INTRODUCING NEW MEDICATION PRESCRIPTION AND ADMINISTRATION CHART

1. INTRODUCING NEW MEDICATION PRESCRIPTION AND ADMINISTRATION CHART 8 Feb2013

2. content • Introduction/Background • Three different types of Prescription and Administration (P&A)chart • Lay out of the (P&A) chart • How to Prescribe? • How to record Administration? • How to order medication? • Do(s) and Don’t(s) • Q&A

3. Background • Current prescription and administration sheet- document since 1960’s • Card use for recording • Prescribing and administration record • Ordering of medication need to be done separately • Actual administration time is not captured • Alarming rate of transcribing errors

4. Problems with old cardex • Transcribing – leads to error

5. Problems with old cardex • Drs need to rewrite prescription every 2-3 days • For some medications, unsure of route if not written (egazithromycin 500mg od)

6. Three different Types • Parenteral prescription and administration chart • For non-oral, non topical route of administration

7. Three different Types • Non-Parenteral prescription and administration chart • For oral and topical medication

8. Three different Types • Medication with Frequent dose changes Prescription and Administration chart • For parenteral and non parenteral medication with frequent dose changes, i.e. ivi insulin, heparin, inotropes

9. List of Medications with Frequent Dose Changes • IVI Inotropes (Dopamine, Dobutamine, Nordrenaline) • IVI Midazolam • IVI Morphine • IVI Insulin (Actrapid, Insulatard) • IVI Heparin • Fixed dose parenteral & non-parenteral medications with frequency>6 times/day (eg: Artificial tears 1 drop q2H) • NebA:V:N

10. Layout of the prescription and administration chart • Consist of 2 pages where the second is the carbonized to the first • Page 1(original copy)-ward use • Page 2 (carbonized copy)- pharmacy use Heading and Allergies history (page 1 and 2)

11. Layout of the prescription and administration chart Prescription Page 1 &2

12. Layout of the prescription and administration chart Administration record Page 1

13. Layout of the prescription and administration chart Administration record for medication with frequent dose changes

14. Layout of the prescription and administration chart Page 1 Signature index and Patient’s detail

15. Layout of the prescription and administration chart Page 2 Carbonized copy of prescription and pharmacy supply record Prescriber official stamp and patient’s information sticker can’t be carbonized

16. Layout of the prescription and administration chart

17. How to prescribe • First thing: Check patient’s name and detail • Check for allergies history

18. How to prescribe 3 1 IVB 5 Pantoprazole 4 0800 To off the medication, remember to fill in the signature index 40mg bd 24/10 2 2000 27/10 Dr lee linlin MPM6565 6

19. How to prescribe • Remember to put your stamp on the carbonized copy and check the patient's detail is available on it too.

20. How to precribe • For medication with frequent dose changes, the range of dose need to be stated 8mg in 50mL D5 at rate of 10-20mL/hr

21. How to record administration • First thing: Check patient’s name and detail • Check for allergies history

22. How to record administration 1 24/10 2 Bc 3 1000 5 Bee Chong Bc 4

23. How to record administration • IVI with dose changes (i.e. inotropes, insulin, heparin) • Documentation done on every nursing shift as well as whenever dose changes IVI 1 24/10 24/10 5 Noradrenaline 0800 6 1200 2 8mg in 50ml D5 at 5-10ml/hr 6mL/hr 3 10mL/hr 7 ffp 4 IVI

24. How to order medication • Check all information needed is available and correctly written: • Name, dose and instruction (frequency), route of administration, start date • Prescriber’s signature and official stamp/ clearly written name and MPM number • Patient’s detail • Separate each prescription from the carbonized copy • Send the prescription to pharmacy

25. How to order medication

26. How to order medication • Re-ordering of medication • Keep the prescription in patient’s folder • Check for re-ordering date every morning • Send prescription to pharmacy on the re-ordering date, Please ensure the patient is still on the medication • Each prescription is valid for 7 days from the first supply TCH 6 24/10 26/10 pantoprazole IVB 40mg bd pantoprazole 24/10 IVI 40mg bd 24/10 Dr lee linlin MPM6565

27. How to order medication • Re-ordering of medication • Transcribe to new prescription and administration chart after 7 days

28. How to supply medication New prescription • Enter RN to MMUS dispensing desktop • Check PMR for previous supply • Proceed to issue out stock from MMUS and labeling • On the prescription, enter • Date of supply • Quantity supplied • Initial • Next supply date*

29. How to supply medication 1 26/10 24/10 TCH pantoprazole IVB 6 3 4 2 40mg bd 24/10 Dr lee linlin MPM6565

30. How to supply medication • To count the next supply date • scenario 1 • On 3/1/12 morning, New prescription received for IV B pantoprazole 40mg bd, no previous supply. 6 vials supplied and the next supply date • Last dose of supplied will be used on 5/1/12 night. Therefore, next supply date will be on 5/1/12 • Scenario 2 • On 5/1/12, receive repeat order for prescription from scenario 1 • 3 vials supplied. • Last dose on 7/1/12 morning. Therefore next supply date will be on 7/1/12 In conclusion, ward are allow to order when they have 1 more dose with them (applies for antibiotic and oral medication)

31. How to supply medication • To enter pharmacy notes, please include your initial and date. • For medication with frequent dose changes where dose and instruction is written ranges (supply the maximum?) • For incomplete prescription, reject the prescription by entering reason on the pharmacy notes column • If prescription received with amendment done on the carbonized prescription, reject the prescription

32. So, What’s new? • NO more Rx except for DRIPS & DISCHARGE • Reject all Rx except DRIPS & DISCHARGE • 1 patient – many sheets all stapled together • Key-in: extra step, write next date of supply • Key-in: 4 + 3 (no more plus one!) • Packing – remove staple and pack as usual • Checking & dispensing – AS USUAL

33. issues • Cannot detect stopped medications • Harder to detect interactions (eg ranitidine & omeprazole) • Carbon copy ‘hilang!’ • Ivi written in iv sheet

34. Do(S) and don’t(s) Check to ensure • Ada patient sticker • Information is complete (dos, frequency etc.) • Ada Dr’s stamp • The dilution/ concentration required and the range of doses prescribed is specified for the frequent dose change prescription (example: IVI Noradrenaline 8mg in 50cc D5%, at 4-10mL per hour)

35. Thank you!