1. Medicines Management To be viewed in conjunction with NMC Standards for medicines management1

2. Important!
Please view in conjunction with the NMC standards for medicines management
In viewing this presentation, reading the NMC standards for medicines management and submitting the form you will have completed your mandatory training
If you still have questions at the end of the presentation please contact your ward/area pharmacy team.

3. Content The following presentation will cover:- General issues
Process on admission of the patient
The drug chart
Patient own drugs and their in-patient stay
Process for patient discharge
Calculations/conversions
Controlled drugs
Costing
Summary

4. General issues
Ensure treatment room doors are closed and that drug cupboard doors are locked.
Controlled drug (CD) cupboard keys must be on a separate set to other cupboard keys.
The in-patient pharmacy is open Monday to Friday 8am to 6pm and Saturday and Sunday 10am to 4pm.
During the week most wards receive a daily visit from a member of the pharmacy team, please let the team know of any issues, discharges or patient medicines needed.
If there are issues and the pharmacy team are not on the ward please bleep them for assistance.
Stock top-ups are performed throughout the week also, please communicate any changes in stock needs with the team.

5. Patient admission – key priorities
On admission an allergy status is a high priority, ensure all allergies are written on the drug chart, all trained staff can do it.
Check pharmacy grey box on the drug chart to see if pharmacy team have already identified and/or sorted any issues
If the patient has their own drugs or a medication list compare to the drugs prescribed on the drug chart before administering
Query any discrepancies with the team
If the patient does not have any medicines with them ask if a relative/carer can bring them in (especially inhalers and eye drops) 5

6. Patient admission – key priorities (cont)
If from a nursing/residential home ensure a copy of the MARS is placed in the notes
Message in a bottle scheme – have they brought in a bottle with their information in?
Put any patient’s own drugs (PODs) in the bedside locker (locked), keep GTN sprays and inhalers available to the patient but out of easy access of other patients
Controlled drugs (CDs) must be locked away immediately or returned home with a relative if preferred or in a blister pack and not being used.

7. Role of clinical pharmacy team Documenting drug histories
The grey box is for Pharmacy to complete but nurses may find it useful to identify any discrepancies found between drug history and drug chart

8. Prescription/drug chart requirements
Indelible and drug name in capital letters
Dated
Signed by prescriber
Name of patient
Address of patient/hospital number
DOB – especially children <12 years of age
Indication and course length for antibiotics
Consultant prescribing
team – for costing
Weight of patient
Height of patient
Allergy status
Correct ward name- so delivered to right place 8

9. Checking Patients own drugs (PODs)
To ensure suitability for use check medicine is –
For this patient
In date and dispensed in the last six months
The correct drug (contents match box and label)
The correct strength
Labelled correctly
In an acceptable condition
Clearly identifiable – i.e. in foil strips clearly named
Check POD against drug chart – the prescription may have changed
Please give all patients a green bag:-
On admission
During stay
On discharge
Encourage patients to bring their medicines back into hospital in the green bag (available from pharmacy) 9

10. PODs – compliance aids
NOMADs Blister packs Redidoses Dossette
Compliance aids are not a reason to allow a patient to miss a dose
When patients bring in their own compliance aids they may be used
! If a patient requires a compliance aid on discharge, pharmacy require 48 hours notice and an accurate discharge letter 10

11. During patient stay
Monitor drug chart for changes or new items and order as needed
Endorse the chart according to what has been taken by the patient – ensure clarity in dose administered
? Unavailable – is it really? Check fridge, treatment rooms and previous ward if patient has been moved
Monitor the patient’s condition and think about the drugs being given- is it appropriate to give drug?
Only use stock items or drugs labelled for THAT PATIENT. It is against Trust policy to give a patient a medicine that is labelled for somebody else
Ensure medicines are given on time particularly antibiotics and Parkinson’s disease medicines
Sign for all administered medicines including oxygen 11

12. Endorsements
Generally pharmacy will endorse medicine charts in green ink
28 CS 6/ means 28 were supplied by CS on 6th Oct
14 POD 6/10-means the patient has 14 of their own tablets on the 6th Oct
PODH means the patient has their own supply at home
CD – Controlled drug
STOCK – this drug is held on the ward in the stock cupboard
Look at the endorsement to find out where you will get a supply from before putting drug unavailable on the chart or ordering 12

13. On discharge
The discharge letter is to be checked against the patients medication for:
Correct medication
Correct strength
Correct form
All directions correct
TTO packs directions completed correctly including NAME of patient and frequency of administration
Expiry date, especially eye drops
Sufficient quantity to either complete course or until can obtain further supply from GP
Policy now states: IN POSSESION of MINIMUM OF FOURTEEN DAYS SUPPLY
The 14 days supply includes any medicines the patient has at home
Exception : TB meds – 28 days supply minimum 13

14. Useful Calculations/Conversions
1 gram = ?? milligrams
1000 milligrams
1 milligram = ?? micrograms
1000 micrograms
1 microgram = ?? nanograms
1000 nanograms
-Convert grams to milligrams
Multiply by 1000
-Covert milligrams to grams
Divide by 1000
-Convert milligrams to micrograms 14

15. Controlled drugs Ordering
Use CEDAR and complete all fields correctly (check with IT ex 5000 if your usual windows log in does not give you access to CEDAR)
Orders placed after 12pm will not be supplied until the following day, if urgent for that day bleep the dispensary manager (# )
Do not order CDs at the weekend or on bank holidays unless absolutely essential as pharmacy have limited staffing levels – only those marked urgent will be processed at weekends
Controlled drug electronic discharge letters can only be dispensed if LEGAL. This means the total quantity required must be in words and figures (e.g. 28 twenty eight), the form must be written (e.g. capsules/suspension) and the prescription must be signed by the prescriber.
Only trained nurses may collect CDs (need Trust ID) 15

16. Controlled drugs CD registers Ensure it is legible
Index at the front of the register -it is a good idea to leave at least 10 pages between each stock CD page so that you don’t have to keep transferring the balance over to another random page
Double check:
Drug name, strength, form, quantity, expiry, calculations
Two members of staff to sign in and out and check levels
If you are entering POD CD’s into a register please leave plenty of lines between each entry so that when they are administered to THAT PATIENT or need returning to pharmacy or the patient there is room to sign them out 16

17. Controlled drugs DO If an error is made in the controlled drug book:-
Bracket the error
Document error on line below and put correct quantity
Make sure it is countersigned
DO NOT
Cross out
Use correction fluid 17

18. Medicine costs awareness
It is good practice to ask patients to bring in their own medicines from home, it ensures consistency in medication supply, assists with drug history taking and improves the efficiency of the pharmacy service by enabling the team to dispense necessary items only. The following slide gives an idea of the costs of some commonly used medicines. It is not the intention that any patient misses a dose however it assists all health economies if patients own medicines are used whilst in hospital where appropriate. It is Trust policy that all patients have access to a minimum of 14 days supply of their medicines on discharge so using PODs during the in-patient stay is not detrimental in any way. 18

19. Medicine costs (from BNF 63)
Tazocin 4.5g inj x = £14.21
Pregabalin 75mg caps x = £64.40
Fresubin 2kcal drink 100ml = £1.80
Seretide 125mcg evohaler = £35.00
Seretide 250mcg evohaler = £59.48
Lantus 3ml pen x = £41.50
Tiotropium inhaler (spiriva) = £34.87
Enoxaparin 40mg x 1 injection = £4.04
Rotigotine 4mg patches (28) = £117.71
Linezolid 600mg tablets x =£445.00
Good stock control is essential, storing medicines in the correct place and regularly checking expiry dates reduce waste and cost.

20. Summary
The presentation has pulled together common issues surrounding medicines management, the nurses role and their responsibilities.
It must be recognised that the drug chart is a legal document and all acts and omissions need to be fully and accurately recorded
Adhering to the NMC standards and Trust policies not only ensures a positive patient experience but will also reduce unnecessary re-admissions, waste and costs.
If you require further advise, clarification or support please contact your ward/area pharmacy team.