How should medication orders with dosing ranges be entered?

Question: How should medication orders be entered when there are options for either the dose or frequency given for medication administration?

Context: It may be desirable for patients to be provided a medication dose that falls within a pre-determined range, with discretion provided for adjustments based upon symptoms or other considerations (e.g., laboratory results).

When prescribers order a single scheduled medication order with ranged dosing, system restrictions (such orders cannot work with decision supports) cause delays as extra pharmacist resources are required to interpret the prescriber's intent. Accordingly, AHS medication policy stipulates that ranged dosing should be restricted to the very few situations where a combination of regular and as-needed orders is not possible or appropriate. 

Answer: Dose range requests should be handled through two separate (but linked) orders. The first sets a regular baseline dose at consistent intervals. The second specifies an as-needed (PRN) dose that can supplement the baseline, possibly at a different administration frequency.

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