All Prescriber Bulletin - Med Order Start Times

All-user-bulletins highlight developments that all physicians need to be aware of when using the Connect Care clinical information system.

Take note of Medication Order Start Times

If an inpatient medication order is entered without an explicit start time, the default (standardized medication administration time, SMAT) can lead to unintended first dose timing, and possibly additional dose administration. 

The default when ordering an ongoing medication (e.g., furosemide 40 mg po daily) is for "As Scheduled" dose timing, which results in the first dose being given at a default time (e.g., 08:00, depending upon the medication). This works well most of the time. However, if an independent dose is ordered and given just before the continuing medication order, the clinician may want to explicitly set the "Starting" time to avoid two doses close together. This, of course, depends on intent.

Universal best practice: Take note of the starting time and the resulting anticipated initial schedule of dose times to confirm that this fits clinical need.