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ICU Prescription Sheet

ICU Prescription Sheet. Why?. Do we need to change?

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ICU Prescription Sheet

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  1. ICU Prescription Sheet

  2. Why? • Do we need to change? The hospital has changed to a system where prescription and administration are on the same sheet (TPAR). This allows omissions to be easily seen. It also means that the administration and record cannot be separated and lost. ICU has been instructed to adopt a similar system. • Do we not use TPAR? TPAR was extensively trialled in ICU and found to be inadequate for our needs. So we have had to design a form that suits our needs better than the TPAR. Any constructive feedback would be welcome.

  3. What? • There is a system currently being used in ICU, which is similar to TPAR, but so far appears better adapted to our needs. • The ultimate aim is to move to an electronic system, which is currently being developed.

  4. When? • The trial of the document is continuing. • Once we have the proofs back from the printers, we would aim to make the final changes and start using the system properly. Hopefully in colour to make it easier to differentiate between the different sections.

  5. The new sheet • Landscape booklet • Coloured sections for ease of reference. • More space for prescription than the current Kardex.

  6. So what will it look like?

  7. Once only Prescriptions

  8. Regular Prescriptions • Regular oral/ NG/ NJ drugs • Regular injections/infusions

  9. As Required Prescriptions • Any drug that is to be used on an as required basis

  10. Continuous Infusions • Continuous infusions • Sedative agents (Propofol/Midazolam) • Analgesics (Morphine/Alfentanil etc…) • Inotropes and vasopressor infusions (Dobutamine/noradrenaline etc) • Epidural or peripheral nerve catheter infusions

  11. General rules for Prescribers • Write legibly. If those that are administering the drug cannot read it, it won’t be given! • Write the names of drugs in full and where possible the generic name • Use metric doses and standard abbreviations miligram=mg gram=g mililitre=ml micrograms to be written in full ( not mcg or μg) • Use standard abbreviations for routes as in the next slide

  12. Routes of administration

  13. Prescribing • The next few slides are designed to take you through how to prescribe a drug on the new chart. • Each section will be covered in turn. • There are instructions for all who use the document on the rear cover. Any comments, or errors / omissions that are noted will be gladly listened to.

  14. The front cover • As well as once only prescriptions the front cover has several other important sections that should be carefully filled in. • It is largely self explanatory. • In particular the sheet number, dates written and discontinued are important

  15. The front cover • The allergies and sensitivities section. If none known then please put NKA. The instructions will be changed to reflect this. • There will also be a box to state whether more than one chart is in use (hopefully a rare event)

  16. Regular Prescriptions Drug Name • generic where possible • in full Paracetamol

  17. Regular Prescriptions Drug Name Route • oral/NG/NJ/Jej/IV etc Paracetamol IV

  18. Regular Prescriptions Drug Name Route Dose • mg • g • micrograms Paracetamol IV 1 g

  19. Regular Prescriptions Drug Name Route (oral/NG/NJ/Jej/IV etc) Dose Form Infusion Injection Nebulised Liquid Tablet Capsule Paracetamol IV 1 g Infusion

  20. Regular Prescriptions Drug Name Route (oral/NG/NJ/Jej/IV etc) Dose Form Start date and signature Paracetamol IV 1 g Infusion 18/03/07 Bloggs

  21. Regular Prescriptions Drug Name Route (oral/NG/NJ/Jej/IV etc) Dose Form Additional instructions e.g. with or after food Paracetamol IV 1 g Infusion 18/03/07 Bloggs

  22. Times Correct Wrong Insert Times: • 24 hour clock • In order over 24 hours • Use ‘even’ hours i.e. 02.00, 04.00 NOT 13.00, 03.00 etc…

  23. Regular Prescriptions 06.00 Drug Name Route (oral/NG/NJ/Jej/IV etc) Dose Form Additional instructions Insert Times 24 hour clock In order over 24 hours ie 06.00, 12.00, 18.00 etc Try and make the times ‘even’ hours i.e. 02.00, 14.00 etc Paracetamol IV 1 g Infusion 12.00 18/03/07 Bloggs 18.00 24.00

  24. Stopping a drug Drugs in all the sections should be stopped in this way 18 19 20 03 03 03 06.00 Paracetamol IV SN SN 1 g Infusion 12.00 SN SN Bloggs 18/03/07 18.00 20/3/7 SN SN MB 24.00 SN SN Diagonal line through the rest of the administration record Dated and Initialled Single diagonal line through the whole prescription box Double vertical line through the remainder of the day (or the next day if not enough space).

  25. As Required Prescriptions Drug Name, Dose, Route and Form as per the Regular section. Tramadol 50mg IV Inj

  26. As Required Prescriptions • Drug Name, Dose, Route and Form as per the Regular section. • Maximum frequency that you wish to prescribe the drug. Tramadol 50mg IV Inj 4 hourly

  27. As Required Prescriptions • Drug Name, Dose, Route and Form as per the Regular section. • Maximum frequency that you wish to prescribe the drug. • Date and sign the drug • Indication for the drug • The indication box could also be used to state the maximum dose of drug that can be given in a period. Tramadol 50mg IV Inj 4 hourly 18/03/07 Bloggs For Pain. Max 400mg in 24 hours

  28. Drug, Route, and Indication as for previous sections. Continuous Infusions Morphine Sulphate IV For Pain

  29. Drug, Route, and Indication as for previous sections. The dose may be stated as a range mg per hour mls per hour for drugs of a fixed (and stated) concentration micrograms per kilogram per minute for inotropes and vasopressors. For ease the units have been pre printed. Cross out those that are not required Continuous Infusions Morphine Sulphate IV 0-10 18/03/07 Bloggs For Pain

  30. Discontinuing a whole chart • Single clear line through the front cover, and across each active page. • Clearly date and initial that it is discontinued • Write a new one if required. 0 1 0 1 3 2 0 0 1 1 SMITH John 12/3/2007 12/3/2007 1 19/3/2007 MB

  31. For those administering Drugs • If it is illegible or unclear then discuss with a senior or member of medical staff. Don’t presume that you can guess correctly! • Record everything as accurately as possible • The instructions don’t cover every potential problem or circumstance. Discuss any problems – it may not be new.

  32. Instructions for those administering medicines • The ‘Regular’ and ‘As Required’ medicines sections should be checked at each administration round to ensure that inadvertent omission or double dosing is avoided. • Ensure entry is made on administration record each time drug is given. Initial in relevant date column and time row. • Check that all drugs prescribed at a certain time are administered. • If a drug is not administered, enter the reason in the appropriate box using the coding system. Then discuss with senior nursing or medical staff as to why it cannot be given.

  33. CODES FOR THE NON-ADMINISTRATION OF PRESCRIBED MEDICINES • If a dose is not administered, initial and enter the appropriate code in the box with a circle drawn round it. • Then discuss with senior nursing or medical staff as to why it cannot be given

  34. Questions? • If you have any questions or comments then please contact: Ian Mellor Diane Campbell or Debbie Corner

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