4.1 PRESCRIPTION REQUIREMENTS
- Each medication prescription must meet all the
legal requirements as per the Pharmacy Act of B.C. before the
medication is dispensed.
- No member of the healthcare team is obliged to
participate in the preparation, dispensing, or administration of any
medication that is contrary to hospital policy (e.g. Parenteral Drug
Therapy Manual Policy). Refusal to carry out a medication order must
be discussed with the supervisor and prescribing physician, and a
note made in the chart.
physician must complete the patient allergy status form in the chart
prior to the first medication order. Nurses at UBCH and the
Preadmission Clinic and pharmacists may also complete the form. No
order will be processed or drug dispensed unless allergy status form
is completed. Exception: If a physician is unable to come to the
hospital to admit the patient, the nurse may take a verbal allergy
status order and write it in the physician’s order section. In this
case, the physician must complete the allergy status form in the
chart within 24 hours.
All medication orders must be written on the VA Prescriber’s Order
Form labelled with patient’s name and MRN.
that are pre-printed onto a self-adhesive label or rubber stamp will
not be accepted. On
admission, medications taken prior to admission should be ordered
using the appropriate Medication Reconciliation Order Form (Peri-Op,
- All medication orders must be legible and specify
the drug name, dosage or dosage range, the route of administration,
and the frequency and duration of administration. Unsafe
abbreviations must not be used. Refer to Policy 4.14 Do Not
Use List of Dangerous Abbreviations, Symbols and Dose Designations.
- PRN orders must include a frequency limitation or a
maximum number of doses per day and indicates the condition or
symptom for which any PRN drug is to be administered.
- The physician
must include the date and time that the order is written as well as
his/her signature, printed name and MSP# or college ID#.
- Clinical Clerks and Residents must indicate CC or
Res. after their signature.
- Clinical clerks must indicate on all medication
orders the name of the physician with whom the order has been
- Phone orders are not accepted from Clinical Clerks.
- "Suggest" orders written in the
Prescribers Orders section will be processed by Pharmacy once a
written or verbal counter-signature is obtained from a prescriber
from the admitting service.
- Nurse Practitioners registered with the College of Registered Nurses
of BC (CRNBC) are authorized to prescribe medications as set out in
their scope of practice. The CRNBC and individual Nurse
Practitioners, not the Pharmacy, are responsible for ensuring
appropriate prescribing within their scope of practice.
independently order all formulary multiple vitamin preparations
for ORAL and ENTERAL administration (as long as the patient is able
to take medications via naso-gastric tube and is not NPO) at the usual daily dose
without a physician's order at VA. Single
entity vitamin and IV preparations must still be ordered by a
(Multivites, VItogen®) 1 tablet PO daily
Minerals (Centrum Forte®/Select®) 1 tablet PO daily
with Zinc (Z-Bec®) 1 tablet PO daily
Vitamin B with C (Renavite®)
1 tablet PO daily
Infantol® 5-10 mL
must be ordered by a MD due to high alcohol content)
supplements will be considered only if program patient care
guidelines recommend a multivitamin supplement for patient’s
condition, or if all the following criteria are met:
malnourished or at risk of nutritional deficiencies
Expected length of
stay is greater than 7 days
Patient is unable
to eat sufficient food/supplements to meet daily recommended intake
Patient is unable
to modify dietary intake to meet DRI
supplementation is problematic based on a patient’s co-existing
condition (e.g. hemosiderosis, iron overload syndrome), then
iron-containing multivitamin products (i.e. Centrum Forte®/Select®)
should not be ordered without prior consultation with a physician.
include date, multivitamin and dose, signature, printed name, RD,
CDBC Registration Number.
- Charts must be flagged to indicate a new order has been written.
- New orders must be written in full post-operatively. “Resume preop
meds” is not acceptable. See also Automatic Stop Orders Policy 4.3.
- Once processed, no orders written on the physician's order form may
be changed with add-ins, write-overs or by crossing an order out. A
discontinued order must be written, along with a new order.
- To order cytotoxic agents, a
Parenteral Chemotherapy/Immunotherapy pre-printed order form (PPO)
must be used if the cytotoxic agent is not part of an existing PPO.
These forms provide information required to safely prepare and
administer the chemotherapy agents.
Written orders for parenteral doses of cytotoxic agents required for
administration the same day must be received in Pharmacy by 1600hr
whenever possible. The time, date and duration of therapy for each
drug must be included when appropriate.