Safest Way to Express Medication Orders
The safest way to express a medication order is to use the "rights" of medication administration framework, which includes specifying the right student/patient, right medication, right dose, right route, right time, and right documentation, with clear and complete information avoiding abbreviations and using leading zeros before decimal points while eliminating trailing zeros.
Key Elements of Safe Medication Orders
The British Journal of Anaesthesia guidelines on medication safety in the operating room 1 and the "Rights" of Medication Administration framework from the Journal of Pediatrics 1 provide comprehensive guidance on expressing medication orders safely:
Right Patient Identification
- Use patient's full name and identifiers
- Verify patient identity before administration
- Use photo verification when available
Right Medication
- Write the complete medication name (avoid abbreviations)
- Specify the exact formulation
- Cross-reference with patient allergies
- Check expiration dates
Right Dose
- Express weight-based dosing in mg/kg when appropriate
- Use leading zeros before decimal points (e.g., 0.5 mg, not .5 mg)
- Avoid trailing zeros after decimal points (e.g., 5 mg, not 5.0 mg) 1
- Include total daily dose and frequency
Right Route
- Clearly specify administration route (oral, intravenous, etc.)
- Avoid abbreviations that could be misinterpreted
- Use specific language for route (e.g., "intravenous" rather than "IV")
Right Time
- Specify exact administration times or intervals
- Avoid vague timing instructions
- Include duration of therapy when applicable
Right Documentation
- Document all aspects of medication administration
- Record time of administration
- Document any patient response or side effects
Best Practices for Medication Order Writing
Avoid Common Pitfalls
- Avoid abbreviations: Studies show that abbreviations contribute significantly to medication errors 2
- Eliminate Latin terminology: Use plain English rather than arcane Latin words and shorthand abbreviations that are subject to misinterpretation 2
- Prevent illegibility issues: Computerized physician order entry (CPOE) has been shown to reduce medication errors by 70% compared to handwritten orders, with a 97% reduction in illegibility errors 3
Format and Structure
- Write out instructions completely
- Specify subsequent administration requirements for IV fluids
- Avoid "open-ended" orders that don't include duration or reassessment parameters 4
- Include patient weight in kilograms when relevant for dosing
System-Level Safeguards
- Use standardized order forms when possible
- Implement barcode verification systems
- Utilize computerized physician order entry systems
- Have pharmacy review all medication orders
Examples of Safe vs. Unsafe Medication Orders
Unsafe Order:
"Vanc 1g IV q12h"
Safe Order:
"Vancomycin 1 gram intravenously every 12 hours. Infuse over 60 minutes. Total daily dose: 2 grams. Duration: 7 days."
The safe order follows FDA guidelines for vancomycin administration 5, specifying the complete medication name, exact dose, administration route, frequency, infusion time, total daily dose, and duration of therapy.
Conclusion
Following the "rights" of medication administration framework and avoiding common pitfalls like abbreviations, illegible handwriting, and incomplete information are essential for safe medication ordering. Computerized physician order entry systems have demonstrated significant reductions in medication errors 3, 6 and should be utilized when available.