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Description: long term care skilled facility received an order from md for lorazepam 2mg/ml.Administer 1 mg im q 6 hours prn severe agitation.The order was entered point click care by the nurse.When choosing from the drug drop down menu.Lorazepam 2mg/ml solution was chosen.The dose = 1 mg and route of im was chosen and appeared on the mar.The system electronically submits to the xxxx electronic system.A narcotic continuation order was handwritten at facility and included the im route of administration.No doses had been administered when the consultant pharmacist arrived for monthly review.When checking the refrigerator, a bottle of lorazepam 2mg/ml oral solution was present with the directions to administer 1 mg po.No lorazepam injection was received from pharmacy for this resident.No documentation of a clarification from pharmacy concerning question on route of administrator was found.Consultant pharmacist asked adon to contact pharmacy.The pharmacist replied that they no longer had record of the original point click care electronic order and stated the doctor's office had faxed an oral order to the pharmacy.He stated the physician's prescription overrode the original order.However, the mar was not changed to po and the intent of the prescriber was for im injection for severely agitated pt not able to receive po.Many concerns exist: why does the drop down menu not specify oral solution or injectable solution when facility nurse chooses drug, especially since concentration is the same for both? if the pharmacy received a prescription that differed from the electronic order, why was the facility not called for verification and update to mar? the mar which is generated at the facility from point of care systems reads: 1 mg solution im and the pt has a bottle that reads dose of 1mg (0.5ml).My fear was that the oral solution could be used in administering an im dose.The pharmacy did agree to immediately take back the incorrect dosage from and obtain proper prescription for the im dosage form.I will follow immediately take back the incorrect dosage form and obtain proper prescription for the im dosage form.I will follow up with point click care concerning their identification of drug dosage form.The chosen solution allowed either po or im to be 'route of administration'.I can see this being a more wide-spread problem.Thank you.(b)(6).(b)(4).Medication administered or used by the pt: no.Where the error occur: long term care facility.Type of staff made initial error: nurse.Pt counseling provided: unk.Severity: error occurred; medication did not reach pt.
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