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

4.72 Special precautions should be taken in situations such as replenishment of re-packed drugs,drugs from the ward return and medications not picked up by patients, etc.Pharmacy Service Hours4.73 In order to improve the quality of services, round-the-clock pharmacy services wereintroduced in QMH, PMH and TMH in October 2001. The 24 hours pharmacy serviceshould be further rolled-out to all acute general hospitals when resources are available.Ward Stock Supplies4.74 To maintain the continuity of drug supplies outside pharmacy service hours and for variousother operational reasons, ward stocks will still be required to facilitate the process of supplyand administration of medications to patients. In order to maintain a proper ward stocksystem, the following points should be considered :(a) The reasons for keeping ward stocks must be well established. The items included in theward stock list must be appropriate to the practice/activity of each individualspecialty/unit.(b) Particular caution should be exercised regarding the drug items that have commonlybeen involved in potential medication errors, such as concentrated forms of drug itemsthat required dilution into larger volume, e.g. concentrated KCl injection (refer toAppendix 6). These drug items should not be kept as ward stock in general care areas.All ward stock items must be supplied in appropriate labelled containers.(c) The range of ward stocks and the quantity kept for each item should be minimised. Theward stock item level should be updated periodically.(d) A list of ward stock items should be maintained and periodically reviewed. Anyunnecessary items should be deleted. The addition of any item to the list must beexamined critically.(e) Pharmacy staff should be actively involved and responsible for the whole process ofward stock management e.g. by using a bar-code topping up system.(f) In the absence of barcode topping up system due to resource constraints, the “two bottlesystem” should be employed. This will help the nursing staff monitor the levels of wardstocks more easily.Emergency Drug Supplies outside Pharmacy Service Hours4.75 When a 24 hours pharmacy service is not feasible, access to a limited supply of medicationsfrom the Night Cabinet should be available to doctors or nursing staff for use in initiatingurgent medication orders. For the “Cluster Pharmacy Model”, an effective and efficientward stock replenishment system and special arrangement for ad hoc / urgent requirementsmust be in place.31