MODULE 5│USA
HOSPITAL PHARMACY INTERNSHIP
HOSPITAL PHARMACY INTERNSHIP
Interpretation of Medication Order
and Preparation of Labels
At the end of the module, the student must be able to:
• Demonstrate understanding of the format and
components of a typical institutional medication order
• Demonstrate ability to review and interpret every
medication order and resolve any problems or
uncertainties with it before the drug is entered into the
dispensing system
• Demonstrate ability to create a proper label of drug based
on medication order.
Medication Order
Medication Prescription and Medication Orders
Typically, the term “prescription” refers to a medication order on a
prescription blank that is transmitted in writing, verbally, or
electronically to be filled in an outpatient or ambulatory care setting.
The term “medication order” refers to a physician’s written,
electronic, telephone, or verbal request for a medication in an
inpatient setting.
Medication Order
• A medication order is written by a practitioner for a medication
that will be administered. Medication orders are required
before a nurse may administer medications.
• A medications order must include specific information before
the medication order can be carried out. As with other orders,
the medication becomes a permanent part of the patient
record.
• A medication order may be written, typed, or it may be given
verbally or by telephone to a licensed nursed or pharmacist.
Medication Order Requirements
Below is a list of the information that should be included in a medication
order.
• Patient’s Name
• Date and time the order is written
• Name of medication to be administered
• Dose of the medication
• Route by which the medication is to be administered
• Frequency of administration of the medication
• Signature of person writing the order
Patient’s Name
• The medication order should always include the patient’s
name.
• You should also be aware of the patient’s name or initial if
they have one.
• This can help you to avoid any confusion with another
patient that has the same last name.
• That patient’s name is not located on the patient’s chart
but, also on individual documents including the
medication order.
Date and Time the Medication Order is Written
• The date and time the order is written should always be
included in the medication order. This information helps
the medication from being overlooked. Not only will you
Hospital Pharmacy Internship
know exactly when the medication was ordered, but you
will also know when the first dose is due.
• There is more than one shift in a 24hour period. It can get
busy and there may be oversight with medication orders.
Especially when a medication order is written close to or
during shift change. The date and time will help prevent
medication errors. It also helps prevent missed doses.
• The date and time are also important for medications given
over a specific time period and needs to be discontinued
on a specific day. When the medication order is dated and
time you will know which dose will be the last dose.
Name of the Medication to be Administered
• It goes without saying that the name of the medication
should be on the medication order. The name of the
medication may be written as the brand name and/or
generic name. Generic medications are well-known and
used by many healthcare facilities.
Dosage of the Medication
• The dosage of a medication is normally stated using the
metric system. However, sometimes medication orders are
written using household system. The metric system is the
most widely used system. It is also considered to be the
safest system for the measurement of medication dosage.
You are more likely to see household measurements in the
community setting.
• There are certain abbreviations used to indicate
medication amounts. These common abbreviations are
used on the medication order.
Route the Medication is to be Administered
• The route of medication administration is included in the
medication order. Specifying the route is important
because some medication can be given via more than one
route.
• Some medications may be safe for administration to a
patient via one route and not safe for a different patient via
the same route.
Frequency of Administration of the Medication
• The frequency a medication is to be administered is
included in the medication order. Most of the time the
frequency is written using medication dosage
abbreviations.
• The healthcare facility’s policy or the pharmacy department
determines the frequency and times for routine
medications.
• Also, healthcare facilities use military time or 24-hour
clock. Midnight is 0000 hours and counts till 2400 hours.
So 9 AM will be 0900 hours and 9 PM will be 2100 hours.
• For medications given before a particular meal such as
before breakfast, the administration time will vary
depending on the time meals are served at that facility.
• For medications given once or twice a day, the time of day
will depend upon the medication and the patient’s plan of
care. Also, some facilities may have standard times for the
administration of medications once a day (QD) or twice a
day (BID)
• Sometimes a patient may have a preference about the
time they want to take a particular medication. Consider
the patient’s choice as long as it falls within the guidelines
of safe practice.
Signature of Person Writing the Order
• The medication order must include the signature of the
prescribing practitioner.
• When a facility uses a computerized system, the prescriber
has a username and password that identifies them as the
prescriber. Their information is automatically added to the
medication record. There is no need for a handwritten
signature with these systems.
• The signature whether handwritten or computer-generated
makes this order a legal part of the patient’s chart.
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 Types of Medication Order
There are several types of medication orders. They are based on
the medication must be given and the urgency of the dose.
There are also different policies for medication administration that
affect medications orders. Some facilities discontinue all
medications when a patient goes and to surgery and the
medications have to be reordered.
Standing Medication Orders
• A standing medication order is a set of prewritten orders
that a nurse can use to administer treatments and
medications.
• These are usually written by a specific practitioner and
allows the nurses to administer certain medication without
a physician order. In a way, these are the physician
orders. Standing orders are approved by the practitioner.
• Standing orders are used until they are canceled or until
the number of days has passed for the standing order.
These orders usually contain the number of treatments to
be given and how long the treatments should last.
PRN Medication Orders
• These medications are only given when the patient
requires them. Medications for pain relief, sleep, and
nausea can be written as PRN orders. Sometimes you will
find medications for blood sugars and high blood pressure
given as a PRN medication order.
• PRN medication orders usually have guidelines for when,
what doses, and how often the medication should be
administered. With PRN medication you must use
assessment and discretion when administering.
Single One-Time Medication Orders
• These medications are given only once at a specific time.
Medications given preoperatively are usually single one-
time medication orders.
• Medications used to treat an acute symptom may be
given as a single one-time order. And medications used
for diagnostic procedures are given as a single one-time
dose.
• Once the dose is given the order is no longer active. If the
patient needs another dose of the same medication
another order must be written.
Stat Medication Orders
• These orders are for a medication that be given
immediately. These orders are also for a single dose of
medication.
• A stat order may be written and another order to continue
the same medication for a specific time at a specific dose.
This medication order must include all the requirements of
any medication order. Stat orders are usually written in
emergent situations.
Now Medication Orders
• These orders are written the patient needs the medication
quickly but not immediately. The now medication order is
a single one-time dose of medication. There is usually an
hour window of time to give a now order medication, but
as always check your facility’s policy.
Receiving and Processing of Medication Order
Receiving Medication Orders
Medications orders come to the pharmacy in various ways:
• Written Medication Order – Orders are handed-
delivered to the pharmacy or one of its satellites or are
sent via a mechanical method, such as fax transmission
or pneumatic tube.
• Scanned Medication Order – Some institutions utilize
technology that allows a scanned image of a written order
to be transmitted to the pharmacy for processing.
• Computer Physician Order Entry (CPOE) – Medication
orders entered directly into the computer system by the
Hospital Pharmacy Internship
prescriber.
• Telephoned Medication Order – may be telephoned to
the pharmacy by either the prescriber or an intermediary,
such as a nurse.
Upon receipt of a medication order, two steps should be taken.
• The first is to review the order for clarity and completeness.
• The second is to prioritize the order on the basis of a
number of factors, including the time the medication is
needed, the seriousness of the condition that is being
treated, and the urgency of the other medication orders
waiting to be processed.
Processing Medication Orders
After an order has been received, determined to be clear and
complete, and prioritized, it is ready to be processed.
Processing usually involves a computer, but some pharmacies still
use a manual system (typewriters, pen and paper, profile cards, or
notebooks).
A number of steps are involved in processing an order.
• First, the patient must be positively identified to avoid
dispensing medication to the wrong patient.
• Then, a number of order entry steps occur to update the
patient’s medication profile. These steps include such task
as.
✓ choosing the current medication from the database
✓ identifying the administration schedule
✓ and entering any special instructions
• Finally, the medication must be selected, prepared or
compounded, checked, and dispensed for use.
Preparation of Dispensing Labels
Dispensing Labels
When a prescription
medicine or an over-
the-counter medicine is
dispensed to the
patient, a dispensing
label giving specific
instructions on its
usage shall be fixed to
the packaging of the
medicine.
If the dispensing label
is fixed to the original
commercial pack, it
should not obscure
important information
on the original label.
When a medicine has
to be prepared or taken out of the original pack, the dispensing label
shall be fixed on an envelope or ana suitable container used for
packaging the medicine.
Minimum Labelling – GSD
• Generic name
• Strength of medicine
• Individual Dosage Instructions
The route of administration should be stated if other than oral.
Design and Readability
On individual patient prepacks, the design of the manufacturer’s
label should allow the addition of the pharmacy label without
covering important patient information.
Primary patient information elements should be adjacent to each
other so that they can be read at a glance and should not be
distributed amongst the remaining text.
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There should be a “patient side” reserved for primary patient • Machine readable bar code to reduce medications errors
information with a clear blank space for the pharmacy label. • Name of marketing authorizations holder
• Name of pharmacy/dispensing agency
Any information that is not primary Information should appear on • Date of dispensing
the other sides of the container.

• Pharmacy labels should be printed or typewritten. Print

size should be a minimum 2 mm type size and in a clear
font, such as Arial. The print should not fade when
exposed to water or sunlight. Manufacturers’ labels
should fulfil establishment criteria for good readability.
• Abbreviations and unfamiliar expressions should not be
used, especially for the indications for use and dosage
instructions.
• Graphic symbols for patient instruction should not be used
alone but should always be combined with written
instructions.

Individualized Primary Patient Information

Pharmacies/dispensing agencies should individualize the pack of the

prescribed medicine by use of a pharmacy label.

Prescribed medicines are personal medicines. Many medicines can be

used for a variety of illness and in a range of doses. The indication or
intended use and dosage instructions are generated for the specific
patient by his/her prescriber.

Whenever practical, individualized in formation should be put in the

inner packaging.

Primary patient information should be easy for the patient especially the
elderly patient, to read. It is the critical information to be read and
understood before the patient starts taking the medicine. Therefore, it
should not be broken up amongst any supplementary that is less
important to the therapeutic situation.

Primary patient information elements are:

Generic information:
• Name of medicine
• Strength
• Warnings and directions for if use (if necessary)
Individualized information:
• Name of patient
• Dosage instructions
• Indication or intended use

A common format is recommended for primary patient information.

Good Labeling of Prescribed Medicines (GLPM)

The following label elements, in no particular order of priority, are

considered optimal for Good Labeling of Prescribed Medicines
(GLPM):

• Product name – This may be the brand name

• Generic name of active ingredients – Preferably adjacent to
the product name. The International Nonproprietary Name
(INN) should be used, and the chemical form relevant to the
strength.
• Strength – Expressed in numerals and units as parts of the
product name for each active ingredient.
• Dosage form
• Route of administration
• Total quantity in the package (e.g., number of tablets, ml of
liquid)
• Individual dosage instructions – As stated or agreed with the
prescriber
• Individual indication or intended use - As stated or agreed
with the prescriber
• Batch identification – This is applicable to both bulk
dispensing or original packs
• Expiry date – Expressed as a “used before” date. If the
medicine has a limited shelf life once the package open, this
should also be on the label.
• List pf excipients – All excipients of medical relevance
• Any special instructions – For example “Do not chew”, “Take
with a meal”
• Any special storage instructions – For example “Store
between 2-8c”, “Keep out of sunlight”
• Any special warnings or precautions – for example “Do not Reference/ Source:
drink alcohol”, “This medicine may make you feel sleepy” • Review notes in NEOLMS USA
• Name of the prescriber • Discussion Video
• Name of the patient
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