reconciliation and prescriptions

medication reconciliation

• is the process of comparing the medications a patient is currently taking with the ones the provider orders.

• This is done at every transition in care (admission, transfer, discharge) to avoid:

  • Duplications

  • Omissions

  • Wrong dosages

stat

Give immediately, one time only

prn

"As needed" — nurse decides based on symptoms (e.g., pain, nausea).

one time

Given once at a specific time (e.g., before surgery).

standing orders

Routine meds for common conditions (e.g., nitroglycerin for chest pain).

scheduled/standard

Given at set times (e.g., every 8 hours).

written order

Handwritten (rare now).

cpoe

Computerized Prescriber Order Entry — safer, reduces handwriting errors.

telephone order

• Provider gives order over phone, nurse writes and repeats back.

verbal order

• Spoken orders (used in emergencies). Must be written and signed later.

safe order

• Medication name

• Dosage

• Route (how it's given)

• Frequency (how often)

• Special instructions or parameters (e.g., “Hold for BP < 90/60”)

abbreviations

• Some abbreviations are unsafe and not approved (e.g., "U" for units can be mistaken for 0).

• Nurses must know and use approved abbreviations only.

look sound alike medications

• Hydralazine vs. Hydroxyzine, MSO4 vs. MgSO4

• These can easily be confused — always double-check.

mar/Medication Administration Record

• Document showing all prescribed meds.

• Used to track what was given, when, and by whom.

• Can be paper or electronic.

• Must be updated and checked before giving meds.

variance

Any deviation from the standard or expected process (could include wrong time or late dose).

near miss

A mistake caught before reaching the patient.

error

A mistake that reaches the patient (e.g., wrong med, dose, time, route).

types of error

• Prescribing errors (wrong drug or dose written)

• Omission (missed dose)

• Wrong patient/route/time

• Unauthorized drug

• Extra dose or wrong rate

barcode medication administration

Scans patient’s ID band and the med to ensure a match.

smart pump

IV pumps that alert you if you program a dose that’s too high or too fast.

high risk medications

• These meds can cause serious harm if used incorrectly.

• Examples: Insulin, anticoagulants (heparin), opioids, chemotherapy, IV potassium.

• Extra precautions are needed:

  • Double-checking dosages

  • Second nurse verification

  • Specific protocols for administration and monitoring