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

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cytotoxic and central intravenous admixture services by pharmacy would improve qualityand safety. In addition, a number of issues have been considered :(a)(b)(c)Limiting the choices of available drugs in pharmacy and the dose concentration orstrength for each drug would help to reduce the chances of errors.Complete, updated information on the reconstitution, dilution and compatibility ofintravenous drugs should be supplied by pharmacy to the nurses on the wards foreducational and cross-checking purposes. 1Doctors who have prescribed unconventional strengths or forms of a drug should becontacted by a pharmacist in order to discuss for modifying the prescription.Accuracy in Dispensing4.59 Proper in-house checking procedures should be built into the dispensing system in thepharmacy. The pharmacy staff must remain alert in the process of data entry, as similar drugcodes often give rise to medication errors. It is important to recognise that the merechecking of the label against the content is not sufficient. Reference should always be madeto the ORIGINAL prescription in checking the end product of the dispensing process for thecorrectness of the drugs and any possible undesirable interactions amongst them. The doublecheck system should be practised whenever possible.4.60 For high risk drug items e.g. digoxin, or those known to be associated with seriousmedication errors, all steps in the dispensing process especially the calculation of dose,should be checked independently by another member of the pharmacy staff, preferably apharmacist.4.61 Every prescription order and all dispensed medications should preferably be checked by apharmacist, for detecting and dealing with any potential medication errors and potentialproblems such as contraindicated drug, drug interactions. Any necessary clarification in aprescription order must be resolved with a doctor before the medication is dispensed andadministered to the patient.Labelling of Dispensed Medications4.62 The labelling of dispensed medications allows for the positive identification of the drug andthe patient to whom the drug is supplied. Proper labelling should be provided on alldispensed medications in compliance with the requirements of the Hong Kong MedicalCouncil and the Pharmacy and Poisons Board. The list of requirements for the labelling ofmedications is as follows :(a) Name of patient(b) Date of dispensing(c) Trade name or pharmacological name of the drug 2(d) Dosage per unit1 Cross-checking is defined as checking the correctness of the information or a calculation by a different personwhile double-checking is defined as checking the correctness twice by the same person or by a different person.2 In HA, this will be in the form of approved pharmacological name or when unavoidable, trade name of the medication(i.e. in the case of compound preparation). Exemption might be made for approved research when patients have giventheir fully informed consent, the drug name might not be included.29
(e) Method and dosage of administration(f) Precautions where applicableAll of the above labelling requirements are applicable to the dispensing of medications forout-patients. In the case of in-patient medications, such as Individual Patient Dispensing andWard Stock, appropriate labelling should be used.Containers of Dispensed Medications4.63 All medications should be supplied in clean, safe and appropriate containers.Manufactures’ Original Packaging and Labelling4.64 In order to reduce errors that could arise from inappropriate packaging and labelling of themanufactures’ original products, users’ immediate feedback to the CPO on the issues isdeemed necessary. This will facilitate the CPO in future products selection, advisingvendors on improvement and liaising with the Department of Health on the regulatorycontrol on packaging and labelling of pharmaceutical products.Re-packaging of Medications from the Manufacturers’ Original Containers4.65 Re-packaging of medications refers to re-packaging and re-labelling of commonly used drugproducts from the manufacturers’ original packages to suitable and convenient quantities fordispensing and drug distribution.4.66 The process of re-packaging must be supervised and checked by authorized personnel in thepharmacy and proper in-house rules should be in place to safeguard the procedures.4.67 The process of re-packaging should be performed in a suitable demarcated area in thepharmacy with appropriate lighting and minimal distraction.4.68 The re-packaged unit should be properly labelled with clear identification of the drug, aretraceable batch reference and any other relevant information to fit on the label as far aspossible.4.69 Proper records of re-packaged drugs should be kept in case of any future recall.Drug Replenishment4.70 Drug replenishment includes replenishment to the drug shelf and automated dispensingmachines should be performed and counterchecked by well-trained dispensing staff. Properrecording and checking mechanisms should be in place to facilitate the replenishment andrecall of drugs.4.71 Replenishment of stocks should follow the “First In, First Out” principle to ensure properstocks rotation. The stocks should be placed in the correct locations against the shelves’labels clearly marked with the proper drug names, strengths and dosage form etc in anorderly and tidy manner.30
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 28 and 29: 4.46 When the use of CM is permitte
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
Page 78 and 79: Appendix 8Guidelines for Supply of
Page 80 and 81:
substitution with other drugs in ac
Page 82 and 83:
Appendix 9Samples of the Line Label
Page 84 and 85:
Appendix 10Guidelines on the use of
Page 86 and 87:
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
Page 96 and 97:
Appendix 14Guidelines on the Handli
Page 98 and 99:
Appendix 15Medication Incident <str
Page 100 and 101:
Hospital Authority Medication Incid
Page 102 and 103:
QUALITY ASSURANCE IN DRUG THERAPYHO
Page 104 and 105:
Fig. 1: ADR voluntary reporting sys
Page 106 and 107:
PROCEUDRE FOR QUALITY COMPLAINTSONP
Page 108:
Part II Procurement Section, CPO1.
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