Why are medication orders written this way?

Nurses General Nursing

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Is this common practice in writing orders? If so, why? For example: 3 mg coumadin 1/2 tab daily. Why doesn't it read, 1.5 mg coumadin daily? OR at least give the complete order: 3 mg coumadin 1/2 tab for a total of 1.5 mg daily? I would expect that there should never be a number present in an order for a nurse to read that is not being administered, when possible. I've seen this cause med errors on both the part of the nurse and the pharmacy.

Our EMR which doubles as an E-script had the same problem, it's an easy fix though, you just need to have them separate the "dispense as" drop down box (which will be limited to available dosages) from the "dose" box which shouldn't have defined limits.

Good to know.

We're switching to an E-MAR eventually, and one of my reservations was that we wouldnt be able to re-write some of the iffy ways pharmacy writes the medication orders.

They need to understand that the dispensing of medication and the administration of medication are two different things.

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Specializes in Critical Care.
Good to know.

We're switching to an E-MAR eventually, and one of my reservations was that we wouldnt be able to re-write some of the iffy ways pharmacy writes the medication orders.

They need to understand that the dispensing of medication and the administration of medication are two different things.

I am truly ashamed at how Nursing has responded to the development of EMR's. The initial unofficial position of the ANA on EMR's was that they were bad and we were not going to play any role in their development, and for some reason we now complain that EMR's don't appear to have been developed with any Nurse input (no $$$$ sherlock). As a result most EMR's are not in any way Nurse-friendly and in general don't facilitate Nursing care.

I think that most Nurses who still actually practice Nursing don't agree with the idea that Nurses should not have any input into EMR's, and luckily most EMR's are still fairly open to Nursing feedback and can be changed to accommodate Nursing care and patient safety surprisingly easily, it's just takes someone to actually make the changes.

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I see this all the time in the SNF charts I review. I think it's dangerous for a number of reasons, and it's certainly not approved standard of practice for physicians to prescribe it that way. Note that "1/2 tab" is not a "dose." As an example:

Physician wants Randomycin 250mg given; since it comes in 500mg tabs, he writes "Randomycin 250mg, 1/2 tab." Alas, unbeknownst to him, pharmacy has just started stocking 250mg tabs because the manufacturer got so many requests for 250mg doses. And of course, now the patient is getting 125mg and no one the wiser.

This is why nurses have to pass medication "math" (really basic algebra) in nursing school. If we are asked to give 250mg and we see the tabs are labeled 500mg we know to give 1/2 of it (assuming it's possible to break it safely and give a broken tab).

Here's a nationally-approved protocol on this.

http://www.guideline.gov/content.aspx?id=39268&search=writing+dose

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Specializes in Adult Internal Medicine.

The basic requirement for outpatient prescriptions (for most states) are drug name, drug strength, dosage form, and dispense number/quantity. Obviously inpatient where meds are being administered and outpatient where meds are being taken are much different beasts.

I wish our system included a "dosage" field but it doesn't; it is a shame that is doesn't because it seems to be easy enough to add.

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Specializes in Pedi.
The basic requirement for outpatient prescriptions (for most states) are drug name, drug strength, dosage form, and dispense number/quantity. Obviously inpatient where meds are being administered and outpatient where meds are being taken are much different beasts.

I wish our system included a "dosage" field but it doesn't; it is a shame that is doesn't because it seems to be easy enough to add.

That seems legit for outpatient prescriptions but not so much for inpatient orders. I just looked at my online patient portal as I take a medication that I take 1 1/2 tablets of. The way it is written is 0.15 mg (0.1 mg tablet, take 1.5) twice a day for 90 days. Dispense 270. If I were inpatient or if I were giving this exact dose to a patient in the hospital, I'd expect the order to be written as "desmopressin 0.15 mg PO BID" with no mention of how many tablets the dose would be.

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Thank you all for the feedback. I found it to be helpful/informative.

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Is this common practice in writing orders? If so, why? For example: 3 mg coumadin 1/2 tab daily. Why doesn't it read, 1.5 mg coumadin daily? OR at least give the complete order: 3 mg coumadin 1/2 tab for a total of 1.5 mg daily? I would expect that there should never be a number present in an order for a nurse to read that is not being administered, when possible. I've seen this cause med errors on both the part of the nurse and the pharmacy.

I just encountered the 1.5 Coumadin order yesterday..wondered the same thing!

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I was so irate at work the other day when I discovered a "blah blah 300 mg take 2 tabs."

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