Prescription Chart with Omissions and Errors (space for notes below)
INPATIENT MEDICATION PRESCRIPTION CHART AND ADMINISTRATION RECORD
Surname Hospital no. Gender Allergies, sensitivities and adverse drug
Patient 123456 Male reactions
Medicine/substance and details of reaction
First Name Admission Date Weight(kg)
Joe 22/05/2020 60 kg
Date of Birth Ward Height(cm)
18/03/1945 Apple 170 cm
Consultant Trainee Dr Chart………. Date: Signature:
Noble A. Prescriber Of…………….
Other Charts in Diabetes Epidural PCA Parenteral Syringe Other (specify)
Use (tick) Nutrition driver
Complete Electronic VTE Risk Signature: A. Prescriber Date: 22.05.2020
Assessment
MEDICINES MANAGEMENT
Medication History Completed on Patient Name and Designation Date
Electronic Record M. Pharma Ward Pharmacist 23.05.2020
Date and Time Discharge Prescription Written Verified by (Name and Signature) Date
ONCE ONLY MEDICATIONS - premedication, loading doses, surgical antimicrobial
prophylaxis
Date and Medication Name Dose Route Sign & Given Date and Pharmacy
Time Bleep By Time
22/05 22.00 Prednisolone 30 mg PO AP 123 AN 22/05 22.15
22/05 22.00 Amoxicillin 500 mg IV AP 123 AN 22/05 22.15
22/05 22.00 Furosemide 40 mg IV AP 123 AN 22/05 22.15
22/05 23.15 Aminophylline in 300 mg IV AP 123 AN 22/05 23.30
100 mL Sodium
Chloride 0.9%
over 20 minutes
Codes for when medicine(s) not administered as prescribed
1 Patient away from ward 2 Patient unable to receive e.g. NBM 3 Patient refused
4 Self-medicating witnessed 6 Self-medicating not witnessed 7 Delayed administration – state reason
8 Other – state reason X Omitted on instruction of doctor
OXYGEN PRESCRIPTION
Date Dose Route Target Frequency – Sign & Date Stopped, Nurse
Started (% or Nasal Cannula, saturation continuous or Bleep Sign & Bleep Sign
L/min) Simple Face Mask, when
Reservoir, Venturi, required
Humidified, other
22/05 24% Venturi Mask 88-92% Continuous AP 123 24/5 AP 123 AN
ORAL ANTICOAGULANT PRESCRIPTION - DIRECT ORAL ANTICOAGULANT (DOAC)
Indication Date Length of Sign & Pharmacy Refer to anticoagulant clinic
AF Started Treatment Bleep 28 TTA Anticoagulant book & alert card given
24/05 Long-term A. Prescriber MP 24/5
123 Patient counselled
Patients newly started on a DOAC e.g. apixaban, dabigatran, edoxaban, rivaroxaban, must be referred
to the anticoagulant clinic, be provided with the relevant anticoagulant alert card and counselled on
the medicine before discharge.
Medication Date
Time Dose
Edoxaban 24
06
Date 24/05 Route PO 09 60 mg AN
Sign & Bleep 12
A.Prescriber 18
Instructions 22
24
ORAL ANTICOAGULANT PRESCRIPTION - VITAMIN K ANTAGONIST
Indication Date Length of Sign & Pharmacy Refer to anticoagulant clinic
Started Treatment Bleep Anticoagulant books given
Target INR Patient counselled
Patients prescribed Vitamin K Antagonists e.g. warfarin, must have a follow-up appointment, be
provided with a completed anticoagulant record book and counselled on the medicine before
discharge.
Medication Date
INR
Route PO Dose at 18:00
Sign & Bleep Signature
Given By
Pharmacy codes:
S = stock drug IP = inpatient supply POD = patient’s own medicine
TTA = dispensed by pharmacy with instructions POSH = patient’s own supply at home
REGULAR PRESCRIPTION
Date 22 23 24
Medication Time Dose Additional Information
Enoxaparin 06
09
Route SC Sign & Bleep 12
A. Prescriber 123
Date 22/5 18 40 mg
Pharmacy 22
S 23/5 MP 24
Medication Time Dose Additional Information DRIVEN BY OXYGEN
Salbutamol 06
09 5 mg AN
Route NEB Sign & Bleep 12 5 mg AN STOP
A. Prescriber 123
Date 22/5 18 5 mg A Prescriber 24/05/20
Pharmacy 22 5 mg AN
S 23/5 MP 24
Medication Time Dose Additional Information DRIVEN BY OXYGEN
Ipratropium 06
09 5oo mcg AN
Route NEB Sign & Bleep 12 500 mcg AN STOP
A. Prescriber 123 500 mcg
Date 22/5 18 A Prescriber 24/05/20
Pharmacy 22 500 mcg AN
S 23/5 MP 24
Medication Time Dose Additional Information with/after food
Prednisolone 06
09 30 mg AN AN
Route PO Sign & Bleep 12
A. Prescriber 123
Date 22/5 18
Pharmacy 22
S 23/5 MP 24
Medication Time Dose Additional Information
06 500 mg
Amoxicillin AN AN
09
Route IV Sign & Bleep 12 500 mg AN AN
A. Prescriber 123
Date 22/5 18
Pharmacy 22 500 mg X AN AN
S 23/5 MP 24
Medication Time Dose Additional Information
Amiodarone 06 200mg AN
09
Route PO Sign & Bleep 1214 200mg AN
A. Prescriber 123
Date 23/5 18
Pharmacy 22 200mg AN AN
S 23/5 MP 24
REGULAR PRESCRIPTION
Date 22 23 24
Medication Time Dose Additional Information Rate should not exceed 4 mg/minute
Furosemide 06
09 40 mg AN AN
Route IV Sign & Bleep 12
A. Prescriber 123
Date 22/5 18
Pharmacy 22 40 mg AN AN
S 23/5 MP 24
Medication Time Dose Additional Information Contains budesonide and formoterol
06 Rinse mouth after use
Symbicort
09 1 puff X AN
Route INH Sign & Bleep 12
A. Prescriber 123
Date 22/5 18
Pharmacy 22 1 puff X AN AN
POD 23/5 MP 24
Medication Time Dose Additional Information
06
09
Route Sign & Bleep 12
Date 18
Pharmacy 22
24
Medication Time Dose Additional Information
06
09
Route Sign & Bleep 12
Date 18
Pharmacy 22
24
Medication Time Dose Additional Information
06
09
Route Sign & Bleep 12
Date 18
Pharmacy 22
24
Medication Time Dose Additional Information
06
09
Route Sign & Bleep 12
Date 18
Pharmacy 22
24
AS REQUIRED MEDICATIONS
Medication Date
Salbutamol
Indication SOB - COPD Time
Dose Route Start Date
2 puffs INH 22/5 Dose
Max Dose/Frequency in 24 hours
4-6 hourly Route
Sign & Bleep Pharmacy Given
A. Prescriber 123 POD 23/5 MP By
Medication Date
Paracetamol
Indication Pain/Fever Time
Dose Route Start Date
1g PO 23/5 Dose
Max Dose/Frequency in 24 hours
Route
Sign & Bleep Pharmacy Given
A. Prescriber 123 S 23/5 MP By
Medication Date
Indication Time
Dose Route Start Date
Dose
Max Dose/Frequency in 24 hours
Route
Sign & Bleep Pharmacy Given
By
Please indicate the reason where option 7 OR 8 has been chosen for not administered as prescribed
Date Time Signature Reason for non-administration/delay and action taken
INFUSION PRESCRIPTION
Infusion Fluid Medication Duration Administration
Route Signature
Date Name and Approved Name Rate of Date Given Checked Start Finish
/Line Volume & Bleep Pharmacy
Strength and Dose Infusion Given By By Time Time
Sodium 18 mL
Aminophylline AP
22/5 IV Chloride 250 mL per
123
23/5 AN NU 00:15 14:10
250 mg hour
0.9%
Sodium
1000 Potassium AP
23/5 IV Chloride mL
3 hours
123
23/5 AN NU 12:30 15:30
40 mmol
0.9%
Notes on Prescription Chart
Prescription Chart with Omissions and Errors Highlighted
On the next page, find the same drug chart with the errors and omissions highlighted. If you
did not manage to find them all, try again and compare the two prescriptions. Be sure to try and
find the errors on the charts above before continuing.
Explanations and learning points can be found at the end of the document.
INPATIENT MEDICATION PRESCRIPTION CHART AND ADMINISTRATION RECORD
Surname Hospital no. Gender Allergies, sensitivities and adverse drug
Patient 123456 Male reactions
Medicine/substance and details of reaction
First Name Admission Date Weight(kg)
Joe 22/05/2020 60 kg None Known
Date of Birth Ward Height(cm)
18/03/1945 Apple 170 cm
Consultant Trainee Dr Chart 1 Date: 22/05/2020 Signature: A. Prescriber
Noble A. Prescriber Of 1
Other Charts in Diabetes Epidural PCA Parenteral Syringe Other (specify)
Use (tick) Nutrition driver
Complete Electronic VTE Risk Signature: A. Prescriber Date: 22.05.2020
Assessment
MEDICINES MANAGEMENT
Medication History Completed on Patient Name and Designation Date
Electronic Record M. Pharma Ward Pharmacist 23.05.2020
Date and Time Discharge Prescription Written Verified by (Name and Signature) Date
ONCE ONLY MEDICATIONS - premedication, loading doses, surgical antimicrobial
prophylaxis
Date and Medication Name Dose Route Sign & Given Date and Pharmacy
Time Bleep By Time
22/05 22.00 Prednisolone 30 mg PO AP 123 AN 22/05 22.15
22/05 22.00 Amoxicillin 500 mg IV AP 123 AN 22/05 22.15
22/05 22.00 Furosemide 40 mg IV AP 123 AN 22/05 22.15
22/05 23.15 Aminophylline in 300 mg IV AP 123 AN 22/05 23.30
100 mL Sodium
Chloride 0.9%
over 20 minutes
Codes for when medicine(s) not administered as prescribed:
1 Patient away from ward 2 Patient unable to receive e.g. NBM 3 Patient refused
4 Self-medicating witnessed 6 Self-medicating not witnessed 7 Delayed administration – state reason
8 Other – state reason X Omitted on instruction of doctor
OXYGEN PRESCRIPTION
Date Dose Route Target Frequency – Sign & Date Stopped, Nurse
Started (% or Nasal Cannula, saturation continuous or Bleep Sign & Bleep Sign
L/min) Simple Face Mask, when
Reservoir, Venturi, required
Humidified, other
22/05 24% Venturi Mask 88-92% Continuous AP 123 24/5 AP 123 AN
ORAL ANTICOAGULANT PRESCRIPTION - DIRECT ORAL ANTICOAGULANT (DOAC)
Indication Date Length of Sign & Pharmacy Refer to anticoagulant clinic
AF Started Treatment Bleep 28 TTA Anticoagulant book & alert card given
24/05 Long-term A. Prescriber MP 24/5
123 Patient counselled
Patients newly started on a DOAC e.g. apixaban, dabigatran, edoxaban, rivaroxaban, must be referred
to the anticoagulant clinic, be provided with the relevant anticoagulant alert card and counselled on
the medicine before discharge.
Medication Date
Time Dose
Edoxaban 24
06
Date 24/05 Route PO 09
Sign & Bleep 12
A.Prescriber 123
18 30 mg AN
Instructions 22
24
ORAL ANTICOAGULANT PRESCRIPTION - VITAMIN K ANTAGONIST
Indication Date Length of Sign & Pharmacy Refer to anticoagulant clinic
Started Treatment Bleep Anticoagulant books given
Target INR Patient counselled
Patients prescribed Vitamin K Antagonists e.g. warfarin, must have a follow-up appointment, be
provided with a completed anticoagulant record book and counselled on the medicine before
discharge.
Medication Date
INR
Route PO Dose at 18:00
Sign & Bleep Signature
Given By
Pharmacy codes:
S = stock drug IP = inpatient supply POD = patient’s own medicine
TTA = dispensed by pharmacy with instructions POSH = patient’s own supply at home
REGULAR PRESCRIPTION
Date 22 23 24
Medication Time Dose Additional Information
Enoxaparin 06
09
Route SC Sign & Bleep 12 STOP
A. Prescriber 123
Date 22/5 18 40 mg AN A.Prescriber 24/05/20
Pharmacy 22
S 23/5 MP 24
Medication Time Dose Additional Information DRIVEN BY AIR
Salbutamol 06
09 5 mg AN
Route NEB Sign & Bleep 12 5 mg AN STOP
A. Prescriber 123
Date 22/5 18 5 mg A Prescriber 24/05/20
Pharmacy 22 5 mg AN
S 23/5 MP 24
Medication Time Dose Additional Information DRIVEN BY AIR
Ipratropium 06
5oo
09 micrograms
AN
5oo
Route NEB Sign & Bleep 12 micrograms
AN STOP
A. Prescriber 123 5oo
Date 22/5 18 micrograms A Prescriber 24/05/20
5oo
Pharmacy 22 micrograms
AN
S 23/5 MP 24
Medication Time Dose Additional Information FOR 5 DAYS with/after food
Prednisolone 06
09 30 mg AN AN
Route PO Sign & Bleep 12
A. Prescriber 123
Date 22/5 18
Pharmacy 22
S 23/5 MP 24
Medication Time Dose Additional Information FOR 5 DAYS
Amoxicillin 06 500 mg AN AN
09
Route IV Sign & Bleep 1214 500 mg AN AN
A. Prescriber 123
Date 22/5 18
Pharmacy 22 500 mg X AN AN
S 23/5 MP 24
Medication Time Dose Additional Information 200 mg tds for 7 days, then bd for 7 days then od thereafter
Amiodarone 06 200 mg AN
09
Route PO Sign & Bleep 1214 200 mg AN X X X X X
A. Prescriber 123
Date 23/5 18
Pharmacy 22 200 mg AN AN
S 23/5 MP 24
REGULAR PRESCRIPTION
Date 22 23 24
Medication Time Dose Additional Information Rate should not exceed 4 mg/minute
Furosemide 06
09 40 mg AN AN
Route IV Sign & Bleep 12 40 mg AN AN
A. Prescriber 123
Date 22/5 18
Pharmacy 22
S 23/5 MP 24
Medication Time Dose Additional Information Contains budesonide and formoterol
Symbicort Turbohaler 400/12 06 Rinse mouth after use
09 1 puff X AN
Route INH Sign & Bleep 12
A. Prescriber 123
Date 22/5 18
Pharmacy 22 1 puff X AN AN
POD 23/5 MP 24
Medication Time Dose Additional Information Contains tiotropium
Spiriva Handihaler 06
09 18 AN
micrograms
Route INH Sign & Bleep 12
A. Prescriber 123
Date 24/5 18
Pharmacy 22
POD 23/5 MP 24
Medication Time Dose Additional Information
06
09
Route Sign & Bleep 12
Date 18
Pharmacy 22
24
Medication Time Dose Additional Information
06
09
Route Sign & Bleep 12
Date 18
Pharmacy 22
24
Medication Time Dose Additional Information
06
09
Route Sign & Bleep 12
Date 18
Pharmacy 22
24
AS REQUIRED MEDICATIONS
Medication Date
Salbutamol MDI 100 micrograms/puff
Indication SOB - COPD Time
Dose Route Start Date
2 puffs INH 22/5 Dose
Max Dose/Frequency in 24 hours
4-6 hourly Route
Sign & Bleep Pharmacy Given
A. Prescriber 123 POD 23/5 MP By
Medication Date
Paracetamol
Indication Pain/Fever Time
Dose Route Start Date
1g PO 23/5 Dose
Max Dose/Frequency in 24 hours
4-6 hourly max QDS Route
Sign & Bleep Pharmacy Given
A. Prescriber 123 S 23/5 MP By
Medication Date
Indication Time
Dose Route Start Date
Dose
Max Dose/Frequency in 24 hours
Route
Sign & Bleep Pharmacy Given
By
Please indicate the reason where option 7 OR 8 has been chosen for not administered as prescribed
Date Time Signature Reason for non-administration/delay and action taken
INFUSION PRESCRIPTION
Infusion Fluid Medication Duration Administration
Route Signature
Date Name and Approved Name Rate of Date Given Checked Start Finish
/Line Volume & Bleep Pharmacy
Strength and Dose Infusion Given By By Time Time
Sodium 18 mL
Aminophylline AP
22/5 IV Chloride 250 mL per
123
23/5 AN NU 00:15 14:10
250 mg hour
0.9%
Sodium 1
1000 Potassium AP
23/5 IV Chloride 6 hours 23/5 AN NU 12:30 18:30 IP
mL 40 mmol 123
0.9% IP 23/5 US
Key learning points from the prescribing exercise are explained below
1. Allergy and ADR status
• The allergy and ADR status are not completed
• Incomplete documentation of allergy/ADR status can result in a patient experiencing a
drug reaction which can potentially be fatal
o It may also result in optimal therapy being withheld
• Ensure allergy/ADR status is ascertained and documented before prescribing any
medication
2. Drug charts in use
• The number of charts is not documented
• It is important to make a note of the number of charts a patient has, so prescribers are
aware of all prescribed medicines and to avoid missed doses
• Any additional charts in use should be documented on the main drug chart e.g. diabetic
chart
3. Medicines reconciliation
• This is the process of ensuring the patient’s current medication history is correct on
transferring between care settings and any changes made are clearly documented
• To ensure continuity of care, document the name of each medicine, the dosage, frequency
and route of administration.
o Additional information such as formulation, strength and device may be required for
some medicines
• Symbicort inhaler is available in three different strengths and as two different delivery
devices (metered-dose inhaler (MDI) and dry powder inhaler (DPI))
o Therefore, strength and device should be noted on the drug chart
• Salbutamol inhaler is available as two different devices
o The most commonly prescribed inhaler device for salbutamol is the MDI
o Some patients may, however, be using a salbutamol DPI which is a different strength
to the MDI device
o The strength and device should be noted on the drug chart
• The inhaler technique needs to be checked to ascertain whether the patient is using his
inhalers correctly – this can usually be done by a Dr, nurse, pharmacist or pharmacy
technician
o Discuss with a pharmacist if the patient is using their inhalers incorrectly
4. Administration
• When reviewing a patient’s medication, it is vital to check what the patient has actually
received, as this may influence the management of the current situation
• There are no administration signatures for enoxaparin and therefore it is not known
whether these doses have been omitted or the nurse has forgotten to sign
5. Edoxaban
• Enoxaparin and edoxaban should not be given together
o Enoxaparin must be stopped and edoxaban started when the next enoxaparin dose
would have been due
• The patient’s body weight and calculated creatinine clearance should be checked to
ensure the correct dose of edoxaban is prescribed - refer to local Trust guidance and/or
BNF
o According to the patient’s weight, the dose of edoxaban is incorrect and should be 30
mg OD
• Prior to initiation of edoxaban, a clotting screen, renal function, U+Es, FBC and LFTs
should be carried out and assessed – refer to local Trust guidance and/or BNF for further
details
• The patient should be counselled on edoxaban, given the relevant documentation and
referred to anticoagulant clinic at some point before discharge
6. Treatment of COPD
• Always prescribe in accordance with your local Trust COPD and antimicrobial guidelines
• The dose of nebulised ipratropium should be written as 500 micrograms
o Micrograms should not be abbreviated to mcg as it can be misread as mg
• It is recommended nebulised salbutamol and ipratropium are driven by air and not oxygen
to avoid carbon dioxide retention in COPD patients
• For prednisolone the number of days treatment must be documented
o If a reducing dose is required, the regime must be clearly stated
• For amoxicillin the number of days treatment must be documented
o The IV route should be reviewed daily and switched to the oral route when appropriate
o The time interval between amoxicillin doses should be equal e.g. 0600, 1400 and 2200
7. Diuretic therapy
• On admission, the furosemide was switched to the IV route and the dose increased
• The second dose of furosemide should usually be given at lunch time (and no later than 4
pm) to prevent the peak diuretic effect occurring at night and inconveniencing the patient
• Furosemide should be given by slow IV injection at a rate not exceeding 4 mg per minute
due to the risk of ototoxicity associated with a more rapid rate of administration
• Dose and route of furosemide should be reviewed on a daily basis and according to clinical
parameters
8. Aminophylline
• The patient requires an intravenous loading dose of aminophylline 5 mg per kg (diluted
further usually in 100 mL sodium chloride 0.9 %) as an infusion over 20 minutes – check
your local Trust IV medication administration guide
o It is important to ascertain whether a patient is already taking oral aminophylline or oral
theophylline, as these patients should not normally receive a loading dose of
intravenous aminophylline
• The loading dose of aminophylline is followed by a maintenance intravenous infusion of
aminophylline 300 micrograms per kg per hour (dose in elderly)
o Check your local Trust IV medication administration guide for details on how to
prescribe this
• Aminophylline is a narrow therapeutic index drug and a blood sample should be taken 4–
6 hours after starting IV treatment
o Aminophylline is monitored therapeutically in terms of plasma-theophylline
concentration
9. Treatment of hypokalaemia
• It should be noted that furosemide, aminophylline, salbutamol nebuliser and prednisolone
all have the potential to cause hypokalaemia
o Therefore, when prescribed concomitantly the risk of hypokalaemia is increased further
• The usual maximum concentration of potassium that can be infused peripherally is 40
mmols/litre
o Each 20 mmol of potassium is usually given slowly over 2 to 3 hours using an infusion
pump
• Commercially available ready-diluted potassium infusion must be used
• Potassium diluted with sodium chloride 0.9% are preferred for initial potassium
replacement, as those diluted with glucose may further lower potassium levels
10. Oral Amiodarone
• Amiodarone has a long half-life and requires a loading regime of 200 mg TDS for one
week, 200 mg BD for the second week then 200 mg OD thereafter
o When a change in dose is part of a standard initiation regime, this should be
annotated clearly on the drug chart
• Prior to initiation of amiodarone, chest X-ray, potassium level, TFTs, LFTs and ECG,
should be carried out and assessed – see BNF for further information
• Caution should be exercised when amiodarone is prescribed with medicines that may
cause hypokalaemia as there is a risk of torsade de pointes
11. Tiotropium
• Tiotropium is part of the patient’s medication history and should be restarted once the
ipratropium nebules are stopped, as part of the management of his COPD
• Tiotropium inhaler is available as different devices and strengths
o The device and strength should be noted on the drug chart
o It is good practice to prescribe by brand name
• The inhaler technique should be checked
12. Paracetamol
• The maximum dose of paracetamol is 1 g four times daily and the minimum time interval
between doses is 4-6 hours
• The frequency and the maximum dose in 24 hours should be stated to avoid too frequent
or over-dose by exceeding the maximum daily dose of paracetamol, which can lead to
fatal consequences.
