document title: medication use policy phrm -u 105 policy ... · dietitians, and respiratory...

POLICY

WRH Universal (WRU)

Document Title: Medication Use Policy Policy Number: PHRM-U-105

Department: Pharmacy & Medication of 26

Author: Charlene Haluk-McMahon (Medication Safety Officer)

Authorized By: Antoinette Duronio (Director Pharmacy) Karen Riddell (VP Pharmacy) Karen McCullough (CNE)

Last Revision Date: 06/15/2018

Next Review Date: 06/15/2023

Origination Date: 01/22/1998

All hard copies of this document to be considered REFERENCE ONLY. Always refer to WRH Intranet Policy & Procedure Library for latest version.

Medication Use Policy

TABLE OF CONTENTS

Policy ....................................................................................................................................................................... 2

Purpose ................................................................................................................................................................... 2

Scope ....................................................................................................................................................................... 2

Definitions ............................................................................................................................................................... 2

Procedures .............................................................................................................................................................. 3

1. PRESCRIBING .............................................................................................................................................. 3

1.1 General Guidelines: ........................................................................................................................................... 3 1.2 Special Considerations: .................................................................................................................................... 5

2. DISPENSING / PREPARATION .................................................................................................................... 8

2.1 Pharmacist/Nurse Review of Orders ................................................................................................................ 8 2.2 Medication Preparation ..................................................................................................................................... 9 2.3 Medication Labeling ........................................................................................................................................ 10 2.4 Medication Security ......................................................................................................................................... 11 2.5 Medication Returns ......................................................................................................................................... 12 2.6 Medication Storage .......................................................................................................................................... 12

3. ADMINISTRATION / DOCUMENTATION ................................................................................................... 13

3.1 General Guidelines .......................................................................................................................................... 13 3.2 Transfer of Medications .................................................................................................................................. 15 3.3 High Alert Medication ...................................................................................................................................... 15 3.4 Medications from Home (See Appendix D for flow diagram) ....................................................................... 15 3.5 Missing Medications ........................................................................................................................................ 15 3.6 Holding Medications ........................................................................................................................................ 15 3.7 Self-Administered Medications ...................................................................................................................... 16 3.8 Documentation ................................................................................................................................................. 16

4. MONITORING .............................................................................................................................................. 17

4.1 General Guidelines .......................................................................................................................................... 17 4.2 Adverse Drug Event (ADE) Reporting ............................................................................................................ 18

References ............................................................................................................................................................ 18

Appendix A: Medication Administration for patients under “Contact precautions” ....................................... 19

Appendix B: Guidelines for use of the pharmacy-system-generated Transfer Medication Orders ............... 20

Appendix C: Guidelines for use of the pharmacy-system-generated Discharge Prescription ...................... 22

Appendix C: Discharge Prescription .................................................................................................................. 23

Appendix D: Guidelines for use of Ouellette Campus pharmacy-system-generated Discharge Prescription.......... 25

Appendix E: Medication(s) from Home Flow Diagram ....................................................................................... 26

POLICY

WRH Universal (WRU)









POLICY

Medications will be administered to patients by qualified personnel in compliance with federal and provincial laws and regulatory standards of practice.

Medications will be stored, handled and accounted for in a safe manner complying with federal and provincial laws and regulatory standards of practice.

PURPOSE

To define safe and effective practice guidelines for the medication use process at Windsor Regional Hospital. This includes:

medication prescribing,

dispensing/preparation,

storage,

administration/documentation; and

monitoring

Where processes are not specifically defined, refer to regulatory body standards of practice.

SCOPE This policy applies to all Windsor Regional Hospital Health Care Providers or persons who provide health care on behalf of Windsor Regional Hospital who order medications, prepare medications, administer medications and monitor the effectiveness of medication use while caring for and treating patients.

DEFINITIONS

Allied Health Practitioners: Health care providers who are not physicians, but by virtue of their special training, are able

to provide services to the hospital or its Medical Staff, as defined by medical staff bylaws. These would include, but are not limited to, physicians assistants, registered nurse extended class (RNEC), midwives, pharmacists, dietitians, and respiratory therapists.

Authorized Personnel: Individuals authorized to have access to medications, as defined in specific job description, law, and regulation

CMAR: Computer-generated medication administration record

Licensed Independent Practitioner: Any individual permitted by law and this organization to provide care, treatment, and services, without direction or supervision, within the scope of the individual’s license and consistent with individually granted clinical privileges.

MAR: Medication administration record

Medication: Any prescription medication; sample medication; herbal remedy; vitamin; neutraceutical; over-the-counter drug; vaccine; diagnostic and contrast agents used on or administered to persons to diagnose, treat, or prevent disease or other abnormal condition; radioactive medication; respiratory therapy treatment; parenteral nutrition; blood derivative;intravenous solution (plain, with electrolytes and/or drugs) and any product designated by Health Canada as a drug. This definition of medication does not include enteral nutrition solutions (which are considered food products); oxygen and other medical gases.

Nursing Personnel: Registered Nurse (RN) or Registered Practical Nurse (RPN)

Prescriber: Can include a physician or allied health practitioner (under delegated authority) who has been granted prescribing privileges according to medical staff bylaws and hospital policy.

Qualified Personnel: Licensed healthcare professionals responsible for the elements of the medication use process who have demonstrated competence in the medication use process, as defined in their specific job description.

8 Rights PLUS 2: The steps defined in the medication use process:

Right patient Right frequency

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WRH Universal (WRU)









Right medication Right route

Right reason Right site

Right dose Right time

PLUS – Right administration technique & Right documentation

PROCEDURES

1. PRESCRIBING

1.1 General Guidelines:

All medications administered to a WRH patient will be: o Ordered using the regular medication order form or approved preprinted order set (note: over-the-counter

medications require an order), or o Documented on the appropriate procedural record.

A licensed professional authorized to prescribe medications includes, but is not limited to, the prescriber (as outlined in definition) and those that are granted privileges through delegated authority approved by the medical staff (e.g. pharmacist or other allied health practitioner).

The prescriber will review the patient’s current home medication regimen and reconcile the home medication list with the medications ordered on admission.

See the WRH Medication Reconciliation Policy for an overview of the Medication Reconciliation process.

Only medications required to treat the patient’s condition(s) should be ordered. All medications ordered should have an indication for use documented in the patient’s medical record.

The prescriber should interview the patient and document the patient’s allergy information on all admission medication orders.

The prescriber will correctly identify the patient using two separate patient identifiers:

This process should include active participation and communication of identifiers with the patient whenever possible.

The patient’s identity must be verified with each patient encounter.

Refer to the WRH Patient Identification Policy for details.

Medication orders should be complete and include the following: o Patient name/identifier o Date and time the order is written o Name of the medication completely written out – generic name is preferred. Exceptions include combination

products (e.g. Tazocin®, Tylenol No.3®) or those generic names that could be more error prone than the trade name (e.g. Toradol®, Duragesic®, Dilaudid®)

o Dose o Route o Frequency o Special administration instructions – reason for use is required for “as needed” orders o Signature and printed name of the prescriber with contact information and CPSO number

Abbreviations for medication names and clinical symbols are not acceptable.

The WRH Dangerous Abbreviations Policy prohibits the use of dangerous abbreviations and dose designations. Orders containing dangerous abbreviations will be clarified per the WRH Dangerous Abbreviations Policy.

Only WRH approved abbreviations should be used when writing medication orders. This list can be found on the Pharmacy Intranet page >> Drug Information tab.

All medication orders should be written using metric units (e.g. mL, L, mcg, mg, gram).

Medication orders must be written on Windsor Regional Hospital approved order forms.

Medications ordered outside of WRH prior to admission must be reviewed and authorized by the MRP prior to implementation if the original order was not written within the last 30 days.

For long-stay patients, all medication orders will be reviewed and reordered every 90 days while admitted.

All medication orders must be signed by the ordering prescriber.

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Verbal orders for medications may only be taken by qualified personnel in emergency situations and when delays in prescribing would negatively affect patient health status. Per WRH Professional Staff Rules and Regulations: verbal orders will be authenticated immediately afterward.

Telephone orders for medications may be accepted when the prescriber is unavailable to immediately write the order and delays in prescribing would negatively affect patient health status. Per WRH Professional Staff Rules and Regulations: Telephone orders will be authenticated as soon as possible (within twenty-four (24) hours or on his/her first visit to the Hospital thereafter (whichever is sooner)

The qualified personnel responsible for taking a verbal/telephone order must transcribe the medication order immediately to a physician’s order form. Verification read-back of all verbal and telephone medication orders are mandatory to avoid errors. The elements of the medication order read-back will include:

o Patient’s complete name o Drug name (generic preferred) – include spelling the drug name out to avoid errors of sound-alike drugs. o Dosage – pronouncing it in single digits (e.g. 15mg should be read as “fifteen, one – five milligrams) o Route of administration o Frequency – pronouncing it in words (e.g. “three times a day”, NOT tid) o Reason for use on any “as needed” orders o Name, contact information, and service of the provider

**Documentation of the “read-back” is to be noted immediately before the telephone/verbal order notation

The following medications cannot be ordered verbally or by telephone: o Parenteral chemotherapy (telephone orders for dose adjustments can be taken by pharmacists) o Initiation of orders for medications administered by intrathecal or epidural route o Research drugs or drugs available through the Special Access Program of Health Canada

Medication orders must include the name of the medication. General orders such as “continue previous medications”,

“continue/resume pre-op medications”, “meds as at home”, “continue all meds”, “discontinue pre-op meds”, etc. are subject to misinterpretation and are not acceptable.

If these are written, the nurse will contact the practitioner and a clarification order will be written.

Only current, active orders may be reordered using the drug name only.

Orders for medications that have been stopped are considered new orders and must be completely rewritten including the drug name, dose, frequency, route, etc. An order that changes in any way, i.e. dose, route, frequency, is considered a new order and must be completely rewritten.

Where there is any doubt about the accuracy, clarity, safety or validity of any medication order, the medication will be held until clarification is obtained from the practitioner. If the practitioner is not available / does not respond to a page, another practitioner (e.g. practitioner “on-call” for the individual or program, or Chief of Service) will be contacted.

The MRP is to respond within 30 minutes if contacted for medical problems. If an employee is unsuccessful at contacting a member of the Professional Staff in within the 30 minute timeframe for a patient related matter, and at the contact listed as primary on the directory, the following procedure is to be followed:

1. Contact the subsection head if applicable, if unsuccessful then:

2. Contact the Chief of the Department. If unsuccessful then:

3. Contact the Chief of Staff

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1.2 Special Considerations:

Clarifications: Signed orders must never be altered. Once an order/preprinted order has been signed any changes/additions to those orders MUST be written as a new order.

This applies to all handwritten orders, order sets and Admission Medication order forms.

Pediatric / Neonatal orders: Weight, in kilograms, must be included on all orders.

Medication orders for pediatric / neonatal patients weighing 50kg or less MUST be written using weight-based dosing. (e.g. mg/kg) along with the patient-specific dose for drugs that have a published pediatric/neonatal mg/kg (or other appropriate unit of measure) dosing guideline. The dose should not exceed the maximum dose.

Example: Ceftriaxone 250mg (50mg/kg, pt weighs 5kg) IV every 24 hours

Chemotherapy orders: All parenteral chemotherapy orders must be written or entered into OPIS by the physician. Medication orders for chemotherapy drugs will include the patient-specific dose and the mg/kg, mg/m2, units/m2, area under the curve, or other dosing method used to calculate the patient-specific dose.

Hypoglycemic medications: All glycemic control orders (i.e. insulin, oral hypoglycemic, glucose, capillary blood glucose monitoring) will be placed on the buff-coloured “glycemic control treatment records” or applicable preprinted order set. If glycemic control medication orders are written on the incorrect treatment record, one nurse must transcribe the orders to the appropriate glycemic control treatment record/order set AND a second nurse must perform an independent double check. Both nurses must sign to validate that correct transcription has occurred

When new insulin orders are written, “see new orders” will be documented in red pen on the previous insulin order.

Automatic Stop Order: is a date or time that is predetermined and approved by the Pharmacy & Therapeutics Committee and Medical Advisory Committee to discontinue a medication.

1.2.1.1: All medication orders will remain active until discontinued by the prescriber or a hard stop date is reached as defined in this policy.

1.2.1.2: Unless otherwise ordered, anti-infective medications will follow a 7-day automatic stop.

1.2.1.3: An order written for a specific number of doses will override the automatic stop.

1.2.1.4: A report will be generated 24-48 hours prior to the medication expiration date and will be placed in the physician’s order section of the chart for review by the prescriber.

1.2.1.5: The prescriber will review each medication listed on the automatic stop order, indicate any medications to be reordered, and sign the order. The prescriber may also reorder the medication by rewriting it in full on a ‘physician’s order form’. All reorders are to be faxed to the pharmacy department for processing..

Range Order is a medication order in which the dose, frequency or route varies over a prescribed range or interval.

1.2.2.1 Dose ranges will be interpreted as follows:

o The lowest dosage in the range will be used to initiate therapy.

o If the response to initial therapy is inadequate, the dose will be escalated within the range, based on the clinical judgment of the qualified personnel, to achieve the desired end point.

o If in the clinical judgment of the qualified personnel, the lowest dose in the range will be inadequate to achieve the desired end point, the rationale and supporting information for the dose selected will be documented in the medical record.

o The rationale and supporting information (e.g. pain score, previous response, symptoms, etc.) for all dosage adjustments will be documented in the patient’s medical record.

1.2.2.2: Frequency ranges are not acceptable.

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Orders written with frequency ranges will be interpreted as the shortest time interval within the range prescribed (e.g. an order written as every 4 to 6 hours will be interpreted as every 4 hours)

1.2.2.3: Route ranges will be interpreted as follows:

A route range should be interpreted as the least invasive route being the route of first choice. Routes of administration from least to most invasive: PO (oral) / NG (nasogastric) / PR (per rectum) / SC (subcutaneous) / IM (intramuscular) / IV (Intravenous) (e.g. PO or IV … PO should be interpreted as the preferred route. The parenteral route should be the alternative used if the patient is unable to take the medication by mouth.)

**Prescribers should recognize that doses may NOT be of equal potency as the route of administration changes and dose adjustments should be written accordingly.

Titrating Order is an order in which the dose is either progressively increased or decreased in response to the patient’s

parameter as specified within the initial order. The order must clearly indicate a starting dose with specific parameters for titration and include a lower and upper dose limit. (e.g. ‘start dopamine infusion at 5 mcg/kg/min and titrate from 0-20 mcg/kg/min to maintain SBP greater than 90mmHg)

Taper Order is an order in which the dose is decreased by a specific amount within each dosing interval. The order must clearly indicate specific dosage increments with timing intervals. (e.g. prednisone 40mg daily for 2 days, then 30mg daily for 2 days, 20mg daily for 2 days, 10mg daily for 2 days, then stop)

As Needed (PRN) Order is an order acted upon based on the occurrence of a specific indication or symptom.

All PRN orders must include the indication for use.

Orders without an indication for use will be clarified as per the “Patient Order Processing Policy

Hold Orders:

1.2.3.1: When the prescriber writes an order to “hold” a medication, the order should include specific clinical parameters or the length of time the medication is to be held (e.g. “hold for SBP less than 100mmHg”, or “hold for 24hrs then reassess”).

1.2.3.2: Hold orders without clinical parameters or limited time/number of doses will be placed on hold in the pharmacy patient profile system. When the next CMAR is printed, administration times will not appear next to the held medication, instead, the notation “ON HOLD” will appear.

1.2.3.3: The prescriber is responsible to reassess hold orders.

NPO Orders: No medications will be administered when a patient is NPO. If medications are required while the patient is NPO, an order must be written to specify the medication to be continued. (i.e. “NPO except meds”, “NPO except ramipril and metoprolol”)

Medication Samples: Prescribers shall not bring in medication samples for hospitalized patients. Any exceptions to this policy must be approved by a Windsor Regional Pharmacist and will be made on an individual patient basis where it is deemed that there is significant risk that the patient will not receive their essential medication (e.g. disadvantaged population) unless it is facilitated by the pharmacy department. If sample use is required, the medication sample will be reviewed, identified and appropriately labeled by a pharmacist/other qualified healthcare professional.

Medications from Home: (see Appendix D for flow diagram)

1.2.4.1 Medications brought from home by the patient should be sent home with the visiting family or caregiver. If they cannot be sent home, they must be secured on the nursing unit and sent home with the patient on discharge. All medications must be placed in Ziploc bag or envelope and seal with tamper proof tape or staple to prevent tampering. Store all patient home medication in designated lock cupboard and return key to Pyxis. Notation to be made on the discharge form as to whether the medications were returned to the patient or destroyed.

1.2.4.2 Non-narcotic medications brought from home may only be used for administration during the inpatient admission if:

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1.2.4.2-1 The prescriber has ordered the non-formulary medication for use during the admission, AND

1.2.4.2-2 A pharmacist or other qualified healthcare professional, when a pharmacist is unavailable, has reviewed and identified the medication in the bottle/vial to match the prescriber’s order. The pharmacist/other qualified healthcare professional will affix a verification label on the patient’s own medication vial to signify that the medication has been verified and is ready for use.

1.2.4.2-3 For patient’s narcotic non-formulary medications, the nurse and nurse witness fill out the Home Medication form and must include:

-patient demographics -narcotic name, strength, and quantity -nurse name and signature -witness name and signature All medications must be placed in Ziploc bag or envelope and seal with tamper proof tape or staple to prevent tapering. Store all patient home medication in designated lock cupboard and return key to Pyxis. At discharge, the nurse will return the medications to the patient and document this in the progress notes

1.2.4.2-4 In the event that a patient’s medication brought from home is an insufficient quantity for the duration of the admission, an additional supply will need to be requested by the nurse to the family/caregiver. In the event that there is no family/caregiver, the nurse will need to contact the pharmacist for any additional supplies to ensure a new review and identification occurs prior to the medication being administered.

Changes in Level of Care: A change in the intensity of services required as a result of changes in the patient’s health status. Patients moved between the acute care hospital and outpatient departments or rehabilitation units or complex continuing care units or mental health units are discharged from the sending unit and admitted to the receiving unit. Refer to Medication Reconciliation policy/guidelines

1.2.5.1 New medication orders must be written / prior med orders must be authorized for the following changes in level of care:

A patient that has undergone any surgical or other procedure requiring higher level anaesthesia (excludes mild to moderate sedation)

A patient that is transferred from: o the Critical Care Program (CCP) to a non-CCP bed o a general care unit to the CCP unit

A patient is admitted from the following areas: o Same day surgery to a patient care unit

A patient is discharged from: o A general patient care unit and admitted to a rehabilitation unit (and vice versa) o A general patient care unit and admitted to a complex continuing care unit (and vice versa) o A general patient care unit and admitted to a mental health unit (and vice versa)

1.2.5.2 To facilitate the transfer process, the transferring physician may generate a “Transfer Medication Orders” form from the pharmacy patient profile system. See Appendix B for Guidelines for Use of the “Transfer Medication Orders” form

1.2.5.3 When the “Transfer Medication Orders” form is not available:

All medication orders must be re-written.

Internal transfer orders will be re-written by the prescriber transferring from the higher acuity unit. (i.e. written by the prescriber in ICU when going from ICU/CCU to unit, or from the unit to the ICU/CCU)

External transfer orders will be written/authorized by the accepting MRP

The prescriber will reconcile each medication against the current medication administration record and the admission medication history, and decide which medications to continue or discontinue.

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1.2.5.4 Blanket orders are not acceptable (e.g. “resume previous orders”, “resume pre-op orders”, “resume home medications”). If these orders are written, the prescriber will be contacted for complete medication orders.

Discharge Medication Orders:

1.2.6.1 Prior to discharge, the prescriber should review the list of medications that patient was on at home (located on the Admission Medication Orders) and the current medication administration record.

1.2.6.2 The prescriber may generate the “Discharge Prescription” form from Horizon Meds Manager/WORX and will indicate which medications to continue or discontinue, and order any additional new medications. See Appendix C for Guidelines for Use of the “Discharge Prescription” form.

1.2.6.3 The prescriber must review and reconcile all medications before the patient is discharged.

1.2.6.4 On discharge, the nurse will review the list with the patient and provide a copy of the Horizon Meds Manager/WORX/manually generated “Medication Card”.

1.2.6.5 Prescription medications that have been prescribed, dispensed, and administered in the hospital may not be sent home with the patient. (i.e. creams, inhalers, eye drops supplied by WRH inpatient pharmacy are to be disposed of at discharge).

1.2.6.6 Blanket discharge orders are not acceptable (i.e. “discharge on same home meds”). If these orders are written, the prescriber will be contacted for complete discharge medication orders.

2. DISPENSING / PREPARATION

2.1 Pharmacist/Nurse Review of Orders

2.1.1 All medications administered must be ordered/documented. Over-the-counter medications require an order in the chart.

2.1.2 The pharmacist will review all medication orders against the patient’s medication profile for validity, safety and appropriateness prior to dispensation and administration.

2.1.3 For orders written outside of pharmacy operational hours:

2.1.2.1: Administration of the new medications ordered during non-pharmacy covered hours should be postponed until the pharmacy opens, whenever possible.

2.1.2.2: When clinical care of the patient would be compromised by postponing implementation of the new order, the nurse may access the medication using the override function in the automated dispensing device (i.e. pyxis) or from the night cabinet.

The amount of medication removed should be sufficient to meet the ordered dose and should not exceed the amount required to last until a pharmacist is available to review the order.

2.1.2.3: The nurse removing medications via override will review the orders for safety, efficacy, and appropriateness. See 2.1.4 for parameters which require review. Any concerns, issues or questions that arise are to be clarified with the prescriber before retrieving and administering the medication.

2.1.2.4: The on-call pharmacist can be contacted for additional clarification or information on orders.

2.1.2.5: A retrospective review of the orders will occur by the pharmacist as soon as possible the following morning when the pharmacy department opens.

2.1.4 The pharmacist review of the medication order prior to dispensing and administration is not necessary when:

A licensed independent practitioner controls the ordering, preparation and administration of the medication. This includes but is not limited to the following clinical areas: Operating Rooms, Radiology, Emergency Room, and Endoscopy procedure area.

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In urgent situations when such a review would cause a medically unacceptable delay, such as when the patient experiences a sudden change in clinical status. The pharmacist will review the order as soon as possible after the administration of the dose and should review any orders prior to the administration of subsequent doses if an order is written to continue therapy.

2.1.5 The pharmacist review (and nurse review if initiating medication orders outside of a pharmacist review) of the order

will include the following:

2.1.5.1: Identification of the patient using two separate patient identifiers.

2.1.5.2: The patient’s real or potential allergies, sensitivities, or adverse drug reactions:

If allergies are not documented on the patient admission records, then the pharmacist (or nurse) is responsible for contacting the prescriber / nursing unit to determine the allergy status prior to dispensing.

If a prescribed medication is listed as an allergy, the pharmacist (or nurse) should contact the physician to recommend therapeutic alternatives. This should be documented in the patient’s profile in the pharmacy information system.

If a discrepancy is found between the allergy information documented in the medical record and electronic information system, the pharmacist (or nurse) will reconcile the allergy/adverse drug reaction information with the patient and contact the prescriber to clarify the allergy or if indicated, recommend a therapeutic alternative.

If allergy information is not readily available due to the patient’s status or when obtaining such information would cause a medically unacceptable delay, the pharmacist (or nurse) may use professional judgment in dispensing the medication prior to the review of allergy information

2.1.5.3: Therapeutic duplication

2.1.5.4: Appropriateness of medication, dose, route or frequency.

2.1.5.5: Any drug-drug interactions

2.1.5.6: Any pertinent laboratory values (e.g. serum creatinine for renally eliminated drugs, INR for warfarin orders, etc.)

2.1.5.7: Contraindications

2.1.5.8: Variation from criteria for use

2.1.5.9: Other relevant medication related issues or concerns

2.1.6 The pharmacist and/or nurse will contact the prescriber in the event that a clarification is needed for any of the above stated elements.

2.2 Medication Preparation

2.2.1 All sterile medication, intravenous admixtures, or other drugs that require compounding, mixing, manipulation or admixing should be prepared according to standardized concentrations (refer to the Windsor Regional Hospital IV manual of formulary drugs), labeled, and dispensed by the pharmacy except:

In emergency situations when the pharmacy preparation would cause medically unacceptable delay. (e.g. after pharmacy hours, life-threatening situations)

When drug product stability is short.

2.2.2 Medications that are not commercially available are prepared in pharmacy in accordance with provincial and federal

regulations.

2.2.3 Any medication prepared outside the pharmacy should be initiated in the area where it was prepared.

2.2.4 Any medication prepared outside the pharmacy and not initiated should NOT be transferred with the patient. The receiving unit nurse should prepare the medication new.

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2.2.5 In ambulatory or other areas in which pharmacy may not be preparing the medications, processes

related to preparation, dispensing, safety, storage, and infection control should be utilized. (e.g. aseptic technique preparation). The stopper on all medication vials should be disinfected prior to insertion of a sterile needle to aspirate contents.

2.2.6 It is recommended that a filter needle/filter straw be used in the preparation of any medication aspirated from a glass ampoule to prevent infusion of glass microparticles that may occur during breaking/opening of the ampoule. Solutions in plastic ampoules do not require filtering prior to administration unless specifically indicated by the manufacturer.

2.2.7 Medications in care areas are to be maintained in the most ready to administer forms available from the manufacturer.

Where feasible, and not available in ready the administer forms from the manufacturer, unit doses will be repackaged by the pharmacy department or a licensed repackager.

2.2.8 During hours of operation, Pharmacy will receive and order from the nursing unit and will process according to the following turn around times:

STAT CRITICAL orders immediately after receiving phone call STAT orders 15-30 minutes from the time the order was received Antibiotic orders 30-60 minutes from the time the order was received Routine orders 60-90 minutes from the time the order was received

2.2.9 Refer to the WRH Automated Dispensing Device (Pyxis) policy for medications removed from the automated

dispensing cabinet.

2.3 Medication Labeling

2.3.1 All medications, medication containers, or other solutions on and off a sterile field must be labeled. These would include, but are not limited to, syringes, medicine cups, and basins.

2.3.2 Medications and solutions both on and off the sterile field are to be labeled even if there is only one medication being used.

2.3.3 Labeling occurs when any medication or solution is transferred from the original packaging to another container.

2.3.4 All medication or solution labels are verified both verbally and visually by two qualified individuals whenever the person preparing the medication or solution is not the person who will be administering it.

2.3.5 No more than one medication or solution is labeled at one time.

2.3.6 Any medications or solutions found unlabeled will be appropriately disposed of immediately.

2.3.7 All original containers from medications or solutions remain available for reference in the perioperative or procedural area until the conclusion of the procedure.

2.3.8 All labeled containers on the sterile field are appropriately disposed of at the conclusion of the procedure.

2.3.9 At shift change or break relief all medications and solutions both on and off the sterile field and their labels are reviewed by entering and exiting personnel.

2.3.10 All medication and solution labels should include:

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Drug name, strength, amount (if not apparent from the container)

Expiration date when not used within 24 hours

Expiration time when expiration occurs in less than 24 hours

The date prepared and the diluent for all compounded IV admixtures and parenteral nutrition solutions

2.3.11 When preparing individualized medications for multiple specific patients, or when the person preparing the individualized medications is not the person administering the medication, the label also includes the following:

Patient name and ID number

Patient location

Directions for use and any applicable cautionary statements either on the label or attached as an accessory label (e.g. “refrigerate”, “for IM use only”, etc)

2.3.12 Compounded IV admixtures, total parenteral nutrition (TPN) and total nutritive additive (TNA) solutions should be labeled with the scheduled date, time and rate of administration when appropriate.

2.4 Medication Security

Definition of secure medication: Drugs and biologicals are stored in a manner to prevent unmonitored access by unauthorized individuals.

2.4.1 Secure areas are those that are restricted to authorized individuals and those where patients and visitors are not allowed without the supervision of an authorized individual.

2.4.2 An area in which staff is providing care to patients or preparing to receive patients (e.g. setting up for procedures before the arrival of a patient) would generally be considered a secure area.

2.4.3 When a patient care area is not staffed, all medications are expected to be locked.

2.4.4 Nursing units utilizing medication carts will keep the medication cart at the nursing station when not in use. It is preferred to utilize locked medication rooms, if available, to secure medications (including medication carts).

2.4.5 When mobile medication carts (unit dose carts, anaesthesia carts, epidural cars, etc) are not stored in a locked room, the mobile medication cart will be locked and stored in a secure area when not in use.

2.4.6 Access to locked storage areas where medications are stored will be limited to authorized individuals.

2.4.6.1: Individuals who require access to medications to perform their job duties, as defined in their job descriptions, will be considered authorized individuals. Examples include nurses, pharmacists, pharmacy technicians, radiology technicians, respiratory therapists, etc.

2.4.6.2: Ancillary support individuals who require access to locked storage areas where medications may be stored in order to perform their assigned job duties would be considered authorized individuals, for purposes of this policy.

2.4.6.2.1 Individuals who are responsible for restocking supplies in a locked storage area would be considered authorized. Examples include central supply staff.

2.4.6.2.2 Individuals responsible for maintenance of the environment in a locked storage area would be considered authorized. Examples include facilities/maintenance, biomedical engineering, security, etc.

2.4.7 Unauthorized personnel, in accordance with the hospital’s policy and law or regulation, CANNOT obtain access to medications

2.4.8 All medications will be properly and safely stored according to the manufacturer’s recommendations.

2.4.9 Only approved medications are routinely stocked and stored. Approval shall be obtained from the unit manager AND a pharmacy manager.

POLICY

WRH Universal (WRU)









2.4.10 All narcotic (Narcotic - CDSA I) and controlled substance (Schedule G - CDSAIII) medications must be locked within a secure area. Narcotic and controlled substances requiring refrigeration will be stored in a locked box within the refrigerator

2.4.11 Medications delivered to the patient care areas should be secured as soon as feasible.

2.4.12 Medications not administered following removal from a secured area should be secured as soon as feasible.

2.5 Medication Returns

2.5.1 If a unit dose medication has been removed from pyxis and is no longer required, the nurse should „return‟ the medication to pyxis and place it in the pyxis return bin.

2.5.2 If a bulk medication, IV medication, or patient-cassette medication has been discontinued or changed, the nurse should place the medication in the appropriate pharmacy return bin. Medication stored at room temperature should be placed in the “return to pharmacy” bin in the medication room. Medications requiring refrigeration should be placed in the pharmacy return bin in the unit medication fridge.

2.5.3 If a patient is discharged, the nurse should remove all medications from the pharmacy drop off bin and the patient’s cassette and place in the “return to pharmacy” bin in the medication room. Refrigerated medications should be placed in the pharmacy return bin located in the unit medication fridge.

2.6 Medication Storage

Prepared medications are to be stored under conditions suitable for product stability. The method of storage of medications in patient care areas should conform to the same system as that utilized in pharmacy.

This includes:

2.6.1 Medications should be stored at proper temperatures.

2.6.1.1: Multiple dose vials

Multiple dose vial injections (including vaccines) are considered stable/useable for 28 days, unless otherwise indicated by the manufacturer recommendations.

Auxiliary labels indicating the expiration date should be attached to the exteriors of the bottles once opened.

Multiple dose vials should be stored at temperatures as specified on the label.

2.6.1.2: Single dose vials/containers

Single dose vials/containers should be stored as indicated on the label and any remaining drug should be appropriated disposed of after each administration.

2.6.2 Medications should be stored to ensure product stability.

All expired, contaminated, or spoiled medications should be removed from the medication storage area and be sent to the pharmacy department for proper disposal

Light sensitive medications should be protected from light through the use of amber bottles, amber vials, or an amber plastic bag.

2.6.3 No food or drinks will be stored in medication fridges.

2.6.4 All medication storage areas will be periodically inspected by the pharmacy department to ensure medications are stored properly.

POLICY

WRH Universal (WRU)









3. ADMINISTRATION / DOCUMENTATION

3.1 General Guidelines

3.2.1 The following healthcare professionals are authorized to administer medications: licensed independent practitioners, nursing personnel (as defined under the “Definition” section), medical assistants, respiratory therapists, physical therapists, pharmacists, imaging technologists, radiologic technologists.

3.2.2 All medications administered to the patient must have a complete and signed order by an authorized prescriber.

3.2.3 Authorized healthcare professionals will ensure that the client consents to the administration of medications.

When possible and appropriate for age/cognitive status, the authorized healthcare professional will inform the patient or the patient’s family of the medication (along with purpose) and dose being given at the time of the medication administration.

Medication information resources may include: CPS, LexiComp, etc.

3.2.4 Authorized healthcare professionals will ensure that the principles of infection prevention and control are applied when administering medications (refer to Appendix A).

3.2.5 The patient’s MAR / CMAR will be brought to the patient’s bedside during the medication administration process.

3.2.6 Medications will be brought to the patient’s bedside still in the packaging to allow for a double check at the time of medication administration. Medications will not be “pre-poured” away from the patient’s bedside.

Exceptions:

bulk nursing unit stock medications

medications requiring crushing (the empty packages will be brought to the bedside for confirmation)

3.2.7 Authorized healthcare professionals will correctly identify the patient using two separate patient identifiers.

This process should include active participation and communication of identifiers with the patient whenever possible.

When not possible, the MAR must be checked against the patient identification band.

The patient’s identity must be verified with each patient encounter.

Refer to the WRH Patient Identification Policy for details.

3.2.8 Prior to administration, the authorized healthcare professional will verify the “8 rights” plus the following:

Right patient

Right medication

Right reason (ensure the medication being given is suitable for the patient’s condition) Right dose

Right frequency

Right route

Right site, and

Right time

A visual inspection of the medication for particulate matter or discolouration

Expiration dates if available

Any contraindications and allergies

3.2.9 If the nurse discovers a discrepancy between the documented allergy information through interview with the patient, the nurse will contact the prescriber to notify him/her of the updated allergy information to determine a therapeutic alternative.

POLICY

WRH Universal (WRU)









3.2.10 Scheduled medications include all maintenance doses administered according to a standard, repeated cycle of frequency (e.g. q4h, QID, TID, BID, daily, weekly, monthly, annually). Scheduled medications will be administered according to the approved standard medication administration times:

http://wrhintranet.wrh.on.ca/SitePublished/intranet/documentrender.aspx?documentRender.IdTyp e=5&documentRender.GenericField=&documentRender.Id=38247

3.2.11 Time-critical scheduled medications are those where early or delayed administration of maintenance doses of greater that 30 minutes before or after the scheduled dose may cause harm or result in substantial sub-optimal therapy or pharmacological effect. Time-critical scheduled medications should be administered 30 minutes before or 30 minutes after the designated administration time. Examples of time-critical scheduled medications include:

Medication with a dosing schedule more frequent than every 4 hours

Scheduled (not prn) opioids used for chronic pain or palliative care (fluctuations in the dosing interval may result in unnecessary break-through pain)

Immunosuppressive agents used for the prevention of solid-organ transplant rejection or to treat myasthenia gravis

Medications that must be administered apart from other medications (e.g. iron supplements and thyroid medications).

Medications that require administration within a specified period of time before, after, or with meals. For example, rapid-, short-, or ultra-short acting insulins.

3.2.12 Non-time-critical scheduled medications are those where early or delayed administration within 60 minutes should not cause harm or result in substantial sub-optimal therapy or pharmacological effect. Non-time-critical scheduled medications should be administered within 60 minutes before or after the designated administration time. Examples of non-time-critical scheduled medications include:

Medications with a dosing schedule no more frequently than every 4 hours. (e.g. weekly, daily, BID, TID, q6h, q8h, etc).

3.2.13 For medications not administered within the 30-60 minute guidelines as noted above, the dose will be administered as follows:

3.1.13.1: If the time of administration is less than Y2 way of the interval, the medication should be administered as soon as possible and the next dose is to be administered at the next scheduled time. (e.g. a once daily medication due at 1000 was not administered and the omission was discovered at 1700. The dose is given once every 24 hours. Since the dose omission is discovered within 12 hours of the scheduled admin time, the dose may be given, documented as a late administration, and reported as a medication incident using the online medication incident reporting system.

3.1.13.2: If the time of administration is more than Y2 past the schedule interval, then the prescriber should be contacted for further instructions regarding the missed dose. The instructions should be documented and the omission reported as a medication incident using the online medication incident reporting system. The next dose should be administered at the next regularly scheduled time.

3.2.14 Medications should not be administered orally to patients that cannot receive anything by mouth due to a physician’s order or clinical condition (e.g. NPO order prior to a procedure or NPO after failure of a swallowing assessment)

For patients on insulin therapy and NPO status, the nurse should contact the prescriber for new insulin orders. This should include orders on whether to administer or hold insulin orders until nutritional status is determined and achieved.

3.2.15 Medications requiring “handling precautions” will be indicated as such on the CMAR and will be labeled with the appropriate auxiliary label:

(make sure these are still the right stickers being used) For complete information on personal protective equipment needs and other handling instructions, please refer to the WRH policy for Safe Handling of Cytotoxic Agents,

or

http://wrhintranet.wrh.on.ca/SitePublished/intranet/documentrender.aspx?documentRender.IdTyp

POLICY

WRH Universal (WRU)









3.2.16 Discharge prescriptions will not be used as orders for administration of medications while the patient is at Windsor Regional Hospital.

3.2 Transfer of Medications

3.2.1 When a patient is transferred to another unit, the medications that are to be continued (according to transfer orders) should be transferred with the patient to the receiving unit.

Exception: any medication prepared outside the pharmacy and not initiated in the original unit should not be

transferred with the patient and should be appropriately disposed of.

3.2.2 Medications that are not to be continued in the new patient area should not be transferred to the unit and should be returned to the pharmacy department.

3.2.3 On discharge, hospital supplied medications are not to be sent home with the patient. These medications must be returned to pharmacy.

3.3 High Alert Medication

3.3.1 Refer to the posted WRH High Alert Medication Policy 3.3.2 Refer to the posted WRH Independent Double Check Policy

3.4 Medications from Home (See Appendix E for flow diagram)

3.5.1 Medications brought from home by the patient should be sent home with the visiting family or caregiver and removed from the hospital.

The prescriber has ordered the non-formulary medication for use during the admission, AND

A pharmacist or other qualified healthcare professional, when a pharmacist is unavailable, has reviewed and identified the medication in the bottle/vial to match the prescriber’s order. The pharmacist/other qualified healthcare professional will affix a verification label on the patient’s own medication vial to signify that the medication has been verified and is ready for use.

3.5.2 In the event that a patient’s own medication supply is an insufficient quantity for the duration of the admission, an additional supply may be brought into the hospital. When the additional supply is received, the nurse will need to contact the pharmacy department to perform a new review and identification of product prior to administering any of the medication.

3.5.3 For deceased patients, medications will be destroyed. Destruction must be documented in the patients chart on the home medication form. Documentation must include medication destroyed. For narcotics, destruction must be witnessed and witness must document on the home medication form. Home medication form should be placed in patient chart.

3.5 Missing Medications

3.5.1 If a medication is not available on the unit, but is listed on the MAR, a “missing medication communication form” (form # 0357 R94-06) should be sent to the pharmacy department for processing.

3.5.2 Medication documentation should not indicate “not available” when pharmacy is open. When pharmacy is closed “Global find” is available to find a medication not available on the unit. The on-call pharmacist may be paged if the medication cannot be found.

3.6 Holding Medications

3.6.1 The physician should be notified for clarification of the order if a medication cannot be administered due to:

Incomplete, unclear or illegible order

An allergy of adverse drug reaction to a medication

Unavailability of the medication

Patient condition precludes administration (i.e. vomiting, seizure, etc.)

A medication incident that requires follow up intervention

POLICY

WRH Universal (WRU)









Patient/family refuses the ordered medication

3.6.2 Unless otherwise ordered, medications requiring a pulse check should be held on adult patients if the apical rate is less than 60 beats per minute AND the physician will be notified for further instructions.

3.6.3 Unless otherwise ordered, antihypertensive/diuretic agents should be held if the blood pressure is less than 90/60mmHg AND the physician will be notified for further instructions.

3.7 Self-Administered Medications

3.7.1 Requirements for patient self-administration:

A physician’s order for the patient to self-administer medications

The patient must be 18 years of age Patient must express a desire to participate

Patient must be able to read, write and understand basic instructions

The patient must have the ability to be responsible for his/her own medications past discharge

The patient must be able to state basic information about the medications they are self-administering Patient must sign a consent form agreeing to participate in the program

Instructions as to how to self-administer should be provided by nursing staff

The nurse will witness the self-administration of the medication and will document all doses of all self-administered drugs on the CMAR/MAR

Nursing personnel should verify that the patient understands usage, indication, potential for side effects, and any monitoring parameters, as appropriate

3.8 Documentation

For additional specifics, please refer to the posted Medication Administration Record Policy

3.8.1 All medications will be transcribed and administration documented on the MAR / CMAR.

3.8.2 All new medication orders will be transcribed to the MAR / CMAR by a nurse.

3.8.3 A nurse is responsible for reconciling the accuracy of the transcription and will sign/initial the order on the MAR / CMAR. Verification will be done against the original order.

3.8.4 All orders will be checked and verified against the previous MAR / CMAR and against any original orders written since

the last 24 hour check.

3.8.5 When updating the MAR / CMAR for a discontinued medication:

Write “discontinued” on the MAR / CMAR next to the last dose of medication given

3.8.6 The nurse/authorized personnel who administer a medication must record their initials next to the administration time. The actual administration time should be documented if it differs from the predefined standard administration time. This documentation will occur immediately after the patient has been witnessed taking the medication. If an injection has been given, document the site next to the admin time If a patch is applied, document the patch location next to the admin time If vital signs are required, record these next to the admin time

3.8.7 If a second nurse administers a dose of medication for the primary nurse, the administering nurse will place their initials next to the recorded dose given and sign and print their name in the MAR / CMAR signature area.

3.8.8 For those high-risk medications requiring an independent double check, both nurses/authorized personnel will place their initials next to the recorded dose given (or designated area of a specified flow sheet) and sign in the MAR / CMAR signature area. See WRH Independent Double Check policy

3.8.9 If a medication dose is held, “held” should be documented next to the administration time and the physician should be notified when appropriate. Documentation of reason for hold will be written in the progress notes.

POLICY

WRH Universal (WRU)









3.8.10 If a medication is not given for any reason, the nurse will use the appropriate MAR code surrounded by a circle

indicating the reason the medication is not given. Acceptable MAR codes, as listed on the bottom of each MAR page, include:

NPO – nothing by mouth R – patient refused N&V – nausea and vomiting OTU – patient off the unit SPN – see progress note HOLD – medication held *the pharmacy department is to be notified if a drug dose that due is not found/available

3.8.11 Intramuscular and subcutaneous injection sites and transdermal patch locations will be noted next to the dose given.

For removal of transdermal medication patches, the nurse should document their initials that the previous patch was removed before applying the new one.

Insulin administration and injection site will be documented on the Diabetic Flow Sheet. Subcutaneous anticoagulant administration and injection site will be documented on the Anticoagulant Flow Sheet.

3.8.12 Orders which have a predetermined number of doses to be administered will be numbered next to the administration

time as number dose / total number due. (I.e. 3 ordered doses of post-op antibiotics would be documented as dose 1/3, dose 2/3, and dose 3/3 next to the administration times)

3.8.13 Physicians will document any physician-administered medications on the appropriate treatment record, flow sheet or MAR / CMAR. An order must be written & faxed to pharmacy for any med administered

3.8.14 Respiratory therapy or other qualified personnel will document medications administered by them on the MAR / CMAR.

3.8.15 All medication administration records will remain with the patient’s medical record. The most current MAR / CMAR is to be placed in the patient’s chart if the patient is being sent off the unit for any diagnostic test or procedure.

3.8.16 Variances related to medication administration should be entered in the online medication incident reporting system.

3.8.17 Disposal of medications Medication will be wasted in the dedicated medication disposal bins

4. MONITORING

4.1 General Guidelines

4.1.1 Medication administration will be supervised and medication will NOT be left in a patient room / at the bedside for them to take on their own unless authorized per applicable self-med policy. Nurses and qualified personnel must witness that the medications have been taken by the patient.

4.1.2 Each patient’s response to medication is monitored.

4.1.3 The clinical needs of the patient will direct the level of monitoring that is performed and documented.

4.1.4 Monitoring includes:

The patient’s clinical response to the medication, including relevant laboratory results

The patient’s own perceptions of the efficacy of the medication

The patient’s own perceptions of the side effects to the medication

POLICY

WRH Universal (WRU)









4.2 Adverse Drug Event (ADE) Reporting

4.2.1 Adverse drug events (includes adverse drug reactions and medication variances) are defined as follows:

Medication error / incident (Source: College of Nurses of Ontario Practice Standard, Medication: Revised 2008 and Institute for Safe Medication Practice Canada) A medication error is defined as any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer. Such events may be related to professional practice, health care products, procedures and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring and use.

Adverse Drug Reaction (ADR) (Source: World Health Organization) Any untoward medical occurrence that may present during treatment with a pharmaceutical product, but which does not necessarily have a causal relationship with this treatment. Adverse drug events are comprised of Medication Variances, Adverse Drug Reactions, Side Effects from the singular effects of one medication or the combined effects of more than one medication, and Undesirable Physiologic Responses to drug therapy.

4.2.2 When a variance occurs in one of the steps of the medication use process, this variance should be reported using the online occurrence reporting system. Refer to the WRH Adverse Event and Near Miss Reporting policy.

4.2.3 When an ADE is suspected: 4.2.3.1: The qualified personnel should notify the attending physician or resident to determine if additional orders are

necessary to care for the patient. 4.2.3.2: A clinical assessment of the patient should be documented in the progress note section in the patient’s medical

record. 4.2.3.3: The attending physician or resident must notify the patient that an adverse drug event has occurred.

REFERENCES

College of Nurses of Ontario

College of Physicians and Surgeons of Ontario

Institute for Safe Medication Practice

Institute for Safe Medication Practice – Canada: Medication Safety Self Assessment for Hospitals Canadian Version II

Accreditation Canada Managing Medication Standards and Required Organizational Practices

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WRH Universal (WRU)









APPENDIX A: MEDICATION ADMINISTRATION FOR PATIENTS UNDER “CONTACT PRECAUTIONS”

Organize the CMAR binder and medications to be brought to the patient’s room.

Perform hand hygiene and don appropriate personal protective equipment (PPE).

Using a Virox® wipe for MRSA and VRE or Clorox® wipe for C. difficile, wipe down the bedside table/surface that the CMAR binder and medications will be placed on.

Place the medications and CMAR binder on top of the Virox®/Clorox® -wiped area.

Remove gloves, perform hand hygiene, and apply new gloves.

Perform patient identification using 2 patient identifiers and verify the medication(s) to be administered. Pour and administer medication(s).

Remove gloves, perform hand hygiene and sign off medications on the CMAR

Upon exiting the patient’s room:

Don gloves

Using a Virox®/Clorox® wipe, wipe down the CMAR binder & any bulk medication containers

(i.e. inhalers, cream/ointment tubes, etc). Any single-unit-dose medications should be

discarded/wasted accordingly. To prevent contamination do not return to pyxis or pharmacy.

Remove PPE

Perform hand hygiene

Pick up CMAR binder and any unused medications

Exit the room and return supplies to their storage location

POLICY

WRH Universal (WRU)









APPENDIX B: GUIDELINES FOR USE OF THE PHARMACY-SYSTEM-GENERATED TRANSFER

MEDICATION ORDERS

1) Log into Citrix

2) Click on “Clinicals” folder

3) Click on “Horizon Meds Manager” (HMM)

4) Log into HMM

User ID: 1st initial of first name + 1st five letters of last name

Password: 8 character password

5) Choose the printer destination (i.e. Which unit printer do you want the reports to print on?) Scroll and click on the name of the unit printer that you want the reports to print on. (***the default of “Auto” will print to the pharmacy department)

6) Choose “assignment” Leave as default of <no assignment>

7) Find the patient:

Enter the unit (i.e. ME2, RH1, CC5, etc.) in the “room” field and hit enter, then pick the patient from the unit census list, OR

Enter the current hospital visit (account/encounter) number in the “Hosp #” field and hit enter.

8) Print the TRANSFER MEDICATION ORDERS:

click “print” on the top tool bar

Scroll to and click on “reports”

Double-click on “Clinical Patient”

Double-click on “Transfer Medication Orders”

Ensure “current patient” displays in the „selection criteria‟ area

**** Click the “Active Only” box **** (or every medication the patient has ever been ordered in the hospital will print, including any discontinued meds)

Click on the “print” button

9) Review the patient’s current MAR against the TRANSFER MEDICATION ORDERS to ensure all information on the order form is complete and up-to-date.

New orders may not have been processed by the pharmacy department prior to the generation of the TRANSFER MEDICATION ORDERS

Previously noted CMAR discrepancies may not yet have been corrected by the pharmacy department

10) Compare the TRANSFER MEDICATION ORDERS against the patient’s INITIAL home medication list (aka Med Rec form) to address any home medications that have „fallen off‟ the patient’s profile. Use the last page to address any missing medications that need to be reordered or officially discontinued

11) INITIAL in the appropriate box to “continue”, “stop”, “hold”, or “change”.

Sign AND Print your name at the bottom of each page

POLICY

WRH Universal (WRU)









POLICY

WRH Universal (WRU)









APPENDIX C: GUIDELINES FOR USE OF THE PHARMACY-SYSTEM-GENERATED DISCHARGE

PRESCRIPTION 1) Log into Citrix

2) Click on “clinicals” folder

3) Click on “Horizon Meds Manager” (HMM)

4) Log into HMM

User ID: 1st initial of first name + 1st five letters of last name

Password: 8 character password

5) Choose the printer destination (i.e. Which unit printer do you want the reports to print to? “Auto” will print to the unit that the patient is currently admitted to)

6) Choose “assignment” Leave as default of <no assignment>

7) Enter patient information Enter current hospital visit number in the “Hosp #” field to ensure the correct patient profile is chosen.

8) Print the DISCHARGE PRESCRIPTION:

click “print” on the top tool bar

Scroll to “reports” and double-click Double-click on “Clinical Patient”

Double-click on “Discharge Prescription”

Ensure “current patient” displays in the „selection criteria‟ area

**** Click the “Active Only” box **** (or every medication the patient has ever been ordered in the hospital

will print, including any discontinued meds)

Click on the “print” button

9) Review the patient’s INITIAL home medication list (aka Med Rec form) and current MAR against the DISCHARGE PRESCRIPTION.

INITIAL in the appropriate box ... watch for therapeutic interchanges & instruct accordingly.

Sign AND Print your name at the bottom of each page

ALL NARCOTICS AND CONTROLLED DRUGS MUST BE HANDWRITTEN on the last page of the discharge prescription (**CPSO # is required as per new narcotic writing regulations)

Use the last page to address any medications that do not appear on the patient’s HMM profile and need to be reordered or officially discontinued.

POLICY

WRH Universal (WRU)









APPENDIX C: DISCHARGE PRESCRIPTION

POLICY

WRH Universal (WRU)









POLICY

WRH Universal (WRU)









APPENDIX C: GUIDELINES FOR USE OF THE OUELLETTE CAMPUS PHARMACY-SYSTEM-GENERATED DISCHARGE PRESCRIPTION

1) Login to Storefront

2) Search in upper right hand corner for the desired item “Discharge RX WRO” or “Transfer Form WRO”

(NOTE: If you click on Details – you can save it as a Favorite for later use)

3) Double click on it (or click Details then Open)

4) Once the application opens a window will appear prompting for an account number. Enter the patient’s account

number (visit#) here with a CAPITAL “W” prefix. (For example, account number 1234567 would be

“W1234567”) Then hit ENTER or click OK.

5) Once the report appears you can print it by clicking on the Print icon in the upper left corner. Be mindful of the

printer it is directing to print and change as required.

TIP: You can click on the Refresh button in upper left corner to prompt to generate another report for a different

patient. (without having to start all the way at the beginning again).

6) Close application (“X” out) when finished.

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WRH Universal (WRU)









APPENDIX D: MEDICATION(S) FROM HOME FLOW DIAGRAM

document title: medication use policy phrm -u 105 policy ... · dietitians, and respiratory...

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