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Three quick tips for medication safety success

Ambulatory Safety Monitor, March 3, 2004

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For every medication you prescribe, document a diagnosis, condition, or indication for use. The diagnosis does not have to be within the physician medication order-unless your facility policy requires it-but it does need to be in the medical record. This medical record must be accessible to all staff involved in the medication-use process.

The JCAHO requires you to write and document your orders clearly-and requires other staff, such as pharmacy or nursing, to contact you at any hour if they can't read your writing, rather than interpreting it themselves.

Consider the following three tips to help everyone to read your orders:

1. Clean up messy handwriting

 Take a few extra seconds to write legibly. Print if necessary, or consider having your prescriptions electronically generated.

 Ask someone to read a sample of your prescriptions and give you feedback on your legibility.

 Ask your hospital to consider implementing a computerized physician-order entry system.

2. Don't use 'as needed'

Medication orders or prescriptions that are written "as needed," or PRN, without a specific frequency, have often led to errors involving inappropriate doses. To avoid these errors, note the drug's indication-for-use in order to document why you are prescribing that particular drug.

You don't have to write an indication for PRN medications that only have one understood use, such as a stool softener, but you do have to write an indication if the PRN drug can have more than one possible use, such as Benadryl®. Your organization's policies should clarify when an indication-for-use is required.

TIP: Always indicate a frequency (e.g., Q4H PRN) and dose range (e.g., 20-40 mg) on PRN orders. Also include the reason for the drug and dose (i.e., PRN pain, PRN, fever).

3. Verbal orders and critical lab values

The JCAHO has made improving communication Goal #2 of its 2004 National Patient Safety Goals. As a result, you must reduce your reliance on oral and telephone orders. The bottom line: No verbal orders unless it's an emergency.

Never leave verbal orders on a nurse's or pharmacist's voice mail. This violates the JCAHO's National Patient Safety Goals. Besides, most state laws require nurses and pharmacists to obtain the order directly from you or your agent. Otherwise, they must call you directly to get the order and a confirmation read-back.

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