Drug Orders - Pharmacology

A drug order, also called a medical prescription, is an instruction from a provider to give a patient medication. Providers such as a physician, dentist, podiatrist, advanced practice nurse (in most states), and other authorized licensed healthcare providers can write a drug order. Physician assistants can also write a drug order but require the co-signature of a physician.

All drug orders are written on a prescription pad or on an order sheet if written in a healthcare institution. Sometimes orders are written into a computerized drug order system. A verbal drug order is sometimes given but must be followed up with a written drug order within 24 hours.

Drug orders are written using the abbreviations shown in Table (Commonly used abbreviations for drug orders) and must contain:

  • Date and time the order (prescription) was issued.
  • Name of drug and whether or not a generic form of the drug can be substituted for a brand-name drug.
  • Drug dose.
  • Route of administration.
  • Frequency and duration of administration.
  • Special instructions such as withholding or adjusting dosage based on nursing assessment, laboratory results, or drug effectiveness.
  • Signature of the prescriber.
  • Signature of the healthcare providers who took the order and transcribed it.

Commonly used abbreviations for drug orders.

Table : Commonly used abbreviations for drug orders.

TYPES OF DRUG ORDERS

There are four types of drug orders. These are:

Routine orders: This is an ongoing order given for a specific number of doses or number of days.

Example: 1/31/05 7:30 P.M. Lasix (furosemide) 40 mg., PO, qd (signature) This is an order to give 40 milligrams of Lasix by mouth once a day. Once a day medications are generally given around 9 A.M. or 10 A.M. based on the healthcare institution or patient choice if at home. Lasix is a diuretic.

One-time order: This is a single dose given at a particular time. Example: Demerol 50 mg with Vistaril 25 mg IM at 10 A.M. or 2 h before call to the OR.

This is an order to give Demerol (meperidine) 50 milligrams with Vistaril (hydroxyzine) 25 milligrams intramuscularly at 10 A.M. or one hour before call to the operating room.

PRN: This is an order to give a medication if specific criteria exist, such as a headache, fever, or pain and at the patient’s request.

Example: Advil 600 mg po q 6 h prm for mild to moderate knee pain. This is an order to give Advil (ibuprofen) 600 milligrams by mouth every six hours as needed for mild to moderate knee pain.

STAT: This is a single dose order to give at once or immediately Example: Give Benadryl 50 mg. po Stat.

This is an order to give Benadryl (dyphenhydramine) 50 milligrams by mouth immediately.

There are also protocols for administering medications. This is a set of criteria that indicates under what conditions a drug may be given. There are two types of protocols: standing orders or flow diagrams (algorithms). Standing orders are an officially accepted sets of orders to be applied by nurses, physician assistants, and paramedics in the care of patients with certain conditions or under certain circumstances.

For example, if a patient is not breathing and has no heartbeat, an algorithm has been developed to administer different medications such as epinephrine and other cardiac stimulants to resuscitate the individual. Other standing orders include orders for Tylenol (acetaminophen) 600 milligrams q 4 h by mouth or per rectum for a temperature > 101.4°F.


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