Transcript Medicines Management To be viewed in conjunction with NMC

Medicines Management
To be viewed in conjunction with NMC
Standards for medicines management
NMC
Standards
Important!
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Please view in conjunction with the NMC
standards for medicines management
www.nmc-uk.org/Publications/Standards
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In viewing this presentation, reading the
NMC standards for medicines
management and submitting the form
you will have completed your mandatory
training
If you still have questions at the end of
the presentation please contact your
ward/area pharmacy team.
Content
The following presentation will cover:
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General issues
Process on admission of the patient
The drug chart
Patient own drugs and their in-patient stay
Process for patient discharge
Calculations/conversions
Controlled drugs
Costing
Summary
General issues
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Ensure treatment room doors are closed and that drug
cupboard doors are locked.
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Controlled drug (CD) cupboard keys must be on a
separate set to other cupboard keys.
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The in-patient pharmacy is open Monday to Friday 8am to
6pm and Saturday and Sunday 10am to 4pm.
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During the week most wards receive a daily visit from a
member of the pharmacy team, please let the team know
of any issues, discharges or patient medicines needed.
If there are issues and the pharmacy team are not on the
ward please bleep them for assistance.
Stock top-ups are performed throughout the week also,
please communicate any changes in stock needs with the
team.
Patient admission – key priorities
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On admission an allergy status is a high priority,
ensure all allergies are written on the drug chart, all
trained staff can do it.
Check pharmacy grey box on the drug chart to see if
pharmacy team have already identified and/or
sorted any issues
If the patient has their own drugs or a medication
list compare to the drugs prescribed on the drug
chart before administering
Query any discrepancies with the team
If the patient does not have any medicines with
them ask if a relative/carer can bring them in
(especially inhalers and eye drops)
Patient admission – key priorities
(cont)
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If from a nursing/residential home ensure a copy of
the MARS is placed in the notes
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Message in a bottle scheme – have they brought in a
bottle with their information in?
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Put any patient’s own drugs (PODs) in the bedside
locker (locked), keep GTN sprays and inhalers
available to the patient but out of easy access of
other patients
Controlled drugs (CDs) must be locked away
immediately or returned home with a relative if
preferred or in a blister pack and not being used.
Role of clinical pharmacy team
Documenting drug histories
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The grey box is for Pharmacy to complete but nurses may find it
useful to identify any discrepancies found between drug history
and drug chart
Prescription/drug chart requirements
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Indelible and drug
name in capital letters
Dated
Signed by prescriber
Name of patient
Address of
patient/hospital
number
DOB – especially
children <12 years of
age
Indication and course
length for antibiotics
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Consultant
prescribing
team – for costing
Weight of patient
Height of patient
Allergy status
Correct ward nameso delivered to right
place
Checking Patients own drugs (PODs)
To ensure suitability for use
check medicine is –
 For this patient
 In date and dispensed in
the last six months
 The correct drug (contents
match box and label)
 The correct strength
 Labelled correctly
 In an acceptable condition
 Clearly identifiable – i.e. in
foil strips clearly named
Check POD against drug chart
– the prescription may have
changed
Please give all patients a green
bag:On admission
During stay
On discharge
Encourage patients to bring
their medicines back into
hospital in the green bag
(available from pharmacy)
PODs – compliance aids
NOMADs
Blister packs
Redidoses
Dossette
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If a patient requires a
compliance aid on
discharge, pharmacy
require 48 hours
notice and an
accurate discharge
letter
Compliance aids
are not a reason
to allow a
patient to miss
a dose
When patients
bring in their
own compliance
aids they may
be used
During patient stay
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Monitor drug chart for changes or new items and order as
needed
Endorse the chart according to what has been taken by
the patient – ensure clarity in dose administered
? Unavailable – is it really? Check fridge, treatment rooms
and previous ward if patient has been moved
Monitor the patient’s condition and think about the drugs
being given- is it appropriate to give drug?
Only use stock items or drugs labelled for THAT PATIENT.
It is against Trust policy to give a patient a medicine that
is labelled for somebody else
Ensure medicines are given on time particularly antibiotics
and Parkinson’s disease medicines
Sign for all administered medicines including oxygen
Endorsements
Generally pharmacy will endorse medicine charts in green ink
28 CS 6/10
- means 28 were supplied by CS on 6th Oct
14 POD 6/10-means the patient has 14 of their own tablets
on the 6th Oct
PODH
- means the patient has their own supply at home
CD – Controlled drug
STOCK – this drug is held on the ward in the stock cupboard
Look at the endorsement to find out where you will get a
supply from before putting drug unavailable on the chart
or ordering
On discharge
The discharge letter is to be checked against the patients
medication for:
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Correct medication
Correct strength
Correct form
All directions correct
TTO packs directions completed correctly including NAME of
patient and frequency of administration
Expiry date, especially eye drops
Sufficient quantity to either complete course or until can
obtain further supply from GP
Policy now states: IN POSSESION of MINIMUM OF
FOURTEEN DAYS SUPPLY
The 14 days supply includes any medicines the patient has
at home
Exception : TB meds – 28 days supply minimum
Useful Calculations/Conversions
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1 gram = ?? milligrams
 1000 milligrams
1 milligram = ?? micrograms
 1000 micrograms
1 microgram = ?? nanograms
 1000 nanograms
-Convert grams to milligrams
Multiply by 1000
-Covert milligrams to grams
Divide by 1000
-Convert milligrams to micrograms
Multiply by 1000
Controlled drugs
Ordering
 Use CEDAR and complete all fields correctly (check
with IT ex 5000 if your usual windows log in does not
give you access to CEDAR)
 Orders placed after 12pm will not be supplied until the
following day, if urgent for that day bleep the
dispensary manager (#6555 2321)
 Do not order CDs at the weekend or on bank holidays
unless absolutely essential as pharmacy have limited
staffing levels – only those marked urgent will be
processed at weekends
 Controlled drug electronic discharge letters can only be
dispensed if LEGAL. This means the total quantity
required must be in words and figures (e.g. 28 twenty
eight), the form must be written (e.g.
capsules/suspension) and the prescription must be
signed by the prescriber.
 Only trained nurses may collect CDs (need Trust ID)
Controlled drugs
CD registers
Ensure it is legible
Index at the front of the register -it is a good idea to leave
at least 10 pages between each stock CD page so that you
don’t have to keep transferring the balance over to
another random page
Double check:
Drug name, strength, form, quantity, expiry, calculations
Two members of staff to sign in and out and check levels
If you are entering POD CD’s into a register please leave
plenty of lines between each entry so that when they are
administered to THAT PATIENT or need returning to
pharmacy or the patient there is room to sign them out
Controlled drugs
If an error is made in the controlled drug
book:-
DO
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Bracket the error
Document error on line below and put
correct quantity
Make sure it is countersigned
DO NOT
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Cross out
Use correction fluid
Medicine costs awareness
It is good practice to ask patients to bring in their own
medicines from home, it ensures consistency in
medication supply, assists with drug history taking and
improves the efficiency of the pharmacy service by
enabling the team to dispense necessary items only.
The following slide gives an idea of the costs of some
commonly used medicines. It is not the intention that any
patient misses a dose however it assists all health
economies if patients own medicines are used whilst in
hospital where appropriate.
It is Trust policy that all patients have access to a
minimum of 14 days supply of their medicines on
discharge so using PODs during the in-patient stay
is not detrimental in any way.
Medicine costs (from BNF 63)
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Tazocin 4.5g inj x1
= £14.21
Pregabalin 75mg caps x56
= £64.40
Fresubin 2kcal drink 100ml
= £1.80
Seretide 125mcg evohaler
= £35.00
Seretide 250mcg evohaler
= £59.48
Lantus 3ml pen x 5
= £41.50
Tiotropium inhaler (spiriva)
= £34.87
Enoxaparin 40mg x 1 injection = £4.04
Rotigotine 4mg patches (28)
= £117.71
Linezolid 600mg tablets x 10
=£445.00
Good stock control is essential, storing medicines in
the correct place and regularly checking expiry dates
reduce waste and cost.
Summary
The presentation has pulled together common issues
surrounding medicines management, the nurses
role and their responsibilities.
It must be recognised that the drug chart is a legal
document and all acts and omissions need to be
fully and accurately recorded
Adhering to the NMC standards and Trust policies
not only ensures a positive patient experience but
will also reduce unnecessary re-admissions, waste
and costs.
If you require further advise, clarification or support
please contact your ward/area pharmacy team.