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ICU Prescription Sheet. Why?. Do we need to change?

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Presentation Transcript

Why?

  • Do we need to change?

    The hospital has changed to a system where prescription and administration are on the same sheet (TPAR). This allows omissions to be easily seen. It also means that the administration and record cannot be separated and lost. ICU has been instructed to adopt a similar system.

  • Do we not use TPAR?

    TPAR was extensively trialled in ICU and found to be inadequate for our needs. So we have had to design a form that suits our needs better than the TPAR. Any constructive feedback would be welcome.


What?

  • There is a system currently being used in ICU, which is similar to TPAR, but so far appears better adapted to our needs.

  • The ultimate aim is to move to an electronic system, which is currently being developed.


When?

  • The trial of the document is continuing.

  • Once we have the proofs back from the printers, we would aim to make the final changes and start using the system properly. Hopefully in colour to make it easier to differentiate between the different sections.


The new sheet
The new sheet

  • Landscape booklet

  • Coloured sections for ease of reference.

  • More space for prescription than the current Kardex.




Regular prescriptions
Regular Prescriptions

  • Regular oral/ NG/ NJ drugs

  • Regular injections/infusions


As required prescriptions
As Required Prescriptions

  • Any drug that is to be used on an as required basis


Continuous infusions
Continuous Infusions

  • Continuous infusions

    • Sedative agents (Propofol/Midazolam)

    • Analgesics (Morphine/Alfentanil etc…)

    • Inotropes and vasopressor infusions (Dobutamine/noradrenaline etc)

    • Epidural or peripheral nerve catheter infusions


General rules for prescribers
General rules for Prescribers

  • Write legibly. If those that are administering the drug cannot read it, it won’t be given!

  • Write the names of drugs in full and where possible the generic name

  • Use metric doses and standard abbreviations

    miligram=mg gram=g mililitre=ml

    micrograms to be written in full ( not mcg or μg)

  • Use standard abbreviations for routes as in the next slide



Prescribing
Prescribing

  • The next few slides are designed to take you through how to prescribe a drug on the new chart.

  • Each section will be covered in turn.

  • There are instructions for all who use the document on the rear cover. Any comments, or errors / omissions that are noted will be gladly listened to.


The front cover
The front cover

  • As well as once only prescriptions the front cover has several other important sections that should be carefully filled in.

  • It is largely self explanatory.

  • In particular the sheet number, dates written and discontinued are important


The front cover1
The front cover

  • The allergies and sensitivities section. If none known then please put NKA. The instructions will be changed to reflect this.

  • There will also be a box to state whether more than one chart is in use (hopefully a rare event)


Regular prescriptions1
Regular Prescriptions

Drug Name

  • generic where possible

  • in full

Paracetamol


Regular prescriptions2
Regular Prescriptions

Drug Name

Route

  • oral/NG/NJ/Jej/IV etc

Paracetamol

IV


Regular prescriptions3
Regular Prescriptions

Drug Name

Route

Dose

  • mg

  • g

  • micrograms

Paracetamol

IV

1 g


Regular prescriptions4
Regular Prescriptions

Drug Name

Route (oral/NG/NJ/Jej/IV etc)

Dose

Form

Infusion

Injection

Nebulised

Liquid

Tablet

Capsule

Paracetamol

IV

1 g

Infusion


Regular prescriptions5
Regular Prescriptions

Drug Name

Route (oral/NG/NJ/Jej/IV etc)

Dose

Form

Start date and signature

Paracetamol

IV

1 g

Infusion

18/03/07

Bloggs


Regular prescriptions6
Regular Prescriptions

Drug Name

Route (oral/NG/NJ/Jej/IV etc)

Dose

Form

Additional instructions

e.g. with or after food

Paracetamol

IV

1 g

Infusion

18/03/07

Bloggs


Times
Times

Correct Wrong

Insert Times:

  • 24 hour clock

  • In order over 24 hours

  • Use ‘even’ hours i.e. 02.00, 04.00 NOT 13.00, 03.00 etc…


Regular prescriptions7
Regular Prescriptions

06.00

Drug Name

Route (oral/NG/NJ/Jej/IV etc)

Dose

Form

Additional instructions

Insert Times

24 hour clock

In order over 24 hours

ie 06.00, 12.00, 18.00 etc

Try and make the times ‘even’

hours i.e. 02.00, 14.00 etc

Paracetamol

IV

1 g

Infusion

12.00

18/03/07

Bloggs

18.00

24.00


Stopping a drug
Stopping a drug

Drugs in all the sections should be stopped in this way

18 19 20

03 03 03

06.00

Paracetamol

IV

SN

SN

1 g

Infusion

12.00

SN

SN

Bloggs

18/03/07

18.00

20/3/7

SN

SN

MB

24.00

SN

SN

Diagonal line through the rest of the administration record

Dated and Initialled

Single diagonal line through the whole prescription box

Double vertical line through the remainder of the day (or the next day if not enough space).


As required prescriptions1
As Required Prescriptions

Drug Name, Dose, Route and Form as per the Regular section.

Tramadol

50mg

IV

Inj


As required prescriptions2
As Required Prescriptions

  • Drug Name, Dose, Route and Form as per the Regular section.

  • Maximum frequency that you wish to prescribe the drug.

Tramadol

50mg

IV

Inj

4 hourly


As required prescriptions3
As Required Prescriptions

  • Drug Name, Dose, Route and Form as per the Regular section.

  • Maximum frequency that you wish to prescribe the drug.

  • Date and sign the drug

  • Indication for the drug

  • The indication box could also be used to state the maximum dose of drug that can be given in a period.

Tramadol

50mg

IV

Inj

4 hourly

18/03/07

Bloggs

For Pain. Max 400mg in 24 hours


Continuous infusions1

Drug, Route, and Indication as for previous sections.

Continuous Infusions

Morphine Sulphate

IV

For Pain


Continuous infusions2

Drug, Route, and Indication as for previous sections.

The dose may be stated as a range

mg per hour

mls per hour for drugs of a fixed (and stated) concentration

micrograms per kilogram per minute for inotropes and vasopressors.

For ease the units have been pre printed. Cross out those that are not required

Continuous Infusions

Morphine Sulphate

IV

0-10

18/03/07

Bloggs

For Pain


Discontinuing a whole chart
Discontinuing a whole chart

  • Single clear line through the front cover, and across each active page.

  • Clearly date and initial that it is discontinued

  • Write a new one if required.

0 1 0 1 3 2 0 0 1 1

SMITH

John

12/3/2007

12/3/2007

1

19/3/2007 MB


For those administering drugs
For those administering Drugs

  • If it is illegible or unclear then discuss with a senior or member of medical staff. Don’t presume that you can guess correctly!

  • Record everything as accurately as possible

  • The instructions don’t cover every potential problem or circumstance. Discuss any problems – it may not be new.


Instructions for those administering medicines
Instructions for those administering medicines

  • The ‘Regular’ and ‘As Required’ medicines sections should be checked at each administration round to ensure that inadvertent omission or double dosing is avoided.

  • Ensure entry is made on administration record each time drug is given. Initial in relevant date column and time row.

  • Check that all drugs prescribed at a certain time are administered.

  • If a drug is not administered, enter the reason in the appropriate box using the coding system. Then discuss with senior nursing or medical staff as to why it cannot be given.


Codes for the non administration of prescribed medicines
CODES FOR THE NON-ADMINISTRATION OF PRESCRIBED MEDICINES

  • If a dose is not administered, initial and enter the appropriate code in the box with a circle drawn round it.

  • Then discuss with senior nursing or medical staff as to why it cannot be given


Questions
Questions?

  • If you have any questions or comments then please contact:

    Ian Mellor

    Diane Campbell

    or

    Debbie Corner


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