Critical Time Medication Procedure

Transcription

1 Ref:PharmMM74 Critical Time Medication Procedure INITIATED BY: APPROVED BY: DATE APPROVED: Suzanne Scott-Thomas, Amanda Halloway Endorsed by Medication Safety Committee Sept 2011 VERSION: 1.1 OPERATIONAL DATE: DATE FOR REVIEW: DISTRIBUTION: 3 years from date of approval or if any legislative or operational changes require FREEDOM OF INFORMATION STATUS: Open

2 Definition of a Procedure A procedure is a set of detailed step-by-step instructions that describe the appropriate method for carrying out tasks or activities to achieve a stated outcome to the highest standards possible and to ensure efficiency, consistency and safety. Minor Amendments If a minor change is required to the document, which does not require a full review please identify the change below and update the version number. Type of change Addition of drug name heparin Removal of levomepromazine Tigabine to Tiagabine Why change made Inclusion error Inclusion error Spelling error Page number Date of change Version 1 to 1.1 Name of responsible person Amanda Halloway Amanda Halloway Amanda Halloway i

3 CONTENTS Definition of a Procedure... i Minor Amendments... i 1. Purpose Principles Definition Responsibilities Procedure Prescribing Supply of Medication Non Conformance Training Equality Impact Assessment Statement References... 6 Appendix A CTM medication list...7 Appendix B - Drug class and indication in which the drug may be a critical time medication 9 ii

4 1. Purpose Omitted or delayed medicines are the second largest cause of medication incidents identified by the National Patient Safety Agency. Omitting or delaying the administration of medications for certain indications can have serious and even fatal consequences. The aim of this procedure is to highlight the groups of medication that, when used for certain indications, are deemed to be critical time medications and to ensure that systems are in place to prevent a critical time medication being delayed or omitted for patients while in hospital. This procedure is to comply with recommendations made by the NPSA Rapid Response Report February 2010 RRR009 Reducing harm from omitted and delayed medicines in hospital. This procedure does not include the administration of resuscitation medication included in the LHB resuscitation boxes. 2. Principles Identified critical time medications must not be delayed or omitted for certain indications unless there are appropriate clinical reasons for doing so. The medicine management processes and systems must be in place and complied with to support the above principle for patients in secondary care. 3. Definition A critical time medication is a medication that must be administered to a patient at the prescribed time or within two hours of the prescribed time. Many of these critical time medications may be needed with greater urgency, patients need should be assessed on an individual basis and appropriate action taken. e.g status epilepticus treatment is needed immediately. If you are unsure contact a Doctor, pharmacist or senior member of staff. Critical time medication where timeliness of administration is crucial are anti-infectives, anti-epileptics, anticoagulants, insulin and medicines for Parkinson s disease. A full list of medication names is included in Appendix A. There is other medication which when used in specific indications can be deemed Critical Time Medication, this is included in Appendix B for information. 3

5 4. Responsibilities In order for a critical time medication to be administered promptly:- - Prescribers must promptly prescribe and inform qualified nursing staff of any changes to a medicine chart (including when the medicine chart is completed upon admission). - Nursing staff must obtain and administer the medication promptly. - Pharmacy staff must supply or advise on where to locate the drug promptly. 5. Procedure 5.1 Prescribing Prescribers must prescribe any regular or new medication promptly so that the administration of critical time medication is not delayed or omitted. On admission a medicine reconciliation process must be done to ensure all appropriate regular medications are prescribed correctly. Similarly where there has been a transfer of care and on discharge, accurate medication details must be sent to the next responsible prescriber. Where medication is to be administered at a specific time this must be prescribed by documenting the actual time for administration in the specify time boxes. i.e. One off (stat) or new prescriptions of critical time medication must be brought to the attention of the nursing staff by the prescriber, in particular if they are required outside of the normal medication rounds. It is the responsibility of the prescriber to verbally inform nursing staff that they have prescribed new medication, to enable the medicine to be administered in a timely manner. 4

6 5.2 Supply of Medication Medication is supplied to the ward as per the medication supply procedure. Where medication is identified as critical time medication this should be written in the comments box of the in-patient medication administration chart by either the prescriber, pharmacist or nurse. It is unacceptable to delay or omit a critical time medication and every effort must be made to obtain a supply. To support this: Pharmacy will: Ensure all identified critical time medication is available either in their emergency drug cupboards in RGH and PCH or available to be supplied remotely via the automated pharmacy system. Ensure that all ward stock lists include the critical time medication identified for that ward speciality. Ensure that all identified critical time medication ordered is supplied as a priority in order to comply with the medication being administered within two hours of the prescribed time for administration. Where critical time medication is unable to be supplied i.e. unavailable from manufacturer or where there will be a significant delay in supplying i.e. out of hours, an alternative preparation or medication will be agreed in consultation with the prescriber. Nursing Staff will: Make every effort to obtain a supply, placing a non administration code 5 i.e. medication unavailable, on the medication chart for a critical time medication is unacceptable. If critical time medication is omitted for any reason, the reason must be clearly stated in the nursing notes and the Doctor caring for that patient must be informed promptly. Within normal pharmacy opening hours, the usual supply procedure will apply, however, nursing staff should highlight to pharmacy staff that a critical time medication is required. Pharmacy will respond accordingly. Outside of normal pharmacy hours, nursing staff must check that the medication hasn t already been supplied i.e is in stock cupboards, pharmacy delivery box, patients medication locker. Check whether the patient has their own supply which is available and appropriate to use. Check if the medication is available from another ward, please follow the transfer of medication between wards procedure. Contact the bed manager (PCH) or access the emergency drug cupboard directly (RGH) to locate the medication. 5

7 If the medication cannot be found then the emergency duty pharmacist can be contacted via the bed manager. 6. Non Conformance This procedure is subject to audit and non conformance will be reported to the LHB Medication Safety Committee and reported as medication incidents. 7. Training Training will be provided via the e learning package: medication prescribing and administration which will be completed on induction for all new clinical, nursing and pharmacy staff. Existing staff will be trained via cascade of information from line managers initiated by pharmacy staff and information on Sharepoint. 8. Equality Impact Assessment Statement Once the Procedure has been assessed each document should have one of the following statements: This Procedure has been subject to a full equality assessment and no impact has been identified. 9. References Reducing harm from omitted and delayed medicines in hospital. NPSA 2010/RRR009 Reducing harm from omitted and delayed medicines in hospital. A tool to support local implementation. UKMI

8 Appendix A Critical Time Medication Alphabetical list These are critical time medicines when used to treat the indications listed above. Resuscitation drugs are not included in the list as these will always be needed immediately. This list is not conclusive and should be used in conjunction with the BNF. (Antiretrovirals and insulins have not been listed individually). * = non-formulary contact prescriber or pharmacy for advice. aciclovir amantadine amikacin amoxicillin amphotericin anidulafungin antiretrovirals apomorphine bemiparin benzatropine benzylpenicillin bivalirudin bromocriptine cabergoline* carbamazepine caspofungin cefotaxime ceftazidime ceftriaxone cefuroxime chloramphenicol ciprofloxacin clarithromycin clindamycin clobazam clonazepam co-amoxiclav co-benaldopa co-careldopa co-trimoxazole dalteparin* danaparinoid* daptomycin diazepam doripenem* doxycycline enoxaparin entacapone ertapenem erythromycin eslicarbazepine ethosuxamide fluconazole flucloxacillin flucytosine fondaparinux gabapentin gentamicin heparin Imipenem cilastatin (Primaxin ) with insulin itraconazole lacosamide lamotrigine lepirudin* levetiracetam levofloxacin linezolid lorazepam meropenem metronidazole micafungin* midazolam moxifloxacin orphenadrine oxcarbazepine 7

9 paraldehyde pergolide phenobarbital/ phenobarbitone phenytoin piperacillin with tazobactam (Tazocin) pivmecillinam* posaconazole pramipexole pregabalin primidone procyclidine rasagiline rifampicin ropinirole rotigotine rufinamide selegiline sodium fusidate sodium valproate stalevo teicoplanin temocillin ticarcillin with tiagabine clavulanic acid (timentin ) tinzaparin* tolcapone* topiramate trihexyphenidyl tigecycline vancomycin vigabatrin voriconazole zonisamide 8

10 Appendix B Drug class and indication for which the drug may be deemed a critical time medication. The following are listed in categories as they appear in the BNF. Please use in conjunction with the BNF to identify individual drugs with a class. BNF chapter Drug class Indication when the drug will be a Critical Time Medication Emergency treatment of poisoning Antidotes Poisoning, overdose 1. Gastro-intestinal system Proton pump inhibitors massive GI bleed 2. Cardiovascular system Cardiac glycosides tachycardic patients, especially when the patient is cardiovascularly compromised 2.2 Diuretics pulmonary oedema 2.3 Anti-arrhythmics acute arrhythmias 2.4 Beta-adrenoreceptor blocking drugs treatment of acute arrhythmias, angina, hypertensive crisis, nstemi, STEMI, peri-operatively and thyrotoxicosis Vasodilator antihypertensive drugs hypertensive crisis Nitrates i.v. treatment of unstable angina and heart failure s.l. treatment of acute chest pain Calcium-channel blockers tachyarrhythmias and angina 9

11 2.7 Sympathomimetics All indications 2.8 Anticoagulants Treatment and thromboprophylaxis especially perioperatively 2.9 Antiplatelet drugs acute treatment of ACS, STEMI and ischaemic stroke Fibrinolytic drugs acute MI, acute ischaemic stroke, massive PE 2.11 Antifibrinolytic drugs and haemostatics Acute bleeding (Nb Blood products are obtained from haematology) 3. Respiratory system Bronchodilators beta 2 agonists acute asthma, exacerbation of COPD and premature labour Bronchodilators - antimuscarinics acute asthma, exacerbation of COPD Theophylline acute asthma 3.2 Symbicort acute asthma Antihistamines acute allergic reactions Pulmonary surfactant respiratory distress syndrome in neonates 4. Central nervous system Anxiolytics - benzodiazepines acute psychotic episodes, alcohol withdrawal and status epilepticus Antipsychotic drugs acute psychosis 4.6 Drugs used in nausea and vertigo acute vomiting and prophylaxis of vomiting in patients on chemotherapy 4.7 Analgesics pain 4.8 Antiepileptic drugs preventative and acute treatment of epilepsy (NB when used for other indications omission can lead to seizures in non-epileptic patients) 4.9 Drugs used in Parkinsonism and related disorders Parkinson s disease and oculogyric crisis 10

12 5. Infections 5.1 Antibacterial drugs acutely unwell patients with systemic infection First dose should be given as soon as possible 5.2 Antifungal drugs systemic infection 5.3 Antiviral drugs systemic infection and HIV/AIDs Antimalarials treatment of malaria 6. Endocrine system Insulins hyperkalaemia, diabetes mellitus (must need to be given at appropriate time with respect to meals) Treatment of hypoglycaemia Thyroid hormones severe hypothyroid states /coma Glucocorticoid therapy acute asthma, addisons, exacerbation of COPD peri-operatively and spinal cord compression 7. Obstetrics, gynaecology, and urinary tract disorders 8. Malignant disease and immunosuppression Prostaglandin and oxytocics treatment of postpartum haemorrhage, urgent induction and augmentation of labour Myometrial relaxants postponing premature labour Other neoplastic drugs leucoreduction Antiproliferative immunosuppressants prophylaxis of organ rejection Corticosteroids and other prophylaxis of organ rejection immunosuppressants 9. Nutrition and blood Parenteral preparations for fluid and urgent correction of fluid or electrolyte imbalance electrolyte imbalance Calcium Magnesium severe hypocalcaemia acute asthma, arrhythmias, prevention if seizures in pre-eclampsia and treatment and prevention of seizures in eclampsia Vitamin B group alcohol withdrawal with signs of Wernicke s encephalopathy Vitamin K treatment of haemorrhage or threatened haemorrhage 11

13 associated with high INR 10. Musculoskeletal and joint Non-steroidal anti-inflammatory pain diseases drugs Gout and cytotoxic-induced hyperuricaemia acute attacks of gout 10.3 Drugs for the relief of soft-tissue inflammation and topical pain relief extravasation 11. Eye 11.3 Anti-infective eye preparations severe infection 11.4 Corticosteriods and other antiinflammatory preparations severe inflammation 11.6 Treatment of glaucoma acetazolamide emergency reduction of intra-ocular pressure 14. Immunological products and 14.5 Immunoglobulins After exposure to certain infections in certain vaccines circumstances. Tetanus immunoglobulin is readily available, other immunoglobulins will need to be obtained from an outside source and so should be given as soon as possible Normal immunoglobulins Liase with prescriber to ascertain urgency in acute indications. 15. Anaesthesia Drugs for malignant hyperthermia 12