Transcript ICU Prescription Sheet

ICU Prescription Sheet
Why?
• Do we need to change?
The hospital has changed to a system where prescription
and administration are on the same sheet (TPAR). This
allows omissions to be easily seen. It also means that the
administration and record cannot be separated and lost.
ICU has been instructed to adopt a similar system.
• Do we not use TPAR?
TPAR was extensively trialled in ICU and found to be
inadequate for our needs. So we have had to design a form
that suits our needs better than the TPAR. Any constructive
feedback would be welcome.
What?
• There is a system currently being used in
ICU, which is similar to TPAR, but so far
appears better adapted to our needs.
• The ultimate aim is to move to an electronic
system, which is currently being developed.
When?
• The trial of the document is continuing.
• Once we have the proofs back from the
printers, we would aim to make the final
changes and start using the system properly.
Hopefully in colour to make it easier to
differentiate between the different sections.
The new sheet
• Landscape booklet
• Coloured sections for ease of reference.
• More space for prescription than the current
Kardex.
So what will it look like?
Once only Prescriptions
Regular Prescriptions
•Regular oral/ NG/ NJ drugs
•Regular injections/infusions
As Required Prescriptions
•Any drug that is to be used on an as required basis
Continuous Infusions
•Continuous infusions
•Sedative agents (Propofol/Midazolam)
•Analgesics (Morphine/Alfentanil etc…)
•Inotropes and vasopressor infusions
(Dobutamine/noradrenaline etc)
•Epidural or peripheral nerve catheter infusions
General rules for Prescribers
• Write legibly. If those that are administering the
drug cannot read it, it won’t be given!
• Write the names of drugs in full and where
possible the generic name
• Use metric doses and standard abbreviations
miligram=mg
gram=g mililitre=ml
micrograms to be written in full ( not mcg or μg)
• Use standard abbreviations for routes as in the
next slide
Routes of administration
Intravenous=IV
Intramuscular=IM
Oral=O
Nasogastric=NG
Nasojejunal=NJ
via jejunostomy = JEJ
Inhalation=INH
Per rectum=PR
Per Vaginam=PV
Suiblingual=SL
Topical=TOP
Subcutaneous=SC
Prescribing
• The next few slides are designed to take you
through how to prescribe a drug on the new
chart.
• Each section will be covered in turn.
• There are instructions for all who use the
document on the rear cover. Any comments,
or errors / omissions that are noted will be
gladly listened to.
The front cover
• As well as once only
prescriptions the front cover
has several other important
sections that should be
carefully filled in.
• It is largely self explanatory.
• In particular the sheet
number, dates written and
discontinued are important
The front cover
• The allergies and
sensitivities section. If none
known then please put
NKA. The instructions will
be changed to reflect this.
• There will also be a box to
state whether more than one
chart is in use (hopefully a
rare event)
Regular Prescriptions
Paracetamol
Drug Name
– generic where possible
– in full
Regular Prescriptions
Paracetamol
IV
Drug Name
Route
– oral/NG/NJ/Jej/IV etc
Regular Prescriptions
Paracetamol
1g
IV
Drug Name
Route
Dose
– mg
– g
– micrograms
Regular Prescriptions
Paracetamol
1g
IV
Infusion
Drug Name
Route (oral/NG/NJ/Jej/IV etc)
Dose
Form
Infusion
Injection
Nebulised
Liquid
Tablet
Capsule
Regular Prescriptions
Paracetamol
1g
18/03/07
IV
Infusion
Bloggs
Drug Name
Route (oral/NG/NJ/Jej/IV etc)
Dose
Form
Start date and
signature
Regular Prescriptions
Paracetamol
1g
18/03/07
IV
Infusion
Bloggs
Drug Name
Route (oral/NG/NJ/Jej/IV etc)
Dose
Form
Additional instructions
e.g. with or after food
Times
Correct
Wrong
06.00
Insert Times:
12.00
•
•
•
18.00
24.00
24 hour clock
In order over 24 hours
Use ‘even’ hours i.e. 02.00, 04.00
NOT 13.00, 03.00 etc…
18.00
24.00
05.00
12.00
Regular Prescriptions
06.00
Paracetamol
1g
24.00
06.00
Infusion
12.00
18/03/07
18.00
IV
Bloggs
12.00
18.00
24.00
Drug Name
Route (oral/NG/NJ/Jej/IV etc)
Dose
Form
Additional instructions
Insert Times
24 hour clock
In order over 24 hours
ie 06.00, 12.00, 18.00 etc
Try and make the times
‘even’
hours i.e. 02.00, 14.00 etc
Stopping a drug
Drugs in all the sections should be stopped in this way
18 19 20
03 03 03
Paracetamol
IV 06.00
1g
Infusion
18/03/07
SN SN
12.00 SN SN
Bloggs
20/3/7 18.00 SN SN
MB 24.00 SN SN
Dated and
Initialled
Single diagonal
line through the
whole prescription
box
Double vertical line
through the remainder of
the day (or the next day if
not enough space).
Diagonal line
through the rest
of the
administration
record
As Required Prescriptions
Tramadol
IV
Inj
50mg
Drug Name, Dose, Route
and Form as per the
Regular section.
As Required Prescriptions
Tramadol
IV
Inj
50mg
4 hourly
•Drug Name, Dose,
Route and Form as per
the Regular section.
•Maximum frequency
that you wish to
prescribe the drug.
As Required Prescriptions
Tramadol
IV
Inj
18/03/07
50mg
4 hourly
Bloggs
For Pain.
Max 400mg in 24 hours
•Drug Name, Dose, Route
and Form as per the Regular
section.
•Maximum frequency that
you wish to prescribe the
drug.
•Date and sign the drug
•Indication for the drug
•The indication box could
also be used to state the
maximum dose of drug that
can be given in a period.
Continuous Infusions
Morphine Sulphate
For Pain
IV
• Drug, Route, and
Indication as for
previous sections.
Continuous Infusions
Morphine Sulphate
0-10
18/03/07
For Pain
Bloggs
IV
• Drug, Route, and Indication
as for previous sections.
• The dose may be stated as a
range
– mg per hour
– mls per hour for drugs of a
fixed (and stated) concentration
– micrograms per kilogram per
minute for inotropes and
vasopressors.
• For ease the units have been
pre printed. Cross out those
that are not required
Discontinuing a whole chart
0 1 0 1 3 2 0 0 1 1
SMITH
John
12/3/2007
1
12/3/2007
19/3/2007 MB
•Single clear line
through the front
cover, and across
each active page.
•Clearly date and
initial that it is
discontinued
•Write a new one
if required.
For those administering Drugs
• If it is illegible or unclear then discuss with
a senior or member of medical staff. Don’t
presume that you can guess correctly!
• Record everything as accurately as possible
• The instructions don’t cover every potential
problem or circumstance. Discuss any
problems – it may not be new.
Instructions for those
administering medicines
• The ‘Regular’ and ‘As Required’ medicines sections should be
checked at each administration round to ensure that inadvertent
omission or double dosing is avoided.
• Ensure entry is made on administration record each time drug is given.
Initial in relevant date column and time row.
• Check that all drugs prescribed at a certain time are administered.
• If a drug is not administered, enter the reason in the appropriate box
using the coding system. Then discuss with senior nursing or medical
staff as to why it cannot be given.
CODES FOR THE NON-ADMINISTRATION
OF PRESCRIBED MEDICINES
• If a dose is not
administered, initial and
enter the appropriate code
in the box with a circle
drawn round it.
• Then discuss with senior
nursing or medical staff as
to why it cannot be given
1. Patient refused
2. Patient away for
investigation or
procedure
3. Medicine out of
stock
4. Nil by mouth.
5. Once only
medication given
6. Dose withheld
Prescriber’s
instructions
7.
Nausea/vomiting
8. Unable to
swallow
9. No intravenous
access
10. Other
……………………
.……..
11. Other
……………………
.……..
12. Other
……………………
.……..
General Comments:
Questions?
• If you have any questions or comments then
please contact:
Ian Mellor
Diane Campbell
or
Debbie Corner