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IVPB
intravenous piggyback












ml,mL
milliliter (equivalent to cc)







NPO, npo
nothing by mouth

NS, N/S
normal saline (sodium chloride, 0.9%)






PCA
patient controlled analgesia



PRN, prn
whenever necessary







QNS
quantity not sufficient









stat
immediately and once only












ISMP
Institute for Safe Medication Practice

monitors medication administration and identifies practices that have contributed to medication errors
ISMP

JCAHO
Joint Commission on Accreditation of Healthcare Organizations

has approved a list of dangerous abbreviations that have been prohibited effective 1/1/04
JCAHO

medication orders contain 6 parts
 1. date
 2. patient's name
 3. Medication name
 4. dosage or amount of medication
 5. route or manner of administration (if no route is specified, the oral route is usually the appropriate one)
 6. Time to be administered, or frequency

when taking a telephone order, always obtain:
the name of the person calling in the order & write the name of that person & the time the call was made next to the medication ordered

all phone orders must be followed by:
a read back statement

it's the responsibility of the health care practitioner to check:
medication order for completeness by noting the 6 items

the physician must sign all verbal and telephone orders within:
24 hours

the prescription blank contains 2 additional items:
physcian's Drug Enforcement Administration registration # if it's controlled substance & the # of times that the prescription can be refilled

on a prescription blank, check for:
completeness, legibility & accuracy, including date, patient's name, medication name, dosage, router, frequency or time, # of refills and DEA # for controlled substances

some states have passed legislation requiring:
name of the medication to be legibly printed or typed & may require the quantity of the drug prescribed to be in both textual & numerical formats. the prescriber must also print his or her name under the signature

example of legislation passed:
Legible Prescription Law, which became effective in FL on 7/1/03

original system of weights & measure for writing med orders
apothecary system

Is a pharmacist or druggist
Apothecary

the preferred system of measurement & is used at the present
metric system

the lease accurate system of measurement
household system

medication orders are concerned with only 2 types of measurement:
 1. measuring fluids, or liquid measure
 2. measuring solids, or solid weight

includes the minim, fluid dram, fluid ounce, pint, quart and gallon  liquid
 grain, dram, ounce & pound  solid
 apothecary




a ___ is approx equivalent to 1 minim of water, but the type of solution may cause variation
drop

invented by the French in the late 18th century & is the international standard for weights & measures
metric system

includes liter and the milliliter, which is approx equivalent to the cubic cmliquid
 gram & the milligram  solid
 metric

equipment most commonly used for measuring meds include:
medicine cup & various syringes calibrated in millilters and/or minims

5 mL (metric converted to household)
1 tsp

15 mL (metric converted to household)
1 tbsp

30 mL (metric converted to household)
2 tbsp

240 mL (metric converted to household)
1 measuring cup (240 mL)

500 mL (metric converted to household)
1 pt

1,000 mL (metric converted to household)
1 qt

1g (metricgrams converted to metricmilligrams)
1,000 mg

0.6g (metricgrams converted to metricmilligrams)
600 mg

0.5g (metricgrams converted to metricmilligrams)
500 mg

0.3g (metricgrams converted to metricmilligrams)
300 mg

0.2g (metricgrams converted to metricmilligrams)
200 mg

0.1g (metricgrams converted to metricmilligrams)
100 mg

0.06g (metricgrams converted to metricmilligrams)
60 mg

0.05g (metricgrams converted to metricmilligrams)
50 mg

0.03g (metricgrams converted to metricmilligrams)
30 mg

1 lb (pounds converted to kilograms)
0.453592 kg

1 kg (kilograms converted to pounds)
2.2 pounds (lb)

to convert pounds to kilograms:
divide # of pounds by 2.2

be careful in calculating the weight in kg because:
the slightest error, especially in pediatric doses could result in serious or fatal consequences

many meds are dispensed by the pharmacist in:
unitdose form (which each individual dose of med is prepackaged in a seperate packet, vial or prefilled syringe)

when the dosage ordered differs from the dosage on hand, the problem can be solved simply by completing 3 basic steps:
 1. check whether all measure are in the same system; convert if necessary
 2. write the problem in equation form using the appropriate formula & labeling all parts & complete the necessary calculations
 3. check the accuracy of your answer for reasonableness & have someone else verify your calculations

basic calculation:
 desired dose
 ______________ X quantity of onhand dose
 onhand dose

cautions for the basic calculation method:
 1. label all parts of the formula
 2. use the same label for desired and onhand doses
 3. use the same label for the quantity & the answer (the amount to be given)
 4. reduce fractions to lowest terms before dividing
 5. mulitply by the quantity after dividing
 6. take extra care with decimals
 7. convert fractions to decimals
 8. round off decimals to one decimal place after computations complete
 9. verify the accuracy of calculations w/an instructor
 10. question the answer if not within normal limits

describes the relationship between 2 #'S
ratio ex( 1 g: 15 gr)

consists of 2 ratios that are equal:
proportion ex(1 g: 15gr = 2 g: 30 gr)

known unit of : known = desired unit : unknown
measure equivalent of measure equivalent

to solve the problem:
multiply the 2 outer terms or extrems & then multiply the 2 inner terms or means

cautions for the ratio & proportion method:
 1. label all parts of the equation
 2. the ratio on left contains the known quantity & the ratio on right contains desired and unknown quantities
 3. terms of the 2nd ratio must be in the same sequence as those in the 1st ratio
 4. multiply the extremes 1st and then the means
 5. take extra care w/decimals
 6. convert fractions to decimals. round off decimals to 1 decimal place
 7. label the answer
 8. verify the accuracy of calculations w/instructor
 9. question any unusual dosage not w/i normal limits

in neonates, ___ & ____ needed for drug absorption & metabolism are not fully develped.
renal function & some enzyme systems

is more permeble
neonates bloodbrain barrier

contributes a greater percentage of the neonates body weight, also affecting drug aborption
total body water

appropriate dosage for children, as well as adults, must take into consideration variables such as:
age, weight, sex & metabolic, pathological or psychological conditions

recommended pediatric drug dosages are derived from:
data obtained in clinical trials utilizing sick children

when preparing drug dosages for children, always refer to:
PDR or AHFS Drug Information (AHFS DI)

recommended dosages of drugs are often expressed:
in the references as a # of milligrams per unit of body weight, per unit of time

factors leading to possible dangerous cumulative effects for geriatric:
slower metabolism, poor circulation, or impairment of liver, kidneys, lungs or central nervous system.

can affect assimilation of drugs & interfere with therapeutic effect:
any chronic disease, debility, dehydration or electrolyte imbalance

prevention of medication errors:
 1. never lease the decimal point naked. always place a zero before a decimal point
 2. never place a decimal point & zero after a whole #
 3. avoid using decimals whenever whole #'s can be used as alternatives ex(0.5 g can be expressed as 500 mg)
 4. have a 2nd qualified person doublecheck any calculations for accuracy
 5. always question the order if you have any difficulty interpreting the spelling of a drug name or the # used for the dosage, or the dosage seems inappropriate

