The national medication chart

A summary of the 2012 changes

NATIONAL MEDICATION SAFETY PROGRAMME

• Review of original chart completed in March 2012 considered feedback from:– Change requests submitted by DHBs using the chart– Paediatric requirements consultation– Themes from the pilot of the long stay chart (16 days)

• Revisions made to the chart retaining key safety features

• Agreement to provide a suite of charts based on duration of stay in hospital– 8 day chart – for majority of patients – 16 day chart – for longer stay patients– 1 day chart – for emergency department and day stay patients

National medication chart

• Key feedback messages:

– Incorporate paediatric requirements into existing chart – no need for a separate chart

– Investigate how we can view medicines succinctly

– Incorporate venous thromboembolism prevention documentation into the chart

– Increase the number of days to eight

– Provide a longer stay and shorter stay chart

– Include a prompt for prescribers to review prescriptions and re-prescribe

– Make the dose box clearer for variable doses and decimal point

– Make it scannable for electronic records

Review of the national medication chart

Revisions made to the content of the chart• Combined paediatric and adult documentation

One space for height

One space for BSA Gestational age

for ALL neonates

Two spaces for weight available

Revisions made to the content of the chart• VTE prevention fields incorporated for use for all adult patients

(not for patients under 18 years of age) – VTE risk assessed on admission

– VTE risk reassessed within 24 – 48 hours of admission and again if clinical condition changes significantly

Revisions made to the content of the chart• New style dose boxes

• Addition of dose calculation box for all paediatric dosing and if using weight based dosing for adults

Specific direction about where to prescribe dose ranges

Defining lines around decimal point and larger space to write units

Revisions made to the content of the chart• More medicines per page

– Eight PRN and 23 regular medicine spaces

• Increased duration– Chart now covers eight days– Additional 16 day chart for long stay patients

• 16 day chart has – one PRN medicine page

– three Regular medicine pages with fold out flaps

Revisions made to the content of the chart• Administration with flaps

— Document administration across with the flap open = 12 days and then with the flap closed = 16 days

— Administrators check under the flap when administering medicines

Black line to visually trigger that flap is closed

Flap open

Revisions made to the content of the chart• Reduced administration times from six to five rows per medicine

• Removal of yes box from allergies and adverse reactions boxes

Removal of Yes box

Revisions made to the content of the chart• Prompt to re-prescribe on last administration day of medicines

• Designs for scanning into electronic health record– Barcode on front page– Shaded grey area “do not write on this area” with scissors picture– Space to complete patient name and NHI on pages

• six and nine of the 8 day chart • six and ten of the 16 day chart

• 15 DHBs have implemented the chart into their hospitals. – A big thank you to the teams who have made this happen in their organisations– The 16 day and 1 day chart should enable these DHBs to expand to areas not

currently using the national medication chart and fulfil the needs of long stay and short stay patients

• Medication safety team is working with the remaining five DHBs to implement the national medication chart

Implementation status

Next steps

• 8 day chart available for ordering from Wednesday 10 July 2012. – Same price structure as current national medication chart– Existing stocks of chart to be used first

• 16 day chart available for ordering from Wednesday 25 July 2012– Price structure more than current – DHBs will be sent a sample of the chart to assist with their decisions on what wards

will use these

• Posters outlining the changes will be available for DHBs to download• User guide for the national medication chart will be updated• Electronic Change Register will be made available to capture requests

for the next review in two years time• 1 day chart to be developed and the aim is to have it available for

ordering in November 2012

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The Commission