Safe and Effective Prescribing 2014 Senior Medics Training Pharmacy Department

Policies and guidance relating to medicines Policy on Governance Arrangements relating to Medicines Medicines Policy Procedure for allergies, idiosyncrasies to medicines and food Delayed and omitted doses of medicines Policy for medicines reconciliation on admission of adults to hospital Rules relating to all activities involving CDs Guidelines for patient self-administration of medicines Antimicrobial policy Anticoagulation guidelines

Allergy Procedure for allergies, idiosyncrasies to medicines and food Every patient needs a documented allergy status JAC has a NKDA button No patient should be prescribed, supplied or administered without being complete – including outpatient prescriptions Re-confirm on each admission

Allergy - Errors Since the implementation of EPMA we have had 2 incidents of patients receiving medicines that they are allergic to Patient was documented as allergic to tramadol on EPMA and the prescriber overrode the warning to continue to prescribe it. NKDA was entered incorrectly onto EPMA, as the patient was allergic to penicillin. They were prescribed penicillin and developed a rash.

Missed doses Delayed and omitted doses of medicines Reasons have to be entered on to EPMA for any missed doses Prescribers must be alerted after missing 1 dose of a critical medicine or 2 doses of any other medicine Critical medicines should not be omitted Antibiotics, Antifungals, Antivirals Anticoagulants Immunosuppressants Parkinson’s Anti-epileptic medications Insulin Resus medicines Desmopressin Missed doses report sent to wards and pharmacists

Missed Doses of Desmopressin Patient with diabetes insipidus admitted without her desmopressin tablets Next morning, ordered by nurses but non-stock order form lost – ?never reached pharmacy Following morning ordered again and supplied, but patient had already missed 48 hours Patient hypernatraemic, vigorous rehydration but deteriorated and died

Antibiotics Antibiotic stewardship protocol – to reduce inappropriate antibiotic use Start SMART then focus Must follow Trust guidelines Ensure review dates especially for Tazocin Include indication and Stop/review date Restricted list or not as per policy need micro approval and a documented code Right antibiotic/Right time Antibiotic webpage and new app

Antimicrobials –do not delay Patients with sepsis must have the first dose prescribed and administered within one hour How to obtain restricted antibiotics

Anticoagulation Thrombosis prevention, investigation and management of anticoagulation guidance Our Trust uses dalteparin as LMWH VTE risk assessment must be completed – part of JAC Weigh the patient for treatment doses ACS policy – fondaparinux and ticagrelor Rivaroxaban/dabigatran/apixaban - care on admission

Controlled Drugs Rules relating to all activities involving CDs Ward, Theatre and department SOPs for CDs Accountable Officer – Andrew MacCallum (Director of Nursing) Procedures Usage monitored CQC registration and NHSLA

Pharmacy: Sources of advice Ward pharmacist Medicines Information x2587 Hospital protocols - intranet link Quick Links : clinical guidelines Antibiotic Policy BNF Smart apps (Athens log-in)

Reporting Medication error reporting DATIX system we try to learn from errors Medicines Safety Group review trends Adverse Drug Reaction reporting Use MHRA yellow cards when appropriate, as well as DATIX

EPMA update VTE risk assessment – 24 March YouTube training videos – warfarin, VTE Selection errors from drop down box (penicillin/penicillamine, cyclizine/cyclophosphamide) Read only access through JAC Ensure training completed