Name: RAFAEL, DUNE VIENIS KAREN N.

Year & Section: BS-

Pharmacy 4A
Group No.: _____________________ Date Started: November 09,
2009
Date Submitted: ______________

Exercise No. 3
THE MEDICATION SHEET AND CARDS

I. Objectives:
a. To create a medication sheet and card,
b. To fill the medication sheet and card correctly, and
c. To understand the importance of medication sheet and card.
II. Data Output:
The output of this exercise is printed in separate paper after the
conclusion.
III. Answers to Questions:
1. Give the respective use of the following medication cards:
Note: My answers are based on the Davao Regional Hospital 9DRH
protocols.
a. Whole yellow card – bid/q 12 hr medications
b. Yellow card w/ one slit – for IV medications
c. Whole pink card – for tid medications
d. Pink card w/ one slit – for oral medications
e. Pink card w/ two slits – for IVTT medications
f. Whole green card – for q 4 hr medications
g. Whole orange card – for qid medications
h. Whole blue card – for q 6 hr medications
2. How are discontinued drugs labeled in medication sheets?
Discontinued drugs are labeled by putting a “D/C” mark using
red ink pen and putting a long horizontal line on the entire column. The
date, time, signature and name of the pharmacist who discontinued
the medication should be written.
3. For drugs or medications that are changed, what are the necessary
corrections to be done?
At the end of the column, a “changed” mark is written and the
entire column is crossed out by a long horizontal line using a red ink
pen. The date, time, signature and name of the pharmacist on duty
should be written.
4. What are the necessary comments on medications that are hold?
Comments such as “on hold” or “hold” are necessary on
medications that are hold.
5. For medications that have been completed, what are the necessary
comments/remarks?
The entire column should be crossed out using a red ink pen and
“completed” should be written on its end (to the right). The date, time
and signature of the pharmacist should be written legibly.
6. If medications have precautions, how is this entry made?
Precautions should be written under the “comment section” of
the sheet if provided.
 7. The medication card facilitates drug medication and therefore should
include what information?
Medication card should include the hospital information, name of
patient, age, sex, address, date, attending physician’s name, ward
name/location/number, bed number, name and amount of drug
ordered including its dosage, frequency, route of administration, the
name and signature of the pharmacist who prepared the medication/s
and the medicating nurse..

I. Conclusion:
Medication sheet and card are important instruments in order to
keep the pharmacist, physician and nurses in track with the
medications of the patient. These instruments are vital in order to
properly document the events of medication and serves as a guide in
order to track medication errors. Filling up medication sheets and
cards should follow the hospital’s protocols.
 ST. LUKE’S HOSPITAL
Father Selga Street, Davao City

PATIENT DRUG PROFILE

Patient Name: Thomas Anzalone Address: 2098 West

Central Avenue
Age: 31 Height: 5’11” Weight: 185 lbs
Sex: Male
Attending Physician: Kris Jezreel N. Noveno, MD Ward: 65-R Bed
No.: 0057
Diagnosis: Acute Schizophrenic episode
Date Admitted: August 14, 2009 Date Discharged: August
18, 2009

Route of
Drug Frequenc Date
Dosage Administratio Diet
Description y/Time Ordered
n
Intramuscula August 14, Regular diet
Haloperidol 5-10 mg q 4 hours
r 2009
August 17,
Risperidone 2 mg Oral b.i.d. IV Fluids
2009

Discontinu
ed
Medication
8/17: D/C
Haloperidol

PRN / STAT Drug History Allergies

Medications
8/14: Haloperidol 5
mg IM STAT.
• Outpatient
8/14: Haloperidol 5-10
mg IM PRN agitation.
• Smoker 2 ppd for 10 Penicillin
years
medications include
fluphenazine. Adverse Reactions
8/14: Dry mouth,
constipation, tardive
dyskinesia
Diagnostic Impressions
Acute schizophrenic
episode
8/14: BP: 130/74; HCT:
39%
BUN: 11; Hgb: 12.5 g/dL;
Cr: 1.0
8/14: Na: 140; K: 4; Cl: 95;
CO: 25

ST. LUKE’S HOSPITAL

Father Selga Street, Davao City

MEDICATION SHEET

Patient Name: Thomas Anzalone Address: 2098 West

Central Avenue
Age: 31 Height: 5’11” Weight: 185 lbs
Sex: Male
Attending Physician: Kris Jezreel N. Noveno, MD Ward: 65-R Bed
No.: 0057
Date Admitted: August 14, 2009 Date Discharged: August
18, 2009
Diagnosis: Acute Schizophrenic episode

DOSAGE, TIME/DAT
CLASSIFICATIO NAME OF ROUTE OF 8/1
E 8/14 8/15 8/16 8/17
N DRUG ADMIN. &
ORDERED 8
FREQUENCY
 I. Parente Haloperid 5-10 mg; 8/14/09 6- 6- 6- 6- 6-
ral ol IM; q 4 hrs 10-2 10- 10- 10- 10-
2-6- 2-6- 2-6- 2-
10-2 10-2 10-2 D/C
II. Oral Risperido 2 mg; bid 8/17/09 - - - 6-6 6–
ne D/C

III. Treatme None None None - - - - -

nt
IV. STAT/PR Haloperid 5 mg; IM; 8/14/09 10:3 - - - D/c
N ol STAT 0
am

Haloperid 5-10 mg; 8/14/09 - - - - D/C

ol IM; PRN
agitation

St. Luke’s Hospital

Father Selga Street, Davao City

Name:
Name:Thomas
Thomas Anzalone
Anzalone Ward:
Ward:65-R
65-R
Age
Age
&& Sex:
Sex:
31,
31,
Male
Male Bed
BedNo.:
No.:
0057
Date:
0057 ______________ A.P.: Noveno,
MD.Date: 17-Aug-2009 A.P.: Noveno, MD.

Risperidone
Haloperidol
7.5 mg
2 mg
IM PRN
IM b.i.d.
agitation
Prepared
Prepared
By:
By:
Dune
DuneRafael,
Rafael,
RPh
RPh Sheila
Sheila
N.N.
Noveno,
Noveno,RNRN
Pharmacist
Pharmacist
onon Duty
Duty
Medicating
Medicating Nurse
Nurse
 St. Luke’s Hospital
Father Selga Street, Davao City

Name: Thomas Anzalone Ward: 65-R

Age & Sex: 31, Male Bed No.:
0057
Date: 14-Aug-2009 A.P.: Noveno, MD.

Haloperidol
7.5
5 mg
mg IM q
STAT
4 hrs.
Prepared By:
Dune Rafael, RPh Sheila N. Noveno, RN
Pharmacist on Duty Medicating Nurse