What is the proper format for writing medication repeats at rounds?

How to Write Proper Medication Repeats at Rounds

When writing medication repeats at rounds, use explicit dosing instructions that specify exact times or time periods (e.g., "8 AM, 2 PM, 8 PM") rather than frequency-based instructions (e.g., "three times daily"), and prescribe the lowest possible daily dose frequency to maximize patient compliance.

Core Principles for Writing Medication Orders

Use Explicit, Unambiguous Language

• Specify exact times or time periods rather than frequency intervals, as this dramatically improves patient comprehension—instructions with specific times (e.g., "morning, afternoon, evening") are understood 89% of the time versus only 53% for hourly intervals (e.g., "every 8 hours") 1

• Patients with limited literacy are 2.7 times more likely to misinterpret frequency-based instructions even when using explicit language, making precise timing critical 1

• Avoid abbreviations like "qid" (4 times daily), "tid" (3 times daily), or "bid" (twice daily) in patient-facing instructions, though these remain standard in medical documentation 2

Optimize Dosing Frequency for Compliance

• Prescribe once-daily regimens whenever therapeutically appropriate, as compliance improves from 59% with three-times-daily dosing to 83.6% with once-daily dosing 3

• This represents the single most important action to improve medication adherence 3

• For chronic conditions requiring continuous therapy (such as antihistamines for allergic conditions), once-daily non-sedating formulations should be prioritized 4

Essential Components of Every Medication Order

Patient Information

• Full name, age, and medical record number 5
• Weight (essential for pediatric dosing and weight-based medications) 2

Medication Details

• Generic and brand name (when applicable) 5
• Exact strength (e.g., "500 mg" not just "metformin") 5
• Dosage form (tablet, capsule, liquid, injection) 2, 5

Dosing Instructions (Most Critical Section)

Use this format for maximum clarity:

• Dose amount: Specify exact quantity (e.g., "10 mg" or "2 tablets")
• Route: PO (by mouth), IV, subcutaneous, etc. 2
• Timing: Use explicit times or time periods
  • PREFERRED: "Take at 8 AM and 8 PM" or "Take in the morning and at bedtime"
  • AVOID: "Take twice daily" or "Take every 12 hours" 1
• Duration: Specify total treatment length (e.g., "for 7 days" or "continue until follow-up") 5
• Total quantity: State total amount to dispense 5

Special Considerations for Specific Populations

Pediatric Dosing

• Round calculated doses appropriately based on medication class 2:

  • Narrow therapeutic index drugs (digoxin, morphine): Do not round 2
  • Most antibiotics: Round by 5-15% to practical volumes 2
  • Medications allowing 10-15% rounding: Round to convenient measuring increments (e.g., 6 mL instead of 5.82 mL) 2

• Adjust doses for age and renal function, particularly for medications like cyclophosphamide where dose reductions are needed for patients >60 years or with creatinine >300 mmol/L 2

Renal Impairment

• Document dose adjustments explicitly for renally cleared medications 2, 4
• For loratadine in severe renal impairment (CrCl <10 mL/min), use with caution and document rationale 4

Maintenance Therapy

• Specify maintenance duration explicitly: For conditions like vasculitis, maintenance therapy should continue for at least 18-24 months 2
• Taper instructions must be precise: "Reduce prednisone by 5 mg every week until reaching 10 mg daily, then continue at 10 mg daily" rather than "taper slowly" 2

Common Pitfalls to Avoid

Ambiguous Frequency Instructions

• Writing "TID" without specifying whether with meals or at specific intervals creates confusion 1
• "Every 8 hours" is less clear than "8 AM, 4 PM, midnight" for shift workers or patients with irregular schedules 1

Incomplete Duration Specifications

• Failing to specify duration leads to premature discontinuation or excessive continuation 2
• For antibiotics, always state total days (e.g., "for 10 days") 5

Inadequate Monitoring Parameters

• When prescribing medications requiring monitoring (e.g., methotrexate, azathioprine), document monitoring schedule: "Check CBC and LFTs every 4-6 weeks" 2

Documentation for Rounds

When writing repeats at rounds, structure your note to include:

1. Current medication with exact dosing as outlined above
2. Indication for continuation or modification
3. Any dose adjustments with rationale (e.g., "Increased lisinopril from 10 mg to 20 mg daily due to persistent BP 145/92")
4. Monitoring plan if applicable
5. Duration of therapy or next reassessment point

This systematic approach reduces medication errors, improves patient comprehension, and enhances compliance—the three pillars of effective medication management 5, 1, 3.