring devices
drop— gtt
teaspoon— t, tsp = 5 mL
tablespoon— T, tbs = 3 tsp
cup—c = 8 ounces

48. Household Measurement System
15 gtt = 1t 1tbs = 3t Review: 60gtt = _____t 2tbs = ______t 3 t = ______ gtt 45 gtt _____tbs