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Bnf, Pharmacology And Prescribing In The Nhs






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Bnf, Pharmacology And Prescribing In The Nhs Bnf, Pharmacology And Prescribing In The Nhs Presentation Transcript

  • Grzegorz Chodkowski (MD) Riga, Radisson SAS 2009 BNF, Pharmacology and Prescribing in the NHS
    • Know the medicine well enough to administer safely 
    • Check and be certain of patient identity
    • Know the care plan
    • Administer in the context of patient condition
    • Check for allergy and the expiry date before administering
    • Know the following so you correct and understand prescription instructions: 
    Key Points
    • Medication prescribing is:
      • Appropriate
      • Safe
      • Legible
      • Accurate
      • Clear
      • Indelible
    • The patient must be identifiable
      • patient's name
      • address
      • date of birth
      • hospital number
      • age if under 12 (legal requirement)
      • weight if under 12 (legal requirement)
    Prescribing Core Knowledge (for all clinical staff)
    • The Allergy box must not be left empty
    • Use approved names (rINN) in black ink and BLOCK CAPITALS
    • Metric doses
    • Write micrograms and units in full
    • Indicate the route and times of administration
    • Administration times should be agreed with the nursing team and the 24-hour clock used. Specify precise times if important.
    • Do not alter existing prescriptions. Rewrite if a change is made.
    • Only one chart should be active
    • Discontinue a treatment by crossing through it and cancelling subsequent recording panels. Add your initials and the date.
    • Antibiotics must be prescribed for a stated time period.
    • Place X in administration box to indicate drug not to be given at specific time & day
    • If a drug is to be administered by a pre-prepared protocol or patient specific direction this must be explicitly referred to on the chart
    Prescription Chart Standards
    • Safe prescribing depends upon you putting yourself in the mind of everyone who might read and act on your script, patient, nurse, pharmacist and fellow prescriber.         
    • Dangerous errors tend to be:
    • Wrong medication in context
    • Wrong dose (too much)
    • Mistakes, are more likely when tired or distracted or interrupted. Every-one makes mistakes and every one will make the occassional bad mistake
    • Team work and taking responsibility for checking others and then acting appropriately is the most effective way of reducing patient harm.
    • All should accept the correction of potential mistakes in good grace 
    • Many safety issues are due to culture and can be corrected by system change
    • Insulin is the most common cause of administration error
    • Anticoagulants are the most common cause of life threatening prescribing error.
    • All clinical staff should know the risks with prescribing so they can be detected.
    Medicines Safety
    • Methotrexate given daily instead of weekly
    • Writing ug for microgram which might be read as mg and patient given 1000 times too much. 
    • Allergy box on drug chart left empty
    • Three fatal episodes where a prescriber prescribes a penicillin to someone documented to be allergic penicillin and the penicillin is given despite the allergy being stated on the wrist band(s) and drug chart 
    • A study comparing administration error in UK, Germany & France found
      • Product not labelled/incorrectly labelled in 43%, 99% and 20% of doses  respectively
      • Wrong diluent used in 1%, 49% and 18%
      • Wrong administration selected for 49%, 21% and 5% of doses observed
      • At least one deviation from aseptic technique was observed among 100%, 58% and 19%
      • In the UK, no cleaning of preparation area or hand washing was observed for any of the prepared doses
      • Only 1% of cases swabbing the vial top
      • In the UK, the most frequent medication errors were related to an incorrect administration rate (48%).   
    • Thank You!
    • Any Questions?