Pharmacology, part 3: Prescriptions

Hi, I'm Cathy with Level Up RN. In this video, I will be discussing prescriptions, including the types of prescriptions and the timing of administration, as well as prescription components, telephone orders, and prescription abbreviations. And at the end of the video, I'm gonna give you guys a little quiz to test your knowledge of some of the key points I'll be covering, so definitely stay tuned for that. And as always, I will be following along with our Level Up RN pharmacology flashcards. If you have our flashcards, definitely pull those out, so you can follow along with me, and pay close attention to the bold, red text on these cards because those represent the most important facts that are very likely to show up on a nursing school exam.

Let's first talk about the types of prescriptions that you may encounter. First of all, we have our time critical scheduled medications. So what are some examples of time critical medications? These can include antibiotics, anticoagulants, as well as insulin. So for these time critical medications, we need to give them within 30 minutes of the scheduled time. So they can be up to 30 minutes early or 30 minutes late, but it has to fall in that window. All right. Next, let's talk about our non-time critical scheduled medications. So for medications that are scheduled daily, weekly, or monthly, we can give those within two hours of the scheduled time. However, if the, uh, medication is prescribed more frequently, so twice a day, which is BID, or three times a day, which TID, then we need to give those within one hour of the scheduled time. And again, every facility will have its own policy, so definitely follow your facility's guidelines on when you need to, um, give different medications for your patients.

Then we have our one time or single dose prescription. This is where you give the medication once at a specified time. And then a stat order means that you're going to give that medication once immediately. And then we have our PRN, or as needed prescriptions. PRN, uh, prescriptions include the dose, frequency, and under what circumstances you can give the medication. So the most common PRN medications include pain medications and nausea medications.

And then finally, we have what's called standing orders. Standing orders are pre-written medication orders that can be given for defined circumstances on a particular unit. So for example, there are often standing orders for hypoglycemia. So if your patient experiences hypoglycemia, you can refer to those standing orders and get them glucagon, like right away. Um, that way you don't have to, like, call the doctor and wait for them to call you back, and in the meantime, your patient is, um, you know, dying from a hypoglycemic coma. So that's why we have standing orders in place. Another example of a standing order, um, set maybe for chest pain, so that you can, um, automatically give nitroglycerin to your patient who is having chest pain. So those are just some, some examples of standing orders that I've seen at my hospital.

So let's now talk about the components of a prescription. Every prescription needs to include the patient's name, the date and time of the prescription, the medication name, the dose strength and form of the medication, the frequency of administration, and the route of administration. And then if any refills are allowed, that needs to be noted on the prescription. And then the provider needs to sign that prescription. So as a nurse, you will be taking telephone orders. That is standard practice. So there are some best practices when it comes to taking a telephone order. So you ideally would like to have a second RN listen in on the call to be sure that you're getting an accurate prescription. You want to repeat the prescription back. So the provider will give you the prescription over the phone. You want to write that down. And then you want to repeat back what you have written to ensure accuracy. And then make sure the provider signs that prescription within 24 hours.

Let's now go over some common prescription abbreviations, starting with abbreviations for route. So G-tube means gastrostomy tube. ID means intradermal. IM means intramuscular. IV means intravenous. IVP means intravenous push. IVPB means intravenous piggyback. J-tube means jejunostomy tube. NG means nasogastric tube. NJ means nasojejunal tube. OG means orogastric tube. PO means by mouth or orally. PR means by rectum. SL means sublingual or under the tongue. And then SubQ means subcutaneous.

Let's now go over prescription abbreviations that deal with frequency. So AC means before meals. AM means before noon. BID means twice a day. H or HR means hour. HS means bedtime, so hours of sleep. MIN means minute. PC means after meals. PM means evening or afternoon. PRN means as needed. Q means every. So when you see Q2H, that means every two hours. Or Q4H means every four hours. QID means four times a day. STAT means immediately. And TID means three times a day. Other common abbreviations include an A with a line over it, which means before. A C with a line over it, which means with. D5NS, which means dextrose 5% in normal saline. D5W, which is dextrose 5% in water. GTT means drop. NPO means nothing by mouth. NS means normal saline. Half NS means 0.45% normal saline. A P with a line over it means after. PER means by or through. LR means lactated Ringer's. RX means prescription. An S with a line over it means without. And then SIG means directions.

The prescription abbreviations shown on the left side of the table should not be used because they are error-prone. So instead, you should use what is shown here on the right side of the table. There are other error-prone abbreviations out there, but these really represent the most common ones that you will see asked about on a nursing school exam. So instead of MS or MSO4, you should use morphine. Instead of MGSO4, you should write out magnesium sulfate. We should not use decimal points without a leading zero. So the example here is point five milligrams, and if you can't see the decimal point, it will look like five milligrams. So instead, you want to use a leading zero. So zero point five milligrams. We also don't want to use trailing zeroes. So in this case, we have two point zero milligrams. If you don't see that decimal point here, then that looks like 20 milligrams. So we want to leave off the trailing zero. So in this case, we just want two milligrams. We don't want to use U or IU, and instead, write out units. We should not use QD, and instead, write out daily. QOD should not be used. Instead, write out every other day. And then SC and SQ should not be used for subcutaneous. So instead, you can write out subcutaneously or SubQ.

All right. It's quiz time. Are you guys ready? I've got three questions for you. First question. Your patient is scheduled to receive their antibiotic at 19:00. What are the earliest and latest times this medication should be administered? The answer is 18:30 and 19:30. So up to 30 minutes before the scheduled time through 30 minutes after the scheduled time. Question number two. What does the prescription abbreviation BID mean? The answer is twice a day. And question number three. Which of the following is correct? Point seven milligrams, zero point seven milligrams, point seven zero milligrams, or zero point seven zero milligrams. The answer is zero point seven milligrams. So we want that leading zero, but not the trailing zero. All right. I hope this video has been helpful. Take care, and good luck with studying.