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

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4.46 When the use of CM is permitted to be given to the patients treated in the HA hospitals,either under research protocols or authorized by the doctors, the details of CM prescribed bythe CM practitioners should be properly recorded in the patients’ medical records.4.47 In any case, the use of CM should be indicated by the doctors on the MARs as “ChineseMedicines”. The MARs should be sent / faxed to the Pharmacy for computer entry so that itwill be indicated in the patient’s profile that “Chinese Medicines” are being used. Theadministration of CM should be properly recorded as with the practices for otherconventional medications.Nurse-initiated Medications4.48 In order to facilitate effective patient care, under the authority of appropriate writtenprotocols approved by Hospital DTC, qualified nurses may be allowed to initiate certainmedications on their own. Individual hospitals may consider and approve a list of nurseinitiatedmedications. Such protocols should specify the rank of nurses allowed to initiatemedication on the approved list and specify limits on the number of doses, dosages to begiven. Medications initiated by nurses should be checked and countersigned by a doctorwithin :(a) 48 hours in the case of non-poisons,(b) 24 hours in the case of poisons (i.e. controlled medicines which are under theclassification of Schedule I to III in the Pharmacy and Poisons Ordinance.)Discharge Medications4.49 Doctors should prescribe all the medications that the patients are currently taking and notjust those required for discharge. However, when the supplies of certain medications are notrequired, they should be clearly indicated in the MOE with the action status (dispense inclinic / purchase by patient / keep record only). When the manual discharge prescriptionsare made, the action status used in the MOE should be written on the prescriptions.4.50 Particular care should be taken when patients are taking two or more similar drugs or thesame drugs in different dosage forms. The possibility and consequences of drugs beingprescribed previously or subsequently at outpatient clinics should be considered.(B) RECOMMENDATIONS ON PHARMACY DRUG SUPPLY SYSTEMPharmacy Drug Supply System4.51 The Pharmacy drug supply system should be designed so as to facilitate drug distribution, toestablish a complete drug profile for each patient and to minimise the amount of ward drugreturn. All in-patient prescriptions should go through the pharmacy vetting system whichacted as a safe guard before the drugs administered to the patients. All drug orders receivedby the pharmacy must be input into the system in order to maintain a complete patient’smedication profile.4.52 The Computerised Automatic Refill System (CARS) is one of the drug supply systemscurrently being used in HA hospitals. This system facilitates the drug distribution process27
and generates a complete drug profile for each patient. It is a medication refill systemdesigned to save nursing time. The refill duration should be decided locally with the aim ofminimising the amount of ward drug return and drug wastage.Individual Patient Dispensing4.53 The majority of inpatient medications should be supplied on an individual patient basis bythe pharmacy. Individual patient dispensing enables the pharmacist to verify the safety andappropriateness of each prescription order and to detect and deal with any potentialproblems such as drug interactions and drug allergies before supplying medications to wards.The correct dispensing of medications is the professional responsibility and duty of thepharmacy staff.Involvement of Pharmacists in the Drug Administration Process4.54 Pharmacists should take an active role in the drug administration process which is anintegral part of patient care. This should be achieved through having a Clinical PharmacyService at the ward level. All information available including that contained within thepatients’ notes as well as that obtained on ward rounds and by direct communication withthe doctor and patient should be used by the clinical pharmacists to offer advice to doctorsand nurses on appropriate medications and potential medication-related problems.4.55 Pharmacists should ensure that medications are used rationally, cost-effectively and in theirproper therapeutic context. Verification by the prescribing doctors must be made shouldthere be ambiguity or doubt in the appropriateness of the drug orders.Clinical Pharmacy Service4.56 A Clinical Pharmacy Service involves the practice of pharmacy in a multidisciplinaryhealthcare team with the objective of achieving the best possible quality use of medicationsand thus providing optimal patient care. The service includes medication history taking,drug supply, drug therapy monitoring, drug information, discharge patient counselling andpharmacokinetic interventions. The Clinical Pharmacist-run Compliance and Refill Clinicshave been set up, as part of the clinical pharmacy service initiatives, in many specialistclinics of the hospitals.4.57 A Satellite Pharmacy Service is a mode of operation in the Clinical Pharmacy Service. It hasalready been implemented in PMH, PYNEH, TKOH and TMH with satisfactory results. TheSatellite Pharmacy is in close proximity to the wards. It enhances the involvement of theclinical pharmacy service and the efficiency of the in-patient pharmacy service. It optimisesthe drug distribution system and minimises the amount of ward drug supply. This results inreduced ward drug return and unnecessary drug wastage. Nurse dispensing duties arereduced and more nursing time can be given to patient care. It also allows a unit dosedispensing system to be practised.Preparation of Drugs4.58 Pharmacists are recommended to supply drugs in the most appropriate form or the mostready-to-administer form in order to minimise errors. Therefore, the provision of TPN,28
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 26 and 27: Electronic prescribing (Medication
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
Page 76 and 77: 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
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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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