hand, the appropriate technology must be available to ensure that an application can be deployed across an enterprise without any loss of performance; some early EP programs in the US failed because the technology used was not scaleable. 3 On the other hand, technology may fail to deliver benefits if it does not meet needs, or it requires that practice is altered to accommodate system use.1 Indeed, experi- ence from the US suggests that healthcare providers need a technology strategy to ensure that technology supports the organisation’s goals, rather than fitting busi- ness processes around the available technology. 4 Appropriate use of electronic systems to support current and emerging business processes will be facilitated by highly configurable systems, use of service-oriented architecture and the involve- ment of clinical professionals and domain experts in their design.
Medicines Management in Hospitals: Existing
Medicines Management in Hospitals: Existing Business Processes 45
ONCE ONLY DRUGS AND PREMEDICATION DRUGS
DOCUMENT REASONS IN CARE PLAN IF APPROPRIATE
Approved Drug Name Dose Route Prescriber Signature Time to beGiven Date to beGiven Time GivenDate and Check by:Given by: PharmacySupply
Fig. 3.2 Medicine administration charts
5. Continuous infusions. These are intravenous infusions that are given at a fixed or variable rate to treat a specific disease. Unlike fluids, continuous infusions will be small volume (250 ml or less) and will consist of medicines with specific pharmacological activity. Furthermore, because of the potent effects of the drugs used, they are usually delivered by a syringe driver, which will maintain a more
REGULAR PRESCRIPTIONS
Approved Drug Name
Date:
Regular Times Other Times
0600 1000 1200 1400 1800 2200 Dose
Date
Pharmacy Supply:
Pharmacy Supply:
Pharmacist Chock
Route
Frequency:
Signature
Special Directions
Approved Drug Name VARIABLE TIMES/DOSES
Signature
Special Directions
Dose Route
Date
Pharmacist Check Pharmacy Supply
Pharmacy Supply
Time Date
Dose Initial Check
RECORD OF ONCE ONLY STANDING ORDER DRUGS/FLUID GIVEN
Approved Drug Name Dose Route Signature of Nurse/Midwife Date Time Given by: Check by:Pharm supply
Approved Drug Name Diluent Volume Route
CONTINUOUS INTRAVENOUS / SUBCUTANEOUS DRUG INFUSION THERAPY
Supply Supply Pharmacist Check
Date
Time
Rate
Volume infused Initial/
Check
Flow Rate (ml / hr) Date Pump Code:
Concentration (mg/ml etc.) Prescribers Signature Special Directions
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accurate flow rate than can be achieved with the burette on a fluid giving set. An example of a continuous infusion would be isosorbide dinitrate, 50 mg in 50 ml infusion, given at a variable rate of between 2 and 4 mg/h for the treatment of ischaemic (angina) pain.
When prescribing a medicine, the prescriber writes the details on the drug chart, and the various boxes on each section in the drug chart prompts the clinician to include all relevant details for a particular order type. The prescription is then signed by the prescriber.
The drug chart is then used as the basis for medicine supply and medicine administration in the hospital. Medicines are supplied against the formulation details on the drug chart, either from ward stock, if a medicine is used regularly on a ward, or direct from the pharmacy. Pharmacists make prescription-related enquiries based on the details on the drug chart, and make any relevant additions or amendments on the chart (traditionally in green pen, in UK hospitals). Nursing staff then administer the medicine to the patient according to the detail on the drug chart.
Each administration of a regular medicine is initialled by the nurse administering the medicine. The date, time and initials of the administering nurse are recorded for other prescription types. If a regular, or scheduled, prescription is not administered, an agreed missed dose code is placed in the administration box, instead of the nurse’s initials. This indicates the reason why a dose is not administered – for example, the patient refused the medicine, the patient is “ nil by mouth ” or the medicine is not available. For fluids and intravenous medicines, there is the facility to record that an infusion was stopped because of a blockage in the giving set, or extravasation – where the intravenous cannula has come out of the patient’s vein, and the drug is leaking into the surrounding tissues.
While a patient is an inpatient, all medication will be recorded on and adminis- tered on the drug chart, with the exception of anaesthetics and perioperative medication, and possibly some departmental investigations. However, when the patient is discharged, a discharge prescription is written (this is sometimes referred to as a “ to take out/away ” (TTO/TTA) prescription) and sent to the pharmacy to be prepared. The discharge prescription is usually completed on a separate form, in duplicate or triplicate, and includes the attending clinician’s diagnosis, treatment and planned follow-up or care plan.
This prescription recording system has been used for many years. Nevertheless, in practical terms, there are many problems associated with it.
(a) Because prescriptions are handwritten – often in a hurry by busy clinicians – they may be illegible or incomplete. Alternatively, in patients with large num- bers of medicines, there may be inadvertent duplications.
(b) Nursing staff may have to query prescriptions before they administer them, leading to inefficiencies in the medicine administration process.
(c) The drug chart can be lost. If there are two or more charts, they may become separated from each other.
(d) Medicine administration may be delayed when a drug chart is not on the ward for any reason – for example, when a patient is having an investigation in another department, and the chart has gone with him or her.
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