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!