Enter a medication order
the way it should be done.
A compact, clinician-built reference for medical students and residents: the anatomy of a complete order, common pitfalls, side-by-side correct vs. incorrect examples, and an AI reviewer that catches problems before you sign.
Acetaminophen 650 mg PO Q6H PRN pain or fever ≥ 38.0°C Max 3000 mg / 24 h Indication: post-op pain Duration: 72 h or until d/c
A cross-cover page at 02:14.
The order the intern almost signed — and the one RxFlow rewrote.
A composite from real inpatient near-misses. Every element the intern missed is exactly what an alert pharmacist would have caught on read-back at 03:00 the same morning.
68-year-old woman, post-op day 1 total knee replacement, weight 62 kg, creatinine 1.6 (baseline 0.9 → CrCl ~ 32), home on fentanyl 25 mcg/h patch for chronic back pain. Nurse pages for “pain med, she's uncomfortable.” Intern types the fastest thing they can think of.
morphine 4 mg IV q3h prn pain
- Renal accumulation: morphine-6-glucuronide clears through the kidney — CrCl 32 means metabolites stack across doses, respiratory depression risk.
- No PRN trigger: "prn pain" leaves it to the nurse — no pain score threshold, no severity trigger, no linkage to the reported 4/10 vs 8/10.
- No max dose: the intern didn't cap the 24-hour total. Six 4 mg doses = 24 mg IV morphine ≈ 72 mg PO equivalents added onto a fentanyl patch.
- Home-med collision: the fentanyl patch (60 MME/day equivalent) was never reconciled. Stacked opioid MME > 90 = CDC red-line.
- No hold parameters: nothing tells the nurse to withhold for RR < 10, SpO₂ < 92 %, or increasing sedation.
Hydromorphone 0.2 mg IV q4h PRN pain ≥ 5/10 Max 1.2 mg IV / 24 h Renal-dose adjusted (CrCl 32) — avoid morphine Hold for RR < 10, SpO₂ < 92 %, RASS ≤ -2 Continue home fentanyl 25 mcg/h patch Total daily MME cap: 90 (incl. patch) Duration: 48 h, reassess POD-3 Indication: post-op TKA pain
- Drug swap: flagged morphine in CrCl < 60 → suggested hydromorphone (no active renal metabolite).
- PRN trigger: anchored dosing to a pain-score threshold, not the nurse's intuition.
- 24-h cap: auto-generated based on q4h × single-dose math.
- Home-med reconciliation: pulled the fentanyl patch from admission recon, computed the running MME, and set the cap accordingly.
- Hold parameters: RR + SpO₂ + RASS thresholds appended automatically.
- Duration + reassess: forced an explicit stop-date so the taper isn't left running.
Most order errors are not knowledge gaps — they're incomplete entries.
EMRs accept what you type. They will let you sign “tylenol 2 tabs prn” even though it lacks a dose in mg, a route, a frequency, and an indication. We teach the discipline the EMR doesn't enforce.
Anatomy of an order
Eight required elements broken down with examples, edge cases, and the abbreviations to avoid.
Correct vs. incorrect
Side-by-side cards from real-world scenarios: heparin drips, vancomycin loads, insulin sliding scales.
Interactive simulator
A mock inpatient order form with field-level validation. Build an order, see exactly what's missing.
Paste a typed order. Get structured, clinical feedback.
Powered by Claude Sonnet 4.5. The reviewer parses your order, flags missing elements, surfaces dangerous abbreviations and look-alike sound-alike risks, and returns a clean rewrite you can paste into the EMR.
- Verdict: safe · needs review · unsafe
- Per-field error list with concrete fixes
- High-alert medication flags (anticoagulants, insulin, opioids)
- Rewritten order in standard inpatient format
A complete inpatient order — every time.
Built for the bedside reality.
When you're paged at 02:00 for a sleeping order, you don't reach for a textbook — you type. This site exists so the way you type matches what a vigilant pharmacist would want to read back.
Dr. Elmira Baghdasaryan
Creator of RxFlow Review. Built for medical students and residents learning the discipline the EMR doesn't enforce — a compact, clinician-authored reference for inpatient order entry, backed by an AI reviewer that catches gaps before you sign.