August 2016
Objectives
Prescribing & Zero tolerance
NPSA
Medicines Reconciliation
Policies
Pharmacy Services
“The General Medical Council (GMC) states that all doctors must keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment “
“ Administering or dispensing against unclear and incomplete prescriptions within the NHS in the past has led to serious patient injury and doing so may result in charges of negligence and disciplinary action against the health professionals involved in all stages of the medication process.”
Prescriptions must be clear, accurate, safe & appropriate
BVH - A Zero Tolerance approach to Safe Prescribing
Be printed in clear and legible handwriting
Include the full drug name - Abbreviations should be avoided, ie BFZ, FeS04
Prescribers must specify the dose units clearly:
Microgram: microgram (not mcg or μg),
Units: UNITS (not u or iu)
What medication would you give this patient?
Abbreviations should be avoided to reduce the risk of errors at all stages of the medication administration process
Review and analyse patient safety incident reports
Identify common risks Implement safer practice
◦ Insulin ◦ Anticoagulants ◦ Methotrexate ◦ Lithium ◦ Potassium
16,600 patient safety incidents Including death
26 per cent were due to the wrong insulin dose, strength or frequency
one death after clinicians misinterpreted the abbreviation of the term ‘unit’.
Medicine most frequently identified as causing preventable harm and admission to hospital
Ensure that patients prescribed anticoagulants receive appropriate information
Patients should be informed of:
◦ Tablet strengths/colours
◦ INR (blood monitoring)/blood tests
◦ Yellow book
◦ Side effects
◦ Food/drink interactions
◦ Drug interactions
◦ Hobbies
◦ Other healthcare professionals
Reports of incorrect dosing frequency of oral methotrexate
Oral methotrexate is a safe and effective
medication if taken at the right dose and with appropriate monitoring. However, very occasionally problems with taking the medication can cause serious harm and even death.
“The aim of medicines reconciliation on hospital admission is to ensure that medicines prescribed on admission correspond to those that the patient was taking before admission.” ◦ NICE 2007
The patient Family / carers Nursing homes MAR sheets (medication administration records) Repeat prescriptions GP surgeries Pharmacies Letters/faxes from GPs Previous admission records Previous discharge letters Patients own drugs Dosette boxes IDEALLY USE AT LEAST TWO RESOURCES
Ensure all NEW medicines are documented with reasons for their initiation explained.
Ensure all DISCONTINUED medicines are documented – preferably with reasons.
Ensure all DOSE CHANGES are documented – preferably with reasons
Medicines Policy
Zero Tolerance
Antimicrobial formularies (adult & paeds)
Gentamicin/Vancomycin monitoring
Potassium
VTE-dalteparin
Warfarin
Lithium
……AND LOTS MORE!
EMC
BNF
cBNF
Document Library
Uptodate
Open 7 Days 8.45-5pm Pharmacist ward visit Mon-Fri Weekend: new admissions & discharges
Ward pharmacists (bleeps) One stop/meds rec. technicians Medicines Information (3791) Emergency on-call service for out of hours
Any questions?