LEC11 Safe Use of Medications in the Hospital Part 2 PDF

Safe Use of Medication in the Hospital PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content ASHP guidelines relative to the safe use of medications in hospitals  Labelling a...

Safe Use of Medication in the Hospital PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content ASHP guidelines relative to the safe use of medications in hospitals  Labelling and medication containers  Dispensing in-patient prescriptions  Dispensing out-patient prescriptions  Drug cabinets in nursing units  Medication orders & cards  Preparation & administration of medications  Recording of medications  Medication errors  ASHP Guidelines Whyand Labelling inpatient medicationdispensing containers (basic)  Labelling should be done by pharmacist or under supervision of pharmacist  Pharmacist should be consulted for making labelling guidelines  Medication label should be typed or machine printed  Use of pen or pencil or adhesive should be prohibited and labels should not be superimposed on other label  Label should bear identification of pharmacy  One order should be filled and labelled at a time  Accessory or caution labels should be used where necessary  Metric system should be preferred over apothecary system  Name of therapeutically active system should be present where there is mixture of ingredients  ASHP Guidelines Why inpatient Labelling dispensing and medication containers  Labels for medication should indicate the amount of drug dispensed  Perishable drugs should have date of expiry mentioned  Route of administration and dilution technique (if needed) should be mentioned  Proper storage containers should be used to maintain stability and integrity of medicines (light resistant, child lock cap, etc.)  Medications brought by patients should be properly checked, recorded and labelled as patient own medications  Floor stock medications should carry codes to identify source and lot number of medications  ASHP Guidelines Why inpatient dispensing In patient dispensing  Label should bear additional information than general labelling  Patient name, non-propriety name of medicine, Strength, date of issue and initials of dispensing pharmacist  Label should also identify batch and source of drug Out patient dispensing  Label should bear additional information than general labelling  Patient name, non-propriety name of medicine, Strength, date of issue and initials of dispensing pharmacist  Name of prescriber and address  Caution and direction labels  ASHP Guidelines Why Druginpatient Cabinets in dispensing Nursing Unit  Adequate space, lighting, ventilation and working space  Inner lockable narcotic cabinet  Adequate means of security  Particular arrangement in accordance with established plan for particular hospital (alphabetically, speciality  Only drugs, equipment for preparation and administration should be stored in medication cabinets  Controlled drugs should be inventoried, recorded and inspection  Reconstitution of antibiotics at nursing level should be kept minimum.  ASHP Guidelines Why inpatient Medication dispensing orders  Medication should be dispensed only on written order of physician, exceptions should be covered by written policy  Emergency verbal orders may be accepted via nurse, but physician should verify before administration and signed  Stat telephone orders may be accepted but recorded and signed by a physician as soon as physician is available  Medication order cancellation policy should be devised  Medication order should be legibly written and any discrepancy or confusion should be consulted with physician before dispensing  Medication order should include Name of medication, Dosage in metric system, Signature or id of physician (in case of electronic order), route and date of order.  ASHP Guidelines Medication cards Why inpatient dispensing  Medication card should contain all identification details of patient and the medication prescribed with start and stop date  Should be clearly written in ink or printed and verified by the nurse against physician order  Cards for “delayed” or “omitted” medications should not be with regular medication card file  On assuming charge of patient, nurse should reconcile the medications against physician orders  ASHP Guidelines Why inpatient Preparation dispensing of medication  Ascertain that dose is not administered  Selection medication from cart and check from medication card for correct medication, timing and route  Give full attention while preparing medication for administration  Read the label three times  Medication used for preparation but not administered must be discarded  Pharmaceutical calculations should be checked by other nurse or ideally by a pharmacist and apothecary system should be used  ASHP Guidelines WhyRecording inpatient dispensing of medications  All medicines prescribed, dispensed or administered should be recorded to patient medical records  There should be established procedure for recording of patient medical history including medications and diagnosis  ASHP Guidelines Why inpatient Medication dispensing Errors  Each hospital should have clear statement policy for all medication errors which should include Reporting and recording Review and report Corrective and preventive policies  Report should be shared with management within the defined time limit and corrective actions should be noted  ASHP Guidelines Why Druginpatient dispensing interaction surveillance  Each hospital should have drug interaction surveillance program run by a pharmacist that should have following actions Preparation of drug interaction reporting form Method to check drug – drug, drug – food , drug – lab reports interactions Recording of identified interactions and extent of effect  Medication safety Why inpatient dispensing Pharmacists role  Ongoing counselling and education: A structured framework for patient consultations can improve the way patients monitor their medications and prevent potential problems with medication safety or drug interactions.  Screen for any issues: Ask patients about existing health issues, such as high blood pressure or diabetes, that might worsen due to medication interaction.  Medication safety Why inpatient dispensing Pharmacists role  Discuss all medications: Schedule one on one time with patients to go over all their medications. This step can help prevent side effects or drug interactions resulting from prescriptions from multiple doctors.  Educate patients: Remind patients of the role and importance of each medication in their regimen.  Emphasize adherence: Stress the importance of adherence for better outcomes. Thank you