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

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Electronic prescribing (Medication Order Entry -- MOE)4.27 Discharge and home leave prescriptions can be prescribed through the Medication OrderEntry (MOE) system. While electronic prescriptions improve legibility and remove theambiguity of orders, this should be developed in the in-patient section (In-patient MOE).Verbal Orders4.28 Only in emergency and approved circumstances may a verbal order be given if the doctor isunable to attend personally. The instruction may only be accepted by an Enrolled orRegistered nurse who must immediately record the instruction in the patient’s MAR andannotate it a ‘verbal order’.4.29 After the instruction has been written, it must be READ BACK to the doctor checking thepatient’s identity, drug name, dosage, frequency and method of administration. It is theresponsibility of the doctor giving the verbal order to ensure the correct interpretation of theverbal order.4.30 The nurse receiving the message must, after following the normal checking procedure,administer the drug and personally give both verbal and written instructions to the nursestaking over from him/her.4.31 A verbal order must be confirmed in writing by the doctor concerned as soon as possibleand within 24 hours at the latest [refer to Pharmacy & Poisons Regulations, Cap. 138A,Section 23(4)].4.32 Dangerous Drugs should not be ordered through verbal orders (refer to Dangerous DrugsRegulations, Cap. 134A, Section 3).Patient’s Own Medications4.33 Patients should always be asked if they have brought any medications into hospital withthem. To prevent unauthorised self-administration, brought-in medications should be takeninto safe custody by the nursing staff and shown to the doctor and/or pharmacist.4.34 The patient’s own medications should not normally be administered in hospital unless theyhave been positively identified, specifically prescribed by the doctor and when supplies arenot immediately available from hospital sources. The general practice of allowing patientsto continue their own brought-in medications without verification should not be encouraged.(Identification of medications currently used in the HA may be searched by the TabletIdentifier on HA intranet http://cpointra/tabident.php;Registered Pharmaceutical in Hong Kong may be searched on the website of Department ofHealth http://www.info.gov.hk/pharmser/Reg_ir/download_pharm.html)4.35 The protocol / logistics for identification, prescribing and administration of brought-inmedications to patients should be endorsed by the hospitals’ DTC.25
4.36 If the patient’s own medications are to be administered in hospital, the prescription orderand administration of brought-in medications should then be recorded in the patient’s MARand the MAR should be sent / faxed to the pharmacy for order vetting and computer input.4.37 These medications should be returned to patients on discharge with a clear indication as towhether they are to be continued / discontinued.Drug Samples4.38 Drug samples should include not only new drugs but also post-marketing drugs which arenew to that hospital. In 2002, a mechanism for the management of drug samples in the HAhas been endorsed by the DURC (refer to Appendix 5). The hospital DTC or an equivalentcommittee should establish policies and procedures to approve, control and monitor the useof drug samples in the hospitals and their affiliated clinics.4.39 As with all medications, the drug samples approved for use must be dispensed by thepharmacy. This will enable HAHO to keep an updated record of all the drug samples usedin the HA.4.40 The standards, drug recalling and incidents reporting mechanisms applicable to medicationsuse in the hospitals should apply to drug samples.4.41 The introduction of drug samples to the Hospital Formulary should follow the normal newdrug application procedures as established by the hospital DTCs.4.42 Patients should be fully informed that drug samples are prescribed to them for trial only overa definite period.Clinical Trial Medications4.43 Individual hospitals should draw up their own protocols regarding the supply, storage,preparation and distribution of clinical trial medications. Appropriate details regarding suchclinical trial medications should be supplied to the pharmacy before the commencement ofthe clinical trial.Record of all Medications4.44 All medications including routine drugs, clinical trial medications, brought-in drugs, drugsample, intravenous fluid, insulin and TPN should be prescribed properly and theiradministration recorded accordingly.Chinese Medicines (CM)4.45 The use of CM in the HA hospitals should follow the guiding principles of the “HospitalAuthority Guidelines on Interface Issues between Chinese Medicine and ConventionalWestern Medicine” (refer to Clinical Manuals / Guidelines of Chinese Medicine on HAintranet).26
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 22 and 23: CHAPTER FOURRECOMMENDED PRACTICES A
Page 24 and 25: Drug Name4.11 There should be a hos
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
Page 72 and 73: 2.1 Concentrated potassium chloride
Page 74 and 75: Appendix 7Supply of Antidotes and D
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複本 Antidotes and emeg drug lis
Page 78 and 79:
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
Page 84 and 85:
Appendix 10Guidelines on the use of
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Appendix 11Guidelines on Patient Se
Page 88 and 89:
Operational Guidelines7. The operat
Page 90 and 91:
COC(N) Paper 12/2004Approved by COC
Page 92 and 93:
7.4 Evaluation Record and report th
Page 94 and 95:
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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