Monthly Archives: May 2017

Pharamcy Intervention Report

Pharmacy Interventions Reports

To Contact physicians by telephone, direct meeting or through a written report if clarification or correction is needed for any medication orders orders/Prescriptions.

Documentation of all corrections / Physician action should be followed by the pharmacist using the pharmacy intervention form

Pharamcy Intervention Report

Pharamcy Intervention Report

Hospital Doctor White coat..

Dress code

Dress code is a term used to describe an acceptable standard of dress.

Uniforms: Are clothes of a specific color and design that shall be wearied by Pharmacy employees during their duties and to be provided to employees by their hospital

Dress code is important to:

  1. Ensure the consistency in the professional appearance of the Pharmacy staff while on duty.
  2. Ensure personnel are easily identified as the hospital Pharmacy Staff member.
  3. Ensure compliance with infection control guidelines / standards.

Employees must:

  • Adhere to the dress code while on duty.
  • Wear their identification tag while on duty.
  • Wear uniform (clerk staff should wear a Beige color coat, licensed pharmacist and technician should wear white color lab coat).

Supervisor shall ensure that personnel under him/her supervision adhere to the standards.

Unit Dose System

The unit dose system of medication distribution is a pharmacy-coordinated method of dispensing and controlling medications in organized health-care settings.

It is a system of drug distribution in which a portable cart (medication trolley) containing a drawer for each patient’s medications is prepared by the hospital pharmacy with a 24-hour supply of the medications.

It is safer for the patient, more efficient and economical for the organization, and a more effective method of utilizing professional resources.

How to order a medication for a patient?

The requested medications will be prescribed in the patient Medication Administration Record (MAR) with clear handwriting. With full medication information including: patient name, drug name, strength, dosage in metric units, route of administration, frequency, start and stop date, and time of administration.   

All orders for Medications are transcribed & entered electronically on an automated unit dose order with full patient’s information and the name of the nursing unit. A print out of the order will be generated then checked, signed and stamped by an Authorized Licensed physician.

Electronic Medication orders should include: date and time ordered, Diagnosis, Allergy history, drug name, and doses in metric units, route of administration, frequency, start and stop date, and time of administration.                                                              

-Unit dose Medication orders will be received in the pharmacy for verification  ,checking and reviewing medications before dispensing and must confirm that: the prescribed

medications shall be matched with the diagnosis ,the  dosage is appropriate, No allergy history, No drug or food interaction and no incompatibilities.

Medication Reconciliation form must sent to the Pharmacy upon patient admission, in order to review the pre medication list for the patient and compare it with the admission medication.

-When a patient is transferred to/from a different level of care (e.g. MICU, SICU) all medications should be Hold in MAR and the computer system. Then medication shall be Revived in the MAR and the computer by an Authorized Licensed Physician or his designee.

All Medications that are ordered for admitted patients are subjected to automatic stop process to ensure that the potent drugs are reviewed in a timely fashion.

If the physician decides to continue the medication after the stop date, he /she should initiate a Re-order that is authorized by his signature and stamp.

Types of orders:

STAT Order

An order, for an urgently required medication, which is filled immediately within 20 minutes from the time of ordering  (e.g. Aspirin 300mg tablet STAT means: one dose immediately)

New Order:

An order contains new medication prescribed to the patient in a regular frequent manner. (e.g. Aspirin 300mg tablet PO TID for (7days)

Re-Order:

An order allowing the continuation of the same medication for the same patient after reaching the discontinue date.

Discontinue Order:

A notification order to stop the medication.

Telephone Orders:

Order given by telephone when the doctor is unable to be present in the nursing unit to write then enter the formal order, this includes reporting of critical test results.

Verbal Orders :

 

Order given verbally when the doctor is unable to write the actual order in the patient’s file.

  • The Use of Telephone/Verbal orders should be extremely rare. And only during extreme emergency when immediate action is required and the   Doctor is unable to write the actual order.
  • Telephone orders are not permitted for:
  • Narcotic/controlled medications & High Alert Medication (Except in ICU)
  • The prescribing physician must sign the unit dose computerized order Within 24 hours.

PRN Order

The order of PRN must have the followings:

  • Indicate a frequency and the dose range
  • Include the reason for the PRN medication.

PRN Doses Dispensed by Unit Dose Section:

Sufficient doses will be dispensed to cover the patient until the next scheduled refill. In case where the order written by the physician is not a fixed schedule, the following policy will be adhered to:

  1. If ordered on the fixed scheduled and PRN, two extra doses are to be dispensed unless it is exceeding the maximum dose.
  2. If ordered on an hourly schedule (i.e. 4-6 hours), base your supply on the maximum doses possible as if it had been written every 4 hours.

Antibiotics Orders

Automatic Stop Orders (ASO) shall be enforced for all antibiotics unless the exact numbers of doses have been clearly specified by the treating physician.

Criteria:

Antibiotic injection/Tablets

  • Prophylactic Antibiotic       24 hours “or one dose only”
  • Empiric Antibiotic                 72 hours
  • Therapeutic Antibiotic        7 days

All Antibiotics orders should be written in the Antibiotic order form, which is part of the MAR.

 Restricted antibiotics   Dispensing of restricted antibiotics have to be approved by the microbiology consultant.

 

 

 

Pharmacy Security Measures

PHARMACY SECURITY MEASURES

To insure that pharmacy is operating under strict security measures

  • Limited access to Outpatient/Inpatient Pharmacies and security measures are in place.
  • Identification of whom OPD Pharmacy Staff has keys to OPD Pharmacy.
  • Narcotic and Controlled room’s key is restricted to Narcotic and Controlled in-charge.
  • Not more than two (2) keys shall be available in outpatient Pharmacy.
  • The outpatient Pharmacist Supervisor and the Senior Pharmacy Clerk are the only Pharmacy Staff shall have the key.
  • The outpatient Pharmacy shall be opened by the Pharmacist Supervisor or his designee.
  • The outpatient Pharmacy shall be closed by the Pharmacy Senior Clerk or his designee.
  • In case of emergency may happened in outpatient pharmacy out of duty hours, a copy of outpatient pharmacy keys will be available in inpatient pharmacy, safety staff, security man and pharmacist on duty (if possible) will be able to take the key and open the pharmacy to do the necessary action and they should return back the keys directly after solving the problem. A form of (receiving the keys during emergency) will be filled by concern people.
  • Inpatient pharmacies are opened 24 hours and the access shall be limited only to authorized personnel.
  • All medications that transferred from pharmacy to (unit/ward) or vice versa, should be only through looked medication trolleys or/and closed medication boxes.
  • For narcotic and controlled room one Key is available with the narcotic & controlled In-charge and another backup kept with pharmacy supervisor
  • Narcotic & Controlled medications are stored in secured steel lockers inside a room with duple door as per Gov. Regulations.
  • All wards/units that have medications floor stock should be kept in locked cabinet Inside secured medication room, Narcotic and Controlled medications should kept in a Duple door cabinet, crash cart must kept locked.
  • Paramedical items, cosmetics) is done annually and whenever it is Necessary.

1 Pharmacy Department Scope of Services

SCOPE OF SERVICE

Management will support the Pharmacy through the appropriate channel to utilize their professional judgment and extend their responsibilities, to include participation in programs dealing with the safe handling of medication throughout the hospital, whilst working with other members of the health care team and Participate in medication use review and patient care audits. Also provide safe and effective use of medicines in the hospital. And ensure their legitimate role in each step of medication therapy in the hospital, which includes the promotion of rational therapeutics and improvement of patient care. The pharmacy department is to implement clinical intervention program and redefine the role of Pharmacists in minimizing preventable adverse drug events and applying cost-effectiveness drug therapy. This program deals with Medication interactions, Poor patient compliance and Patient counseling.

PROCEDURES & RESPONSIBILITIES

Licensed Pharmacists, Pharmacy Technicians and Pharmacy Supportive Staff

Pharmacy Director, Pharmacy Supervisor

  1. The pharmaceutical services Staffed by a sufficient number of competent personnel (Licensed Pharmacists, Pharmacy Technicians and Pharmacy Supportive Staff) that met with the size and scope of the services of the hospital
  2. Professional Pharmaceutical Services, which include Unit Dose Dispensing Section, Outpatient Service Section, Intravenous Admixture, Electrolytes and TPN Services Section and Narcotics and Controlled Drug Dispensing Section.
  3. Hospital Pharmacy Services, which include Education & Training of Pharmacy Staff Pharmacy Intervention, Patient and Family Education, Pharmacy and Hospital Committees (Pharmacy & Therapeutic committee, DUR, Infection control, CPR, Pain Management, Medical Record, Hospital Executive Committee (Leadership Council), Hospital Utilization Committee, AMPS Committee and FMS Committee).
  4. Support Services, which include Repacking Section, Inventory Control System, Drug Requisition System, Nursing Units Inspection, Extemporaneous Formulation Section, and Floor Stock Distribution System.
  5. Space, equipment, technology and supplies must be provided to allow the required professional and administrative functions of the pharmaceutical services to promote patient safety through Correct Storage, Correct Preparation, Correct Dispensing and Correct Administration of Medication.
  6. The scope of the pharmaceutical service must be consistent with the medication requirements of the patients, served as determined by the medical staff and the Pharmacy and Therapeutics Committee
  7. Written policies and procedures that cover and develop a list of Formulary System through Pharmacy Board and Pharmacy and Therapeutic Committee, together with the medical staff, and representative of other discipline as appropriate.
  8. Written policies and procedures governing the safe administration of medication and biological must be developed by the Pharmacy staff in cooperation with the medical and nursing services, and as necessary, representatives of the disciplines.

Obstetric Anesthesia Care

Obstetric Anesthesia care

A significant number of women require advice and care from anaesthetists before, during or after childbirth. The requirement is often urgent and may occur at any time.

Obstetric Anaesthesia is providing safe skilled analgesia and anesthesia for pregnant patients. This includes:

  1. Epidural analgesia for labour.
  2. Anaesthesia for operative procedures

Obstetric Unit provides 24-hour service for the analgesic, anaesthetic and resuscitation requirements of women admitted to the hospitals with conditions associated with childbirth. Whenever available a named consultant should have responsibility for the organization and management of the service. Specialist has to be assessed as competent by a consultant anaesthetist with responsibility for obstetric anaesthetic services before undertaking obstetric anaesthesia care.

Mothers may require specialist consultation, assessment and advice. Anaesthetists are responsible for analgesia, anaesthesia, resuscitation and intensive care. An on call anaesthetist, is available for the provision of anaesthesia for an instrumental oroperative procedure.

  1. Where an epidural analgesic service is provided an anaesthetist of adequate experience should be immediately available to the obstetric service throughout the 24 hours.
  2. And in case of high risk cases will inform the anaesthesia consultant on call.

The on call anaesthesia consultant will cover the obstetric unit when the on call specialist is busy. Pre and post procedure visiting of patients for assessment and explanation, early detection of complications. Written notes and records of all visits and clinical procedures undertaken should be documented.

Support Services

  • Hematology (including coagulation studies) and biochemistry services must be available to provide rapid analysis of blood and other body fluids and to make available blood and blood products for transfusion without delay and in sufficient quantities. A supply of uncross matched 0 Rh. negative blood or screened and group-confirmed blood must always be available for emergency use. Rapid efficient communication channels must exist to avoid delay in the event of massive hemorrhage.
  • There must be provision for rapid availability of consultation with other specialists experienced in non-obstetric aspects of pregnancy such as cardiac disease and diabetes.
  • Imaging services are available if needed.

Premises

  1. A dedicated operating theatre must be available at all times for obstetric anaesthesia.
  2. An appropriately equipped post anaesthetic Recovery room of adequate size and staffing for the work of the unit must be available within or close to the labour ward.
  3. Emergency resuscitation equipment and a cardiac arrest procedure must exist for obstetric patients and be known to all staff.

Intensive Care

Maternity unit must have access to an appropriately staffed ICU for transfer of patients, either pre- or post- delivery as required. That whilst in the ICU, patients will continue to receive obstetric care from the obstetric team involved.

Training and Education

  1. Whenever available consultant anaesthetist should be nominated in charge of training in obstetric anaesthesia and analgesia.
  2. Guidelines for the management of obstetric and anaesthetic complications such as failed intubation, major hemorrhage, inhalation of gastric contents, anaphylaxis and post spinal Epidural puncture headache must be established and rehearsed.
  3. There must be clear written guidelines for the emergency resuscitation of pregnant women, oral intake during labour and management of such conditions as pre-eclampsia and diabetes.

Patient Information

  1. Women must have the opportunity to make informed choices about pregnancy, delivery, analgesia and anaesthetic interventions. Access to an anaesthetist in the antenatal and postnatal period is available.
  2. Whenever an anaesthetic or analgesic intervention is to be undertaken, the woman must be given appropriate relevant information in terms that she can understand. Any questions must be answered and consent obtained for any intervention.

Pediatric Anesthesia Care

NEONATE: 0 -30 DAYS

INFANTS: 1 MONTH-12 MONTHS

CHILD: 12 MONTHS — 14yrs

Anesthesia for children requires specially trained staff and special facilities. Provision should be made for parents to be involved in the care of their children. The service will be led at all times by ANAESTHETIST who anaesthetizes children regularly. Adequate assistance for the anesthetist by staff with pediatric training and skills must be available. Pediatric anesthesia equipment must be available where children are treated.

 

Anesthesia for children demands specifically trained staff and special facilities. Neonates may require treatment in a specialist center. Where appropriate, provision should be made for parents to accompany their children at all times. Day case surgery is increasing and appropriate arrangements must be made to treat children separately from adults. Consent to treatment should, where possible, be obtained from both the child and the parent or guardian as per the hospital consent policy. Provision of anesthesia for children undergoing elective surgical and allied procedures. The service will include preoperative assessment and preparation of Patients, and care during and after anesthesia.

Provision of high dependency and intensive care services appropriate to the type of surgery and arrangements for the stabilization and transfer of children requiring more specialized intensive care. Provision of a service for the relief of acute pain. Provision of resuscitation services. Parents will be encouraged to be involved in the care of their children.

Who does what!

Anesthetist

  1. The patient should be seen in the pre-operative clinic by the anesthetist, in elective cases and the procedure eg; inhalation Induction, pain management recovery fasting guidelines discussed with the parents.
  2. Consent for regional blocks etc.; should be taken.
  3. Should be competent to manage pediatric cases, in case of complications should discuss the case with senior anesthetist and ask for help.
  4. Skilled in pediatric resuscitation.
  5. Responsible for postoperative pain management.

Anesthesia technician

  1. Responsible for preparing and assisting the anesthetist in doing the case.
  2. Checking the machine equipment etc, before the start of case and discussing with anesthetist any special requirements.

Nursing Staff

  1. Responsible for receiving the patient and nursing in a silent, comfortable atmosphere in theatre reception.
  2. Should discuss with the anesthetist regarding any concerns.
  3. Recovery nurses should be trained in managing pediatric cases.
  4. Skilled in pediatric resuscitation

REFERENCE

  • Royal College of Anaesthetists. Guidance on Day Case Anaesthesia. 1999.
  • Caring for Children in the Health Services. Just for the Day: Children admitted to hospital for Day treatment. London: NAWCH, 1991.
  • The Children Act. 1989.
  • Royal College of Anaesthetists. Guidance for Purchasers on Preanaesthetic Care. 1999.
  • Royal College of Anaesthetists. Guidance for Purchasers on Postoperative Care. 1999.
  • Royal College of Anaesthetists. Guidance for Purchasers on Intraoperative Care. 1999.
  • Royal College of Anaesthetists. Guidance on Pain Management Services. 1998.
  • Royal College of Anaesthetists. Guidance on Anaesthetic Practice in Respect of Resuscitation. 1999.
  • Department of Health. Welfare of Children and Young People in Hospital. London: HMSO, 1991.
  • Royal College of Surgeons of England and the British Association of Paediatric Surgeons.
  • A Report of the Working party on Surgical Services for the Newborn. London, 1992.
  • The British Association of Paediatric Surgeons. A Guide for Purchasers of Paediatric Surgical Services. Edinburgh. 1995.
  • CBAHI 3rd Edition Hospital Standards
  • JCIA 5th Edition Hospital Standards
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