Lecture Math for the pharmacy technician Concepts and calculations Chapter 4 – Lynn M. Egler, Kathryn A. Booth

Chapter 4, Drug orders. This chapter begins with the seven rights of medication administration, abbreviations, and controlled substances. This chapter shows the various ways in which drug orders may be written and how to interpret physicians’ orders and prescriptions. It emphasizes safety and shows how drug orders and prescriptions can easily be misread, giving added detail to detecting errors and forged or altered prescriptions.

Math for the Pharmacy Technician: Concepts and Calculations

Chapter 4: Drug Orders

Egler • Booth

Drug Orders

Learning Objectives

 Summarize the Rights of Medication

Administration.

 Interpret a written drug order

 Identify on the information on a

medication order needed to dispense

medications.

When you have successfully completed Chapter 4, you will

have mastered skills to be able to:

 Locate on medication administration

records or medication cards the

information needed to administer

medication.

 Recognize incomplete drug orders

 Select appropriate action for

confusing, incomplete, or illegible

drug orders.

 Identify and verify DEA numbers.

 Recognize classifications of

controlled substances.

 Recognize prescription errors and

forged or altered prescriptions.

 Interpret and use pharmaceutical

and medical abbreviations and

terminology.

Introduction

 In order to correctly calculate a

medication dose, you must be able to

read and understand the drug order.

 This chapter will discuss:

 Drug orders

 Patient’s rights

 Medication administration systems

 Your responsibilities

the rights!

Right Patient

You are responsible if an error occurs.

 Name on original order must be exactly

the same as the name on the Medication

Administration Record ( MAR ),

medication card, or prescription.

 Verify the full name.

 Ask “What is your name?”

 Check the bed number and tag.

 Read the patient’s identification

 Check the expiration date.

 If the patient questions a

medication, then recheck it.

 A patient always has the right to

refuse a medication.

 Dispose of medicine according to

facility guidelines.

Right Drug (con’t)

 Always check medication

three times:

1 when you take it off the shelf.

2 when you prepare it.

3 when you replace it on the shelf.

 Check it three times even if

it is prepackaged, labeled,

Right Dose

Later you will learn how to convert from

the dosages ordered by the doctor to

the desired dose.

 Use extreme caution when calculating

dosages.

 Pay special attention to decimal points.

Right Route

 A drug intended for one route is

often not safe if administered via another route.

 Some medications are produced in

different versions for different routes.

 For example: suppositories, oral

tablets, or injections

 Be especially careful between

Right Time

 Some medications must be given at

a specific time.

 Some medications are given before

or after food, depending on

food-drug interactions.

 Other medicines can be spaced over

waking hours.

Right Technique

 Medications must be given correctly

according to the order For example:

 Buccal between cheek and gum

 Sublingual under the tongue

 If unsure, check references materials.

Examples:

Physicians’ Desk Reference (PDR)

Facts and Comparisons

Right Documentation

 Be sure that the right documentation

is completed

For example, inpatient facilities

administer medication to the patient The health professional who

administered the medication must,

immediately after the patient takes

the medication, sign the medication

administration record (MAR)

Table 4-2 Abbreviations Commonly

Used in Drug Orders

Table 4-2 Abbreviations Commonly

Used in Drug Orders (con’t)

Table 4-2 Abbreviations Commonly

Used in Drug Orders (con’t)

Table 4-2 Abbreviations Commonly

Used in Drug Orders (con’t)

Abbreviations

Joint Commission on Accreditation of

Healthcare Organization (JCAHO) has

established a list of “Do Not Use” and

“Undesirable” abbreviations.

See Tables 4-3 and 4-4 on the following

slides.

Be certain to check abbreviations

carefully when reading drug orders.

Table 4-3 “Do Not Use” Abbreviations

Table 4-4 “Undesirable” Abbreviations

Table 4-4 “Undesirable” Abbreviations

(con’t)

no known allergies nothing by mouth after

without before

drop, drops long acting suppository tincture

left eye both eyes

by mouth; orally subcutaneous, beneath the skin

Frequency

a.c., ac, AC, ac

b.i.d., bid, BID

night after meals when necessary, when required

4 times a day immediately

3 times a day

Note: Do not use QD or QOD instead write “Daily” or Every other day”

Outpatient Settings

 Physicians’ orders are given as

prescriptions that are filled at a

pharmacy or through the mail.

 Prescriptions include all the elements

of a physician’s order as well as the

physician’s name and prescriber

number.

Physician’s Drug Order

 Full name of the patient

 Full name of the drug

 Outpatient Settings written as

prescriptions

 Inpatient Settings written on

physicians’ order forms

Prescription Form

I Heal, MD Best Medical Clinic 123-456-7890 Name Anna Versary Date April 19, 2012

Address

Rx: Lopressor 50 mg QUANTITY: # 90

SIG: i tab po tid Refills: 5

AH1234567 I Heal, MD Prescriber ID #

Controlled Substances

 A controlled substance is a drug that

has the potential for addiction, abuse,

or chemical dependency, also referred

to as a narcotic

 There are five categories of controlled

substances listed by schedule.

Controlled Substances (con’t)

 Schedule I-Drugs have a high

level for potential abuse and

are unacceptable for medical

use in the United States These

drugs are not to be prescribed.

For example: marijuana,

heroin.

Controlled Substances (con’t)

 Schedule II-Drugs have a high level

for potential abuse and dependency

Drug orders must be on a written or

typed hard copy order and have DEA

number and prescriber signature

Referred to as narcotics Quantities

are limited and NO REFILLS are

allowed.

Controlled Substances (con’t)

 Schedule III-Drugs have less

potential for abuse than Schedule I

and II drugs, but still have a

moderate potential for dependency

Drug orders may be ordered by

phone or in writing and may have

five refills in a six-month period.

For example: butalbital, hydrocodone/codeine.

Controlled Substances (con’t)

 Schedule IV-Drugs have a low level for

potential abuse, and limited potential

for dependency Drug orders may be

ordered by phone or in writing and

may have five refills in a six-month

period.

For example: alprazolam (Xanax®), diazepam

(Valium®), zolpidem (Restoril®).

Controlled Substances (con’t)

 Schedule V-Drugs have a low level for

potential abuse, and limited potential

for dependency Drug orders may be

ordered by phone or in writing and

may have five refills in a six-month

period.

For example: diphenoxylate (Lomotil®),

pregabalin (Lyrica®)

DEA Numbers

 The Drug Enforcement Administration

(DEA) of the Justice Department passed

the Controlled Substances Act in 1970

It regulates the distribution of

controlled substances

 Federal law mandates that any

prescriber that writes a medication

order for a controlled substance must

be registered with the DEA and are

given a DEA number that must be listed

DEA Numbers (con’t)

 A DEA number always consists of two

letters followed by seven numbers The

second letter is the initial of the

prescriber’s last name.

 An example of a DEA number is

AH1234567

Formula to Verify DEA Numbers

 To ensure that a DEA number is

authentic, the following formula is

used for verification Using the

example DEA number of AH1234567.

 Add the first, third, and fifth digits

together;

 Next add the second, fourth, and

sixth digits together and multiply the

 The last number in your

answer of the formula must be

the same as the last number of

the DEA number for it to be

authentic.

Formula to Verify DEA Numbers

(con’t)

Using the formula verify the example

DEA number AH1234567.

 Step 1 Add the first, third, and fifth

numbers.

1 + 3 + 5 = 9

 Step 2 Add second, fourth, and sixth

numbers and multiply by 2.

2 + 4 + 6 = 12 x 2 = 24

 If the answer in Step 3 of the formula

ends in the same number as the last

number of the DEA numbers, it may be

an authentic number

 In working the formula we see that the

example DEA AH1234567 is not an

authentic number; if it were, it would

Detecting Errors and Forged or

Altered Prescriptions

 As a pharmacy technician you need to

know federal and state restrictions for

all schedules of controlled substances

 You must verify the date, DEA number,

and prescriber’s signature on all

controlled substance drug orders

Detecting Errors and Forged or

Altered Prescriptions (con’t)

 On Schedule II drug orders, verify the

allowable quantity limits and that

there are NO refills written

 Inspect the hard copy for paper type

and the order for consistent

handwriting style

 If a prescription looks altered or

forged in any way, follow your facility’s

protocol.

Inpatient Setting

 For inpatient settings, drug orders

are usually written on physicians’

order forms, with space for multiple

orders

 Orders may also be entered into a

computer The patient’s name and

the physician’s signature appear

once on the form

Inpatient Setting (con’t)

Under Medication Orders, the

physician writes the components of

each medication requested in the

CAUTION!

 Never guess what the prescriber meant!

 If the order is not legible, always contact the

prescribing physician to clarify the order.

Verbal Physician’s Orders

 If the physician is unable to write

or personally sign an order, verbal

orders may be used.

 These are governed by state laws

as to which personnel may accept

verbal orders.

 You must be legally permitted to

accept a telephone order.

Verbal Physician’s Orders

(con’t)

 Write the order carefully and legibly

as you receive it, not after the call.

 Identify it as a verbal order.

 Read the order back to the physician.

CAUTION!

 Always be certain that you are

dispensing the correct

medication.

 Many drugs have names that

are similar.

Medication

Administration Systems

 Most facilities have a standard

schedule for administering medication.

 Person who verifies the transcription

ensures that the times listed are

appropriate for the medications.

 Times may need to be adjusted

according to mealtimes or conflicting

medication schedules.

Medication Administration

Records (MAR)

 Legal documents

 Handwritten or computerized printouts

 Contains same information as a

physician’s order form

 Specify the actual times to administer

the medication

 Provide a place to document each

medication administration

 By law, after you give a medication you

must immediately document it

Medication Administration

Records (con’t)

An MAR must include the following information:

 Name of medication, dose, route,

 End date of narcotics and antibiotics

 Special instructions, diagnosis, weight, etc.

Review and Practice

Is the following MAR complete? If not, what is

missing?

Review and Practice

 Answer: In the previous MAR the order

is written correctly and all information

is complete.

Is the following MAR complete? If not, what is missing?

Review and Practice

Review and Practice

 Answer: In the previous MAR:

 Physicians’ Desk Reference (PDR)

 United States Pharmacopeia National

Formulary

 Drug handbooks

 Internet sites

 Software programs used with personal

digital assistant (PDA)

Review and Practice

 Which of the Rights of medication

administration is not listed?

Review and Practice

What do the following abbreviations mean?

pc os qd supp BP

after meals left eye

every day suppository blood pressure

medication orders.

I Heal, MD Best Medical Clinic 123-456-7890 Name Anna Versary Date April 19, 2012

Address Rx: Lopressor 50 mg

QUANTITY: # 90 SIG: i tab po tid Refills: 5

AH1234567 I Heal, MD Prescriber ID #