Management of Patient Medication and Drug Stock Ordering for Magnolia Neuro-Rehabilitation In-Patient Unit Standard Operating Procedure

Transcription

1 Management of Patient Medication and Drug Stock Ordering for Magnolia Neuro-Rehabilitation In-Patient Unit Standard Operating Procedure DOCUMENT CONTROL: Version: 1 Ratified by: Clinical Quality and Standards Group Date ratified: 4 August 2015 Name of originator/author: Pharmacy Technician Name of responsible Medicines Management Committee committee/individual: Date issued: 18 August 2015 Review date: August 2018 Target Audience Registered General Nurses/ Pharmacy Technicians

2 1. AIM To provide sufficient medication to treat patients who are receiving care during their stay on Magnolia ward. To reduce excessive ordering of both stock and patient s own drugs, minimising the risk of medication errors and keeping drug expenditure to a minimum. The SOP also needs to be considered when discharging patients from the service. Standards, Audit and documentation tools NEW PROCEDURE OVERVIEW: EFFECTIVE FROM 1 ST FEBRUARY 2015 As from 1 st February 2015, the provision of medication to the DCIS ward(s) will change. Lloyds Pharmacy of Thorne Road, off Kings Rd, Doncaster will be supplying ALL stock; non-stock, CDA requisitions and TTOs. (Please see contact details on page 5 of this SOP). There will be a Lloyds stock list of drugs which are topped up weekly by the pharmacy technician There will be NO faxing treatment sheets for non-stock requests there will be a Lloyds pad to order non stocked items generically without the need to fax treatment sheets for a clinical check. This allows multiple in-patient use on the ward. This pad can also be used to order any URGENT stock item (if running out before technician weekly top-up). Just need to write stock item on the request There will be a Lloyds specific prescription pad (which replaces the DRI - TTO prescription pads) used by the prescriber to supply take home, labelled medication including any level 2 and 3 patients who self-administer medication. (The only exception to this is when prescriptions for community pharmacies are required e.g. FP10s for Nomad via Weldricks, McGills, Boots etc.) The CDA requisition book for ordering stock controlled drugs will continue to be used BUT please note this MUST be signed by a doctor before sending to Lloyds for dispensing. Lloyds driver will be making twice daily calls Monday to Friday to the ward(s) to either drop off dispensed medications, stock orders etc or to ask if there are any requests for transporting to pharmacy (e.g. CDA stock requisitions) The RDaSH pharmacy technician will conduct a weekly top-up of stock/non stock according to in-patient requirements, NOTE the pharmacy technician will annotate each prescribed item on the drug card with either S for stock items), or NS for nonstock items. Stock and generic (unlabelled) non-stock medication is kept in the drug cupboard for generic patient use.

3 It is the registered nurses responsibility to check the drug trolley and replenish from the stock cupboard for patients who are nurseadministered medication (Level 1), recording any shortage of stock items on the white board, ready for the technician to pick up on Monday if not urgently required. **A current stock list will be attached to the drug stock cupboard to allow ward staff to identify medication which is a stock item to annotate the request accordingly. Newly prescribed items can be ordered generically for In-Patient use for level 1 nurse-administered patient s (no patient-specific label) via Lloyds by completing a Non-stock/Interim stock order form from the Lloyds pad and fax to Lloyd s pharmacy. No need to fax treatment sheet copy. However if the new item is for self-administration levels 2 or 3 it will must be ordered on a Lloyds TTO (ward prescription pad) and signed by the doctor (as full dose and directions required). Any medication orders to be noted in the comments box on the treatment sheets. TTO requests for discharge/overnight leave medication ordering (for both nurse administered and self-administered medication) use Lloyds TTO (ward prescription forms from the pad), fax to Lloyds pharmacy and file top copy in pharmacy filing drawer for Lloyds driver collection. Yellow copy to be retained and used to acknowledge supply receipt. Yellow copy to be filed in careplan. On receipt, patient-labelled medication will be checked against the treatment sheet by one RGN and stored in the patient TTO drawer in the treatment room. Note: two RGNs will check at the point of handing out for leave. NOTE EACH DAY THE PATIENT IS ABSENT FROM THE WARD, THE TREATMENT SHEET SHOULD BE ANNOTATEDE WITH A FOR ABSENT AT EACH DOSE ADMINISTRATION TIME. Leave medication should firstly be accessed from the patient s own self-administering (level 2 and 3) stock (either in bedside locker or in TTO drawer in treatment room) prior to ordering unless there is specific need to restrict volume e.g. over administration risk, confusion. Leave medications should only be ordered as an additional when there is insufficient patient s own medication to cover the period of leave, or when a risk management strategy is identified. The rationale for this should be clearly documented by the decision maker in the patient record. 2. SCOPE The contents of this procedure are applicable to all staff on Magnolia ward who are involved in ordering stock and medicines management. Page 3 of 8

4 3. LINK TO OVERARCHING POLICY AND/OR PROCEDURE This SOP links to the Safe and Secure Handling of Medicines Policy 4. PROCEDURE How to place a weekly stock order of medication for nurse administered Level 1 patients) from Lloyds Pharmacy RDaSH Pharmacy Technician Ward to ensure any blue Lloyds medication boxes are available for the driver to collect daily (Monday to Friday) Pharmacy technician to check ward stock cupboard Monday and order stock and non-stock items as required, up to the agreed maximum level (10 days maximum).note if the needs of the patient(s) for the week ahead, exceed the pre agreed quantities on the stock list, the technician will increase accordingly just for that week. 1) Pharmacy technician will fax the completed pharmacy stock order Monday, ready for Tuesday delivery by Lloyds pharmacy driver. A copy of the most current order will be filed in the pharmacy filing drawer green wallet (for Lloyds driver to take back to branch). NOTE: Registered nurses should rarely need to order the above stock. 2) The top copy of the faxed non-stock order is to be stored in the green wallet in the pharmacy file for the Lloyds driver the bottom (blue) copy should be retained in the non-stock pad and used as reference for recent orders to avoid duplication. Note: Registered nurses to order only if stock is insufficient to meet the needs of the patient. 1) Registered nurse(s) to check the drugs trolley Wednesday night duty and ensure it contains enough medication for patients needs (both stock/ non-stock stock items) prior to the weekend. 2) If stock/ generic non-stock is available in the drug cupboard, top up the trolley. If there is insufficient stock/generic non-stock until the technician visit Monday, order from Lloyds pharmacy (on the non-stock pad and circle either non-stock item or write Stock item in the comments box as appropriate) the minimum amount necessary. Record the order in the comments box on the treatment sheet. 3) Place the faxed request in the green wallet in the pharmacy filing drawer for the Lloyds driver to collect. REMINDER Medication can be identified as S for stock items and NS for non-stock items - there is no need to fax drug cards from now on. Just use the Non-stock / Interim Stock order forms How to order ward top up of newly prescribed non-stock item for patients who are administered medication by registered nurses (level 1) Page 4 of 8

5 Order as above on the non-stock/interim stock pad. No need to fax drug treatment sheets to Lloyds. Circle Non-Stock on the form How to order ward top up for patients who are assessed as safe to Self- Administer medication Pharmacy technician / registered nurse (Levels 2 and 3) For the purpose of ordering medication, stock monitoring for these patients remains the responsibility of the registered nurse and pharmacy technician at levels 2 and 3, although it is recognised that those patient s at Level 2 and 3 will need to carry out stock checks and request medications a week prior to completing their stock in order to simulate self-management and ordering in the home setting, this is an essential part of their discharge planning. At Level 1 the nurse / technician are solely responsible for this act but will use the opportunity to educate and support the patient in preparation for taking on this element of the role. For all patients who self-administer (Level 2 and 3) the pharmacy technician will visit these patients Monday s to check the medication in the bedside locker. If there is insufficient (named patient) supply (7 days or less) the pharmacy technician will request a TTO prescription to be issued by the ward doctor, and arrange for this to be faxed to Lloyds pharmacy. Note - 14 days supply is the maximum that must be ordered at any one time Again, the order should be recorded in the comments box on the treatment sheet. The TTO top copy after faxing should be filed in the green wallet in the pharmacy filing drawer for Lloyd s collection, and the yellow copy retained on the pad. 1) On delivery, a registered nurse must check medication and labels against the treatment sheet and place in the patient s drug locker for self-administering. Any delivery paperwork (for generic stock orders) must be filed in the pharmacy receipt folder stored in the treatment room. How to order for patients pending discharge or going on leave registered nurses 1) BEFORE ORDERING check the Patients TTO drawers in the treatment room (or bedside locker if self-administering) to identify current, appropriately labelled medication which can be used for leave. 2) If insufficient medication for leave, ask the doctor to complete a Lloyds TTO prescription for all discharge / leave medication required. Note - MAXIMUM of 7 DAYS to be ordered (unless identified as having additional needs). See SOP for discharge. Then fax to Lloyds pharmacy. 3) If ordered, on receipt, one registered nurse to check the supply and then place it in the patient-specific treatment room TTO drawer labelled PENDING DISCHARGE / LEAVE medication. Two Page 5 of 8

6 registered nurses to check the medication at the point of patient s leave from the ward. 4) REMINDER while patient is absent from the ward ANNOTATE EACH MEDICATION DOSE WITH AN A IF PATIENT ABSENT. 5) If the discharge is postponed, cancelled or if the medication is changed and the stock no longer required, isolate in the patientspecific TTO drawer with a note for the pharmacy technician stating the reason no longer required and keep locked until the pharmacy technician next visits.. Make a note on the treatment room white board for the technician to dispose or absorb into stock if appropriate. NOTE: To recap, ALWAYS check the treatment room drug cupboards for medication before placing an order Stock and (generic) non- stock supplies will be in the stock cupboard without patient names. Identified on treatment cards as S or NS -used to replenish drug trolley. At no point should any medications be located on the treatment room side all medications should be stored in the appropriate location at all times. Patient named supplies (level 2 and 3 self-administering) for patient locker top-up will be checked on delivery by one registered nurse and placed in the bedside locker. All named patient supplies pending discharge or on leave will be stored in the named patient drawers in the treatment room and clearly labelled PENDING DISCHARGE/ LEAVE. These medication deliveries will be checked on receipt from pharmacy for accuracy by one RGN for generic ward stock top up and two RGNs for discharge / leave medication prior to giving to patient or patient carer as per SOP for Discharge from Magnolia. Any obsolete medication (i.e. medication formulation or dose change, patient discharged and medication not required) to be isolated with clear information for removal, ready to be either, absorbed into stock if appropriate or where necessary disposed of in the pharmaceutical waste bin stored in the treatment room and replenished when full by contacting the Trust porters (via Daniel Bailey Head of Logistics. Drugs for disposal should be placed in the specific drawer in the treatment room Page 6 of 8

7 Alternatively unused medication assessed as unused and fit for use may be transferred to an alternative RDaSH Trust ward or returned to Lloyds pharmacy (when assessed by pharmacy team) by using the Transfer of Medication book only by the Pharmacy technician or Pharmacist Lloyds Pharmacy contact details / Service Level Agreement Main Lloyds pharmacy Monday to Friday 9:00 to 17:00 Telephone (fax: ) DELIVERY TO THE WARD(S) WEEKDAYS TWICE DAILY (A.M & P.M.) Out of Hours Lloyds branch Monday to Friday 17:00 to 23:00 Saturdays 9:00 to 23:00 Sundays 10:00 to 20:00 Telephone NOTE if out of hour s service required fax request to followed by telephone call to out of hours (730519) to inform them of the fax sent. NO EVENING OR WEEKEND DELIVERY WARD WILL HAVE TO MAKE ARRANGEMENTS FOR DELIVERY IF URGENT SAME DAY REQUIRED A.M. or P.M. delivery to the wards during core hours will depend on when the prescription requests are faxed to Lloyd s main pharmacy:- Faxed requests for P.M. delivery need faxing BEFORE 13:00 Faxed requests sent AFTER 13:00 will be delivered A.M NEXT WORKING DAY. If urgent requests are faxed after 17:00 hours, Lloyds out of Hours branch (730519) should be contacted to inform them of the dispensing urgency. Ward staff are responsible for arranging delivery of evening medication collection from this branch Weekly stock/non-stock order requests to be faxed to GLOSSARY OF TERMS STOCK ITEMS agreed list of medication used on the ward for patients who are nurse administered ( Level 1) NON-STOCK ITEMS ALL other medication items which are prescribed for nurse administered patients and will be delivered with a generic label with no dosing to allow use by more than one patient. NAMED PATIENT SUPPLY ordered on a TTO as require patient labels with full directions. This includes levels 2 and 3 self- Page 7 of 8

8 administering and all patients going off the ward on overnight leave or discharge GENERIC medication item which can be nurse-administered to one or a group of patients it is prescribed for and is not labelled for one particular patient. AFTER DISCHARGE OR OVERNIGHT LEAVE the treatment sheets MUST be documented with A and initialled by the RGNs to confirm absent from the ward and that no ward doses have been administered. Prepared by:.. Signature:.. Designation:.. Date:.. I have signed to say that I have read the procedure and understand its implications. Name:. Signature:. Date:... Page 8 of 8