C3.2 R4(b): Accurately transcribe a medication order onto the medication profile or health record #2

Order was faxed ~ 1000hr on Jan 11/17 for:

  • Order written on Jan 10/17:
    Furosemide 40mg IV in the ER tonight then 40mg IV at 800hr
  • On the same order: also written Furosemide 40mg IV, Carvediolol 37.5mg and Bisoprolol 10mg
    • No frequency written for all
    • Med Rec was filled out with no orders ticked off
    • Med Rec only had carvedilol and bisoprolol, but no furosemide doses given previously

Discussed with preceptor and entered:

  • Furosemide 40mg IV x 1 dose at 800hr today
  • In comments: wrote ON JAN 11/17
  • As it is wardstock, nothing will be charged out of Langley Main and no labels would be printed out.

Rationale:

  • Although dose is given, putting furosemide IV x 1 dose on the med profile will provide a record of the furosemide dose so that the team (e.g. nurse, physician, pharmacist) is aware
  • Would help to prompt the physician to reassess the furosemide as only 1 dose is written on the med profile for Jan 11
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s