1. INTRODUCING NEW MEDICATION PRESCRIPTION AND ADMINISTRATION CHART 8 FEB2013

2. CONTENT Introduction/Background Three different types of Prescription and Administration (P&A)chart Lay out of the (P&A) chart How to Prescribe? How to record Administration? How to order medication? Do(s) and Don’t(s) Q&A

3. BACKGROUND Current prescription and administration sheet- document since 1960’s Card use for recording Prescribing and administration record Ordering of medication need to be done separately Actual administration time is not captured Alarming rate of transcribing errors

4. PROBLEMS WITH OLD CARDEX Transcribing – leads to error

5. PROBLEMS WITH OLD CARDEX Drs need to rewrite prescription every 2-3 days For some medications, unsure of route if not written (eg azithromycin 500mg od)

6. THREE DIFFERENT TYPES Parenteral prescription and administration chart For non-oral, non topical route of administration

7. THREE DIFFERENT TYPES Non-Parenteral prescription and administration chart For oral and topical medication

8. THREE DIFFERENT TYPES Medication with Frequent dose changes Prescription and Administration chart For parenteral and non parenteral medication with frequent dose changes, i.e. ivi insulin, heparin, inotropes

9. LIST OF MEDICATIONS WITH FREQUENT DOSE CHANGES IVI Inotropes (Dopamine, Dobutamine, Nordrenaline) IVI Midazolam IVI Morphine IVI Insulin (Actrapid, Insulatard) IVI Heparin Fixed dose parenteral & non-parenteral medications with frequency>6 times/day (eg: Artificial tears 1 drop q2H) NebA:V:N

10. LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART Consist of 2 pages where the second is the carbonized to the first Page 1(original copy)-ward use Page 2 (carbonized copy)- pharmacy use Heading and Allergies history (page 1 and 2 )

11. LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART Prescription Page 1 &2

12. LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART Administration record Page 1

13. LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART Administration record for medication with frequent dose changes

14. LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART Page 1 Signature index and Patient’s detail

15. LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART Carbonized copy of prescription and pharmacy supply record Page 2 Prescriber official stamp and patient’s information sticker can’t be carbonized

16. LAYOUT OF THE PRESCRIPTION AND ADMINISTRATION CHART

17. HOW TO PRESCRIBE First thing: Check patient’s name and detail Check for allergies history

18. HOW TO PRESCRIBE 27/10 Pantoprazole 40mg bd IVB 24/10 0800 2000 Dr lee lin lin MPM6565 To off the medication, remember to fill in the signature index

19. HOW TO PRESCRIBE Remember to put your stamp on the carbonized copy and check the patient's detail is available on it too.

20. HOW TO PRECRIBE For medication with frequent dose changes, the range of dose need to be stated 8mg in 50mL D5 at rate of 10-20mL/hr

21. HOW TO RECORD ADMINISTRATION First thing: Check patient’s name and detail Check for allergies history

22. HOW TO RECORD ADMINISTRATION 24/10 1 Bc 2 1000 3 Bee Chong 4 Bc 5

23. HOW TO RECORD ADMINISTRATION IVI with dose changes (i.e. inotropes, insulin, heparin) Documentation done on every nursing shift as well as whenever dose changes Noradrenaline IVI 8mg in 50ml D5 at 5- 10ml/hr IVI 24/10 1 0800 2 6mL/h r 3 ffp 4 24/10 5 1200 6 10mL/hr 7

24. HOW TO ORDER MEDICATION Check all information needed is available and correctly written: Name, dose and instruction (frequency), route of administration, start date Prescriber’s signature and official stamp/ clearly written name and MPM number Patient’s detail Separate each prescription from the carbonized copy Send the prescription to pharmacy

25. HOW TO ORDER MEDICATION

26. Re-ordering of medication Prescription will be return to ward with the medication supplied and supply information 24/10 pantoprazole 40mg bd 24/10 Dr lee lin lin MPM6565 IVB 1 6 2 TCH 3 26/10 4

27. HOW TO ORDER MEDICATION Re-ordering of medication Keep the prescription in patient’s folder Check for re-ordering date every morning Send prescription to pharmacy on the re-ordering date, Please ensure the patient is still on the medication Each prescription is valid for 7 days from the first supply pantoprazole 40mg bd 24/10 IVB 24/10 6 TCH 26/10 Dr lee lin lin MPM6565 pantoprazole 40mg bd IVI 24/10

28. Re-ordering of medication Transcribe to new prescription and administration chart after 7 days HOW TO ORDER MEDICATION

29. HOW TO SUPPLY MEDICATION New prescription Enter RN to MMUS dispensing desktop Check PMR for previous supply Proceed to issue out stock from MMUS and labeling On the prescription, enter Date of supply Quantity supplied Initial Next supply date*

30. HOW TO SUPPLY MEDICATION 24/10 pantoprazole 40mg bd 24/10 Dr lee lin lin MPM6565 IVB 1 6 2 TCH 3 26/10 4

31. HOW TO SUPPLY MEDICATION To count the next supply date scenario 1 On 3/1/12 morning, New prescription received for IV B pantoprazole 40mg bd, no previous supply. 6 vials supplied and the next supply date Last dose of supplied will be used on 5/1/12 night. Therefore, next supply date will be on 5/1/12 Scenario 2 On 5/1/12, receive repeat order for prescription from scenario 1 3 vials supplied. Last dose on 7/1/12 morning. Therefore next supply date will be on 7/1/12 In conclusion, ward are allow to order when they have 1 more dose with them (applies for antibiotic and oral medication)

32. HOW TO SUPPLY MEDICATION To enter pharmacy notes, please include your initial and date. For medication with frequent dose changes where dose and instruction is written ranges (supply the maximum?) For incomplete prescription, reject the prescription by entering reason on the pharmacy notes column If prescription received with amendment done on the carbonized prescription, reject the prescription

33. SO, WHAT’S NEW? NO more Rx except for DRIPS & DISCHARGE Reject all Rx except DRIPS & DISCHARGE 1 patient – many sheets all stapled together Key-in: extra step, write next date of supply Key-in: 4 + 3 (no more plus one!) Packing – remove staple and pack as usual Checking & dispensing – AS USUAL

34. ISSUES Cannot detect stopped medications Harder to detect interactions (eg ranitidine & omeprazole) Carbon copy ‘hilang!’ Ivi written in iv sheet

35. DO(S) AND DON’T(S) Check to ensure Ada patient sticker Information is complete (dos, frequency etc.) Ada Dr’s stamp The dilution/ concentration required and the range of doses prescribed is specified for the frequent dose change prescription (example: IVI Noradrenaline 8mg in 50cc D5%, at 4-10mL per hour)

36. DO(S) AND DON’T(S) Avoid Amending the prescription without the carbonized copy (except for the stop date and initial) Prescribing using abbreviation Sending the Rx if patient is no longer on the medication (SN)

37. THANK YOU!