Transcript introducing new medication prescription and

INTRODUCING NEW MEDICATION
PRESCRIPTION AND
ADMINISTRATION CHART
8 FEB2013
CONTENT
• Introduction/Background
• Three different types of Prescription and
Administration (P&A)chart
• Lay out of the (P&A) chart
• How to Prescribe?
• How to record Administration?
• How to order medication?
• Do(s) and Don’t(s)
• Q&A
BACKGROUND
• Current prescription and administration sheetdocument since 1960’s
• Card use for recording
• Prescribing and administration record
• Ordering of medication need to be done
separately
• Actual administration time is not captured
• Alarming rate of transcribing errors
PROBLEMS WITH OLD CARDEX
• Transcribing – leads to error
PROBLEMS WITH OLD CARDEX
• Drs need to rewrite prescription every 2-3 days
• For some medications, unsure of route if not written
(eg azithromycin 500mg od)
THREE DIFFERENT TYPES
• Parenteral prescription and administration chart
• For non-oral, non topical route of administration
THREE DIFFERENT TYPES
• Non-Parenteral prescription and administration chart
• For oral and topical medication
THREE DIFFERENT TYPES
• Medication with Frequent dose changes Prescription and
Administration chart
• For parenteral and non parenteral medication with frequent
dose changes, i.e. ivi insulin, heparin, inotropes
LIST OF MEDICATIONS WITH
FREQUENT DOSE CHANGES
• IVI Inotropes (Dopamine, Dobutamine,
Nordrenaline)
• IVI Midazolam
• IVI Morphine
• IVI Insulin (Actrapid, Insulatard)
• IVI Heparin
• Fixed dose parenteral & non-parenteral
medications with frequency>6 times/day (eg:
Artificial tears 1 drop q2H)
• NebA:V:N
LAYOUT OF THE PRESCRIPTION AND
ADMINISTRATION CHART
• Consist of 2 pages where the second is the
carbonized to the first
• Page 1(original copy)-ward use
• Page 2 (carbonized copy)- pharmacy use
Heading and Allergies history (page 1 and 2)
LAYOUT OF THE PRESCRIPTION AND
ADMINISTRATION CHART
Prescription
Page 1 &2
LAYOUT OF THE PRESCRIPTION AND
ADMINISTRATION CHART
Administration
record
Page 1
LAYOUT OF THE PRESCRIPTION AND
ADMINISTRATION CHART
Administration record for medication with frequent dose changes
LAYOUT OF THE PRESCRIPTION AND
ADMINISTRATION CHART
Page 1
Signature index and
Patient’s detail
LAYOUT OF THE PRESCRIPTION AND
ADMINISTRATION CHART
Page 2
Carbonized copy of prescription and pharmacy supply
record
Prescriber official
stamp and
patient’s
information sticker
can’t be
carbonized
LAYOUT OF THE PRESCRIPTION AND
ADMINISTRATION CHART
HOW TO PRESCRIBE
• First thing: Check patient’s name and detail
• Check for allergies history
HOW TO PRESCRIBE
IVB
Pantoprazole
0800
40mg bd
Dr lee lin lin
MPM6565
24/10
2000
27/10
To off the
medication,
remember to
fill in the
signature
index
HOW TO PRESCRIBE
• Remember to put your stamp on the carbonized
copy and check the patient's detail is available on
it too.
HOW TO PRECRIBE
• For medication with frequent dose changes, the
range of dose need to be stated
8mg in 50mL
D5 at rate of
10-20mL/hr
HOW TO RECORD ADMINISTRATION
• First thing: Check patient’s name and detail
• Check for allergies history
HOW TO RECORD ADMINISTRATION
1
24/10
2
Bc
1000
3
5
Bee Chong
4
Bc
HOW TO RECORD ADMINISTRATION
• IVI with dose changes (i.e. inotropes, insulin, heparin)
• Documentation done on every nursing shift as well as
whenever dose changes
IVI
1
24/10
24/10
5
Noradrenaline
2
8mg in 50ml D5 at 510ml/hr
3
6mL/h
r
4
IVI
0800
1200
6
10mL/hr
7
HOW TO ORDER MEDICATION
• Check all information needed is available and
correctly written:
• Name, dose and instruction (frequency), route of
administration, start date
• Prescriber’s signature and official stamp/ clearly written
name and MPM number
• Patient’s detail
• Separate each prescription from the carbonized
copy
• Send the prescription to pharmacy
HOW TO ORDER MEDICATION
HOW TO ORDER MEDICATION
• Re-ordering of medication
• Keep the prescription in patient’s folder
• Check for re-ordering date every morning
• Send prescription to pharmacy on the re-ordering date,
Please ensure the patient is still on the medication
• Each prescription is valid for 7 days from the first supply
pantoprazole
pantoprazole
40mg
bd
40mg bd
Dr lee lin lin MPM6565
IVB
IVI
24/10
24/10
24/10
6
TCH
26/10
HOW TO ORDER MEDICATION
• Re-ordering of medication
• Transcribe to new prescription and administration chart
after 7 days
HOW TO SUPPLY MEDICATION
New prescription
• Enter RN to MMUS dispensing desktop
• Check PMR for previous supply
• Proceed to issue out stock from MMUS and labeling
• On the prescription, enter
•
•
•
•
Date of supply
Quantity supplied
Initial
Next supply date*
HOW TO SUPPLY MEDICATION
1
pantoprazole
24/10
TCH
IVB
6
40mg bd
Dr lee lin lin
MPM6565
24/10
2
3
26/10
4
HOW TO SUPPLY MEDICATION
• To count the next supply date
• scenario 1
• On 3/1/12 morning, New prescription received for IV B
pantoprazole 40mg bd, no previous supply. 6 vials supplied and
the next supply date
• Last dose of supplied will be used on 5/1/12 night. Therefore,
next supply date will be on 5/1/12
• Scenario 2
• On 5/1/12, receive repeat order for prescription from scenario 1
• 3 vials supplied.
• Last dose on 7/1/12 morning. Therefore next supply date will be
on 7/1/12
In conclusion, ward are allow to order when they have 1 more
dose with them (applies for antibiotic and oral medication)
HOW TO SUPPLY MEDICATION
• To enter pharmacy notes, please include your initial
and date.
• For medication with frequent dose changes where
dose and instruction is written ranges (supply the
maximum?)
• For incomplete prescription, reject the prescription
by entering reason on the pharmacy notes column
• If prescription received with amendment done on
the carbonized prescription, reject the prescription
SO, WHAT’S NEW?
•
•
•
•
•
•
•
NO more Rx except for DRIPS & DISCHARGE
Reject all Rx except DRIPS & DISCHARGE
1 patient – many sheets all stapled together
Key-in: extra step, write next date of supply
Key-in: 4 + 3 (no more plus one!)
Packing – remove staple and pack as usual
Checking & dispensing – AS USUAL
ISSUES
• Cannot detect stopped medications
• Harder to detect interactions (eg ranitidine &
omeprazole)
• Carbon copy ‘hilang!’
• Ivi written in iv sheet
DO(S) AND DON’T(S)
Check to ensure
•
•
•
•
Ada patient sticker
Information is complete (dos, frequency etc.)
Ada Dr’s stamp
The dilution/ concentration required and the range of doses
prescribed is specified for the frequent dose change
prescription (example: IVI Noradrenaline 8mg in 50cc D5%,
at 4-10mL per hour)
THANK YOU!