secondary care Flashcards
list medicines where administration should be timely
First doses of injected anti-infectives First doses of injected anticoagulants/ thrombolytics Resuscitation medicines First dose of injected anticonvulsant ‘Stat’ doses of any medicines Insulin Strong analgesics Bronchodilators Glyceryl trinitrate Parkinson’s disease medicines
Causes of omitted or delayed medicines at admission
- Intention to prescribe, but not prescribed
New medicines, or set course
Routine regular medicine
Medicine not available on ward
Medicine not prescribed / delayed prescribing
Medicine not stocked on ward / delay in supply
Non-formulary
Out of hours - Route of administration not available
NBM
No IV access
Unfamiliar preparation, administration, method or
device - Nurse unaware stat dose prescribed
- Patient refused
- Patient not on ward at scheduled administration time
Incomplete or incorrect medication history
Poor communication of medication history on admission
Poor medicines reconciliation process
Clinical judgements based on incomplete, inaccurate, poorly documented or unavailable information may lead to medication errors or adverse events.
Implementing medicines reconciliation at all transitions in care – at admission, transfer and discharge – is an effective strategy for ensuring complete and accurate medication history on admission and preventing adverse drug events.
Any difference between the drug history and the admission prescription chart is known as
medication discrepancy
List examples of an intentional medication medication discrepancy
- starting a medication
- stopping a new medication
- therapeutic substitution
- adjusting dose, form, frequency or route
List examples of unintentional medication discrepancy
- omitting medication
- incorrect medication
- Restarting a discontinued meds
- wrong form, dose, frequency or route
list the contributing factors of medication errors during transfer of care
No access to patient medication list
Transcribing errors in hospital record
Discrepancies between what the patient takes and the medication list
Patient account affected by acute condition
state the four core principles for HCP
HCP ensures all necessary medicines-related information accurately recorded and transferred with patient
HCP taking over care checks medicines-related information has been accurately received, recorded and acted upon.
Patients encouraged to be active partners in managing their medicines when they move – why, when and what medicines.
Medicine-related information should be communicated in a way which is timely, clear, unambiguous and legible
What is medicine reconciliation
The process of identifying the most accurate list of a patient’s current medicines, comparing them to the current prescription chart, and communicating any changes.(NPC)
The process of identifying an accurate list of a person’s current medicines and comparing them with the current list in use, recognising any discrepancies, and documenting any changes, thereby resulting in a complete list of medicines, accurately communicated.(IHI)
State the aim of medicine reconciliation on admission
Aim of medicines reconciliation on admission is to ensure that medicines prescribed correspond with those that the patient was taking before admission.
What is medicine optimization?
the safe and effective use of medicines to enable the best possible outcomes
State the aim of medicine optimization
Aims to ensure that medicines provide the greatest possible benefit to people by encouraging medicines reconciliation, medication review, and the use of patient decision aids.
State how medicine reconciliation should be carried out according to NG5
Recognise that medicines reconciliation may need to be carried out on more than one occasion during a hospital stay – for example, when the person is admitted, transferred between wards or discharged.
When carrying out medicines reconciliation, record relevant information on an electronic or paper-based form.
In primary care, carry out medicines reconciliation for all people who have been discharged from hospital or another care setting. This should happen as soon as is practically possible, before a prescription or new supply of medicines is issued and within 1 week of the GP practice receiving the information.
State the three C’s of medicine reconciliation
collecting information on medication history (prior to admission) using the most recent and accurate sources of information to create a full and current list of medicines, and
checking or verifying this list against the current prescription chart in the hospital, ensuring any discrepancies are accounted for and actioned appropriately, and
communicating through appropriate documentation, any changes, omissions and discrepancies.
List the sources of medication history
Patient / carer Recent print out from GP computer system Repeat prescription B side Hospital discharge summary Medication Administration Record (MAR) from nursing home Patient Medication Record (PMR) Clinical management plan Summary Care Record (SCR) ‘Message in a bottle’ Green bags Patient Own Drugs (PODs) Monitored Dosage System (MDS)
