When a patient is admitted to hospital, the doctor prescribes medication by entering the details on a drug "Kardex".
This is the equivalent of a prescription issued to a patient in the community.
The prescribing record is kept separate from the patient's medical notes; all patients' prescribing records are kept together and administered by the ward nursing staff.
Drugs are prescribed in different frequencies and under different conditions. Regular medication is charted by dose, route of administration and the number of times a day it is to be given.
Other medication is prescribed on an "as required basis".
The medical acronym for this is "p.r.n." and it means the medication can be given when, in the judgment of the nurse, the patient's symptoms require it. The administration of pain-killers and of night sedation is a common example of p.r.n. prescribing. The dosage, the route of administration (oral, intramuscular or intravenous) must be specified as must the timing; however, an element of patient and health professional discretion is allowed for.
Patients and visitors in hospitals will be familiar with the sight of two nurses doing "drug rounds". A medication trolley is wheeled from bed to bed.
Each patient's Kardex is consulted and the nurses cross- check the name, dosage and timing of administration before giving the patient oral medication. Intramuscular medication is subjected to even tighter scrutiny; best practice involves one nurse taking the drug vial while calling out its name, dose and expiry date. His or her colleague checks this against the Kardex and visually double-checks the vial.
The drug is then drawn up under supervision and administered to the correct patient.
There are separate, more stringent regulations covering the administration of controlled drugs such as morphine.
Major hospitals now involve pharmacists in ward rounds in a bid to limit potential medication overdosage and harmful drug interactions.