Table 1.

Checklist for Medication Order Review by Pharmacists^*

Order urgency

Patient location

Type of order (new admission, transfer, post-op, etc.)

Order triaged as urgent, emergent, routine, or general ward stock

Verification of patient’s identity

Medical record number

Name

Age

Sex

Allergies

Disease states/problems

Therapeutic review

Date and time

Review right and left sides of order sheet

Doctor (signature present, consult service suggestions, appropriate prescriber)

Formulary/restrictions/product availability

Complies with medication order writing standards

Contraindications

Laboratory tests/levels (e.g., SCr, K)

Renal function

Dose (weight, renal function, hepatic function, normal range)

Dosage form

Route (appropriate, available)

Schedule/frequency (appropriate, ± food, spacing with other medications)

Administration (NPO, rate, administration policies for IV medications)

Duration (number of days)

Start date / start time

Stop date / stop time

Directions

Interim quantity

Number of labels to be printed

Drug interactions

Duplication (same drug or therapeutic duplication)

Discontinue existing orders replaced by new order

Comments/notes

Actionable items

Order laboratory tests/levels (please specify)

Pharmacist intervention/clarification chart note required

Documentation in pharmacy information system for technicians, pharmacists, or nurses

Communicate with other health care professional

Refer to clinical pharmacist for follow-up

Medication counselling required

Sign name/initial

K = potassium, NPO = nothing by mouth, SCr = serum creatinine.

^*Adapted with permission. © 2009 Winnipeg Regional Health Authority.