Prescribing SafelyPrescribing Safely

Kevin GibbsKevin GibbsPharmacy Manager: Clinical ServicesPharmacy Manager: Clinical Services

University Hospitals Bristol NHS Foundation University Hospitals Bristol NHS Foundation TrustTrust

Aims of talk….Aims of talk….

Discuss the pitfalls of drug history Discuss the pitfalls of drug history takingtaking

Introduce medicines reconciliationIntroduce medicines reconciliation Help you to reduce risk from prescribing Help you to reduce risk from prescribing

medicinesmedicines Identify sources of information which Identify sources of information which

will help you prescribe safelywill help you prescribe safely Revision from 3Revision from 3rdrd year talk! year talk! Give you pointers to ask on your Give you pointers to ask on your

placementsplacements

Why me?Why me?

You will do this every dayYou will do this every day You will be responsible for your prescribingYou will be responsible for your prescribing You will make prescribing errorsYou will make prescribing errors You will be expected to prescribe to NPSA You will be expected to prescribe to NPSA

competencies (Eg Anticoagulant & IVs)competencies (Eg Anticoagulant & IVs) You need to be aware of potential pitfallsYou need to be aware of potential pitfalls You need to think about prescribing safelyYou need to think about prescribing safely You need to know when to ask for helpYou need to know when to ask for help

What is a medication error ?What is a medication error ?

‘ ‘ a medication error is a medication error is any preventable event any preventable event that may cause or lead that may cause or lead to inappropriate to inappropriate medication use or medication use or patient harm while the patient harm while the medication is in the medication is in the control of health control of health professional, patient or professional, patient or consumer’consumer’

Incidence of errorsIncidence of errors

The precise incidence of medication The precise incidence of medication errors in the NHS is unknownerrors in the NHS is unknown

~10-20% of all ADRs are due to errors ~10-20% of all ADRs are due to errors In USA 1.8% of hospital admissions In USA 1.8% of hospital admissions

have a harmful error leading to 7000 have a harmful error leading to 7000 deaths per yeardeaths per year

In Australia – 1% of all admissions In Australia – 1% of all admissions suffer an ADR due to medication errorsuffer an ADR due to medication error

Common error types?Common error types?

Wrong patientWrong patient Contra-indicted Contra-indicted

medicinemedicine Wrong drug / Wrong drug /

ingredientingredient Wrong dose / Wrong dose /

freqencyfreqency Wrong formulationWrong formulation Wrong route of Wrong route of

administrationadministration

Poor handwriting Poor handwriting on Rxon Rx

Incorrect IV Incorrect IV administration administration calculations or calculations or pump ratespump rates

Poor record Poor record keepingkeeping

Paediatric dosesPaediatric doses Poor administration Poor administration

techniquestechniques

Most common types ofmedication error reported

Commonest causes of Commonest causes of medication errorsmedication errors

Lack of knowledge of the drug – 29%Lack of knowledge of the drug – 29% Lack of knowledge about the patient – Lack of knowledge about the patient –

18%18% ““rule” violations – 10%rule” violations – 10% ““Slip” or memory loss – 9%Slip” or memory loss – 9%

JAMA 1995;274:35-43JAMA 1995;274:35-43

Top TherapeuticGroups Reported

Prescribing responsibilitiesPrescribing responsibilities

DrugDrug DoseDose RouteRoute FrequencyFrequency For parenteral therapyFor parenteral therapy

Diluent and infusion Diluent and infusion volumevolume

Access line for Access line for adminsitrationadminsitration

Rate of administrationRate of administration Duration of treatmentDuration of treatment Allergies and sensitivitiesAllergies and sensitivities

• Provide a prescription that isProvide a prescription that is

LEGIBLE (!!!!!)LEGIBLE (!!!!!) LegalLegal SignedSigned Giving ALL Giving ALL

information to allow information to allow safe administrationsafe administration

Controlled Controlled drugsdrugs

The requirements for a hospital take-home prescription are the same

In your handwriting:

1. Name and address of patient

2. Drug and dose

3. Form and strength of the drug

• Modified release

• Strength if liquids/injections

4. Total quantity (or no. of dosage units) in WORDS and figures)

Drug history takingDrug history taking

1.1. What information should be What information should be gathered during a drug history?gathered during a drug history?

2.2. What is the aim of the drug history?What is the aim of the drug history?

3.3. Where do you find the information?Where do you find the information?

4.4. What is “Medicines Reconciliation”?What is “Medicines Reconciliation”?

Drug Histories: What information?Drug Histories: What information?

Current medicationCurrent medication DoseDose FormForm StrengthStrength FrequencyFrequency IndicationIndication

Past medication and treatment Past medication and treatment failuresfailures

Over the counter medicationOver the counter medication ““Recreational” drugsRecreational” drugs Adverse reactionsAdverse reactions Allergies and sensitivities - with Allergies and sensitivities - with

clinical detailclinical detail Estimate of patient adherence / Estimate of patient adherence /

concordance with their medicinesconcordance with their medicines

DHx: Information SourcesDHx: Information Sources

GP admission letterGP admission letter GP records – From surgery / faxGP records – From surgery / fax Patients own tabletsPatients own tablets

““Dosetts” = Multi-compartment compliance aidsDosetts” = Multi-compartment compliance aids

Written lists – Patient / carerWritten lists – Patient / carer Nursing home formNursing home form Pharmacist patient recordsPharmacist patient records Recent discharge lettersRecent discharge letters

GP admission letterGP admission letter

Do not always contain a drug historyDo not always contain a drug history Can only contain those deemed relevant Can only contain those deemed relevant

to admissionto admission Out-of-hoursOut-of-hours

No information for out-of-hours GP No information for out-of-hours GP services to call on; so incomplete or services to call on; so incomplete or reliant on patient’s memory / own reliant on patient’s memory / own medicationmedication

GP recordsGP records

Should be definitive; but:Should be definitive; but: May be inaccurate / incomplete if:May be inaccurate / incomplete if:

Recent discharge not reached GP and acted uponRecent discharge not reached GP and acted upon Recent discharge had changed medicines with Recent discharge had changed medicines with

no explanationno explanation Some drugs are secondary-care only or Some drugs are secondary-care only or

issued in specialist units eg post-issued in specialist units eg post-transplantation / specialist clinics (CF, transplantation / specialist clinics (CF, psychiatric etc)psychiatric etc)

These may not be on the GP recordThese may not be on the GP record The doses may be altered by the originating unit The doses may be altered by the originating unit

not the GP, so GP records may not be accuratenot the GP, so GP records may not be accurate

GP records - 2GP records - 2

Private prescriptions may not be Private prescriptions may not be recorded on GP computerrecorded on GP computer

Watch the date last issuedWatch the date last issued Has this been stopped?Has this been stopped? Is the patient no longer taking the Is the patient no longer taking the

medicinemedicine Adverse reaction?Adverse reaction? Lack of effect?Lack of effect?

Will have allergies and sensitvitiesWill have allergies and sensitvities

Patient’s own medicinesPatient’s own medicines

Are these for the correct patient?Are these for the correct patient? Easy to pick up a relative’s medicines by Easy to pick up a relative’s medicines by

mistakemistake Easy to miss if the same surnameEasy to miss if the same surname

Are they still taking these?Are they still taking these? Stopped without GP being awareStopped without GP being aware Stopped with GP agreement but still on GP listStopped with GP agreement but still on GP list Stopped a while ago but kept “just in case”Stopped a while ago but kept “just in case” Contents of medicine cupboard emptied!Contents of medicine cupboard emptied!

Compliance aid boxes have lists insideCompliance aid boxes have lists inside

Previous drug chart or discharge letterPrevious drug chart or discharge letter

How current are these?How current are these? More recent changes?More recent changes? Check with the patientCheck with the patient

Incidences of errors with typist-generated Incidences of errors with typist-generated lettersletters Co-careldopa 3.125mg tds – Prescribed on next Co-careldopa 3.125mg tds – Prescribed on next

admissionadmission Was 31.25 tdsWas 31.25 tds

Electronic discharge summariesElectronic discharge summaries Errors from picking incorrect drop-down listErrors from picking incorrect drop-down list

Nursing Home listNursing Home list

MARs sheetMARs sheet Medication Administration RecordMedication Administration Record

Similar to a hospital drug chartSimilar to a hospital drug chart Should be an accurate listShould be an accurate list

Community pharmacist recordsCommunity pharmacist records

If one pharmacy is used regularly this If one pharmacy is used regularly this can be a additional source of can be a additional source of informationinformation

Open on saturdaysOpen on saturdays Will include all prescriptions Will include all prescriptions

dispensed fo that patient including dispensed fo that patient including But may also miss hospital-only But may also miss hospital-only

medicinesmedicines

Top 10 drug groups most commonly associated Top 10 drug groups most commonly associated

with preventable drug-related admissionswith preventable drug-related admissions

Drug groupAll preventable drug-

related admissions (%)

ADRs and over treatment

(%)

Patient adherence

problems (%)

Under treatment

(%)

Antiplatelets 16.0 17.3 2.0 8.9

Diuretics 15.9 16.0 20.4 2.2

NSAIDs 11.0 12.0 4.1 0

Opioids 8.5 8.9 4.1 0

Beta-blockers 4.6 4.4 4.1 11.1

Drugs affecting renin

–angiotensin system

4.4 4.6 4.1 0

Drugs used in diabetes

3.5 3.2 9.2 0

Positive inotropes 3.2 3.2 3.1 0

Corticosteroids 3.1 3.2 2.0 2.2

Antidepressants 3.0 3.2 2.0 2.2

Howard et al Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol 2006;63(2):136-147.

Other common pitfallsOther common pitfalls Prescribed & labelled ‘As directed’Prescribed & labelled ‘As directed’ Own tablets not brought inOwn tablets not brought in Several possible strengths eg inhalersSeveral possible strengths eg inhalers Trade names – beware duplicatesTrade names – beware duplicates Patient can’t rememberPatient can’t remember ““Dosett” boxes Dosett” boxes XX tablet identification tablet identification Asking about “your tablets” – Patients Asking about “your tablets” – Patients

will then miss off inhalers, creams etc!will then miss off inhalers, creams etc!

Take extra care if:Take extra care if:

Impaired renal functionImpaired renal function Hepatic dysfunctionHepatic dysfunction ChildrenChildren The elderlyThe elderly Drug is unknown to youDrug is unknown to you Very new drugVery new drug

Medicines Reconciliation: DefinitionMedicines Reconciliation: Definition

DefinitionDefinition ““Collecting an accurate list of the patient's Collecting an accurate list of the patient's

home medicines, using that list to write home medicines, using that list to write prescriptions; and documenting changes prescriptions; and documenting changes or discontinuation of medicines and or discontinuation of medicines and doses”doses”

• NationalNational GuidanceGuidance• National Institute for Health and Clinical

Excellence: Patient Safety Guidance 1. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital.

<http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11897>

Medicines Reconciliation: ProcessMedicines Reconciliation: Process

1.1. Verification:Verification:Collection of the medication historyCollection of the medication history Obtaining a complete and accurate list of each patient's current Obtaining a complete and accurate list of each patient's current

medications (medication history) including name, dosage, medications (medication history) including name, dosage, frequency and routefrequency and route

2.2. ClarificationClarification::Ensuring that the medications and doses are appropriateEnsuring that the medications and doses are appropriate Comparing the in-patient prescription or TTA to the medication Comparing the in-patient prescription or TTA to the medication

historyhistory

3.3. ReconciliationReconciliation::Documentation of changes in the prescriptionsDocumentation of changes in the prescriptions Resolving any discrepancies that may exist between the Resolving any discrepancies that may exist between the

medication history list and prescribed medicines before an adverse medication history list and prescribed medicines before an adverse drug event (ADE) can occurdrug event (ADE) can occur

Note: ADEs can result from omitted drugs or dosesNote: ADEs can result from omitted drugs or doses This is done at admission, on transfer between levels of care, on This is done at admission, on transfer between levels of care, on

dischargedischarge

If we don’t reconcile medication?If we don’t reconcile medication?

Systematic review showed 30-70% for Systematic review showed 30-70% for unintentional variances between the medication unintentional variances between the medication patients are taking and their subsequent in-patients are taking and their subsequent in-patient prescriptionspatient prescriptions11

ExamplesExamples Omeprazole started in ITU for prevention of stress Omeprazole started in ITU for prevention of stress

ulceration. No GI Hx.ulceration. No GI Hx. Carried on for 3 yearsCarried on for 3 years

Admitted for surgery. PMH: RA, HTNAdmitted for surgery. PMH: RA, HTN GP history not usedGP history not used Not given regular meds for 6 daysNot given regular meds for 6 days

Prednisolone 5mg, Methotrerxate, Alendronic acid, ramipril, Prednisolone 5mg, Methotrerxate, Alendronic acid, ramipril, Bendroflumethiazide, Alendronic acid, Folic AcidBendroflumethiazide, Alendronic acid, Folic Acid

Painful joints, stiffness, Painful joints, stiffness, BPBP

1: Campbell etal. A systematic review of the effectiveness of interventions aimed at preventing medication error (medicines reconciliation) at hospital admission. University of Sheffield School of Health and Related Research. September 2007

If we don’t give the GP full details?If we don’t give the GP full details?

How will she know what we have done?How will she know what we have done? What we have stopped and whyWhat we have stopped and why What we have started and whyWhat we have started and why What they should look out for or monitor, Tx What they should look out for or monitor, Tx

goalsgoals Their records will not be up-to-dateTheir records will not be up-to-date Patients are confusedPatients are confused

Different lists from hospital and the GPDifferent lists from hospital and the GP Medication is stopped by GP as no idea Medication is stopped by GP as no idea

why startedwhy started There will be errors on the next admissionThere will be errors on the next admission

Minimum information to be supplied at Minimum information to be supplied at dischargedischarge

Complete and accurate patient details (full name, date of birth, Complete and accurate patient details (full name, date of birth, weight if under 16 years, NHS number, consultant, ward weight if under 16 years, NHS number, consultant, ward discharged from, date of admission, date of discharge)discharged from, date of admission, date of discharge)

The diagnosis of the presenting condition plus co-morbiditiesThe diagnosis of the presenting condition plus co-morbidities Procedures carried outProcedures carried out A list of all the medicines prescribed for the patient on discharge A list of all the medicines prescribed for the patient on discharge

(and not just those dispensed at the time of discharge which are (and not just those dispensed at the time of discharge which are in addition to the regular medication)in addition to the regular medication)

Dose, frequency, formulation and route of all the medicines Dose, frequency, formulation and route of all the medicines listedlisted

Medicines stopped and started, with reasonsMedicines stopped and started, with reasons Lengths of courses where appropriate (e.g. antibiotics, Lengths of courses where appropriate (e.g. antibiotics,

clopidogrel)clopidogrel) Details of variable dosage regimens (e.g. oral corticosteroids, Details of variable dosage regimens (e.g. oral corticosteroids,

warfarin etc)warfarin etc) Known allergies, hypersensitivities and previous drug Known allergies, hypersensitivities and previous drug

interactionsinteractions Any additional patient information provided such as Any additional patient information provided such as

corticosteroid record cards, anticoagulant books etc.corticosteroid record cards, anticoagulant books etc.Further inflromation available at url:Further inflromation available at url:<<http://npci.org.uk/medicines_management/safety/reconcil/process_tools/pt_data_reconciliation.php>>

Safer PrescribingSafer Prescribing Know your patientsKnow your patients Know your medicinesKnow your medicines

Use a limited number if possible to aid familarisation – Use a limited number if possible to aid familarisation – Prescribing FormulariesPrescribing Formularies

Use your resourcesUse your resources PeersPeers PharmacistsPharmacists Specialists (medical & non-medical)Specialists (medical & non-medical) Guidelines and decision support helpGuidelines and decision support help National helpNational help

National Patient safety Agency – Alerts and reportsNational Patient safety Agency – Alerts and reports MHRA – Monthly newsletter for prescribing and adverse MHRA – Monthly newsletter for prescribing and adverse

reactionsreactions Sign-up for this on websiteSign-up for this on website

Alert 20:Promoting Safer Practice Alert 20:Promoting Safer Practice With Injectable MedicinesWith Injectable Medicines

NPSA receives 800 NPSA receives 800 incident reports a incident reports a month concerning month concerning injectable injectable medicines.medicines.

24% of all 24% of all medication medication incident reports.incident reports.

58% of incident 58% of incident reports leading to reports leading to death and severe death and severe harm.harm.

Decision-making with pharmacological Decision-making with pharmacological therapy: therapy: ENCoREENCoRE

EExplorexplore identify patientidentify patient nature of symptomsnature of symptoms other medicines or other medicines or

treatmenttreatment allergies and ADRsallergies and ADRs adherence to adherence to

treatmenttreatment exclude serious exclude serious

diseasedisease NNo medication optiono medication option

unnecessaryunnecessary contra-indicatedcontra-indicated

CCare are ooverver older peopleolder people childrenchildren pregnancy/lactationpregnancy/lactation

RReferefer potentially serious potentially serious

problemsproblems persistent persistent

symptomssymptoms EExplainxplain

suggested course of suggested course of actionaction

Pharmacy helpPharmacy help View charts daily Check doses, calculations etc Check interactions Check appropriateness Provide advice and information Help with prudent antibiotic use Medication reviews for patients On admissions units

Take medication histories Help with reconciliation

Medicines Information Dept.Medicines Information Dept. All hospitals have access All hospitals have access

to one - phone/bleepto one - phone/bleep Any medicines-related Any medicines-related

enquiry egenquiry eg Treatment optionsTreatment options Drugs in pregnancyDrugs in pregnancy Evidence collection and Evidence collection and

collationcollation There to help you There to help you

prescribe safelyprescribe safely

Prescribing guidelines and Prescribing guidelines and resourcesresources Developed to standardise treatmentDeveloped to standardise treatment

Especially: If evidence is conflicting / high risk / Especially: If evidence is conflicting / high risk / high costhigh cost

Evidence based use of medicinesEvidence based use of medicines Find out what is available in your TrustFind out what is available in your Trust Usually intranet-basedUsually intranet-based

BNF / Medusa intravenous drugs guideBNF / Medusa intravenous drugs guide PoliciesPolicies

Medicines codes or policiesMedicines codes or policies MUST read and followMUST read and follow

Intranet-based BNF – Localised with Formulary/Local textIntranet-based BNF – Localised with Formulary/Local text

Intranet IV administration Guide “Medusa”Intranet IV administration Guide “Medusa”

Management of Acute Hyperkalaemia in Adults

GuidePointPage 46 of 11

INFO PRINTING OPTIONS

PAGE ALLQUITSTART BACK

clinical features of acute hyperkalaemia

ECG signsif present treat urgently

• tall, peaked T-waves, followed by flattening of P-wave, prolongation of PR interval, QRS widening, and development of S-wave,

• arrhythmias (bradycardia, VT, VF)

• deterioration to asystole at a serum potassium around 7mmol/L or more

other signs and symptoms (1)

usually asymptomatic but can include;

potential precipitant causes

i

initial management

i

hyperkalaemia is defined as a serum potassium greater than 5.2 mmol/L

• tingling • flaccid paralysis• paraesthesia • muscle weakness

Prescribing QuizPrescribing Quiz

Teams of 4/5 Teams of 4/5 peoplepeople

If need additional If need additional information write information write ‘‘need info on . . .’need info on . . .’

Question 1Question 1

A frail 80 year old lady is admitted with falls, a chest infection A frail 80 year old lady is admitted with falls, a chest infection and feeling sick. and feeling sick.

PMHPMH AF and Hypertension AF and Hypertension DHx DHx Bendroflumethazide 5mg dailyBendroflumethazide 5mg daily

Atenolol 50mg dailyAtenolol 50mg dailyRamipril 1.25mg dailyRamipril 1.25mg dailyAspirin 75mg dailyAspirin 75mg dailyWarfarin 3mg dailyWarfarin 3mg dailyDigoxin 250 micrograms dailyDigoxin 250 micrograms daily

O/AO/A Benzylpenicillin IV 2.4g qds and Benzylpenicillin IV 2.4g qds and Ciprofloxacin po 400mg bdCiprofloxacin po 400mg bd

List 5 potential problems or issues with this prescription….List 5 potential problems or issues with this prescription….

Question 2Question 2

Drug chart =Drug chart =

Benzylpenicillin 2.4G IV qdsBenzylpenicillin 2.4G IV qdsCiprofloxacin 750mg bdCiprofloxacin 750mg bd

After 2 days therapy the patient can be After 2 days therapy the patient can be discharged – write the take home discharged – write the take home prescriptionprescription

(TTO – (TTO – TTo o TTake ake HHome)ome)(TTA – (TTA – TTo o TTake ake AAway) way)

Question 3Question 3

A patient is admitted on-call via GP cover A patient is admitted on-call via GP cover service. The admissions letter states the service. The admissions letter states the medicines as:medicines as:

ISMN 60mg / dayISMN 60mg / dayNifedipine 30mg /dayNifedipine 30mg /dayAtorvastatin 30mg / dayAtorvastatin 30mg / day

Fill in the ‘in-patient’ drug chart for this patientFill in the ‘in-patient’ drug chart for this patient

Question 4Question 4

2001 NHS goal – By how much did 2001 NHS goal – By how much did the number of serious errors in the the number of serious errors in the use of prescribed medicines need use of prescribed medicines need to reduced by 2005?to reduced by 2005?

Question 5Question 5

Give the generic names of the Give the generic names of the followingfollowing

ZocorZocor TegretolTegretol IstinIstin LosecLosec

Question 6Question 6

A patient is going home and needs the A patient is going home and needs the

following:following:

MST 40mg bd for 14 daysMST 40mg bd for 14 days

Please write the prescription (excluding Please write the prescription (excluding

name and address)name and address)

Question 7Question 7

A patient needs Vancomycin 500mg A patient needs Vancomycin 500mg bd IVbd IV

Write up in patient drug chartWrite up in patient drug chart

Question 8Question 8

Patient is due to go home and has the Patient is due to go home and has the

following on in patient Rx:following on in patient Rx:

Amiodarone 200mg tds (started 4 days ago)Amiodarone 200mg tds (started 4 days ago)

Simvastatin 10mg onSimvastatin 10mg on

Furosemide 40mg bd (for post-op peripheral Furosemide 40mg bd (for post-op peripheral

oedema)oedema)

Zopiclone 7.5mg on (started in hospital)Zopiclone 7.5mg on (started in hospital)

Write patients TTO for 1 mthWrite patients TTO for 1 mth

Answer: Question 1Answer: Question 1

Bendroflumethazide 5mg dailyBendroflumethazide 5mg daily Dose for HTN is 2.5mgDose for HTN is 2.5mg

Atenolol 50mg dailyAtenolol 50mg daily ? cause of falls? cause of falls

Ramipril 1.25mg dailyRamipril 1.25mg daily Seems low, has this been dose-Seems low, has this been dose-titrated?titrated?

Aspirin 75mg dailyAspirin 75mg daily Aspirin and warfarin interactionAspirin and warfarin interaction

Warfarin 3mg dailyWarfarin 3mg daily Warfarin and antibiotic interactionsWarfarin and antibiotic interactions

Digoxin 250 micrograms dailyDigoxin 250 micrograms daily Dose ? high as elderly – check Dose ? high as elderly – check levelslevels

Benzylpenicillin IV 2.4G qds Benzylpenicillin IV 2.4G qds

Ciprofloxacin po 400mg bdCiprofloxacin po 400mg bd = IV dose, oral dose is 750mg bd= IV dose, oral dose is 750mg bd1 mark per green answer

Answer: Question 2Answer: Question 2

Change IV to oralChange IV to oral

Amoxycillin 500mg tds for 5 daysAmoxycillin 500mg tds for 5 days Ciprofloxacin 750mg bd for 5 daysCiprofloxacin 750mg bd for 5 days

-1 if unsigned-1 if unsigned 1 marks each1 marks each

Answer: Question 3Answer: Question 3

Isosorbide mononitrate MR 60mg Isosorbide mononitrate MR 60mg prescribed at 8amprescribed at 8am

Nifedipine 30mg MR prescribed dailyNifedipine 30mg MR prescribed daily Atorvastatin 30mg prescribed at nightAtorvastatin 30mg prescribed at night

But an unlikely dose as generally 10mg, 20mg But an unlikely dose as generally 10mg, 20mg or 40mg (No 30mg tablet) - Checkor 40mg (No 30mg tablet) - Check

1 mark each1 mark each -1 if no signature included-1 if no signature included -1 mark if no routes included-1 mark if no routes included

Answer: Question 4Answer: Question 4

40%40%

Answer: Question 5Answer: Question 5

ZocorZocor simvastatinsimvastatin Tegretol Tegretol carbamazepinecarbamazepine Istin Istin amlodipineamlodipine Losec Losec omeprazoleomeprazole

Answer: Question 6Answer: Question 6

MorphineMorphine (Sulphate) (Sulphate) MRMR (SR) (SR) 40mg40mg BDBD (for 14 days) (for 14 days)

28 (twenty eight) 30mg MR tablets 28 (twenty eight) 30mg MR tablets 28 (twenty eight) 10mg MR tablets28 (twenty eight) 10mg MR tablets

(1120mg – one thousand, one hundred (1120mg – one thousand, one hundred and twenty milligrams)and twenty milligrams)

Sign, date and print nameSign, date and print name

Answer: Question 7Answer: Question 7

Drug 

Vancomycin

8 x

Dose 

500mg

Route 

IV

Start Date 

 

6.1.9

Stop Date

Review10.1.9

12  

Signature 

Squiggle

Pharm 18 x

Additional instructions 

In 100mls Sodium chloride 0.9% over 60 minutes via peripheral line

24  

Answer: Question 8Answer: Question 8

Amiodarone 200mg tds for 4 days then Amiodarone 200mg tds for 4 days then bd for 7 days then dailybd for 7 days then daily

Simvastatin 10mg onSimvastatin 10mg on Frusemide 40mg bd for a set timeFrusemide 40mg bd for a set time

Add a note to the GP for reviewAdd a note to the GP for review- will accept a dose change eg 40mg omwill accept a dose change eg 40mg om- No zopiclone should be required as No zopiclone should be required as

started in hospitalstarted in hospital

Summary: Safe prescribingSummary: Safe prescribing

Clear and unambiguousClear and unambiguous Use approved namesUse approved names No abbreviations eg ISMNNo abbreviations eg ISMN Unless G or mg then write units in full Unless G or mg then write units in full

(micrograms or nanograms)(micrograms or nanograms) Avoid decimal points – if needed then make Avoid decimal points – if needed then make

very clear: .5ml very clear: .5ml XX 0.5ml 0.5ml Avoid a trailing zero:Avoid a trailing zero: 1.0mg 1.0mg X X 1mg 1mg Avoid fractions: 0.5mg Avoid fractions: 0.5mg XX 500 micrograms 500 micrograms

Rewrite charts regularlyRewrite charts regularly If amend prescription re-write or sign and If amend prescription re-write or sign and

date amendmentdate amendment For frequency use standard abbreviations For frequency use standard abbreviations

eg od / bd / tds etceg od / bd / tds etc If using a dose by weight calculate the If using a dose by weight calculate the

dose needed (NOT 1.5mg/kg)dose needed (NOT 1.5mg/kg) Take time (e.g. to read patient Take time (e.g. to read patient

information)information) Use your resourcesUse your resources

When in doubt - ASKWhen in doubt - ASK