ANATOMY OF A SIG

Verb1

Qty2

Dosage form3

(Special Dosing Info if applicable) 4 Route5 Frequency6

1 = Only include in Sig once:

Take: tabs, caps, oral liquids (do not use give or administer)
Inhale: oral inhalers
Use: test strips, nasal sprays/inhalers, Intermate, nebulized medication, topical swabs/pads
Irrigate: irrigations
Chew and swallow: chewable tablets
Spray: topical aerosols
Place: sublingual tablets
Instill: eye & ear drops
2=

Duration7

Indication8

Additional Info9

Dissolve: oral lozenges, orally disintegrating tablets, effervescent tabs, troche

Apply: patches, topicals
Swish & Swallow/Spit: some oral liquids
Inject: injections (IM, IV, SubQ)
Sprinkle: powders, sprinkle caps
Mix the contents of: packets
Insert: enema, rectal gels, suppository, vaginal tablet, vaginal applicator

Amount of dosage forms (e.g. 1 for tablet, thin film for cream) in numerals if applicable (e.g. 1 tablet, NOT one tablet).
For liquid products, just list mL amount. Do not include teaspoon, tablespoon or mg amount. cc is reserved ONLY when patient is using an insulin syringe for non-insulin medication.
Partial amounts are listed in decimals, not fractions (0.5 mL, NOT mL)
If amount is a range, do NOT use - symbol. Spell out to (e.g. 1 to 2 tablets)
Dosage values less than 1 are presented with a leading zero and decimal point (e.g. 0.1 mg, not .1 mg). Round to nearest measurable point on accompanying administration device. (e.g. 1
mL oral syringe, can round to nearest 1/100: 0.178 mL = 0.18 mL; 5 mL oral syringe can round to nearest 1/10, sometimes 1/100: 3.75 mL can be measured, but 1.78 mL cannot = round to
1.8 mL)
Trailing zeros after a decimal point are avoided as they may be misread as a tenfold overdose (e.g. 2.0 misread as 20 mg)
Decimals should be avoided when an alternative exists (e.g. 500 mg, not 0.5 gm or 125 mcg, not 0.125 mg)
Partial tablet or suppository amounts are listed as fractions (spelled out, with hyphens) and not decimal points. (e.g. one-half tablet, NOT 0.5 tablet or tablet)
Do NOT use & symbol spell out and (e.g. Take 1 and one-half tablets, NOT Take 1 & one-half tablets)
For pre-filled syringes (needle attached): use contents of 1 syringe as the qty for entire syringe doses. For partial syringes (needle attached), include amount to discard and amount to
administer: e.g. squirt out 0.1 mL and inject 0.9 mL. For syringes with overfill to accommodate needle volume (needle not attached; e.g. compounds) include attachment of the needle and
the marking to squirt down to: attach needle, squirt down to 0.2 mL and inject

3 = Tablet(s), capsule(s)
Puffs(s): oral inhaler
Spray(s): nasal spray, topical

Patch(es)
Suppository(ies)

Unit(s): insulin
mL: oral liquids, injectables

Drop(s): eye drops, ear drops, concentrate

liquids (Lugols)

4 = If strength dispensed differs from strength ordered:

Include total dose in parenthesis: e.g. 100 mg tab ordered, but 200 mg dispensed = Take one-half tablet (100 mg), 100 mg tablet ordered, but 50 mg dispensed = Take 2 tablets (100
mg); 200 mg/5 ml ordered but 100 mg/5 ml dispensed = Take 10 mL (200 mg); 300 mcg/ml ordered but prefilled 300 mcg/0.5 ml dispensed = Inject the contents of 1 syringe (300 mcg,
0.5 ml).
If multiple strengths are required to make a dose:
Enter instructions consistent with how they are worded in the Sig of the prescription.
U-500 doses should be expressed in actual units of U-500 insulin along with the corresponding markings on the syringe the patient is using (e.g., if using a tuberculin syringe: 200 units
[0.4mL]; if using a U-100 insulin syringe: 200 units [40 units mark on U-100 insulin syringe]).
5 = Only include in Sig once:
by mouth (not orally)
topically, to the skin
rectally
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under the tongue (not sublingually")

in mouth (orally disintegrating tablets)
in the [affected] eye

in [affected] ear
vaginally
in nose/each nostril

subcutaneously
intramuscularly
intravenously
Last updated 4/2014 tberg

6 = how often to take/use the dose; in written words (two times a day, NOT 2 times a day). Do not use once confused for 11 in Spanish, or twice (for consistency). one time or two times.
If before or after a meal, specify a meal and not meals. (e.g. Take 1 capsule by mouth daily before meals = Take 1 capsule by mouth one time a day before a meal)
7 = duration of therapy, in numerals, if stated by prescriber in the Sig (e.g. for 7 days, until symptoms resolve). If duration is included but does not appear to represent duration of therapy (e.g.
duration matches days supply AND refills are authorized) do not include in Sig. (e.g. Take 1 tablet daily for 90 days: include for 90 days if no refills, do NOT include for 90 days if refills are
authorized and written quantity = 90 days supply)
8 = if an indication is included on the prescription it should be included in the Sig unless otherwise instructed by the patient or prescriber
9 = If next refill date is noted on hard copy, include in Sig. Other additional information is included in the Sig only if it:
Relates directly to how to take the medication (relates to verb, qty,dose, dosage form, route, frequency, duration or indication). E.g. while catheter in place would be included because it
relates to duration. see primary care provider for refills or goal to wean off would not as it does not related to any of the above.
Is not a repeat of auxiliary label warnings E.g. Do not take with alcohol would not be included if it is already covered in an auxiliary label.
Any other notes or information on the hard copy should be added as a Counsel Note if the pharmacist deems it necessary.
Miscellaneous
A blank space must be present between medication name, dose, and dosage units (e.g. 20 mg, not 20mg)
Unapproved abbreviations* are not to be used on the patient label. (*U, IU, MS (for morphine sulfate), MSO4, QD, AD, AS, AU, OD, OS, OU, MU, ug)
Product specific Sig codes (e.g. Flonase, Zpak, Epipen, Nitro): use even if directions on prescription arent an exact match as long as the basic instruction/meaning is the same. Do not
assume the prescriber intended these directions if they wrote TAD.
If the entire SIG does not fit in the directions area, then Take as directed. See accompanying sheet for specific dosing instructions should be entered and the entire set of directions put into the
External Order Note. Since the External Order Note prints on all receipts in an order, be sure to include drug name in the note if there is more than 1 medication in the order.
Spanish Sigs may deviate from the numeral vs spelled out number rule

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Last updated 4/2014 tberg