A huge part of nursing is medication pass. And in order to do this safely, we need to have a good basic understanding of pharmacology. Let’s dive into medication administration orders, routes, nursing responsibilities, and new orders.
Medication Orders
Understanding how to read medication orders is one of the most important parts of pharmacology and safe medication administration. Familiarize yourself with common medication abbreviations by visiting Medical Abbreviations You Must Know. Plus be sure to visit Nursing Fundamentals: A Guide to the 10 Rights of Medication Administration before administering any medication.
Standard Orders
Standard orders are prescriptions that are given regularly and on a schedule. They usually do not have a set number of doses before being discontinued. The doctor will review these medication prior to discharge.
One-Time Orders
One-time or single prescription orders are given only once. They are typically pre-operative orders that come with a specific administration time. For example, if a patient is going for a colonoscopy, then they are going to need a one-time order for GoLytely to clean out the colon prior to the procedure.
STAT Orders
Most of us know what STAT orders are from watching television shows. Like when they say, “I need Morphine STAT!” They’re asking for the medication to be given right away. STAT orders are only good for one time use and are expected immediately.
PRN Orders
PRN, aka as needed, orders are typically for pain or nausea management. But they can be used for a variety of things like potassium replacement as well. As needed orders have instructions for when they can be given. For example, if the patient is in 9/10 pain, check your PRNs for severe pain. Whereas if the patient is in 3/10 pain, check for a PRN for mild pain. Make sure to follow the orders correctly and don’t double dip with various pain medications unless there is a ‘breakthrough pain’ medication ordered.
Be sure to visit Nursing Fundamentals: A Guide to Pain and Patient Education: How to Effectively Manage Acute and Chronic Pain for more information on treating pain.
Standing Orders
Standing orders are hospital specific. Some hospitals allow nurses to use nursing judgement to give a one-time order for Tylenol if the patient fits certain criteria. These orders are specifically helpful during the middle of the night when you don’t want to wake the doctor for a low-grade fever you know can be taken care of by a dose of Tylenol.
Administration Routes
For every medication order, the route will be explicitly stated. For example, 325mg of Tylenol PO q6 hours for temperature of 99*F or above. In this example, the route is by mouth since the order calls for PO, aka oral, Tylenol. Let’s go over the basic routes of medication pass in pharmacology.
Oral (aka PO)
Oral medications include tablets, capsules, and liquid suspensions. They are the most common route and are the easiest for the patient to continue once discharged from the hospital. Before giving PO medications, make sure that your patient isn’t having any trouble swallowing. If they are, crushing tablets is sometimes an option but make sure to call pharmacy ahead of time to verify. If the medication is liquid, then you might have to mix it with a food thickener if the order allows.
Sublingual
Give sublingual medications under the tongue and fully dissolve them there. An example of a sublingual medication is nitroglycerin.
Buccal
Buccal medications are absorbed in the mouth between the cheek and the teeth or gums.
Subcutaneous
Inject subcutaneous medications into fatty tissue. Typically seen in the abdomen, thighs, or on the side of an upper arm. A common example of a subcutaneous injection is insulin.
Visit Nursing Fundamentals: A Guide to Diabetes, Patient Education: A Guide to Treating and Managing Type 1 Diabetes, and Type 2 Diabetes for more.
Intramuscular (aka IM)
Inject intramuscular medications directly into the muscle. Commonly seen in the deltoid muscle, like when you receive a flu shot.
Intravenous (aka IV)
Intravenous medications go straight into the vein via an IV. Most commonly seen in the arms or hands.
Visit Nursing Fundamentals: A Guide to IV Therapy and A Guide to Intravenous Fluids for more info on IVs
Instillation/Drops
Drop instillation medications in or on a specific area of the body. They are most commonly instilled in the eyes, ears, or nose and are measured in drops, aka gtt.
Transdermal
Apply transdermal medications directly to the skin in the form of a patch. Examples of common transdermal patches include lidocaine or nicotine patches.
Topical
Apply topical medications directly to the skin. Topical medications are in an ointment form, so be sure not to use bare fingers when applying these to avoid drug exposure.
Inhalation
Administer inhalation medications by inhalers. If you are unsure how to administer these, contact the assigned respiratory therapist (RT) to ask for help. Sometimes they’ll even administer these inhalation medications for you.
Nasogastric or Gastrostomy Tubes
To give medications via NG or gastrostomy tubes, the order must include this as the route. It’s a common mistake to crush and give medications via NG tube if the patient has one, but if the order says PO, this is absolutely not okay. Instead, call the doctor to verify the route and suggest the nasogastric or gastrostomy route instead. Not all medications can be crushed and given via NG tube, so check with the pharmacist and/or doctor before doing so.
Visit Nursing Fundamentals: A Guide to Nasogastric (aka NG) Tubes for more info.
Suppositories
Suppository medications go straight into the patients’ rectum. They often come pre-lubricated, but if they aren’t, be sure to grab some extra lubrication before administering. Your patient will thank you.
Nursing Responsibilities
It is the responsibility of the nurse to understand pharmacology and question all orders before administration. Why is this patient getting this medication? Are they currently experiencing any side effects to this med? Is this specific medication safe to give to this specific patient?
It is also the responsibility of the nurse to clarify orders that may not make sense. For example, you wouldn’t give your NPO (nothing by mouth) patient an oral (PO) medication would you? No! You must clarify all orders if you’re unsure about it.
In addition, the nurse must know their pharmacology and be aware of the side effects, adverse reactions, and toxic effects of given medications and be on the lookout for these. Educate the patient and their family to promptly let the nurse know if the patient is experiencing any adverse or toxic reactions.
New Orders
If you are having to call the doctor for a new order, or to clarity an existing one, visit Tips for New Nurses on Calling the Doctor.
Check out the entire Nursing Fundamentals Series below: