How to Read & Transcribe Prescription Orders

 

 

 

Reading Prescriptions

 

 

 

 

• Medication prescriptions are written by Licensed Practitioners.

• The Practitioner’s handwriting may be difficult to read however, it is the responsibility of the Pharmacist to ensure clarity of the prescription order.

 

Transcribing Medication Orders:

• Once a medication has been ordered and dispensed by the Pharmacy, it will be the responsibility of the employee to ensure accurate and timely transcription of the medication onto the correct Medication Administration Record, according to agency protocol.
• Writing legibly is very important when transcribing medications. This can prevent medication errors, and ensure client safety in medication administration.
• The only agency approved abbreviations should be used when transcribing medications
• All orders should be transcribed exactly as written. If an order is written with an unapproved abbreviation, a prescribing practitioner must be called for clarification.
• It is important to compare medications transcribed to medications on hand when preparing monthly Medication Administration Records.

Transcribe means to write down or to copy 

 

In medication administration, it means to copy medication or treatment orders onto the MAR

• Orders are copied onto the MAR when the order is obtained or written

– Initial or sign and date orders written on the MAR

– Transcribe using proper abbreviations or written out completely; include all components of a medication order

– Count number of dosages to be administered instead of the number of days when calculating stop dates for medication orders that have been prescribed for a specific time period, such as antibiotics

– Do not schedule PRN orders for administration at specific times; they are administered when resident “needs” the medication for a certain circumstance

• A discontinue order must be obtained for an order to be discontinued unless the prescribing practitioner has specified the number of days or dosages to be administered or indicates that the dosage is to be changed.