PRACTICE DOCUMENT FOR
MAINTAINING STANDARDS IN
PRESCRIBING AND
ADMINISTERING OF DRUGS
ANSWERS
Name:
Date:
NICU Practice document: prescribing and administering of drugs.
July 2013
Authors: Risk Management Team
Practice Development Team
Neonatal Unit Pharmacist
Introduction
The purpose of this document is to clarify issues around
drug prescribing and administration and thereby enhance
practice. It has been put together as a learning package for
both medical and nursing staff in Neonatal Services.
It has been compiled in response to prescribing and
administrative incidents reported via the risk reporting
system. Examples used are taken from actual incidents that
have occurred within the service, however examples have
been modified to maintain confidentiality.
The document recognizes a need for back up revision
following medical and nursing induction. It aims to assess
your knowledge and competence regarding drug prescribing
and administration and to clarify areas needing further
education.
All staff will be given the document following their induction.
It will need to be completed and returned within two weeks
for marking. Please hand it to Ruby Lopez (Neonatal Nurse)
for marking. Medical staff will be expected to take it to their
first Consultant appraisal for discussion.
We hope you find this a useful tool.
1)
a)
Why is the dose calculator sheet an important safety tool?
 Reduces calculation and administration errors relating to
miscalculation of drug doses.
 Provides a pre-printed intubation chart with agreed doses that is
ready in the event of an emergency intubation
b) When should dose calculator sheets be updated?
 Every Monday morning by SpR.
2)
What is the significance of the purple apron when prescribing,
preparing and administering drugs in neonatal services?
 Staff wearing the purple apron MUST not be disturbed from
prescribing, preparing or administering drugs.
3)
What are the standard drug administration times on the NICU
for:
a) BD doses
 06:00, 18:00 ; 12:00, 24:00
b) TDS doses
 06:00, 14:00, 22:00
c) QDS doses
 06:00, 12:00, 18:00, 24:00
d) Oral supplements of vitamins, Sytron, Sodium, Potassium
 12:00
4)
a) What is the drug prescribing policy for NICU / SCBU?
 No prescriptions are to be written during the ward round, unless
in an emergency
b) What location on the unit (NICU) should all medication be
written up?

The SHO responsible for the room will leave the ward round after
the ward round in that room has finished and will then start
prescribing the fluids etc. They will wear purple aprons to help
avoid being interrupted and will discuss the prescriptions with the
nurse looking after each baby.

Other prescriptions should be written in the doctors room on
NICU
c) What time of the day should most medication be written up?
 As above fluids immediately after the ward round in each room
has finished.
 All other drugs should generally be prescribed immediately after
the ward round.
5)
List 5 aspects of this prescription which contravene the
Addenbrooke’s Good Prescribing Guide and could lead to an
error on the NICU:

Dose units (mg’s) missing

Dosing frequency confusing ? 24 hourly or 18 hourly

No antibiotic indication

No review/stop date

Signature needs to be clearly written with name printed.
6)
If you were responsible for administering this prescription what
other information would you expect to see?
 Weight
 Hospital number
 Dose timings included as per standard dose times
 No abbreviations Benzylpenicillin rather than BenPen
 Prescribers signature to be written clearly and name printed
 Indication for antibiotic
 Stop/review date
 Dose calculation used i.e. 50mg/kg/dose 12 hourly
7)
What 3 things should you expect to do / see when a
prescription is cancelled?
 Crossed out in full
 Signed & printed name by prescriber cancelling prescription
 Dated
8)
Why should original prescriptions not be amended?
 Usually makes prescription illegible or ambiguous
 Historically difficult to review prescription and see when change
was made and what doses were administered on original and
amended prescriptions
9)
What action should be taken if the frequency of a drug changes
after 2 doses?
 Rewrite prescription in full
10)
When is the word “stat” acceptable on a drug chart?
 Never
11)
When should maintenance dosing of caffeine be commenced
following a loading dose?

12)
24 hours after loading dose (but adjusted to the nearest standard
drug administration time.
a) Baby Smith weighs 700g and requires a loading dose of
Caffeine Citrate. The first dose is to be given on 3 January
2003 at 17h00. Prescribe this on the drug chart provided,
followed by a maintenance course of caffeine.
b) Baby Smith receives a loading dose of caffeine and one
maintenance dose when it is noted that the documented
birth weight details are incorrect. The correct weight is
750g. Show the necessary changes you would make to the
prescription chart.
13)
On which charts would you expect to prescribe a continuous
vancomycin infusion and gentamicin doses?
 Vancomycin – on blue continuous vancomycin infusion
prescription chart
 Gentamicin – on pink gentamicin chart
14)
When should levels be taken once an infant has commenced a
Vancomycin infusion?
 From 12 hours after the infusion has commenced.
15)
When should levels be taken on Gentamicin?
 Pre 2nd dose level as either ‘level and give’ or ‘level and hold’.

16)
a) The first dose of Gentamicin is prescribed and given to a
term baby with no concerns about renal function at 16h20
on 14 June. When is the first level due?

Before 2nd dose 16:20 on 15th June
b) When is the second dose due?

Immediately following the level being taken.
c) When is the third dose due?

Once pre 2nd dose level has been confirmed, the timing of the
3rd dose can be confirmed. If level <2mg/L then next dose can
be given at a standard administration time 18:00 on 16th June.
If level >2mg/L then level needs to be rechecked and dose
held until result is <2mg/L
d) What needs to be checked before administering gentamicin?

All aspects included on the double checking prompt.
e) What action would you take if there is a discrepancy from
the gentamicin double checking prompt?
 Complete a CIR form resolve issue and complete form on the
back of the gentamicin prescription chart
17) For a continuous vancomycin infusions what actions should be
taken if Vancomycin levels are?
18)
a) <10mg/l
- Increase daily dose and rate by 50%
b) 10 to <15mg/l
- Increase daily dose and rate by 25%
c) 15 to 25mg/l
- No change to dose
d) > 25 to 30mg/l
- Decrease daily dose and rate by 25%
e) >30mg/l
- Stop infusion and recheck level until
<25mg/L and recommence infusion at
lower rate.
Where should 18 hourly drugs OTHER than Vancomycin and
Gentamicin be prescribed?
 On the ‘Once only’ chart section
19)
An infant, Baby Smith born at 26/40 (DOB 01.01.12) weighing
750g is to be treated with a continuous vancomycin infusion.
There is no indication of renal impairment and his creatinine is
<50micromol/L. Using the drug charts attached (see
appendices) prescribe the loading dose which would be due to
be given at midnight on 03.01.12. What would the Vancomycin
maintenance dose and infusion rate be?
20) What drugs is a continuous infusion of Vancomycin incompatible
with?
 Albumin, amphotericin, benzylpenicillin, cefotaxime, ceftazidime,
dexamethasone, furosemide, heparin, phenytoin, sodium bicarbonate
21)
Prescribe 2 doses of Gentamicin for the same baby with the
first dose due to be given at 2pm on 02.01.12 (see
appendices).
22)
If a drug dosage needed changing after 2 doses, how would
you amend the prescription?
 Cross off original prescription (dating and signing prescription)
 Rewrite prescription in full
23)
Baby Smith weighing 750g is diagnosed with a PDA. The
decision is made to treat with ibuprofen IV. Prescribe this drug
on the attached drug chart with the first dose to be given at
18.00hrs on 08.01.03.
Dose will be 7.5mg/day.
24)
What would you monitor prior to and following administration
of ibuprofen?
 Renal function
 Platelets
 Abdomen (for signs of distension)
 Signs of infection
 Coagulation defects
25)
What is the correct dose of Morphine / kg:
a) As an infusion?
 5-40microgram/kg/hour
b) As a loading dose?
 100microgram/kg

26)
Where can you find information on prescribing Morphine?

NICU handbook

Dose calculator sheets

IV monograph

Intubation charts

Pocket cards

27)
Baby Smith requires a morphine loading dose and subsequent
continuous infusion. If she weighs 750g prescribe a morphine
loading dose and infusion on drug and infusion charts provided.
The loading dose (100 microgram / kg / dose) is to be given at
1pm on 08.01.03 followed immediately by a standard
continuous infusion (diluent is dextrose 10%).
Loading dose is 75 microgram (or can be given as dose banded dose)
Maintenance infusion is 750microgram morphine in 50ml dextrose
10%. 0.25-2ml/hr = 5-40microgram/kg/hr
28)
Baby Smith needs to be fluid restricted. Represcribe the
Morphine infusion at double strength.
Maintenance infusion is 1.5mg morphine in 50ml dextrose
10%. 0.125-1ml/hr = 5-40microgram/kg/hr
29)
A decision to wean Baby Smith off Morphine is made following
a good post op recovery. Paracetamol is prescribed to maintain
pain relief as needed. Prescribe this on the attached chart
accordingly.
Paracetamol IV dose will be 7.5mg/kg (5.6mg) 6 hourly
30)
What is the correct dose of Metronidazole / kg for a baby that is
45 days old:
 7.5mg/kg/dose 12 hourly
31)
Baby Smith is being treated for suspected NEC. Prescribe a
course of Metronidazole.
Dose = 5.6mg 12 hourly
Need to include indication, start date and review date on prescription.
32)
Prescribe hydrocortisone for an 800g infant for the
management of hypotension.
Dose is 2-6mg/kg/day divided into 4 hourly doses
e.g. 800microgram/dose 4 hourly
33)
Prescribe an insulin infusion for a baby who weighs 930g,
where the normal insulin prescription range has not proven to
be effective.
Use 25units/kg (23units) in 50ml sodium chloride 0.9%
e.g.
>18mmol/L
14-18mmol/L
10-14mmol/L
8-10mmol/L
<8mmol/L
0.2units/kg/hour
0.15units/kg/hour
0.1units/kg/hour
0.05units/kg/hour
Stop
=
=
=
=
0.4ml/hr
0.3ml/hr
0.2ml/hr
0.1ml/hr
Other sensible answers are acceptable
34)
Baby Smith weighing 750g requires 3mmols / kg / day of
Sodium and 2mmols / kg / day of Potassium adding to his 10%
Dextrose. He is on 120mls / kg of fluid. Calculate his
requirements and prescribe these as you would expect to see
them on the fluid chart provided.
Dextrose 10% 500ml containing
Sodium chloride
12.5mmol (3mmol/kg/day)
Potassium chloride
8.3mmol (2mmol/kg/day)
35)
Where would you go for guidance if you needed information
relating to the prescription or administration of a drug /
infusion?

NICU handbook

NICU pharmacist

IV Monographs

Medicines Information
36)
37)
What would you do if you noted a discrepancy between the
monograph and the handbook?

Complete CIR form

Discuss prescription with Consultant

Discuss with NICU pharmacist
List 10 things you would check on a prescription prior to
administering a drug.

Legibility of prescription

Name and Hospital number are correct

Weight is correct

Dose is calculated correctly

When was last dose administered

Is frequency correct (e.g. dose frequency need changing with
age)

Prescription has been signed by prescriber

Are any levels or results due before dose can be given

Is route of administration correct

Is drug prescribed at a standard administration time.