2005 Edition Report on Drug Administration Procedure & Practices ...

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CHAPTER FOURRECOMMENDED PRACTICES AND REQUIREMENTS4.1 Based on the problem areas detailed in the preceding chapter and considering the overallobjective of ensuring quality patient care, the Working Group has come up with thefollowing sets of recommended practices and requirements to prevent medication errors andencourage the economical use of drugs.4.2 The Working Group recognised that there are different constraints in the various institutionsand has accordingly incorporated certain flexibilities into these recommended practices andrequirements. Individual institutions should therefore be able to use this document as aframework to draw up/review their existing guidelines.(A) RECOMMENDATIONS ON PRESCRIPTION PRACTICES / PROCEDURES4.3 The Medication Administration Record (MAR), commonly called the Drug Chart, should berecognised as the official document for the entire in-patient drug administration process. Assuch, it should be the ONLY document on which doctors prescribe, for which the pharmacystaff dispense drugs, and according to which the nurses administer drugs. The onlyexception is when computerised order entry arrangement has obviated the need for a paperMAR.Design of the MAR4.4 The MAR should be designed so as to facilitate prescribing by doctors, administration bynurses and dispensing by pharmacy staff. The following are regarded as essentialinformation to be provided in the design of any MAR :(a)Personal detailsInformation on personal details should include name, HKID no., sex, age (or in the case ofneonates, the date of birth, body weight in kg and the identity of the mother), drug allergy,hospital identification number, and preferably the diagnosis of the patient. Beforeprescribing, doctors MUST ensure that the MARs have already been labelled with thecorrect patient’s information.(b)Drug allergyThe drug or any substance that the patient is or becomes allergic to MUST be recorded inthe appropriate areas of the drug orders and patient’s medical records. Doctors should verifyand amend the drug allergy information where appropriate. Patients without drug allergymust be recorded as “NIL” or “No Known Drug Allergy (NKDA)”. Prior to the prescribingof medications, drug allergy records of the patients must be re-checked by the doctors.21
Standard Intravenous Fluid and Drug Additives Administration Form4.5 The administration of intravenous infusion and drug additives has been found to beassociated with serious medication errors, therefore its prescription order and administrationshould be documented as part of the MAR. A model “IV Fluid and Drug AdditivesAdministration Form” has been recommended to hospitals’ DTCs for appropriatemodification for their local use (refer to Appendix 1). The IV form should be madeavailable to doctors, nurses and pharmacists and allow the pharmacist to review and verifythe safety of the intravenous drug order, to check the accuracy of the dose calculation aswell as the dilution and infusion rate of the intravenous infusion before administration. Inorder to minimize the occurrence of medication incidents, the prescribers should reviewintravenous prescription orders on a daily basis.4.6 The prescription order and administration of the other routes of parenteral administrationsuch as intramuscular injection, subcutaneous injection, have already been documented andincluded in the normal MAR.Standard Insulin Administration MAR Form4.7 It has been shown that insulin administration is one of the most frequently reportedmedications incidents in the HA. To ensure patient safety and to safeguard againstmedication incidents in the utilization of insulin in the HA, two structured MAR forms,namely “Insulin Administration / Blood Glucose Monitoring Form” and “IntravenousInsulin Administration Form (DKI or IV insulin pump)” which serve as the templates forprescribing, dispensing and administration of insulin have been recommended to hospitals’DTCs for appropriate modification for their local use (refer to Appendix 2).Legibility4.8 The MAR is the official document detailing the drug treatment for the patient. It is essentialfor doctors to prescribe in a clear and legible manner so as to be understood by all personnelhandling the MAR. Illegible or doubtful prescriptions should always be verified with theprescriber.4.9 Clear and legible prescriptions are an essential requirement of good clinical practice. Thisshould be strongly emphasised in all hospital drug administration guidelines. In addition, anumber of other measures should be considered :-(a)(b)Doctors should be required to write FIRMLY on the MAR with indelible ink, e.g.using a black ball pen.A regular feedback mechanism should be established, in order to enhance theawareness of prescribers to the problem of illegibility.Start Date4.10 This should be included to record the date on which a drug treatment is to commence.22
Page 2 and 3: ForewordMedication safety and provi
Page 4 and 5: Chapter 6 summarizes the specific r
Page 6 and 7: Chapter 6Conclusions and Recommenda
Page 8 and 9: CHAPTER ONETHE WORKING GROUPMEMBERS
Page 10 and 11: CHAPTER TWOTHE PROGRESS REPORT2.1 P
Page 12 and 13: CHAPTER THREEAREAS FOR IMPROVEMENT
Page 14 and 15: Existing In-patient Drug Administra
Page 24 and 25: Drug Name4.11 There should be a hos
Page 26 and 27: Electronic prescribing (Medication
Page 28 and 29: 4.46 When the use of CM is permitte
Page 30 and 31: cytotoxic and central intravenous a
Page 32 and 33: 4.72 Special precautions should be
Page 34 and 35: 4.84 To prevent mixing up medicatio
Page 36 and 37: The Principle of Three checks and F
Page 38 and 39: 4.111 Three-way (red and blue) and
Page 40 and 41: or their discharge or death, should
Page 42 and 43: operational requirement but also it
Page 44 and 45: Quality Complaints on Pharmaceutica
Page 46 and 47: LEVELSHAHOCE / DTOOLS & MECHANISMDU
Page 48 and 49: Medication Incident Report<
Page 50 and 51: Continuing Education6.18 In order t
Page 52 and 53: APPENDICESAppendix 1Appendix 2Appen
Page 54 and 55: Hospital Authority Hospital No. : I
Page 56 and 57: Sensitivity:Prescription/ routewith
Page 58 and 59: Appendix 3aLists of HA-wide Approve
Page 60 and 61: DRUGTeniposideABBREVIATIONVM-26Thia
Page 62 and 63: Appendix 3b“Do Not Use Abbreviati
Page 64 and 65: Appendix 4Schedule for the Administ
Page 66 and 67: Appendix 5Mechanism for the Managem
Page 68 and 69: 4. As with all medications, there s
Page 70 and 71: Appendix 6HA Guideline on Safe Mana
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2.1 Concentrated potassium chloride
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Appendix 7Supply of Antidotes and D
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複本 Antidotes and emeg drug lis
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Appendix 8Guidelines for Supply of
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substitution with other drugs in ac
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Appendix 9Samples of the Line Label
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Appendix 10Guidelines on the use of
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Appendix 11Guidelines on Patient Se
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Operational Guidelines7. The operat
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COC(N) Paper 12/2004Approved by COC
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7.4 Evaluation Record and report th
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DISPOSAL OF HOSPITAL PHARMACEUTICAL
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Appendix 14Guidelines on the Handli
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Appendix 15Medication Incident <str
Page 100 and 101:
Hospital Authority Medication Incid
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QUALITY ASSURANCE IN DRUG THERAPYHO
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Fig. 1: ADR voluntary reporting sys
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PROCEUDRE FOR QUALITY COMPLAINTSONP
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Part II Procurement Section, CPO1.
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