10. Interpretation of the Physician’s Orders



image Interpretation of the Physician’s Orders


LEARNING OBJECTIVES


On completion of the materials provided in this chapter, you will be able to:



Administration of medications is one of the nurse’s most important responsibilities. For medications to be administered safely and effectively, the nurse must know how to interpret the physician’s medication orders.


imageWRITTEN ORDERS


The physician prescribes medications. In hospitals and health care centers, the physician uses a physician’s order sheet, which is part of the patient’s hospital chart or record. The orders are written for a drug to be given until a stated date and time, until a certain amount of the medication has been given, or until the order is changed or discontinued.


The physician’s order requires the date the order was written, the name and dosage of the drug, the route and frequency of administration, and any special instructions. For drugs ordered as needed (prn), the purpose for administration is also added. The physician’s signature is required each time orders are written. In many institutions the time that the order is written is also required. However, if the time is not included, the order is still valid.


The nurse should review the policy and procedure for medication administration at each facility where he or she is employed to determine the appropriate schedule.


To interpret the medication order, the nurse must know the terminology, abbreviations, and symbols used in writing medical prescriptions and orders for medications. A list of the most frequently used abbreviations relating to medications can be found in Table 10-1. Memorize this list. Refer to the Glossary for help with unfamiliar terms.



In many states, other health care providers are legally authorized to prescribe medications. These may include a dentist, nurse practitioner, physician’s assistant, or chiropractor. The nurse should always be knowledgeable about the laws governing practice in his or her own state and facility. In all institutions, nurses should have ready access to the most current listing of individuals credentialed for prescriptive authority.



VERBAL ORDERS


Although verbal orders are discouraged as routine policy, certain situations or emergencies may require telephone orders. Such orders are generally initiated by the nurse. The order must include the same information as the written order: the date and time the order is recorded, the name and dosage of the drug, the route and frequency of administration, and any special instructions. After the nurse has recorded the orders on the patient’s chart, the orders must be repeated to the physician for verification. The physician’s name, a notation that this is a verbal order (VORB, verbal order read back), and the nurse’s signature are required. The physician should sign the verbal orders as soon as possible. The nurse should follow his or her institution’s policy.


Example: 1/18/15 Morphine sulfate 8 mg IM q4 h prn for pain


1400 VORB Dr. James T. Smith/Helen Alexander, RN


SCHEDULING THE ADMINISTRATION OF MEDICATIONS


The physician’s orders provide guidelines for the nurse in planning when each medication will be given to the patient. The purpose for prescribing the medication, drug interactions, absorption of the drug, or side effects caused by the drug may determine when the drug is given. The prescribed order may be very specific or may give the nurse latitude in scheduling.


Most hospitals and health care centers have routine times for administering medications. These times may differ from one hospital to another. The nurse should review the policy and procedure for medication administration at each facility where he or she is employed to determine the appropriate schedule. The guidelines assist the nurse in planning a medication routine that is safe for the patient. Table 10-1 provides examples of planning times for administering each medication at one institution.


The majority of hospitals use computer/military time rather than ante meridiem (AM) and post meridiem (PM) time. Table 10-2 will assist in conversion from computer/military time. Computer/military time can be computed quickly by adding 12 to PM time—for example, 12 + 3 = 1500 hours.


Tags:
Feb 11, 2017 | Posted by in PHARMACY | Comments Off on 10. Interpretation of the Physician’s Orders

Full access? Get Clinical Tree
Get Clinical Tree app for offline access