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?