introducing new medication prescription and administration chart 8 feb2013

INTRODUCING NEW MEDICATION PRESCRIPTION AND

ADMINISTRATION CHART8 F E B 2 0 1 3

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 sheet- document 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

PrescriptionPage 1 &2

LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART

Administration recordPage 1

LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART

Administration record for medication with frequent dose changes

LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART

Page 1Signature index and Patient’s detail

LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART

Carbonized copy of prescription and pharmacy supply record

Page 2

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

27/10

Pantoprazole

1

40mg bd2

IVB

3

24/10

40800

2000

5

Dr lee lin lin MPM6565 6

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 ADMINISTRATION24/1

0

1

Bc

2

10003

Bee Chong

4

Bc

5

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

Noradrenaline

IVI

8mg in 50ml D5 at 5-10ml/hr

IVI

24/10

1

0800

2

6mL/hr

3

ffp4

24/10

5

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

40mg bd 24/10

IVB

24/10 6 TCH 26/10

Dr lee lin lin MPM6565

pantoprazole

40mg bd

IVI

24/10

• Re-ordering of medication• Transcribe to new prescription and administration chart

after 7 days

HOW TO ORDER MEDICATION

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

24/10pantoprazole

40mg bd 24/10

Dr lee lin lin

MPM6565

IVB

1

6

2

TCH

326/10

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!