Medicine orders

Medicines are prescribed by the consultants and doctors who are working in the Hospital.
Chemotherapy medicines must be prescribed by the qualified oncologists only as approved by Credentials & Privileges Committee.
Prescriptions for inpatients must be written only in the Medication Administration Record.
Prescription for outpatients is written in the Prescription Pad.
Discharge medications are written in the Discharge Summary.
All the manual prescription shall be in capital letters
As a general practice generic names are used to write the prescription. As an exception to this when the doctor deems it necessary to prescribe a particular brand, he can do so.
If more than one doctor is prescribing medications for one patient, each individual medication order is to be written separately & each medication order is to be signed.
To change any of the medication orders, doctor must cease the original order and write a new order.

All prescription should contain

It is the policy of the hospital that all prescriptions comply with the law, and contain details that can be clearly interpreted
In case the contents of the prescription are not clear, clarification should be obtained from the concerned doctor before dispensing.
To counter this problem we are using maximum preprinted prescription or Computerized prescription
Alterations and cancellations must be initialed by the doctor.
Only approved conventions and abbreviations should be used.

To write doses

b. For pediatric age group patient are based on age, weight etc.
c. All orders for a drug dose less than one have a zero preceding the decimal amount. E.g. write 0.25mg instead of .25 mg.
d. Decimal points or trailing zeros are not being used e.g. Write 2 mg instead of 2.0 mg.
e. Microgram amounts are being clearly written as “microgram” to clearly distinguish form milligrams (mg).
f. All orders for units are being clearly written in “units”.
g. Orders calculated in either milligrams or micrograms doses are being left in the units in which the calculation was made

Drops: It is being specified as to which orifice (ear, eye, oral) and the number of drops is to be given. Latin abbreviations are to be avoided.
Skin creams: The area of skin on which application is required is being specified along with and the amount to be applied on a given occasion.
Infusions: Is being specified as subcutaneous, intravenous, epidural or intrathecal.
Oxygen: specified as — litre/min via nasal cannula/venturi mask/ventilator
Pediatrics: dose — mg/kg/day in 3 divided doses is being written as — mg thrice-a-day factoring in the patient’s weight. The responsibility is not left on the nurse/pharmacist.
Emergencies: “STAT” is written next to the prescribed item. The doctor notifies the nursing staff when “Stat” orders are written. “Stat” orders are being transcribed immediately and followed.

Clinicians are sensitized on rational prescription of medication. This includes good practices for rational prescription of medication
All handwritten prescriptions shall be written in capital letters.
Prescription errors or illegible prescriptions will be initialed after single strike through and rewritten.
Known drug allergies are ascertained before prescribing. Prominently documented in medical records (IP & OP).
The hospital policy and procedure identify the authority who can write orders. This is done by the treating doctors.
The hospital ensures that all orders for medicines are recorded in the medication administration record. The method of recording is standardized across the hospital.
The hospital ensures that medication orders are clear, legible, dated, named and signed by the appropriate authority. The method of doing this process is left to the concerned person however the importance of legibility of such orders is stressed.
Medication orders contain drug name, dose, route and frequency/ time. In case of more than one drug, separate dose for individual drugs are written. Standard abbreviations are used.