Introduction to Hospital Charts

Question 1

what are the legal requirements for a hospital drug chart?

Answer 1

1) Drug charts are an “authority to administer”
2) Legal Rx requirements do not apply (unless used to prepare discharge medication)
3) BUT are a medico-legal document

Question 2

what is the aim of a hospital drug chart? and which professional bodies set out the recommendations for them?

Answer 2

1) Aim to increase safety and reduce errors in prescribing and administration of medicines
2) Recommendations made by RPS, RCN and Academy of Medical Royal Colleges

Question 3

Outline the Standards for a Hospital Chart (1 of 2)

Answer 3

1) Front page: Patient’s full name, address, DOB, DOA, ward, consultant
2) Drug allergies/ sensitivity box on front page in eye-catching colour, including reaction and name of person recording info
3) Units written in full
4) Box for additional info
5) Space for age, height, weight and BSA
6) Statement re VTE prophylaxis
7) Indication regarding use of other charts
8) Space for medicines management info e.g. Meds Reconciliation
9) Numerical code for non-administration
10) Allow double signing e.g. for CDs

Question 4

Outline the Standards for a Hospital Chart (2 of 2)

Answer 4

11) Written clearly, legibly and indelibly
12) Space for “one-off” doses
13) Space for regular medicines
14) Space for PRN including max daily dose where appropriate
15) Dose change requires complete rewrite of item
16) Pharmacist sign and date to show clinical screen
17) Record of supply for each item
18) Space for IV/SC infusions
19) Colours used on chart should take into account common forms of colour blindness

Question 5

list the different types of drug charts

Answer 5

Many and varied - each Trust will have their own version

1) General drug chart
2) IV chart
3) Others:
- Warfarin
- PCA
- Syringe drivers
- Heparin
- Oxygen etc

Question 6

How would you screen a drug chart?

Answer 6

be methodical

1) Front page→ regular meds → PRN → others
2) Individual drugs then whole chart
3) Consider in context with other information

Question 7

what errors should you look out for on a drug chart?

Answer 7

1) Allergies
2) Unclear handwriting
3) Duplication
4) Abbreviations
- units, micrograms
6) Unclear discontinuation
7) Administration problems
- swallowing, NBM etc

Question 8

List what pharmacists endorse on a drug chart

Answer 8

1) Drug information
2) Dose
3) Frequency
4) Route
5) Additional instructions

Question 9

why do pharmacists endorse on a drug chart?

Answer 9

1) Safety
2) Communication
3) Clarification
4) Save time

Question 10

how would you endorse the pharmacy box on a drug chart?

Answer 10

1) for a Clinical screen→ Initial → date
2) for a Supply → quantity (dose units), initial, date: (28Df5/5)
3) Controlled drugs: CD triangle