Correct vs. incorrect

Real orders, side by side.

Each example below shows a typical scenario you'll meet on the wards. The "incorrect" version is what students often type first; the "correct" version is what pharmacy wants to see.

Case 01

PRN analgesic on a post-op patient

Post-op day 1 cholecystectomy, mild-moderate incisional pain. You're asked to write a PRN analgesic order.

Incorrect

tylenol 2 tabs prn pain

NoteBrand name instead of generic.
Note“2 tabs” is not a dose — pharmacy can't compute mg.
NoteNo route, no frequency, no max dose / 24h.
NoteNo quantitative trigger ('prn pain' is too vague).

Correct

Acetaminophen 650 mg PO Q6H PRN
  trigger: pain ≥ 4/10
  max: 3000 mg / 24 h
  indication: post-op incisional pain
  duration: 72 h or until d/c

NoteGeneric name with explicit dose and units.
NoteDiscrete frequency Q6H — not 'every few hours'.
NotePRN trigger is numeric and verifiable at the bedside.
Note24h dose ceiling protects against hepatotoxicity.

Case 02

Sliding-scale insulin

Type 2 diabetic admitted for cellulitis. NPO until imaging in the morning. Needs blood glucose coverage.

Incorrect

Insulin reg 4 u sc qid

Note“u” is on the ISMP do-not-use list — write 'units'.
NoteNo sliding scale parameters (which BG triggers which dose).
NoteQID is fixed dosing for a sliding-scale order.
NoteNo hold parameter for hypoglycemia or NPO.

Correct

Insulin regular subcutaneous, sliding scale q6h:
  BG 150–200 → 2 units
  BG 201–250 → 4 units
  BG 251–300 → 6 units
  BG 301–350 → 8 units, call MD
  BG > 350    → 10 units, call MD
Hold if BG < 100 or NPO > 2 h pre-procedure
Indication: inpatient hyperglycemia management

Note'Units' fully spelled out — no 'u'.
NoteEach BG range maps to a specific dose.
NoteExplicit hold parameter and escalation triggers.
NoteIndication tied to the active problem.

Case 03

IV antibiotic for community-acquired pneumonia

65 yo with CAP, PSI Class IV, normal renal function. You're starting empiric therapy.

Incorrect

Ceftriaxone IV

NoteNo dose. Pharmacy will reject or assume — both are unsafe.
NoteNo frequency.
NoteNo indication / duration — antibiotic stewardship requires both.

Correct

Ceftriaxone 1 g IV Q24H
  indication: community-acquired pneumonia
  duration: 5 days, reassess D3 with cultures
  + Azithromycin 500 mg IV Q24H per CAP protocol

NoteDose, route, frequency all specified.
NoteIndication and stop date documented (stewardship).
NoteCombination therapy named explicitly — no 'plus macrolide'.

Case 04

Weight-based heparin infusion

PE confirmed by CTPA. Patient weighs 92 kg, normal renal function, no recent bleeding.

Incorrect

Start heparin drip

NoteNo bolus dose, no infusion rate.
NoteNo monitoring plan (aPTT / anti-Xa).
NoteNo protocol named — institutions have specific heparin protocols.

Correct

Heparin (unfractionated) IV per VTE-treatment protocol:
  Bolus: 80 units/kg IVP × 1 (= 7360 units, round to 7400)
  Infusion: 18 units/kg/hr (= 1656 units/hr, start at 1650)
  aPTT in 6 h, adjust per nomogram
  Baseline CBC, aPTT, INR, SCr
  Indication: acute PE
  Duration: until therapeutic on warfarin × 24 h

NoteWeight-based bolus + infusion with calculated values.
NoteMonitoring plan and baseline labs ordered together.
NoteIndication, duration, and transition plan documented.