URGENT = if a routine order is written close to the time when the first dose is given it may become urgent priority. Example; a medication is ordered at 1145 to be started at 1200, the NUC must notify the nurse before 1200

ROUTINE = once orders are completed the nurse’s attention flag is pulled up in the chart to be checked

· Medication orders are transcribed to the patients medication administration record (MAR) and Kardex

· MARS currently used are not kept in the patients chart at nursing station, but in a medication book kept in a bedside chart

· In some hospitals the NUC does not transcribe the order directly to the MAR but on a strip (sticky label) and paperclipped to the physicians order form and the nurse will check and put the strip on the patient’s MAR

· Double check work when finished and sign off with a signature, NUC in red ink next to the physician’s signature, pull up nurses attention flag and leave in designated area

Some hospitals have electronic MARs that will print at the end of the pharmacy’s workday for every patient on the unit, the NUC will put the newly printed MARs in each patient’s bedside chart. Previous MARs are taken and filed in the medication section. If new orders are written in the next 24 hours the NUC hand-writes the new order on the printed MAR and faxes to the pharmacy to be added to the next MAR print out.

NOTATIONS / PROCESSING MEDICATION ORDERS

· The person who processed the orders must indicate what action has been taken to process each one, abbreviations/acronyms are written in RED ink at the end of the order

AWARE Nurse is aware

GIVEN Medication is given

FAXED/SCANNED Faxed to pharmacy

K Kardex

MAR Medication administration Record

To avoid mistakes while processing;

- Consult a resource is you are not familiar with the drug/spelling such as a drug guide, internet or nursing staff

- Ask another member of staff is you cannot read the doctors handwriting

- If anything is missing check with the nurse before transcribing

- If the physician has written an order such as Tylenol #3 for a

patient allergic to codeine do NOT transcribe and talk to a nurse

· If clarification is needed the nurse will communicate with the doctor as the NUC cannot take orders from doctors

· The NUC must transcribe all medication orders to the MAR/Kardex including new meds, changes to existing, discontinued and re-ordered medications

NEW MEDICATION ORDERS

- The NUC must add order to MAR when processing an order for medication

- Write in dates

- Transcribe the medication order

- Write in times the medication is given, according to how it is ordered. Ex; q4h, bid, etc..

- Any days prior to the start date should be crossed off on the MAR

Sometimes the NUC may be required to indicate when the initial dose (ID) will be given by writing ID in RED INK in the signature spaces, cross out any signature spaces before the ID is given

· The date the order is written must always be transcribed to whatever Kardex is being used

· When there is a short-series order the NUC must indicate the last dose (LD) for the medication on the MAR/KARDEX by writing LD next to the last dose and crossing out signature spaces after last dosage time on Kardex, the date/time of the LD is noted in the “stop column”

CHANGES IN MEDICATION ORDERS

· If a doctor writes trade name of drug on first order, and uses generic on the changed order;

- If no discontinuation for original order the NUC would not transcribe the additional order of the same drug without speaking to the nurse (LASIX / furosemide)

· ALWAYS check the MAR when transcribing changed orders to ensure there is not a previous order for the same drug – if there is speak to the nurse to find out if both are given or the first order is discontinued

DISCONTINUED MEDICATIONS

- if a patient no longer requires a medication that has been ordered the physician will write DC or D/C for discontinued

- the NUC must note DC of the medication on the MAR and cross out any remaining signature spaces

If there is not enough space at the bottom of the MAR, a second MAR is added. The NUC attaches the ID label, allergies in RED INK and writes the same dates across the second form that are on the first form. As on the first page MAR the NUC transcribes the medication order to the form and writes times and indicates when the ID is given but writing ID in RED INK in appropriate signature space, any signature spaces before ID is crossed out.

· To alert the nurse that there is more then one MAR the NUC writes in RED INK page 1 of 2 on the first bottom of the first page, and 2 of 2 on the bottom of the second MAR.

PRN Medications are not transcribed to the MAR – scheduled, but instead to MAR – PRN form and the PRN section of the KARDEX.

Drug Interchange

- Sometimes an order will be written by the doctor that is not part of the hospital formulary so the pharmacy will do a “ drug interchange”, the pharmacist will change the physicians medication order and the original order will be discontinued and replaced by another medication order with a similar drug that is available.

Note