Medication orders: Nursing pharmacology

Medication orders are used to communicate which medications to administer to patients and are obtained from the health care provider in the form of written, electronic, or verbal orders. Written and electronic orders are entered directly by the health care provider, whereas verbal orders can be taken in-person or over the phone in certain situations, transcribed by the nurse, and then signed by the health care provider within a certain timeframe. All medication orders will include the date and time the order was made; the name of the medication; its dosage strength, route, and frequency; as well as the signature of the provider.  

As the nurse, you’ll provide safe medication administration by correctly interpreting medication orders. Start by ensuring all the elements of the order are provided. If the order is unclear or if there’s missing information, you’ll clarify it with the health care provider. If the order is handwritten, ensure that it’s legible. Importantly, be sure the order only uses approved abbreviations, since unapproved abbreviations can lead to medication errors. For example, the unapproved abbreviation QD is intended to mean “daily” but could be mistaken for the approved abbreviation QID, meaning “four times a day.” Instead, “daily” should be written out. Finally, be sure you know which medications and dosages are safe for your patient, so you can identify and clarify any concerns with the health care provider. 

Okay, let’s interpret a handwritten medication order to ensure all the elements are provided. You see the date and time the order was written, followed by the medication name, ondansetron. The dosage strength is 4 mg, the route  is IV, and the frequency is every 8 hours. Finally, it’s signed by the prescribing health care provider. Since all the required elements are present and clearly communicated in the medication order, you can begin the medication administration process. 

Let's look at another handwritten medication order. You see the date and time of the order, followed by the medication name, lorazepam. The dosage strength is 2 mg, and the route is PO. However, this order is missing an important piece of information: the frequency. It’s unclear if the health care provider intended this medication to be a one-time dose or be repeated. In this case, you’d need to contact the health care provider and clarify the frequency before administering the medication.