Chapter 4

2. Chapter 4 Medication Orders and Labeling

3. 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.

4. Topics In Slide Show view, click the desired topic to the left to link directly to the related slide. To return to this slide at any point in the presentation, click the Topics button below. • 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

5. Introduction • The origin of medical terminologyis as old as medicine itself • approximately 75% of medical terminology has its roots in the Greek language • the remainder can be traced to Latin

6. 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 word • when a root word contains this combining vowel, the word is said to be in its combined form

7. Medical Root Words, Prefixes, and Suffixes…/2 • A prefixis a word element attached to the beginning of a root word • a prefixoften indicates time, location, direction, or number • A suffixis a word element attached to the end of a root word • the addition of a suffix further defines the meaning of a root word

8. 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 abbreviations • most abbreviations are developed to shorten the length of words and word combinations related to health, medicine, laboratory procedures or tests, and pharmacy

9. 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

10. Medical Abbreviations, Acronyms, and Symbols…/3 Common Pharmacy Abbreviations • Typically seen on medication orders or other written communications between providers and pharmacies • provide important information • might also include abbreviations to communicate specific compounding directives • common for indicating the route of administration and the dosing intervals for prescribed medications

11. Medical Abbreviations, Acronyms, and Symbols…/4 Common Pharmacy Symbols • In addition to knowing pharmacy abbreviations, you need to recognize and understand a number of symbols specific to pharmacy practice • symbols 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

12. Medical Abbreviations, Acronyms, and Symbols…/5 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 States • list integrated into the Performance Standards for Healthcare Accreditation • the nonstandardand potentially dangerous abbreviations should not be used in any healthcare application

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

14. Signa Interpretation…/2 • Signa language combines an assortment of abbreviations, acronyms, and symbols

15. 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?

16. Medication Orders • Medication orders are similar to prescriptions • exclusive 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

17. Medication Orders…/2 • Upon receipt of the medication order, the pharmacy determines what medications and dosages have been ordered and then interprets the signa directions • it 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

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

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

20. Types of Medication Orders…/2 • The physician’s initial order is called the admission orderand is often written while the patient is in the emergency department or has just been admitted to a hospital room

21. Types of Medication Orders…/3 • 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 meds • in 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

22. Types of Medication Orders…/4 • Every time a physician examines a patient, new orders, or changes to existing medication orders, are written • may be referred to as daily orders

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

24. Medication Order Contents and Processing • 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

25. Medication Order Contents and Processing…/2 • 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 • pharmacy • laboratory • nursing

26. Medication Order Contents and Processing…/3 • The treatment orders kept in the medical chart are carbon copies of all medication, diagnostic, laboratory, dietary, and other orders prescribed • the original copyremains 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

27. Medication Order Contents and Processing…/4 • 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 • facilities 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)

28. Medication Order Contents and Processing…/5 • A pharmacist or technician based in either the central pharmacy or a satellite pharmacy enters the order into the pharmacy’s computer system • specialized pharmacy software assists with the identification of patient medication allergies and cross-sensitivities, drug–drugor 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

29. 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

30. Sterile Compound Label Components • The CSP label provides general information • must 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

31. 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

32. Sterile Compound Label Components…/3 • 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

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

34. Sterile Compound Label Components…/5 • The CSP label must also provide the physician’s directions for the medication’s dosing interval

35. Sterile Compound Label Components…/6 • Personnel also add auxiliary labels to clarify special instructions or highlight physician directions for the nursing staff

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

37. Sterile Compound Label Components…/8 • Several factors determine the expiration date, including the stabilityof the drug in its compounded form • storage requirementsmust also be included on the label • Every CSP label must also identify the pharmacy personnel who prepared the compound

38. Sterile Compound Label Verification and Application • 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

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