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Mistakes and inaccuracies in the orders, such as incorrect or missing doses (e.g., magnesium sulfate 16 g instead of 16 m Eq), routes, frequencies of administration, and rates of infusion; typos; and spelling errors, particularly with drug names An exhaustive variety of medications to cover every possible scenario a patient may face (e.g., orders that include multiple analgesics by various routes, laxatives, antacids, a bedtime sedative, antidiarrheal, antiemetic, and others); we’ve previously called these “Don’t bother me” orders, which lead to crowded medication administration records and leave treatment decisions to nurses’ subjective, variable judgment Dosing guidance not provided (e.g., mg/kg or mg/m2 dose not specified along with the calculated dose, particularly for neonatal/pediatric drugs and chemotherapy; safe dose range or maximum safe doses not specified; dosing parameters for titrated drugs not provided) Critical clinical decision support information, reminders, precautions, and/or safety measures not included, such as: monitoring requirements; administration precautions; adjustments for renal impairment or age; maximum adult total dose of acetaminophen not to exceed 3 to 4 grams per 24 hours The format of standard order sets can make them easier to read and comprehend, remind staff to document pertinent information about the patient and prescribed therapy, and draw attention to important information.
Careful attention to the content of standard order sets helps ensure they: 1) are complete, 2) include important orders be-yond what the prescriber may initially consider (e.g., specific monitoring requirements), 3) reflect current best practices, and 4) are standardized among various practitioners who provide care to patients.(1-4) Examples of frequently observed problems with the content of standard orders follow.If you feel we have provided something of value and wish to show your appreciation, you can assist the College and its students with a tax-deductible contribution.For more about giving to Capital, write to CCC Foundation, 950 Main Street, Hartford, CT 06103. Contributions are tax-deductible to the extent allowed by law.No space is provided between the drug name and dose (e.g., propranolol20 mg can be misread as 120 mg), or the numerical dose/volume measure and the unit of measure (e.g., 3Units can be misread as 30 units) Use of error-prone symbols, abbreviations, drug name abbreviations, drug name stems, undefined drug protocol acronyms, or coined names (e.g., magic mouthwash) (see ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations at: org/tools/errorproneabbreviations.pdf) Look-alike drug names listed without using standardized tall man letters to help differentiate them (see the FDA and ISMP Lists of Look-Alike Drug Name Sets With Recommended Tall Man Letters at: org/tools/tallmanletters.pdf) Lack of prompts for patient allergies with description of the reactions; actual weight (in kg or grams only); body surface area for oncology patients; diagnosis/comorbid conditions (e.g., diabetes mellitus, liver or renal impairment, behavioral health disorders, hypertension); and pregnancy/lactation status Complex order sets (e.g., TPN) that list additives in a different sequence and doses in different units (e.g., mg vs. mg/liter) than the pharmacy order entry system No prompts on neonatal, pediatric, and oncology order sets to require the prescriber to include the mg/kg or mg/m2 dose for drugs prescribed according to weight or body surface area, the calculated dose, the actual dates of administration, and the cycle number (for chemotherapy regimens) Managing the initial approval of standard order sets and keeping them current present numerous challenges to organizations.Without a standard process to address the approval and revision of standard orders, unacceptable variations in care and errors are possible.
That site contains hundreds of quizzes, most of them contributed by ESL teachers (and some students) from all over the globe.