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Medication Orders

This lesson will cover the QMAP’s role in translating, transcribing, starting, changing, or stopping medication orders.

Every action a QMAP takes with regard to medication administration requires a physician order. Whether to administer OTC medications, or to crush medications, an appropriate physician order must be present. Read on to learn what constitutes an appropriate physician order, and how to appropriately translate and transcribe the orders onto a Medication Administration Record (MAR).

The Six Components of a Physician Order for QMAPs

QMAPs cannot take a verbal or phone order from a physician under any circumstances.

All orders that a QMAP may follow must be written, faxed, or otherwise digitally available to read, such as in an electronic health record (EHR).

Facilities may accept faxed orders from a physician, but not from a pharmacist unless it is a copy of a signed physician order.

A hand pointing to a checklist on paper, with an illuminated checklist hovering over the paper.

Six Components

  • Client’s Full Name
  • Name of Medication
  • Dose
  • Route
  • Date
  • Physician/Provider Signature

Clients may encounter circumstances where they are sent to the hospital for an inpatient stay. When this occurs, upon the client’s return the facility must obtain new orders for each medication to be administered, including OTC and PRN medications. An order saying: “Resume previous orders” is not acceptable, and the QMAP should notify their supervisor to seek full clarification of the orders from the physician. The formal name for this process is called “medication reconciliation.”

What’s the Dose?

An important part of the order is the dose of the prescribed or OTC medication. The dose is how much drug is given each time the drug is administered. Proper dosage instructions will include the amount of medication (for example: 40 mg), the frequency to administer the medication (for example: twice daily), and how long to continue administering the medication. For example an order for antibiotics may specify to take the medication only for six days. If an order does not specify an end-date, the medication is continued until a new order to discontinue the medication is written and placed in the chart.

What is the “Strength” of the Drug?

The strength of the drug indicates the amount of medication per each unit of drug. For example, in an order for Lasix 40mg PO BID, the strength of the drug is 40mg, and the unit is per each tablet. The strength of the drug is also it’s concentration when in liquid form. For example, oral hydrocodone syrup may come in 5mg/10ml, its strength is 5mg for each 10ml of liquid. In this case, the unit of drug is the 10ml of liquid for each 5mg of drug you want to administer.

Why Metric? Why not Imperial?

The metric system is just better.

In the metric system, a base 10 decimal system of standard weights and measures is used, and size/volume are indicated with prefixes. This allows easy conversion between units!

For purposes of this course, the base units are the gram, and liter. The prefixes include, milli – 1/1000, centi – 1/100, kilo – x1000. So a milligram is 1/1000th of a gram, and a kilogram is 1000 grams. 1 milliliter is 1/1000 of a liter (about a drop). Converting between these is just a matter of moving the decimal back and forth by your conversion factor!

The imperial system is messy.

Also called the ‘household’ system, units are not standard, and converting between them can be tortuous. For example in the imperial system 3 teaspoons are in 1 tablespoon, there are 16 tablespoons in 1 cup, which is eight fluid ounces, and there are four cups in a quart, and four quarts to a gallon… Well, that’s rather difficult to convert between quickly! Lets try weight! There are 16 ounces in a pound, and 2,000 pounds to a ton… Hmmm, not much better eh? So whenever possible, use the metric system!

Refer to your study guide, and pay attention to the equivalents box! You will need this for dosage calculation later!