34.5 Medication Prescription Chart
Every drug, every dose, every route, every check — one chart that makes errors visible before they reach the patient
What it is
A standardised inpatient medication prescription and administration record. The prescriber completes the drug, dose, route, frequency, and indication. The pharmacist checks and signs. The nurse records each administration with time and signature. Allergies are in red at the top — mandatory before prescribing begins. The most common medication errors — wrong dose unit, no allergy check, unsigned doses — are structurally prevented by this chart’s layout.
ASF criterion
Evidence for: Hospital Standard 4, criterion 4.10 (Non-Negotiable) — Medication Prescribing Is Safe.
| INPATIENT MEDICATION PRESCRIPTION & ADMINISTRATION RECORD · ASF-TOOL-EWD-05 | |||||
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| Patient name | DOB | ||||
| ID number | Ward / bed | Weight (kg) | |||
| ⚠ ALLERGIES (complete before any prescribing — write NKDA if none known): | |||||
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| Drug name (generic) | Dose | Route | Frequency | Indication | Start date | Stop date | Prescriber sig. | Pharmacist check ✓ |
|---|---|---|---|---|---|---|---|---|
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| ADMINISTRATION RECORD — for each dose given, record time and sign | ||||||||
|---|---|---|---|---|---|---|---|---|
| Drug | Date | 06:00 | 10:00 | 14:00 | 18:00 | 22:00 | Other | Withheld? Reason |
ASF-TOOL-EWD-05 · Toolkit 34 — Early Warning & Deterioration · france-asf.fr/tools · ASF original © Accréditation Sans Frontières · CC BY-NC-SA 4.0 · Drug names, doses and units must be confirmed against national formulary · Keep this line on all adapted versions
