Consider the following prescriptions and the errors that they highlight…

1)

Patient ID   Mr Andres Aardvark 1/1/32 1 Zoo Street Timbuktu Hospital no:123456	Special Instructions		Allergies       NKDA
Date 1/1/09
Name                Digoxin Route                   Oral Frequency                    OD	Dose   125 mg     Comments   Monitor levels periodically	Time given   0800

• Common mistake: Wrong units of digoxin: it’s Micrograms. And prescribe in capital letters

2)

Patient ID   Mr Andres Aardvark 1/1/32 1 Zoo Street Timbuktu Hospital no:123456	Special Instructions		Allergies       NKDA
Date 1/1/09
Name                DIGOXIN Route                   P.O. Frequency                    OD	Dose   125 mcg     Comments   Monitor levels periodically	Time given   0800

• Common mistake: You need to write out micrograms in full

3)

Patient ID   Mr Andres Aardvark 1/1/32 1 Zoo Street Timbuktu Hospital no:123456	Special Instructions Known Brittle Asthmatic		Allergies       NKDA
Date 1/1/09
Name                Bisoprolol Route                   Oral Frequency                    OD	Dose   100 mg     Comments	Time given   0800       2200

• 4 mistakes: WRONG DOSE! Bisoprol’s top dose is 10mg AND not written in capitals AND contraindicated in Asthma AND once daily

Patient ID   Mr Andres Aardvark 1/1/32 1 Zoo Street Timbuktu Hospital no:123456	Special Instructions		Allergies       NKDA
Date 1/1/09
Name                INSULIN Route                   Oral Frequency                    OD	Dose   10 u     Comments	Time given   0800

• 5 mistakes: No name of insulin (e.g. MIXTARD 30). No comments regarding to give before mealtimes/with food. No correct dosing (always write in words and numbers. Never abbreviate to U –  It’s UNITS, Prescribed to be given orally rather than subcutaneously. Prescribed once per day (usually given twice daily)
• Ie,  MIXTARD 30 INSULIN. Please give 30 (THIRTY) UNITS Twice daily following meals subcutaneously… see below for a written example

So here the correct dosing is:

Patient ID   Mr Andres Aardvark 1/1/32 1 Zoo Street Timbuktu Hospital no:123456	Special Instructions		Allergies       NKDA
Date 1/1/09
Name “MIXTARD 30” INSULIN Route                   SUBCUTANEOUS Frequency                    BD	Dose   10 ( TEN) UNITS     Comments AT MEALTIMES	Time given   0800       1800

4)

Patient ID   Mr Andres Aardvark 1/1/32 1 Zoo Street Timbuktu Hospital no:123456	Special Instructions		Allergies       NKDA
Date 1/1/09
Name DIAMORPHINE Route                   P. O. Frequency   PRN	Dose   2.5mg     Comments When in pain	Time given   PRN as needed

• ERRORS HERE: Incorrect route – diamorphine cannot be given orally but morphine sulphate elixir (oramorph) can be. The dose is correct. The frequency needs to be written up. i.e. Upto 4 times per day, maximum 4 hourly PRN.
• e.g. PARACETAMOL Orally PRN 1g   4 hourly/ Maximum QDS/ Maximum dose in 24 hours 1g.

This means you can give 1 gram of paracetamol every 4 hours. So a patient could have a dose at 0400 then at 0800 then at 1200 then at 1600 and NO MORE CAN BE GIVEN IN THAT 24 hour Period.