Medicines Safety Laura Graham Clinical Pharmacist April 2019 - - PowerPoint PPT Presentation

Medicines Safety

Laura Graham Clinical Pharmacist April 2019

Medicines Safety

• Clinical Pharmacy Service
• Medicines Reconciliation
• “Alarm bell” Medications

Clinical Pharmacy Service

• Opening hours & on-call
• Cover assessment / critical care / surgical

/ medical / aseptic / psychiatry

• Medication review and patient triage
• Prescribing advice
• Discharge prescriptions

WE DO NOT DO MED REC

Medication review and triage

• Aim to review and triage patients as soon

as possible after admission

• Patients on high risk medications – we aim

to review daily

• Expect us to seek you out to discuss

treatment choices

• Look out for pharmacist/technician

comments in notes – often in green pen!

Pharmacy’s role in discharge prescriptions

• Clinical first stage – ward level M-F
• IDL screen / notes / medicine chart / PODs / patient
• Dispensing – pharmacy / ward / ward staff
• medicines gathered & labels on boxes
• Final accuracy check
• emailed to GP / community pharmacy and patient /

secretary copy printed

Electronic IDL & progress tracker

Med Rec - National targets

• SPSP target that within 24 hours of admission

≥ 95% of cases have:

 Demographics recorded  Allergy status recorded  2 sources (one the patient/carer if possible)  Plan (Continue / Withhold / Stop) for each

medicine documented (requires clinician input)

Med Rec Process

• Collect – use the most appropriate

sources given the patients circumstances

• eg. Print med rec report from ECS on

clinical portal

• Confirm – using patient/carer
• Communicate – document plan on med

rec proforma. If any issues document follow up in management plan

Printing the ECS is NOT medicine reconciliation!!

Med Rec sheet in admission docs

Copying a list

• f medicines
• nto this form

introduces errors! Use med rec report print out from clinical portal

Printing med rec report from Portal

Med Rec report from Portal

Our current performance

78% 22%

2019 - Med rec sheet used?

11% 6% 83%

2019 - Second source

Yes - patient/carer Yes - other No 54% 46%

2019 - Continue/ withhold/ disc

63% 37%

2019 - Was the med rec accurate?

“Alarm Bell” Medications

• Warfarin
• DOACs
• Insulins
• Methotrexate
• Colchicine
• Gentamicin / Vancomycin
• Clozapine
• Parkinson’s Disease meds
• Anti-epileptics

And finally...

• Pharmacy are here to help!