Prescribing In The Nhs

Prescribing In The Nhs

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  Grzegorz Chodkowski (MD)Riga, Radisson SAS 2009 BNF, Pharmacology and Prescribing in the NHS
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  Know the medicine wellenough to administer safely  Check and be certain of patient identity Know the care plan Administer in the context of patient condition Check for allergy and the expiry date before administering Know the following so you correct and understand prescription instructions:  Key Points
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  Medication prescribing is: Appropriate Safe Legible Accurate Clear Indelible   The patient must be identifiable patient's name address date of birth hospital number age if under 12 (legal requirement) weight if under 12 (legal requirement) Prescribing Core Knowledge (for all clinical staff)
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  The Allergy boxmust not be left empty Use approved names (rINN) in black ink and BLOCK CAPITALS Metric doses Write micrograms and units in full Indicate the route and times of administration Administration times should be agreed with the nursing team and the 24-hour clock used. Specify precise times if important. Do not alter existing prescriptions. Rewrite if a change is made. Only one chart should be active Discontinue a treatment by crossing through it and cancelling subsequent recording panels. Add your initials and the date. Antibiotics must be prescribed for a stated time period. Place X in administration box to indicate drug not to be given at specific time & day If a drug is to be administered by a pre-prepared protocol or patient specific direction this must be explicitly referred to on the chart Prescription Chart Standards
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  Safe prescribing dependsupon you putting yourself in the mind of everyone who might read and act on your script, patient, nurse, pharmacist and fellow prescriber.          Dangerous errors tend to be: Wrong medication in context Wrong dose (too much) Mistakes, are more likely when tired or distracted or interrupted. Every-one makes mistakes and every one will make the occassional bad mistake Team work and taking responsibility for checking others and then acting appropriately is the most effective way of reducing patient harm. All should accept the correction of potential mistakes in good grace  Many safety issues are due to culture and can be corrected by system change Insulin is the most common cause of administration error Anticoagulants are the most common cause of life threatening prescribing error. All clinical staff should know the risks with prescribing so they can be detected.   Medicines Safety
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  Methotrexate given dailyinstead of weekly Writing ug for microgram which might be read as mg and patient given 1000 times too much.  Allergy box on drug chart left empty Three fatal episodes where a prescriber prescribes a penicillin to someone documented to be allergic penicillin and the penicillin is given despite the allergy being stated on the wrist band(s) and drug chart  A study comparing administration error in UK, Germany & France found Product not labelled/incorrectly labelled in 43%, 99% and 20% of doses  respectively Wrong diluent used in 1%, 49% and 18% Wrong administration selected for 49%, 21% and 5% of doses observed At least one deviation from aseptic technique was observed among 100%, 58% and 19% In the UK, no cleaning of preparation area or hand washing was observed for any of the prepared doses Only 1% of cases swabbing the vial top In the UK, the most frequent medication errors were related to an incorrect administration rate (48%).    Examples:
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  Thank You! AnyQuestions?