Using the medication system

Every medication order begins the same way: you find the drug in the database and select it. The system's drug data comes from First Databank (FDB), a clinical drug reference used across the industry. Because the order is built on whatever you select here, getting the lookup right is the single most important step in the whole workflow. Dosing, scheduling, the MAR, and the pharmacy hand-off all inherit from this choice.

1.1FDB-Powered Search

You start a medication order in the Medication Information form. Its Medication Search panel, shown below, is where you find the drug.

Set the Search Type first: Basic (Dispensable Drug) or Advanced (Package Drug). Then type into the Medication Name or NDC… field, which takes either a drug name or an NDC, and click Search. Your results open in a table to pick from.

Each match shows five columns: a pill image, the name (with strength and form), the route, the strength, and the NDC (covered in 1.2).

Two views: Basic and Advanced

The Search Type radio switches between two views, and they represent two different levels of detail in the database.

A Dispensable Drug (Basic) is the medication described in general: the drug, its strength, and its form, for example "tizanidine 4 mg tablet." This is the level you would write on a prescription. It does not point to any one manufacturer's product, so a Basic result is broad. There is no specific NDC and no pill image, just the drug itself, and the result set stays short.

A Package Drug (Advanced) is one specific, real package: a particular manufacturer's exact product, with its own NDC and pill image. This is the precise, exact level. Because many manufacturers make the same drug, a single dispensable drug can map to dozens of package drugs.

Basic is the quick way to find a drug, but it stops at the dispensable level: it can't show the pill or confirm which exact product you have. Advanced gives you the package drug, the pill image, and the NDC, which is what positive identification depends on. Use Basic for a fast look, but whenever it matters that you have exactly the right product, search in Advanced and confirm the NDC.

	Basic · Dispensable Drug	Advanced · Package Drug
What it represents	The drug in general: name, strength, form.	One specific manufacturer's package.
Level of detail	Broad. No specific product is chosen.	Precise and exact.
Pill image	No.	Yes.
NDC	No. It is not a specific package.	Yes. Unique to each package.
Result set	Short.	Often large. Many packages per drug.
Use it for	A quick, broad search for the drug.	Positive identification, exact-product accuracy, and pharmacy reconciliation.

How to search and select

1. In the Medication Information form, go to the Medication Search panel.
2. Set the Search Type. Basic is selected to start; switch to Advanced for the pill image, the NDC, and positive identification.
3. Type a medication name or an NDC in the Medication Name or NDC… field, then click Search.
4. In the results, use the Image, Strength, and Route columns to confirm the right product.
5. Click the correct row to select the medication.
6. Click OK to confirm. The medication and its image populate the order.

1.2NDCs and Positive Identification

An NDC, or National Drug Code, is the unique number on every medication package. The simplest way to picture it: an NDC is like the barcode on a grocery item. The word "soup" could mean a hundred different cans, but the barcode points to one exact product: one brand, one recipe, one size. In the same way, "tizanidine 4 mg" can describe dozens of different products, but a single NDC identifies one: who made it, the exact drug and strength, and the package it came in.

An NDC is a number in three parts, for example 43063-455-20. In plain terms: the first part is who made it (the manufacturer), the middle is what it is (the drug, strength, and form), and the last is the package size.

Why the NDC matters for positive identification

Two medications can share the same name and strength and still be different products from different manufacturers, and they can look completely different in the hand: a different shape, color, or imprint. The name alone can't tell them apart. The NDC can. It is the one value that positively identifies the exact product, which is what lets staff match what is charted to what is physically in the bottle, and match the order to the pharmacy fill.

Searching by the NDC

When you know the NDC, you can search by it directly. Type the NDC into the same search field and the lookup returns the single exact product that code belongs to, with its image and full detail. No scrolling through near-identical names: the result is the precise medication you have on hand.

For refills, recalls, and accurate records, the NDC, not the name, is the source of truth. It appears in the right-hand column of the lookup results.

The new system records the NDC automatically and shows it on the medication list and order detail, so what's charted always matches the bottle. In day-to-day use the pharmacy interface does most of this work. Fills arrive with the dispensed NDC and the order updates to match what the resident actually has. You'll mostly be reading NDCs to confirm a match, not typing them.

Verifying you've picked the right product

1. Read across the full row, not just the name. Confirm the strength and route match the order.
2. Check the image against what you expect the medication to look like.
3. If you have an NDC to match (from a pharmacy label or an existing record), confirm it matches the row digit-for-digit.

1.3Handling No Results or Ambiguous Matches

Two situations come up regularly: the search returns nothing, or it returns too much and you can't tell the matches apart. Both are recoverable once you understand how the filter works.

When you get no results

• Shorten the search. Type just the drug name, or the first few letters, before adding strength or form.
• Check spelling. The database matches on the text you type; a single wrong letter returns nothing.
• Try the generic name if a brand-name search came up empty (see 1.4).
• Switch to Advanced if Basic came up short. It indexes package-level records and may surface the product.

When you get too many / ambiguous results

• Add one distinguishing term, strength or route, but keep it minimal, since it filters across all columns.
• Use the Image, Strength, and Route columns to separate near-identical names.
• Fall back to the NDC if you have one. It's the one value that's unique per product.

1.4Brand vs. Generic Considerations

FDB carries both brand and generic naming, and the same medication can be found either way. Understanding the relationship keeps you from second-guessing whether you've found the right drug.

• A generic name describes the active ingredient. Generic searches map to dispensable-drug records.
• A brand name is a manufacturer's trade name for that same ingredient. Searching it leads to the same underlying medication.
• The strength and route still have to match regardless of which name you searched. Brand vs. generic changes the name you type, not the product requirements.
• When you select a product, the display shows the brand name with the generic underneath (or the generic alone), so you can confirm they are the same medication.

A selected medication is only the start of an order. Order entry is where you turn that selection into a complete medication record: confirming the drug details and setting the classification, then (in the sections that follow) the dose, schedule, and any special order type. This module picks up at the moment a medication is selected. Scheduling has its own module (Module 3).

2.1What the System Fills In

When you select a medication from the lookup (Module 1), or type a known NDC into the search, the system pulls the product's details out of FDB and fills the Medication Information fields for you, as far as the database has them. The image area also switches from "No Image" to the product photo.

From a single selection the form typically fills in:

Field	What it holds
Medication *	The drug name, for example tizanidine.
NDC Code	The package code for the exact product you picked.
Drug Dosage Form *	The form, for example Tablet.
Route of Administration *	How it is given, for example Oral (PO).
Strength	The dosage strength, for example 4 mg.
Medication Classification *	The controlled-substance class: C2, C3 or C4, C5, or Standard.

* Required field. Required fields must be completed before the order can be saved.

2.2Taper and Multi-Phase Orders

Some medications change dose over time. A prednisone taper, for example, may ramp up and then back down, with a different dose for each stretch of days. The system handles this with the MAR Scheduling section, which holds one row for each phase of the order. This part works the same as it always has.

Each row in MAR Scheduling shows the Dosage, the Date(s) it applies to, the Schedule (the times), and the Instructions. The Edit pencil opens a row to change it, and Void removes it.

To adjust the dose for a date range, or add another phase, click Additional Timings and fill out the MAR scheduling for that timing: the Quantity/Unit, Dosage, MAR Instructions, Start Date, and the Scheduling Options for when it should run. Repeat for each phase of the taper.

2.3Vital Signs and Other Requirements

Beyond the core drug fields, an order can carry requirements that shape how the medication is given and documented. The most important of these for clinical staff is the option to require vital signs at the time of administration.

Requiring vital signs

For a medication that needs vitals taken with it, check "Vital signs must be taken with this medication." That turns on the Vitals Required list, where you choose exactly which readings must be recorded: Blood Pressure, Glucose/Blood Sugar, O2 Sats, Heart Rate, Respiratory Rate, Temperature, and Weight. The vitals you check must be recorded with each MAR administration of that medication.

Other settings on this screen

The same Medication Information screen also carries:

• Drug Categories. Tag the medication's categories, for example Cardiac, Psychotropic, or Supplement.
• Diagnosis. The linked diagnosis, by ICD-10 code, for example J45.20 Mild intermittent asthma, uncomplicated. Use Add New Diagnosis if the one you need is not listed.
• Interventions. Check "Require Interventions Prior to Administration" when something must be done before the dose is given.

2.4PRN (As-Needed) Orders

A PRN order, from the Latin pro re nata, is given as needed rather than on a fixed schedule. Because "as needed" still has to be safe, PRN orders unlock a few settings that fixed-schedule orders do not have, controlling how often and how many times the medication can be given.

The PRN-only settings

• Effectiveness Follow-up. How long after a dose to check whether it worked. In the example, 30 minutes.
• PRN Interval. The minimum time that must pass between doses. Here, 2.0 hours, so no more than once every two hours.
• PRN Max Limit. The most administrations allowed in a day. Here, 10.

Setting up a PRN order

1. Set Scheduling Options to Daily or PRN.
2. In Scheduled Time(s), check PRN.
3. Set the Effectiveness Follow-up, PRN Interval, and PRN Max Limit for safe as-needed use.
4. Confirm the MAR Instructions describe the as-needed use and the same limits.

2.5Editing a Scheduled Timing

To adjust a scheduled time, or change the administration instructions, on an order that already exists, click the Edit pencil on that row in MAR Scheduling. That reopens the timing's fields so you can change them and save.

When you click the pencil, the timing's fields reopen, the same Scheduling Options, Quantity/Unit, Dosage, MAR Instructions, Start Date, and Scheduled Time(s) you used to create it. Make the edits you need, then click Done.

After you click Done, the MAR Scheduling section shows your adjustment, and you will see that the old schedule has been ended rather than erased. The previous row now carries an end date, and a new row holds the updated schedule from the change date forward.

Scheduling sets when a medication runs. On every order, the Scheduling Options pick one of four patterns: Daily or PRN, Every (Interval) days, Specific days of the week, and Specific days of the month. Alongside the pattern you set a Start Date, an end (a Number of Days or an End Date), and the Scheduled Time(s), the times of day the dose is given. The everyday Daily or PRN pattern, including the PRN-only settings, is covered with PRN orders in 2.4; this module details the others.

3.1Every (Interval) Days

For a medication given on a regular day interval, every few days rather than every day, choose Every (Interval) days and set the Interval (Days), the number of days between administrations, along with a Start Date. The system counts the days from the start date and generates the MAR on each interval day.

To set it up, choose Every (Interval) days, enter the Interval (Days) for the gap you want (here 6), pick the time in Scheduled Time(s) (here AM), and set the Start Date. From there the system counts the interval from the start date to each administration date and creates the MAR accordingly.

3.2Specific Days of the Week or Month

For a medication given on particular days, choose Specific days of the week or Specific days of the month, whichever suits the situation, then check the days you need. The dose runs on those days from the Start Date onward.

To set it up, choose Specific days of the week (or Specific days of the month), check the days under Days of the Week (or the dates under Days of the Month), pick the time in Scheduled Time(s), and set the Start Date.

Different doses on different days (a split schedule)

Because each timing carries its own dose and its own set of days, you can use two timings to give different doses on different days. In the example, the order gives 2.5 mg (half a tablet) on Mon, Wed, Fri, and Sat, and 5 mg on Sun, Tue, and Thu, both at Bedtime. Add the second timing with + Additional Timing (see 2.2).

Once an order is active, staff give the medication from the eMAR (the electronic Medication Administration Record). This module covers recording an administration: what you enter, how you sign off, what to do when a dose is not given as ordered, and the vitals an order can require. Scheduling has its own module (Module 3), which sits ahead of this one.

4.1Recording an Administration

When it is time to give a medication, you open it in the eMAR. The administration screen shows the medication, its instructions, and the fields you complete to record the dose. The example below is the PRN albuterol order from Module 2, now ready to administer.

The fields you complete:

• Qty Admin. The amount you actually gave (here 1.0). The Qty/Unit beside it shows the ordered amount, 1.0 Puff (90 mcg).
• Staff signature. Check this to sign off that you administered the dose.
• Notes. Required for this administration because albuterol is a PRN medication; PRN doses call for a note. Whether a note is required depends on the medication.
• Exceptions. When a dose is not given as ordered, for example refused or held, choose the reason here instead of signing it as given.
• Administration Time. When the dose was given.
• Required vitals. The Resp and O2 Sats fields appear, and are required, because this order was set to require those vitals (see 2.3). Record them with the administration.
• Order a fill/refill from Pharmacy. Check this to request a refill of the script while you are here.

4.2Exceptions: Recording a Dose Not Given

A dose is not always given as ordered. The resident may be absent, may refuse, or the dose may be held. When that happens, record the reason in the Exceptions dropdown rather than signing it as given.

To record an exception, open the dose in the eMAR, choose the reason from Exceptions (for example Absent), add any Notes, confirm the Administration Time, and click Save. Leave Staff signature unchecked, an exception is recorded in place of a given dose.

4.3PRN Effectiveness Follow-Up

A PRN order set with an Effectiveness Follow-up (see 2.4) asks you to come back after the dose and record whether it worked. Once the follow-up window has passed, the 30 minutes set on this order, you mark the result and sign off.

To complete the follow-up, open the dose after the follow-up window, choose Effective or Ineffective, check Follow Up Signature to sign, and click Save.

Once orders are entered, the medication list is where nursing and administration keep an eye on everything: what is active, what is waiting for sign-off, and what the pharmacy has asked to discontinue. This module covers reading that list and working the review queues. (Modules 2 through 4, Order Entry, Scheduling, and Administration, sit ahead of this one and are still to be written.)

5.1The Active Medication List

The medication list shows a photo of each medication alongside its class, prescriber, instructions, schedule, start date, and Rx number, so staff can confirm what they are looking at without opening every order. Below each medication name you'll also see the NDC, the generic name, and a row of status icons that flag things like PRN, order type, and alerts at a glance.

Use the Filter medications… box to narrow the list, and click any column header to sort by it (the list is sorted by Medication name by default).

5.2The Four Tabs, and the Review Queues

Tabs across the top of the list keep medications cleanly separated, and each one carries a live count so nothing waiting for attention is hidden.

Tab	What it holds
Active	The medications currently active for the resident. This is the day-to-day med pass list.
Awaiting Approval	New or changed orders that need nursing or administration sign-off before they go active. This is the main review queue.
DC'd Medications	Medications that have been discontinued, kept on record for history and reference.
DC Med Review	Discontinuation requests from the pharmacy that are awaiting review.

Working an awaiting medication

Each item in Awaiting Approval is an incoming order, often from the pharmacy or another source, waiting for you to act on. For each one you have three options:

• Add it as new. Click the row to go in and create it as a new medication.
• Match it to an existing order. Click the link icon to open Match Awaiting Medication, where you match the incoming order to an active order already on file.
• Delete it. Remove it if it is not needed.

The Score shows how close the incoming order is to each order on file. The system compares field names and values, so a near-identical order scores high (here 94%) and looser matches score lower (33%). Use it to find the right existing order to match to.

Reviewing a pharmacy discontinuation request

The DC Med Review tab lists active orders the pharmacy has asked to discontinue. You see the order on file that each request applies to, so you can review it in context. A red icon among the medication's status icons signals that a discontinuation request has been entered for it.

5.3Views, Printing, and Output

The controls at the top right of the list let you change how it looks and get it out of the system:

• List / grid toggle. A one-click toggle switches between the row list and a card grid. Use whichever reads better for the task.
• Print Active Meds. Prints the current active medication list.
• Print, PDF, and Fax. Available from the header for sharing or filing the list.
• + New Medication. Starts a new order. This is the entry point into the Order Entry workflow (Module 2).