مستشفيات القوات المسلحة بمنطقة الطائف AL HADA ARMED FORCES HOSPITALS - TAIF REGION EMERGENCY DEPARTMENT PATIENT EXPERIENCE

[Audio] Good day and welcome, to our presentation today were we will be discussing Medication Management and Use. This presentation will provide an overview of different topics in regards to Medication management and usage.

[Audio] The purpose of medication use and management In reference to the policy is to orient the qualified nurse on medication administration. To decrease medication errors. To assure right administration of medication and to establish guidelines to promote the health and safety of patient.s It also informs us that the Medication Administration Record needs to be compared with the Physicans Orders and Kardex at least one time within each shift. Antidotes for all medication like Heparin, Warfarin and Morphine must be known and readily available when medication is administered in and event that a reaction does occur..

[Audio] Lets take a closer look at our nursing guidelines Nursing guidelines tell us Who can Administer Medication, do staff member needs be registered with Saudi Council or not , it provides us with details regarding the use of a Medication Room, Auto Switch Policy, Adverse Drug Reaction, Micromedix , Share point and Basic Concepts of Drug Administration..

[Audio] In reference to the policy regarding Medication administration we are guided and informed that Medication should be administered only upon Physicians Orders. A Registered Nurse who has passed their prometric examination and is Registered with the Saudi Council can administer all medication. It also informs us that the Medication Administration Record needs to be compared with the Physicians Orders at least once within each shift. Antidotes for all medication like Heparin, Warfarin and Morphine must be known and readily available when medication is administered in and event that a reaction does occur..

[Audio] The policy advises us that when medication is been administered, the registered nurse must ensure that The patient is correctly identified using two identifiers which is 1 Asking the patient for his or her full name and surname. 2 Checking against the patient identification band. Independent double checking and double checking must be done when all medication is administered. All Medication ordered by the physician must be clearly transcribed in the medication administration record. No medication should be left by the patients bedside. If the patient is unable to take the medication at that specific time, it must be returned to the medication room and the reason for not administering the medication must be documented in the medication administration record and nurses notes..

[Audio] All medication ordered by the physician must have the correct date, time and route that it is be administered. The patient should be monitored for any adverse drug reactions and if there any adverse drug reactions does occur, the corrects steps need to be followed as laid in the policy which is, the medication is stopped immediately and attending physician, charge nurse and pharmacy is informed immediately. Proper documentation must be done in the patients records to prevent any litigation..

[Audio] Chemotherapy medication which is regarded as a hazardous medication should be prepared in a work area that is devoted solely to preparing hazardous drugs and be limited to authorized staff only. P-R-N medication – PRO RE nata TO BE GIVEN AS needed, should be administered as ordered by the doctor or attending physician. When the patient is transferred back to the ward from surgery or I-C-U--, all medication must be reviewed by the physician. A BLANKET ORDERS which means: A Doctor will advise the primary nurse or ward to maintain, resume or continue usual medication or treatment without revising it, which is an unacceptable practice and these instruction should not be followed. The correct dosage of all medication should be specified when all medication is been prescribed by the physician on the medication administration record except for sliding scale which is a standing order which needs to be adhered to at all times. No medication should be borrowed from another patient as this can lead to medication errors..

[Audio] Self medication is medication that is taken on their own by the patient and should not be allowed, All self medication must be taken away from patient or returned back to the family..

[Audio] All floor stock must have maximum and minimum levels. There should be a floor stock list available at all times. Over stocking is not allowed and all expired stock or medication should be returned back to pharmacy. All medication must be correctly labelled and stored in the correct place for example H-A-M which is H-I-G-H alert medication should have a red label on it and locked and stored in a separate cabinet. lasa which is look-ALIKE and sound – alike medication should be labelled with a green sticker and stored diagonally on separate shelf..

[Audio] All Floor stock that is opened must be labelled with a orange and white strip beyond use date label that must have a open date and discard date and it must be noted on the label if it is kept in room or refrigerator temperature. Multi dose vials like insulin which is labelled with a red high alert stick must be kept in the fridge and can be used up to 28 days before discarding unless expired then a new vail must be reordered. Creams and Ointments can be used up to 3 months and Syrups can be used up to 6 months before discarding unless the patient has been discharged or there no other patient prescribed on that specific medication..

[Audio] In medication management and usage we have acceptable temperatures that needs to be maintained at all times. The room temperature must be maintained between 18 – 25 degrees Celsius. The humidity must always be less than 60 %. The Refrigerator must be maintained between 2 – 8 degrees Celsius. If there is any abnormal reading or the incorrect reading it must be reported and a work order must be placed with H-V-A-C..

[Audio] In The Medication Mangement And Use Guidelines We Will Explain In The Next Slide About How To Access Micromex, Drug Formalary And Non Formarlary On The Share Point And We Will Discuss About Automatic Stop Medication..

[Audio] In this slide we will now discuss how to access micromedex AND DRUG ForMALARY on share point. Access is done only through google chrome. Go to the pharmacy icon on SharePoint as indicated on the slide with a red circle. Once the link is opened, on the right hand side of the page / screen you will find both Micromedex and drug formulary system. Please note that Drug formulary which is a list of all medication developed by the hospital pharmacy is updated annually/ yearly..

[Audio] In the Auto – Switch Policy it is the replacement of a prescribed medication with another one that differs in the active constituents but is thought to be therapeutically equivalent to the one in the same drug class example Metformin 750 milligrams one tablet daily will be changed or auto switched to Metformin 500 milligrams one tablet twice a day..

[Audio] Closed Loop Medication Management is a revolutionary process that integrates and identity's and eliminates the root cause of a problem like medication error and prevents it from reoccurring. It starts with Making a Informed Care decision and ends with Monitoring the patient and documenting appropriately.

[Audio] With regard to basic concept of Drug Administration, Enteral drugs that is drugs that are administered orally , rectally or through a nasogastric tube should be prepared by the registered nurse and checked against the Medication Administration Record that it is correct prior to be administered.. All medication when mixed should be observed to assure that the medication is stable and there is no signs of precipitation , discoloration and or particles matter prior to patient administration. Enteral Nutritional Products must be stored in the Dietary department. It must be correctly identified and labelled controlled and distributed to the prescribed patient only like T-P-N--. Ensure hat expire date is checked on all medication before administration. Parenteral drugs such Intradermal, Subcutaneous, Intramuscular and Intravenous medication must be prepared prior to administration according to unit dose protocol. All Injections should be administered at different injections sites. There are different techniques in giving injections Intramuscular must be given at a 90 degree angle, Subcutaneous at 45 degrees and intradermal at 15 degrees. Topical and Oral Medication must be administered according to physicians orders and pharmacy protocol and expiry date must be checked prior to administration..

[Audio] medication mangement pathway , We will be discussing in the slides to follow about General Principles of IV Medication Administration, Multi dose and Repackaging, Steps in Medication Management, Medication Error and the Process of Reporting, Near Miss and Sentinel Event..

[Audio] Intravenous medication must be prepared using aseptic technique. Compatibility issues, expiration date and labelling when preparing intravenous medication must be ensured at all times. It is a needleless system..

[Audio] Guidelines for use of single use and Multi dose vails are in place to notify or alert the nurse of the date after which a sterile product is opened or when the ample has been needle – punctured that it should be used within a specific time frame..

[Audio] In beyond –use date, Medication like Folic Acid 5 milligrams/ml in vail form and Lidocaine 1% and Lidocaine 2 % vails as well as insulin, including the insulin pens to discharged after twenty eight days after been opened..

[Audio] What is a near miss, A Near Miss is a error or event that did not produce harm to the patient because is was prevented prior to it reaching the patient and it must not be ignored. It must be reported immediately..

[Audio] A sentinel event is a patient safety event that is not primarily related to the natural course of the patient's illness or underlying condition, that reaches a patient and results in, Death, Permanent Harm, Severe temporary harm that can be critical, potentially life – threatening harm that lasts for a limiting time with no permeant residual but requires transfer to a higher level of care. Suicide of any patient receiving care or within 72 hours of discharge. Air Embolism, Unanticipated death of a full – term infant..

[Audio] All medication errors should be reported in order to identify the gaps and to ensure that those gaps are breached so that future errors can be prevented,.

[Audio] There are 4 main Medication Errors that we will be discussing and explaining in the slides to follow which are, Prescribing Errors, Transcribing Errors, Preparation and Dispensing Errors and Administration Errors..

[Audio] What can be the cause of Prescribing Errors. Prescribing Errors are errors that are caused by, Inappropriate medication selection, Inappropriate dose ordered by the physician, Illegible order or hand writing, Duplicate order, Orders that does not have a date and time, Prescribing in the wrong patient chart or file, Use of prohibited abbreviations like no zero before decimal dose (.5mcg) can be misread 5 mcg instead of 0.5 mcg, Contraindications of a medication, Wrong Frequency, route or duration and receiving Verbal or Telephonic Orders which is not allowed..

[Audio] Transcribing errors can occur when orders are transcribed incorrectly in the patient Medication Administration Record using manual or electronic entries.

[Audio] Similar bottles can result in incorrect dose or strength selection of oral medication when there is preparation of a order.

[Audio] Preparation or dispensing error can be a result of: Wrong Patient, Wrong Medication, Wrong Quantity, Wrong Dose, Wrong Diluent, Wrong Formulation, Inaccurate Labelling, Expired Medication or delay in medication delivery..

[Audio] An administration error is when medication is given incorrectly to a patient. The main cause of Administration Error occurs when the patient is Incorrect identification. No independent double checking and no double checking prior to administering medication has taken place. Ensuring that the primary nurse checks that there is no Incorrect rate, Incorrect route, Incorrect times , incorrect strength of medication prior to medication administration..

[Audio] If a medication error does occur, The Primary Nurse must report it immediately, Report to the Head of Department, the Supervisor, the attending Physician and the head of pharmacy. Make an Incident report using the Sharik on share point, Document in the patient file. C-Q-I will receive the incident report and will do the necessary actions. C-Q-I and Patient Safety department will receive feedback from pharmacy. All Medication Errors Reported must be handled and maintained in a Confidential Manner..

[Audio] In the Guidelines to preventing Medication Errors, the Physicians when prescribing should write complete and clear orders. Unapproved abbreviations should not be used as it may have double or different meanings. It should be written out in full SC should be written in full Subcutaneous, OD should be written in full – Once Daily. Minimize telephonic orders or verbale orders unless in emergency situation or doing a sterile procedure and unable to write the order down. All drug allergies must be written in red and in bold and clear letters for all staff to see..

[Audio] Standard Medication Review gives us a breakdown about, Appropriateness review and the 10 rights of medication administration, Role of a nurse in Standard medication times, List of prohibited Abbreviations and the Medication Administration Record and Documentation..

[Audio] Appropriateness review, is the review of appropriateness of all drugs, the dose, frequency and route of administration, therapeutic duplication, real or potential allergies or sensitivities, patients wight height and physiological information as well as real or potential interaction between medication or food,.

[Audio] When administering medication ensure that the ten medication rights are followed, the ten rights are 1) Right Patient, 2) Right Clinician, 3) Right Reason, 4) Right Medication, 5) Right Dose, 6) Right Route 7) Right Frequency, 8) Right Time, 9) Right Documentation, 10) Right Response.

[Audio] Standard Medication times must be available for all nurses to see as a guideline to used when need to determine staggering times for medication For example If patient has been admitted at 0645 hours and medication is prescribed by the attending physician to be administered T-I-D--, the closer time to 0645 hours according to the medication staggering time guideline is 0700 hours. The next dose will be administered eight hours which will be 1400 hours and the last dose will be administered at 2200 hours. The medication the next day with be administered at the correct time which will be 0600 hours, 1400 hours, 2200 hours..

[Audio] The correct instruction for all medication to be administered at the correct times as ordered by the physician, if at bedtime at night only is should be given at 2200 hours, Twice Daily or B-I-D--, Every 12hours it should be administered at 0900 hours and 2100 hours, Three times Daily, T-I-D--, Every 8 hours , 8hrly it should be administered at 0600 hours, 1400 hours, 2200 hours..

[Audio] There is a prohibited list of abbreviation which can be found under the pharmacy link in the shared folder for example BT Bed Time AD, AS, AU Right Ear , Left Ear, Each Ear and so on, which must not be used as this can cause medication errors..

[Audio] Patient Medication Record must be used for each patient when medication is been prescribed by the attending physician. The patient full details must be filled in and the age, weight height must be included as this information is important for medication computation in pharmacy. Each page is to be filled in with all the patient details and all blank spaces must be filled in at all times. All allergies if any must be filled in clearly and in RED PEN. The first page is for Once Only medication which is initial bolus medication that is to be given thus considering the need to prevent double dosing as time period for a regular dose may overlap. Stat dose is a once off dosage of medication that that needs to be given immediately or right now within the time frame of 30-60 minutes. Under regular medication, please ensure that the doctor complete each medication column, with correct name, date, time, route, frequency and if there any special instructions. If medication is discontinued the doctor should write discontinued and stamp, sign and date that the medication is discontinued..

[Audio] Standard Patient Care comprises of the list of Patient's Own Medication, Medication Reconciliation, Antibiotics Stewardship, Antimicrobial Prophylaxis And the Crash Cart. The next slides provides an overview of each component of the standard patient care..

[Audio] The patients own medication – this refers to Information about Patient own medication that can be found in Policy MPP-MMU-NO011 Which explains that It is medication brought to hospital by the patient upon admission..

[Audio] What is the process to follow if a patient who is admitted to the ward brings his or her own medication from home? 1. Upon admission the primary nurse will fill in the patient own medication form and denoted how the medication was received from the patient. 2. Medication available in the Hospital Drug Formulary must be supplied by pharmacy department . 3. Medication that not in the hospital drug formulary must be stored in pharmacy, labelled with patient's ID on the box and entered in the Pharmacy Computer system under non-formulary drug and issued daily as required..

[Audio] Medication reconciliation as per the policy MPP-MMU Number 10, it is the process whereby the physician compares the patient's medication orders against all the patients medication that they were taking, This is done to avoid medication errors such as omissions of medication, duplication, dose error or even drug interactions..

[Audio] Medication reconciliation as per the policy MPP-MMU Number 10, it is the process whereby the physician must document the complete list of patients current medication, that the patient is currently on admission and discharge and indicate if the patient should continue, discontinue or if the medication should be changed. Physician must use the medication reconciliation form when new medication is been prescribed..

[Audio] Program that promotes the appropriate use of antimicrobials, reduces microbial resistance, and decreases the spread of infections caused by the multidrug-resistant organisms.

[Audio] In this slide we note the antimicrobial restricted list of antibiotics and antifungal medication that can be only be ordered by physician who have that privilege namely the infectious disease doctors..

[Audio] Antibiotic prophylaxis guides us on the time frame of when the prophylaxis must be given and which prophylaxis must be ordered according to which surgery will be performed..

[Audio] We are guided by policy number MPP COP Number 022 regarding Code Ble Protocols and MPP MMU Number 024 when dealing with expired medication and what we as nurses needs when we do have expired medication on our crash cart. An important point to take into consideration is that life –saving drugs that are expired, and cannot be replaced should remain on the crash cart until new stock is available and can be kept up to one year on the crash cart..

[Audio] An important question to be asked, when can the crash cart be opened, an the answer is during a code ble, when there is expired medication or items that needs to be replaced and when the pahrmasist comes to do their monthly checks..

[Audio] In the slides to follow we now going to discuss about high alert medication, hazardous medication, look – alike and sound alike medication, medication recall and what is required from a registered nurse when dealing with types of medication. We will also be briefly explaining about medication calculations..