Procedure

Handle a substitution

Handle a substitution when the ordered medication needs a change, record the reason, and keep the prescriber informed of the swap.

Sometimes the ordered medication needs a change before it reaches the patient. Handle the substitution in Forge, the order system, record the reason, and keep the prescriber informed of the swap.

When a substitution applies

A substitution replaces the ordered medication with another. It fits a few common situations at the pharmacy counter.

Situation	What you record
The ordered drug is out of stock	A swap to an available equivalent, with the reason
A formulary restriction applies	A swap the site's formulary allows, with the reason
A different strength is on the shelf	A swap to the stocked strength, with the reason

The original is kept

The record keeps both

Forge keeps the original order exactly as the prescriber placed it, shown as Originally ordered. The substitution records as a new version beside it, carrying the reason, your name and the time. Both the original and the current medication stay on the record.

Figure 1.Diagram showing an ordered medication, a recorded substitution, the current medication going out for dispense, and the original kept on the record.

What a substitution records

reason string Required	Why the medication is changing, chosen from the list.
replacement string Required	The medication you dispense in place of the original.
note string	A short note to the prescriber, shown as sent.

Handle the substitution

1
Open the order
Select the medication order in your pharmacy worklist, and read what the prescriber placed.
The order shows the drug, dose, route and frequency as they were set.
If the order is ready as placed, dispense it as it stands rather than substitute.
2
Record the substitution and its reason
Select Substitute on the order. Choose the replacement medication and a reason from the list. Add a short note for the prescriber.
Forge records the substitution as a new version, and keeps the original as Originally ordered.
If the change needs the prescriber's decision, hold the order and add your note, so the prescriber updates it.
3
Keep the prescriber informed
The swap appears on the patient's orders for the prescriber, with your reason, your name and the time.
The prescriber sees both the original and the current medication on the record.
4
Verify and dispense the substitute
Verify the substitute as you would any medication order, then dispense it.
The substitute moves through pharmacy verified and dispensed, and the ward sees it is ready.
If a further change comes up, record another substitution, and Forge keeps each version.

Common questions

Does a substitution change the original order?

The original stays exactly as the prescriber placed it, kept as Originally ordered. The substitution records as a new version beside it.

Who is told about a substitution?

The prescriber sees the swap on the patient's orders, with your reason and note, alongside the original medication.

When is the substitute charged?

At dispense, for the strips or vials you issue, like any medication. The original medication draws its own charge only where it was dispensed.

Verify the substitute medication before you dispense it at verify a medication order.