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

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4.111 Three-way (red and blue) and four-way stopcocks (blue only) are predominantly used forthe administration of intravenous solutions and intermittent injection of drugs. A uniformcolour-code for stopcocks has been adopted to facilitate line identification with blue colourdenoting venous line and the red colour denoting arterial line or intra-cranial pressureline. Since simultaneous dual access may be required for venous access only, Four-waystopcock would only be available in blue colour. The guidelines on the use of three-wayand four-way stopcock are shown in Appendix 10.Record of Administration4.112 The MAR should be used as the record of the administration of drugs to patients. This willeliminate any error inherent in other transcribed reference. The supervising RegisteredNurse and nurse learner administering the drugs should sign the MAR.4.113 The date, time of administration and signature should be entered immediately AFTER thedrug has been given and CONSUMED by the patient.Recording and <strong>Report</strong>ing4.114 Whenever a patient refuses or vomits back a drug, the matter should be recorded on thepatient’s MAR. Other reasons leading to an omission in drug administration should also berecorded, e.g. patient was fasting, drug unavailable. If a dangerous drug has to be discardedbecause it has been spoilt or rejected by a patient, the event should be reported to Nurse inchargeand entry made in the appropriate ledger. The doctors concerned should always beinformed.4.115 As part of the ongoing process (not solely at the times of administration of medications) theeffects and side-effects of the treatment experienced by the patient or observed by nursesshould be recorded and reported.Self-medication Programme4.116 Patients are encouraged and trained to self-administer their own drugs as part of theirrehabilitation programme.4.117 Individual hospitals should establish protocols for carrying out this programme. Suchprotocols should specify the selected patient group, the required physical & mentalconditions of the patient, maturity, level of consciousness and educational background.Nurses may refer to Appendix 11 for Guidelines on Patient Self Medication for GeneralPatients and Appendix 12 for Guidelines on Patient Self Medication for Psychiatric Inpatient.For specific procedure such as patient controlled analgesia, ‘Nursing Standards forPatient Care’ formulated by the Nursing Section of HAHO should be referred to.4.118 Pharmacist should provide patient education and counselling on the use of drugs.Appropriate supervision by the nursing staff must be provided and the assessment of thepatient should be documented.37
The Supply of Ward Stocks4.119 Ward stocks should be stored in an orderly manner. The practice of the rotation of stockshould be observed. Any changes in requirements e.g. stock levels, should be referred to thepharmacy for appropriate action.Pooling of Drugs4.120 Pooling, transferring, repackaging and relabelling of ward stocks should be avoided.4.121 Drugs supplied to the ward whether as ward stocks or on an individual patient basis shouldnot be pooled together. Neither should unused medications be pooled together to form‘unofficial’ ward stocks.Relabelling4.122 Labels originally provided by the pharmacy should NOT be altered or amended. In caseswhere labels are inadvertently destroyed or soiled, the container with its contents should bereturned to pharmacy for relabelling.Dispensing outside Pharmacy Service Hours4.123 For the dispensing of A&E and other prescriptions outside pharmacy service hours, the localpolicy of individual hospital should be followed. Dispensing of ward stock medications bydoctors or nurses for home leave and on discharge is not recommended. When this isunavoidable, the medication dispensed should still be clearly labelled and comply with therequirement of the Hong Kong Medical Council and the Pharmacy and Poisons Board.The list of Requirements for the Labelling of Medications is as follows:(a) Name of patient(b) Date of dispensing(c) Trade name or pharmacological name of the drug (refer to Para. 4.62c)(d) Dosage per unit(e) Method and dosage of administration(f) Precautions where applicableBorrowing of Drugs4.124 Borrowing drugs from another patient’s supply or from other wards should be restricted toexceptional circumstances.Method of Drug Return / Disposal4.125 In order to minimise the amount of ward drugs returned, it is important to optimiseprescribing and drug distribution. This would reduce much unnecessary drug wastage andassociated costs. Unused drugs left over by patients because of discontinuation of treatment38
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 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 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
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QUALITY ASSURANCE IN DRUG THERAPYHO
Page 104 and 105:
Fig. 1: ADR voluntary reporting sys
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PROCEUDRE FOR QUALITY COMPLAINTSONP
Page 108:
Part II Procurement Section, CPO1.
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