Medication Management
1)What are the categories of medication used in Hospitals?
Tablets; Injection; Inhalants; suppositories; IV fluids; Ointments; Drops; Suspension; Syrup; Blood; Oxygen.
2)What are the seven rights of medication?
Right patient
Right drug
Right dose
Right frequency
Right route
Right documentation
Right reason/Drop
3)What are the colour codings applied in medication to prevent errors?
Look Alike drugs - Red
Sound Alike drugs –Blue
High risk medication – Orange
Narcotics - Green
4)What do you mean by LASA Drugs?
LA- Look Alike drugs- some drug strips/boxes look similar to another drugs
SA-Sound Alike drugs- some drug name sounds similar to another drugs
5)What are the common Look Alike drugs in our hospital?
DRUG NAME LOOK ALIKE DRUG NAME
TAB.DERIPHYLLIN TAB.DEXAMETHSONE
INJ.FRUSEMIDE INJ.METACHLOPROMIDE
TAB.GLIPIZIDE TAB.DOMPERIDONE
TAB.METFORMIN TAB.PARACETAMOL
TAB.CARBAMAZIPINE TAB.IBUPRUFEN
INJ.CLOXACILLIN INJ.AMPICILLIN
INJ.PHENERAMINE INJ.RANITIDINE
6)What are the common sound Alike drugs in our hospital?
DRUG NAME SOUND ALIKE DRUG NAME
TAB.ALBENDAZOLE TAB.METRONIDAZOLE
TAB.FRUSEMIDE TAB.GLIBENCLAMIDE
TAB.METFORMIN TAB.METRONIDAZOLE
TAB.SALBUTAMOL TAB.PARACETAMOL
CAP.AMOXICILLIN CAP.DOXYCYCLINE
INJ.CLOXACILLIN INJ.AMPICILLIN
INJ DOPAMINE INJ.DOBUTAMINE
7)How will you arrange LASA drugs?
Colour coding differentiation applied in store—Pharmacy—Drug storage cupboard—Drug trolley
Drug verified at three point of usage(while taking from stock, while preparing drug, before administration of drug)
All LASA drugs will be stored in a zigzag manner.
General preventive measures for medication error will be applied.
8)What do you mean by High alert/High risk Medication?
Heightened risk of causing significant harm if it is used in error.
Has narrow therapeutic index
Small change in dosage/blood drug level leads to critical events.
9)What are the High alert medication used in hospital?
APINCH(pneumonic)
Adrenergic agonist(Adrenaline,Atropine)
Potassium & other electrolytes(Potassium Chloride,Sodiumbicarbonate,Calcium Carbonate)
Insulin
Narcotics & Sedatives
Chemo therapy/cardio acting drugs(Dopamine,Dobutamine)
Heparin & other Anti Coagulants (Heparin,Warfarin)
10)What do you mean by medication error?
A medication error is any preventable event that may cause or lead to inappropriate medication use or harm to a patient.
11)Common examples of medication error?
Low dose / High dose
Missed dose
Illegible order
Drug-drug interaction
Inadequate monitoring
Preparation error
Wrong Route/ Wrong time/ Wrong technique/ Wrong patient error
Omission error
12)Preventive measures of Medication error?
Double check while administering High alert drugs
Follow LASA Principles
Periodic Prescription audit & Follow TALL MAN Principle
Adherence to protocols.
Communication & Close monitoring of patients having High alert medications.
Ready with Antidote/Reversal agents
Limit verbal orders.
13)What is Recall policy?
Drugs with following some adverse events or Not satisfied with drug(like turbid in iv fluids) & Expired drugs will be send back to pharmacy with batch number.
Store pharmacist will receive all drugs from same batch number from all departments.
Same will be reported to TNMSC& Necessary action will be taken.
14)What is Narcotic policy?
Under Narcotic drugs and psychotropic substances Act.(NDPS Act) shall be as per the legal and regulatory norms of the government.
Separate stock registers shall be maintained and is subjected to routine expiry checks.
Narcotic and psychotropic drugs shall be stored in a Immovable double lock system and shall be handled by the chief pharmacist and Incharge MO (in store ) incharge staff & duty MO(ward) respectively.
Dispensed only on prescription where in the doctors name, signature and orders are available as the same is mandatory.
Dispensing of new drug shall be based on the receipt of the ampoules(Empty) of the drug dispense to store
In case any expiry of drugs discarding is witnessed with public person reported to the governing officials.
15)What is Verbal order policy?
In case of emergency situations/absence of specilised doctors Verbal order can be accepted from registered medical personnels.
The order should be followed.,
Authorised prescriber identifies self,specifies the patient name& communicates the order.
Read back policy to be followed:Repeats the order back to the authorized prescriber including the patient name,drug name,spelling of drug to avoid an error due to sound alike drugs,Dosage,pronouncing it in single digits(eg 25mg as two five ),route,frequency(eg.,three times daily not TID),requests indication to avaiod medication error.
Proper record containing date,time,authorized prescriber name,receiver name,status & signshould be done with available doctors.
Concerned authorized prescriber (orderd doctor) should complete the prescription in the casesheets within 24 hours.
Proper two way communication should be done by Medical personnels too
Same policy applied for critical values of diagnostic tests.
15)What is Reimbursement policy?
Our hospital don’t have Reimbursement policy
16)What will you do in case of ADE’s?
Incase of adverse drug reaction report to drug formulary committee with ADE forms.
Report store & follow recall policy if necessary(ADE reported in many cases with same drug)
17)Clinical symptoms presented in ADE’S?
Rash
Respiratory rate changes
Bradycardia or tachycardia
Mental status changes
Seizure
Diarrhea
Anaphylaxis
Fever
18)Buffer stock calculation?
Minimum order level:Average consumption * lead time(Routine indent )
Buffer stock=Maximum consumption – Averageconsuption * lead time(Additional drugs)
Reorder level=Minimum order level+Bufferstock(Reminder to indent)
19) Multidose vial policy (MDVP)?
Multidose vial including the specific conditions that warrant immediate disposal, use within a maximum of six hours, and the criteria allowing for an opened vial to be be kept and used for up to 28 days after opening.
Or maximum 10 pricks
Needle should not be left in the vial.
The opening of the vial should be wiped with spirit cotton before each & every use of the vial.
20) How will Oxygen cylinder Manintained in Wards?
Signage boards mentioning CAUTION, INFLAMABLE AREA, NO SMOKING must be displayed.
Full and empty cylinders are stored separately with clear signage board
Full cylinders are stocked in vertical position only.
Empty cylinders are stocked in Horizontal position only.
Regular maintenance of checklist for better emergency care.
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