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3 guide bonnes pratiques prescription medic sept 2013

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3 guide bonnes pratiques prescription medic sept 2013

  1. 1. 8 – Ordonnance de sortie Toute ordonnance de sortie doit également répondre aux mêmes exigences réglementaires. Une copie doit être conservée dans le dossier médical du patient. Réglementation : - Circulaire du 14 février 2012 - Arrêté du 6 avril 2011 - Arrêté du 31 mars 1999 - « Organisation du circuit du médicament en établissement de santé » HAS 2005 - Recommandation s de la DHOS juin 2004 Déclarations Tout évènement indésirable doit faire l’objet d’une déclaration Pharmacovigilance au Centre Régional : 03 80 29 37 42. Toute erreur médicamenteuse fera d’une déclaration auprès du Service Qualité. Consultation lu livret thérapeutique d’HPSM depuis le serveur : H: Pharma 2 Livret Thérapeutique Livret médicaments GUIDE DE BONNES PRATIQUES DE PRESCRIPTION MEDICAMENTEUSE 6 – T2A Les médicaments facturés en sus des GHS doivent être prescrits sur une ordonnance nominative en renseignement impérativement l’indication. Le remboursement intégral de ces médicaments ne sera effectif que si les indications ont été validées par le COMEDIMS. 7 – Evènement indésirable médicamenteux Formulaire à télécharge depuis le serveur : H: Pharma3 INFO PUI-SERVICES A l’attention des médecins prescripteurs Commission du Médicaments et des Dispositifs Médicaux Stériles
  2. 2. La prescription médicamenteuse est le point de départ d’un processus complexe. Elle est transmise à tous les acteurs de santé concernés (médecins, pharmaciens, personnel infirmiers …). Il s’agit d’un véritable outil de travail qui doit être dûment formalisée, qu’elle soit sur support papier ou informatique. Elle est réservée aux médecins prescripteurs autorisés d’HPSM. Elle engage la responsabilité du médecin prescripteur. Le rôle de ce guide de bonnes pratiques de prescription médicamenteuse est la sécurisation du circuit du médicament à l’hôpital. Toute ordonnance, comportant une prescription de médicaments doit après examen du malade et réévaluation de son traitement répondre aux critères réglementaires suivants : 1 – Critères d’identification du patient Nom, Prénom et Age Sexe, Service sur tous les supports ou Etiquette patient Poids Taille ou / et Surface corporelle si nécessaire 2 – Critères d’identification du prescripteur Nom (en entier en majuscules) ou Prénom (initiales) tampon Fonction Signature Date et heure 3 – Principes généraux à respecter Ecrire LISIBLEMENT, PAS D’ABREVIATIONS POSOLOGIES : utiliser exclusivement les UNITES INTERNATIONALES (μg, g, mg, UI …). NB : Arrondir les posologies chaque fois que possible (ex : AMIKACINE IM ou IV 1000 mg/jour au lieu de 1035 mg/jour pour un adulte de 69 Kg – à réévaluer quotidiennement selon le suivi thérapeutique). Préciser si Grossesse, Allaitement, Allergie, Insuffisance Rénale … Faire référence aux protocoles en vigueur (Protocoles douleur, ATB …). Recueillir et trier les médicaments du traitement personnel du patient. Vérifier que l’administration simultanée de médicaments ne présente pas de contre-indications. Préciser les modalités de surveillance du traitement. Classer par cible thérapeutique les lignes de prescription. Réévaluer quotidiennement la prescription. Expliquer la prescription au patient. 4 – Critères d’identification des médicaments NOM du médicament en majuscules (DCI ou / et NOM commercial – se référer au livret thérapeutique ou au Vidal) Dosage (exprimé en mg, g, UI …) Forme pharmaceutique (comprimés, ampoules injectables, gouttes, gélules, suppositoires …) Di fférencier les formes Libération Prolongée des formes classiques (ex : MODOPAR® LP 125mg et MODOPAR® 125mg) Voie d’administration (IV, SC …) Dose par prise en unités spécifiques (ex : 500 mg/4h – 500 mg toutes les 4 heures) Rythme ou Horaires d’administration Eventuellement, nombre de renouvellements Dose totale quotidienne Date de début de traitement Durée de traitement ou date d’arrêt ou de réévaluation 5 - Précautions Signaler par tout moyen au personnel infirmier les nouvelles prescriptions Cas particuliers Cas particuliers Cas particuliers Perfusions IV Aérosols Stupéfiants - Solutions prescrite, Concentration Solutés - Volume exprimé en ml ou en l Injectables - Ajout d’Ions exprimé en mg, g ou mmol - Débit et/ou Durée de perfusion - Voie d’abord (ce ntrale, périphérique …) Médicaments injectables : Préciser les modalités de dilution (nature, véhicule, volume …) Vérifier la compatibilité physico-chimique des produits administrés. ex : LASILIX® + HYPNOVEL®  précipitation Si doute, joindre la pharmacie de l’établissement. Prescription en mg ou μg de Principe Actif Préciser mode de dilution (véhicule, volume), durée nébulisation Gaz médicaux : A prescrire (ex : Kalinox) Indiquer en TOUTES LETTRES : - NOM du médicament - Dosage, Forme pharmaceutique - Nombre d’unités ou quantité par prise, maximum / 24h - Durée prévisionnelle du traitement Prescriptions téléphoniques Elle n’est pas REGLEMENTAIRE. Si urgence, à régulariser par écrit par le même prescripteur.

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