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

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2.1 Concentrated potassium chloride injectionCritical care units• Supply of concentrated potassium chloride injection as floor stock should onlybe limited within these critical care areas, ICU, CCU or equivalent.General wards• No floor stock of concentrated potassium chloride injection is allowed ingeneral wards (1,2) .• Supplies of concentrated potassium chloride injection to general wards mustbe made on individual patient basis with a completed MAR order sent topharmacy (preferably including required concentration, diluent, volume ofinfusion and infusion rate) and checked by pharmacists.• All unused concentrated potassium chloride injections obtained on individualpatient basis with MAR have to be returned to pharmacy immediately upondiscontinuation of treatment.• After pharmacy hours, concentrated potassium chloride injection can beobtained in emergency cupboard if necessary.Supply from Pharmacy• Supplies of concentrated potassium chloride injection to wards in sealed bagwith distinctive warning label and physically separated from othermedications.2.2 Pre-mixed Concentrated potassium chloride minibags and Pre-mixed potassiumchloride solutionsAll wards (Both critical care units and general wards included)• Both pre-mixed minibags and solutions could be supplied as floor stock andreplenished by pharmacy similar to other ward stock items.3. Storage3.1 Concentrated potassium chloride injectionAll wards (Both critical care units and general wards included)• All concentrated potassium chloride injection, including those issued forindividual patient in general wards or as floor stock in critical care units, mustbe stored in DESIGNATED and LOCKED cupboard which must bePHYSICALLY SEPARATED from other similarly packaged frequently useddiluents e.g. ampoules of 0.9% sodium chloride and water for injection.1Under very exceptional circumstances, the respective COS should (i) apply with justifications to CCE via DTC forstocking concentrated potassium chloride solution in areas other than critical care areas and Paediatrics, (ii) beresponsible for the establishment of a safe management system similar to that of Dangerous Drugs.2Exception is granted for Paediatrics pending further review and sourcing of suitable pre-mixed potassiumchloride infusion for use in PaediatricsPage 2/3
3.2 Pre-mixed Concentrated pre-mixed potassium chloride minibags and Pre-mixedpotassium chloride solutionsAll wards (Both critical care units and general wards included)• Storage requirements for pre-diluted potassium chloride solutions are thesame as other ward stock IV solutions, which should be clearly segregatedaway from one another, aiming to prevent any mix-up among differentward stock IV solutions.4. Administration of Potassium Chloride Injection4.1 Concentrated potassium chloride injection(a) Concentrated potassium chloride MUST BE DILUTED before use.(b) For dilution of concentrated potassium chloride, it is recommended to invert themixed infusion bag several times to avoid accumulation of the drug.(c) COUNTER-CHECK during the retrieval for correct product, dosage dilutions, mixingand labeling during the preparation and before administration of the product isessential. Staff should remain alert and be aware of the potential danger ofincorrect use.4.2 Pre-mixed Concentrated Pre-mixed potassium chloride minibags(a) For use only with a CALIBRATED INFUSION DEVICE for exceptionalcircumstances e.g. acute correction(b) COUNTER-CHECK during the retrieval for correct product and before administrationof the product is essential. Staff should remain alert and be aware of the potentialdanger of incorrect use.4.3 Other recommendations(a) A rate controlled infusion pump should be used if the infusion rate of potassiumchloride is faster than 10mmol/hr.(b) Concentration higher than 40mmol/L (i.e. 4 mmol per 100ml) of potassium mustbe used with extreme caution. Infusion flow rate and infused volume must always beclosely monitored and regulated for this high dose therapy.(c) Patients should be monitored for signs and symptoms of hyperkalaemia during andafter infusion.(d) In cases where a patient complains of severe pain at injection site, the prescribershould immediately be notified to consider adjustment of the infusion rate or theconcentration of potassium chloride content.The Drugs and Therapeutics Committee (or equivalent) of individual hospital should formulateits policy on the dosage range and preferred diluents applicable to the clinical needs of itspatients. Staff education and training on the risks associated with concentrated potassiumchloride would be pivotal for improved patient safety.Page 3/3
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ForewordMedication safety and provi
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Chapter 6 summarizes the specific r
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Chapter 6Conclusions and Recommenda
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CHAPTER ONETHE WORKING GROUPMEMBERS
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CHAPTER TWOTHE PROGRESS REPORT2.1 P
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CHAPTER THREEAREAS FOR IMPROVEMENT
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Existing In-patient Drug Administra
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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 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 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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