Prescriptions E-learning and other Flashcards
Aseptic meaning:
free from contamination caused by harmful bacteria, viruses, or other microorganisms.
What are Medicines Policies and what are the four aims of it?
Four aims are:
- Principle: to highlight principles by which drugs are to be stored, supplied, transported and administered within a clinical setting and so closely reflect the HMR 2012
- People: aim to ensure all members of staff are aware of their roles, responsibilities and limitaations with respect to medicine
- Audit: aim to ensure an auditable trail for the handling of medicines including controlled drugs
- RIsk management: aim to help manage the risks that drugs can pose to patients, service users, residents and staff to ensure users recieve appropriately prescrived medicine safely and effectively
NHS hospitals
What is an Inpatient Drug Chart?
An ‘order’ for the administration of drugs to a patient. You would use these charts to document the drug treatement to be given to a patient during their inpatient stay. They are subject to regulations and standards of code.
NHS hospitals - Discharge summary
What are TTOs and TTAs
TTO (to take out) and TTA (to take away) are used to prescribe medication to be given to inpatients on discharge. You would prescribe sufficient medication to allow time for the discharge summary to reach the patient’s GP for medication to be continued. Recommended duration is 14 days.
How to know if a drug is controlled?
Schedule 2 and 3 preparations are identified by the symbols CD2 and CD3 respectively next to the drug in the BNF - You can also find it in Controlled drugs and drug dependence in the BNF
NICE guidance on controlled drugs
What to do when prescribing CDs
- Document the indication and dosing regimen in the patient’s medical records
- Assess the patient’s current clinical need and adjust prescription as appropriate
- Discuss with the patient how their treatment will be reviewed and monitored.
- Be able to discuss prescribing decisions with other HPs if required
Remember to tell their GP bout this
NICE guidance on CDs
What to do for ‘when required’ CDs
- Document clear instructions for when and how to take or use the CD in the patient’s medical notes.
- Annotate the dosage instructions on the prescription ie maximum dose and frequency
- Consider any pre-existing supplies of the CD the patient may have at home before supplying on discharge
Remember to tell their GP bout this
NICE guidance for prescribing CDs
What to do when reviewing or amending a CD prescription
- Adhere to local and national guidance when you prescribe, review or amend a CD prescription and take into account:
- the apppropriate route
- dose
- formulation
Clearly document any deviations from prescribing guidance in the patient’s medical notes.
Remember to tell their GP bout this
NICE guidance for prescribing CDs
What to do when needing to prescribe multiple routes of administration?
- Prescribe each route as a separate item
- Clearly document on the prescription when each route can be used
- CLearly cross-reference to prevent any accidental overdose by dual administration via both routes
Remember to tell their GP bout this
What does GSL, P and POM mean
GSL (General sales list)- drugs available for general sale
P (Pharmacy medicines) - Drugs restricted to sale through pharmacies
POM (Prescription only medicines) - Prescribed by practiioners only. CDs included can only be prescribed by practitioners and restrictions apply to some NMPs
What is meant by an unlicensed medicine?
Medicines that have not been subject to the licensing process so doesn’t have a uK Marketing Authorisation from the MHRA. This may include:
- Clinical trial drugs
- Drugs awaiting MHRA approval
- ‘Specials’ products made specifically for a given purpose and sometimes a named patient
- A drug licensed in another country other than the UK.
The HMR allows for unlicensed drugs to be used if licensed ones aren’t available and the patient needs it
What is meant by off-label prescribing?
Drug that is licensed in the uK but is being used outside the terms of its Marketing Authorisation E.G
- Drug licensed only in adults which is being used for a child (e.g lansoprazole)
- Drug used for an indication not stated in the Marketing Authorisation
- Drug administered via a route other than stated in the licensed way.
Good practice in prescribing unlicensed or off-label drug, what to check?
- Be satisfied that there are no suitable licensed alternatives that would meet the patient’s clinical needs
- Be satisfied that there is sufficient evidence base and/or experience for its use
- Be prepared to take responsibility for prescribing and overseeing the patient’s care (including monitoring)
- Document your decision in the medical notes, including the rationale for the precription
- Make sure that off-label is approved (indicated in the BNF)
- Only prescribe unlicensed drugs with advice from and under the supervision of a senior clinician
- Inform your patient and gain consent where possible for the used of the drug
- Some medicines are routinely used outside the terms of their license. In this case it may be sufficient to describe why the drug isn’t licensed for the proposed use or patient.
What to do when reviewing prescriptions?
- REview all medicaiton regularly
- Stop any unnecessary medicine
- Consider documenting review dates, both within the patient’s notes and on the inpatient charts
What to do when cancelling a prescription on an inpatient drug chart?
- Cross through the entire entry
- Annotate the entry with your signature and a date
- Do not obliterate the entry in its entirety as the medicine is still part of your patient’s medical history
- Document any changes to your patient’s prescribed therapy in the medical notes, including the rationale for change
