Prescribing Getting It Right the First Time - PowerPoint PPT Presentation

1 / 60
About This Presentation
Title:

Prescribing Getting It Right the First Time

Description:

Prescribing Getting It Right the First Time – PowerPoint PPT presentation

Number of Views:152
Avg rating:3.0/5.0
Slides: 61
Provided by: IT86
Category:

less

Transcript and Presenter's Notes

Title: Prescribing Getting It Right the First Time


1
Prescribing (Getting It Right the First Time)
Yolinda Haarhoff Pharmacist Teacher
Practitioner Cambridge Graduate Course for
Medicine (e-mailYolinda.Haarhoff_at_wsh.nhs.uk)
2
Objectives
  • Importance of Teaching Prescribing
  • Why do errors occur?
  • Practical prescribing advice
  • Different drug charts
  • Examples of common errors

3
  • 25 July 2000
  • 113 dead
  • Entire world in shock

4
Deadly Toll of Medication Errors
  • Pilot study in 2 London hospitals
  • What is clear is that we need to know more about
    errors and do more about them
    - Sir George, BMJ March 2002

Adverse events in gt1 in 10 pts
1/3 of these are serious
In 8 of these cases, it lead to the patients
death
5
To Err Is Human
The Audit Commission A spoonful of sugar -
medicine management in NHS hospitals
  • Core cirricula at medical schools do not provide
    a thorough knowledge of safe medicine prescribing
    and administration
  • DoH goal for NHS to reduce medication errors by
    40

6
To Err Is Human Why Teach Prescribing?
  • Errors more likely when new Drs arrive in
    Hospital - Audit Commission a Spoonful of
    sugar
  • Continuing education in prescribing technique
    required for new doctors
    - Irish medical Journal

7
Medication Errors and Reducing Risk JHO
Prescribing OSCE
  • Average achievement 58
  • If 70 was required only 5 would pass
  • Difficulties
  • Drug allergies interactions
  • Writing a CD prescription
  • Unfamiliar with BNF

8
Human Aspects of Errors
  • Impedance of Performance
  • - Fatigue Sleep deprivation
  • - Hunger Long lapses between food/drink
  • - Concentration Lapses
  • - Stress Loss of control/cutting corners
  • - Other factors Alcohol, drugs illness

9
Spot the difference?
Look alike drugs contribute to medication errors
10
Spot the difference?
Look alike drugs contribute to medication errors
11
Spot the difference?
Look alike drugs contribute to medication errors
12
  • Administering the wrong drug could be fatal
  • NHS standard
  • Water
  • Sodium chloride
  • Lignocaine

13
Error Prevention
  • The Five Rs
  • Right Patient
  • Right Drug
  • Right Dose
  • Right Route
  • Right Time

14
Prescribing Protection
Your Best New Friend!
BNF
  • Reference source for prescribing
  • If uncertain, look it up - ALWAYS
  • Use in conjunction with trusts medication
    policy formulary

15
BNF What can it do for me?
  • Front section
  • Prescribing guidance, prescription writing CD
    prescribing
  • Prescribing in children, elderly palliative
    care
  • Emergency treatment of poisoning
  • Middle section
  • Approved Drug Name with indications, S/E,
    cautions dose
  • Back section
  • Appendixes interaction, pregnancy
  • Approved abbreviations (BNF Back page)

16
Formularies Essential Drugs
  • National formularies (e.g. the BNF) provide an
    independent source of advice
  • Hospital formularies reflect hospital choices
  • WHO provide a model list of essential drugs
    (300 items) some controversial!
  • Personal formularies can be useful

Most prescribing limited to 100 formulations
(vs. gt 60,000 total)
17
Legal Aspects Governing Prescribing
  • Medicine Act 1968
  • Poisons Act 1972
  • Misuse of Drugs Act 1971

Regulates ALL retail and wholesale dealings in
medicine
18
The Prescription
Should state - what is to be given to whom and
- by whom prescribed, and give instructions
on - how much should be taken how often, - by
what route and for how long or total quantity
supplied
19
Controlled Drugs Prescriptions
  • Handwritten requirements
  • NAME, FORM STRENGTH of drug and dose
    Morphine sulphate SR tablets 10mg 20mgbd
  • Methadone liquid 1mg/ml
    10ml od
  • TOTAL QUANTITY in WORDS and FIGURES
  • 50 (Fifty) tablets
  • 20 (twenty) ml
  • YOUR Signature and DATE (include bleep no.)
    BNF p7

20
Hospital Prescribing
  • Includes
  • Evaluation of patients current medication
  • Selecting medication for treatment - indication,
    formulary, licence agreements, efficacy
  • Stating considerations - antibiotics duration
    of treatment
  • - warfarin discharge dose next INR date
  • Discharge medication (or TTO) not just a
    rehash of the drug chart

21
Before Writing a Drug Chart
  • ALLERGIES
  • COMPLETE Drug History
  • what they are taking today and why
  • what has been stopped recently
  • what they are buying themselves
  • OTC, herbal, homeopathic and frequency
  • what are they unable to take and why
  • HRT oral contraceptives

22
Before Writing a Drug Chart
  • Sources of information
  • GP letter stating current medication
  • Patients own drugs
  • What have they got with them?
  • Can you positively identify each drug?
  • Is the dosage correct?
  • What state are they in can it be used?
  • Can their relatives/carer bring it in?

23
Prescription/Drug Charts
  • ALLERGIES
  • BLOCK CAPITALSApproved name in BNFNOT trade
    name abbreviations
  • Dose, frequency, route
  • Sign entry with bleep number

If in doubt check, never guess see BNF
24
Drug Name Abbreviations
  • NO!!! ALWAYS Avoid
  • ISMN prescribed, patient got Istin
  • BNF

25
Prescription/Drug Charts
CYCLIZINE 50mg 7/11 S Jones
PO Nausea 150mg/24h
  • PRN criteria
  • frequency
  • max dose
  • indication

26
Completing Drug Charts Important points
  • Care when rewriting drug charts / transferring
    information to discharge summaries
  • Never guess doses - always check the BNF
  • Always double check your prescription you are
    legally responsible for it

27
Example
28
Completing a Prescription Chart
  • Mickey Mouse has been admitted to your ward and
    you have to compete his drug chart from the GP
    repeat slip
  • Atenolol 25mg od
  • Diclofenac 50mg tds
  • GTN spray prn
  • The decision has been made to start with
  • 1) IV antibiotic therapy and the drug of choice
    is cefuroxime 1g tds
  • 2) Paracetamol prn for pain
  • Other information available states that he is
    penicillin allergic and weighs 60kg

29
(No Transcript)
30
Parenteral Administration Chart
31
Parenteral Administration In some hospitals it is
part of the usual drug chart
32
TTO or TTA (To Take Out)
  • What is it actually?

33
Warfarin Chart
34
(No Transcript)
35
Subcutaneous Insulin
36
Insulin Chart
37
FP10
  • Hospital Community
  • Various colours

38
Drug Calculations
  • Strength you want Strength
    you've got it in

x
amount required
Volume youve got it in
Watch out for Pharmaceutical preparations -
suppositories - liquids to tablets or vice versa
39
IV Medication
  • Check Drug indications dosages as in BNF
  • BNF Appendix 6 guidelines additives
  • To be written on Drug Chart NOT Fluid Chart
  • ? Trust IV handbook ?
  • KCL strong solution now handled as CD

40
PrescribingWhere Do Errors Occur?
  • Prescribing process - completing drug chart
    transcription from GP note / Pts own medicine
    - re-writing the drug chart - writing the TTO -
    insufficient discharge information
  • Dispensing process - illegible writing
  • Administration of medication - illegible writing
    on drug chart - unclear instructions



















41
Transcription Error
42
Methotrexate Folic Acid
43
Allergies Interactions
44
Incomplete Drug Chart
45
Never Abbreviate
  • Micrograms
  • Units or iuTinzaparin 3500u

46
TTOs Lack of Information
  • Discharge information needs to be improved to
    prevent prescribing errors
  • Better training for HOs needed in completing
    TTOs
    - Pharmaceutical Journal Jan 2002

47
Dose Error
48
Specify dose
  • Gliclazide 80mg
  • Diclofenac50mg, 75mg or 100mg?
  • Cipramil10mg or 20mg?

49
GP Based Review of TTO Errors
  • Total TTOs 268 28 errorsgt1 error/TTO
  • Other findings - poor communication - changes
    in therapy not communicated

Northumbria Healthcare Trust
50
(No Transcript)
51
Drug ChartTTO
  • Formulation
  • Route

52
Incomplete TTO
53
Incomplete TTO
54
Completing a TTO
The decision is made to discharge Mr Henderson.
In addition to the drugs on his chart, the
pharmacist left you a green note indicating all
the other drugs that have been missed off. Can
you complete the TTO?
  • Other drugs on this chart
  • Ranitidine 150mg twice a day
  • Allopurinol 100mg once daily
  • Nicorandil 20mg once daily
  • Aspirin 75mg once daily
  • Sando K one twice daily
  • GTN spray when required

55
Transcription Error
56
Bioavailability differences
No date or sig.
57
Poor Handwriting Leading to Dispensing Error
58
Poor Handwriting Leading to Dispensing Error
59
Poor Handwriting Abbreviations
60
TTO for the day
  • STOP
  • THINK
  • ASK
  • LISTEN
  • LOOK

Its Your Responsibility!
Write a Comment
User Comments (0)
About PowerShow.com