g. Controlled Medications. These items come from the vault section of the
h. Sterile Products. These medications come from the sterile products section
of the pharmacy.
DA Form 4256
The information on the profile is obtained from the DA Form 4256, Clinical
Record-Doctor's Orders (figure 2-3) and other documents found in the inpatient record
(chart). DA Form 4256 is a set made up of three copies. The original copy stays in the
patient's chart, the second copy goes to the pharmacy, and the third copy is placed in
the nurse's book. The second copy is pink in color and is referred to in the pharmacy as
the "pink sheet." The form is perforated at four places so that as an order is written, that
portion may be removed and sent to the pharmacy. When the profile is prepared, the
specialist should transcribe the patient information data, allergies, diagnosis, and
preexisting conditions as listed in the chart. He should transcribe the physician's order
exactly as it is written on the DA Form 4256 and place his initials in the appropriate
TRANSCRIBING AND CHECKING
After the information has been transcribed from the DA Form 4256, the profile
form is checked for medication errors, overdoses, drug interactions, contraindications,
and possible allergic reactions. The pharmacy copy of the DA Form 4256 should also
be checked against the completed patient profile to make sure there are no transcription
errors. The specialist who performs this check should place his initials in the
appropriate space. Ideally, these two steps, transcribing and checking, should be
performed by different individuals. This reduces the chance for errors.
The information from the DA Form 4256 in figure 2-2 has been transcribed to the
medication profile in figure 2-3. Because hypertension is a known preexisting condition,
the pharmacy should check to see if the patient is on any medication for that condition.
As new orders are written for a patient, they will be added to his profile sheet when they
are received in the pharmacy.
a. No order should be changed without new orders from a physician. The only
exceptions are generic and strength substitution. The rules for these substitutions are
similar to those made in the outpatient pharmacy. The changes should be posted to the
b For a strength substitution, line through the original strength, write in the new
strength, and initial the change. Remember to change the number of doses to reflect
the new strength