The Drug Order
Medications for patient use must be ordered by licensed physicians or dentists (or in some states, by nurse practitioners and physician assistants) acting within their areas of professional training. Placing an order for a medication or treatment is known as issuing a prescription. Initially it may be used verbally or in written form. All prescriptions must contain the following elements: the patient's full name, date, drug name, route of administration, dose, duration of the order, and signature of the prescriber. Additional information may be required for certain types of medications (e.g., for IV administration, the concentration, dilution, and rate of flow should be specified in addition to the method -- "IV push" or "continuous infusion").
Types of Medication Orders
Medication orders fall into four categories: stat, single. standing, and PRN orders.
The stat order is generally used on an emergency basis. It means that the drug is to be administered as soon as possible but only once. For example, if a patient is having a seizure, the physician may order diazepam 10 mg IV stat, which is meant to be given immediately, and one time only.
The single order means administration at a certain time but only one time. For example, a one-time order may be written for furosemide 20 mg IV to be given one time at 7 am. Furosemide would then be administered at that time, but only once.
The standing order indicates that a medication is to be given for a specified number of doses, for example, cefazolin 1 g q6h x 4 doses. A standing order may also indicate that a drug is to be administered until discontinued at a later date, for example, ampicilin 500 mg PO q6h. In the interest of patient safety, however, all accredited health agencies have policies that automatically cancel an order after a certain number of doses are administered or a certain number of days of therapy have passed (e.g., surgery, after 72 hours for narcotics, after one dose only for anticoagulants, after 7 days for antibiotics). A renewal order must be written and signed by the physician before the nurse can continue to administer the medication.
A PRN order means administer if needed. This order allows a nurse to judge when a medication should be administered based on the patient's need and when it can be safely administered.
Health care agencies have policies regarding who may accept verbal orders and under what circumstances they should be accepted. The practice should be avoided whenever possible to prevent medication errors, but when a verbal order is accepted, the person who took the order is responsible for accurately entering it on the order sheet and signing it. The physician must cosign and date the order, usually within 24 hours.
Electronic Transmission of Patient Orders
With the advent of fax machines, many physicians' offices fax new orders to the area where the patient is admitted or transferred. These fax transmissions must have an original signiture within a specified time, often 24 hours. Hospital units also find it useful to fax orders to the nursing home where the individual is being transferred This allows the receiving agency to prepare for the patient or resident, and the original orders, signed by the physician, then accompany the individual at time of transfer.