Chapter 3 Principles of Drug Administration
3.4 Drug Orders and Time Schedules
matter-of-fact attitude should be presented in giving a child medications; using threats or dishonesty is unacceptable and
professionally unethical. Oral medications that must be crushed for the child to swallow can be mixed with flavored syrup, jelly, or the child’s choice of food to avoid unpleasant tastes. However, care must be
taken to avoid necessary food items so that the child does not develop an unpleasant association with these items and refuse to consume them in the future. To prevent nausea, medications can be preceded and followed with sips of a carbonated beverage that is poured over crushed ice.
cap capsule
gtt drop
h or hr hour
IM intramuscular
IV intravenous
no number
pc after meals; after eating
PO by mouth
PM afternoon
prn when needed/necessary
qid four times per day
q2h every 2 hours (even or when first given)
q4h every 4 hours (even)
q6h every 6 hours (even)
q8h every 8 hours (even)
q12h every 12 hours
Rx take
STAT immediately; at once
tab tablet
tid three times a day
tid three times a day
Note: The Institute for Safe Medical Practices recommends the following abbreviations be avoided because they can lead to medication errors: q: instead use “every”; qh: instead use “hourly” or “every hour”; qd: instead use “daily” or “every day”; qhs: instead use “nightly”; qod: instead use “every other day.” For these and other recommendations, see the official Joint Commission “Do Not Use List” at http://www.jointcommission.org/assets/1/18/dnu_list.pdf
with emergency medications that are needed for life-threatening situations.
The term STAT comes from statim, the Latin word meaning “immediately.”
The health care provider normally notifies the nurse of any STAT order so it can be obtained from the pharmacy and administered immediately. The time between writing the order and administering the drug should be 5 minutes or less. Although not as urgent, an ASAP order (as soon as possible) should be available for administration to the patient within 30 minutes of the written order.
The single order is for a drug that is to be given only once, and at a specific time, such as a preoperative order. A prn order (Latin: pro re nata) is administered as required by the patient’s condition. The nurse makes judgments, based on patient assessment, as to when such a medication is to be administered. Orders not written as STAT, ASAP, NOW, or prn are called routine orders. These are usually carried out within 2 hours of the time the order is written by the health care provider. A standing order is written in advance of a situation that is to be carried out under specific circumstances. An example of a standing order is a set of postoperative prn prescriptions that are written for all patients who have undergone a specific surgical procedure. A common standing order for patients who have had a tonsillectomy is “Tylenol elixir 325 mg PO every 6 hours prn sore throat.”
Because of the legal implications of putting all patients into a single treatment category, standing orders are no longer permitted in some
facilities.
PharmFacts Grapefruit Juice and Drug Interactions
Grapefruit juice may not be safe for people who take certain medications.
Chemicals (most likely flavonoids) in grapefruit juice lower the activity of specific enzymes in the intestinal tract that normally
break down medications. This allows a larger amount of medication to reach the bloodstream, resulting in increased drug activity.
Drugs that may be affected by grapefruit juice include midazolam (Versed); cyclosporine (Sandimmune, Neoral); antihyperlipidemics such as lovastatin (Mevacor) and simvastatin (Zocor); calcium channel blockers including nifedipine; certain antibiotics such as erythromycin; and certain antifungals such as itraconazole
(Sporanox) and ketoconazole (Nizoral).
Grapefruit juice should be consumed at least 2 hours before or 5 hours after taking a medication that may interact with it.
Some drinks that are flavored with fruit juice could contain
grapefruit juice, even if grapefruit is not part of the name of the drink. Check the ingredients label.
Agency policies dictate that drug orders be reviewed by the attending health care provider within specific time frames, usually at least every 7 days.
Prescriptions for narcotics and other scheduled drugs are often automatically discontinued after 72 hours, unless specifically reordered by the health care provider. Automatic stop orders do not generally apply when the number of doses or an exact period of time is specified.
Some medications must be taken at specific times. If a drug causes stomach upset, it is usually administered with meals to prevent epigastric pain,
nausea, or vomiting. Other medications should be administered between meals because food interferes with absorption. Some central nervous system drugs and antihypertensives are best administered at bedtime, because they may cause drowsiness. Sildenafil (Viagra) is unique in that it should be taken 30 to 60 minutes prior to expected sexual intercourse to achieve an effective erection. (Note: Sildenafil is also prescribed to hospitalized patients for
pulmonary hypertension.) The nurse must pay careful attention to educating patients about the timing of their medications to enhance compliance and to increase the potential for therapeutic success.
Once medications are administered, the nurse must correctly document that the medications have been given to the patient. This documentation is
completed only after the medications have been given, not when they are prepared. It is necessary to include the drug name, dosage, time
administered, any assessments, and the nurse’s signature. If a medication is refused or omitted, this fact must be recorded on the appropriate form within the medical record. It is customary to document the reason when possible.
Should the patient voice any concerns or adverse effects about the medication, these should also be included.