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PHAM1151

Medicines Management

(insert the module occurrence number here and year of study here e.g. MO1 2021-2022)

Summative Workbook Assessment

Max word count:

(+/- 10% 2000 for PHAM 1151 MSc students’ level 6)

Submission Deadline:

Word Count:

Course Leader: J C Sevenoaks

Cohort:

PTG Leader:   

The workbook assignment for PHAM 1151Level 6Medicines management module is in two parts:

Part 1: Completion of four summative questions linked to learning outcomes 1-4.Total word count for part 1 is 2000 words.

Part 2:  Completion of Essential Skills health numeracy assessment using the SafeMedicate platform with a grade of 30/30 (100%) linked to learning outcome 4. Completion of this SafeMedicate assessment needs to be evidenced as a screenshot inserted into the section marked Part 2,

Further information about this assessment will be given during the module and using the Moodle virtual learning environment and external platform of SafeMedicate.

Parts 1&2both need to achieve as a pass grade to pass the module. A grade will be assigned to the written part 1(pass mark being 40% for level 6 work). A potential word count per question has been allocated which are weighted respectively to the marks for each question. All questions need to be answered.

Part 1: Summative Workbook

Please use this template to complete your workbook.  Details of your patient are given below, and you will find the patient’s PSD/MAR chart in Appendix 1:

Patient scenario:

Prudence Okeke is 17-year-old who identifies as female.  She has been admitted to the Medical Unit (MU) where you are on placement. Her presenting complaint is a productive cough, shortness of breath and fever for the past 2 days which developed while she was recovering from insertion of pins for a compound fracture of her right radius, while an inpatient on the Surgical Unit.  Please not she is right-hand dominant.  She has tested Covid 19 negative.  Her primary diagnosis for this admission is Hospital Acquired Pneumonia. Sputum specimens have been sent for microscopy culture and sensitivity (MC&S) and the organism has been identified. 

Her past medical history is Diabetes Mellitus – type 1 which was diagnosed when she was 10 years of age. Her current medication for this is Novorapid 3 units subcutaneously via Novopen, 20 minutes before meals (or self-adjusted by carbohydrate coverage ratio adjustments). She also takes basal insulin Human Insulatard at 50 % of total daily insulin dose of 15 unit subcutaneously in the morning before breakfast. At last review her HbA1c was 46 mmol/mol. She has no other medical history of note.

She lives at home while studying for A Levels. She has 6 younger siblings and both parents do not speak English. She is a non-smoker, non-drinker and denies use of recreational drugs.

Use the provided patient history and the Patient Specific Directions (PSD) and Medicines Administration Record (MAR) (combined) to develop your answers.

Please answer all four questions in Part 1 (Q1-4). Your work must be supported with appropriate references and includes a reference list.

Part 1

Q 1: Supports Learning Outcome 1 & 2:

Understanding the whole system of medicines management including prescribing, transcribing, dispensing, storage, administering and monitoring of medicines in accordance with local and national policy.Recognise and critically reflect upon the nurse’s role in medication management and delegation to others, administering medication under direct supervision of a registrant in relation to legislation and national guidelines.

Q1:Provide a critical discussion of your future registrants’ role when identifying the legal requirements of a medication prescription prior to the administration of a drug.Support your discussion with national guidelines and policies. (Approximately350 words, 20 marks)

Certain regulations-based practices need to be followed by professionals before prescribing any drugs or administering any drug to avoid legal consequences. The Government of the UK has implemented the Medicine Act of 1968 to govern the marketing, licensing and dealing of medicinal products in the country. Professionals must also follow regulations under the Human medicine regulation 2012 (NICE, 2022). Further, while prescribing controlled drugs, the misuse of drugs act 2001 is applicable specifically 1 to 5 schedules of the act of 2001 is needed to be prioritised by professionals prescribing medications. These schedules signify that any drugs that are prohibited or contain opioid drugs and or have a high potentiality of abuse are needed to be strictly monitored and administered at doses that are safe per the patient’s health condition.

Minimum legal requirements as per Human Medicine regulation 2012 section 217 include 5 conditions that are needed to be followed. Condition A highlights that prescriptions are needed to be given by only licensed practitioners, and prescriptions are needed to be signed in ink by the practitioner. Condition B highlights that the prescription needs to be written in ink for both having and not having any controlled drug. Further, condition C highlights that the prescription is needed to have the address of the practitioner writing it and the date on which the prescription was written, and detail of the kind of practitioner giving it; further, as per condition C, name and address details of the patients and the age of the person if the person aged below 12 years is needed to be mentioned (Government of UK, 2022). Conduction D, as per this regulation, the prescription is needed to be dispensed at the end of six months and in case of repeatable prescription, it is needed to be dispensed within the period of treatment and needs to be dispensed according to the specification mentioned in the prescription. Conditions of E highlight that in case of repeatable prescription, it must not be dispensed more than twice and in case of prescription for oral contraceptive, it must not be dispensed more than six times. All dates mentioned in prescriptions are needed to be correct. As a future registrant, I will follow all these specifications while registering any prescription.

Q2: Supports Learning Outcome 3:  Develop a greater understanding and critically reflect upon factors which contribute to medication errors and how to deal with errors if they occur.)

Q2a: Critically describe, with reference to known evidence base and theory, the “human factors” which contribute to medication errors and strategies which might be employed to reduce the risk of a medication error occurring. Include discussion of learning from mistakes. (Word 325 level 6 max marks 10)

A medication error can occur during prescribing the medication while dispensing and administering the medication. Human factors associated with medication error can be explained by professional-led mistakes while dispensing or administering the medication. There are several reasons for this condition, including excessive stress due to poor shifting leading to errors in properly checking before dispensing,  poor communication between a team of professionals and missing information in patient’s prescription such as allergy details or high-risk medication. The potentiality of human factors leads to medication error increases in case of poor handwriting in prescriptions, leading to misinterpretation and missing information about dosage and complicated medication regimes (AMCOP, 2022). In case medications are transmitted orally, similar names can lead to confusion while the medication skeleton and dispensing. Rodziewicz et al. (2022) mentioned that poor monitoring or double checking on medication dispensed and not arranging medication properly leads to such consequences of medication error. Storage of date medication and not following maintaining a medication registrar and record lead of the medication error. Thus it became evident that there is a need for strict supervision and proper medication storage to rescue the scope of error.

Further, it also becomes necessary to ensure reduced stress over the service providers so that they don’t mix up medication as a result of numerous responsibilities to be solved at the same time. With the help of the theory of planned behaviour, predictive sequences can be followed to limit medication errors led by human factors. As stated by Dionisi et al. (2020), the intended behaviour is determined through the attribute associated with activities. Thus, it becomes necessary to increase professional knowledge of the error. On the other hand, attitude towards behaviour is influenced by knowledge of the consequences of the incident. Subjective norms, as power in this theory, are influenced by individuals’ beliefs regarding their attitude towards the incident. Thus based on the predictive norms while managing medication errors due to human factor error, it’s become necessary to focus on enhancing the basic knowledge of professionals regarding the importance of following the right guide and double checking before dispensing and administering the medications.

Q2b: Reviewing the attached combined PSD/MAR chart,please identify any medication error(s)which have occurred.  Critically evaluate and discuss any action that needs to be taken.(Word 325 level 6 max marks 10)

The first error from the chart is the application of infusion fluoride of 0.9%  NaCl with  10 moles of  KCl. There have been no details recorded regarding the time it has been given or not, whether it has been choked or noted, even though it has been prescribed or recommended by a professional. Thus it became evident that due to the complicated medication regime of different IV and oral medications, the services provider has avoided the infusion fluid being given through the IV route for at least 8 hours. Infusion fluids are necessary to ensure the hydration balance in the patient body to avoid the consequences of dehydration and poor medication impact due to lack of substrate. Another error noticed from the chart is no review data after the application of IV medication for pneumonia purposes, including Tazocin and Gentamicin. While ensuring patient-centred care to patients and patient safety, it becomes necessary for the service provider to update information as per the effect of the medications. However, the current PSD/MAR chart has missed such information. In case the nurse or care service provider responsible for administering medication is needed to be communicated to identify the reason behind such medication administration error. The infusion fluid has not been administered, which causes a great can threat to the patient life. Thus the professional is needed to be informed regarding the error already done, and trite monitoring of the activities of the professional is needed to be made. Such incidents can be easily avoided by ensuring a training session and proper discussion about medication, the requirement of each patient for avoiding confusion. The professionals in charge of medication management can be changed in the case, and other professionals skilled in managing complicated regimes can be assigned. The professional who has made a mistake is needed to go through training, and the authority is needed to check the root causes behind the error happened.

Q3 Supports Learning Outcome 4:Demonstrate skills and evidence-based knowledge to critically deliver safe administration and monitoring of medication via a range of delivery routes including essential health numeracy/calculation skills. With reference to the enclosed prescription chart, discuss the specific administration and monitoring considerations for this patient’s medication.

Q3: You are required to administer the following medication: Insulin Novorapid ^®. Critically evaluate reflect on your role and the process involved in preparing and selection of the write equipment for this medication. The stock insulin is NovoRapid ^®100 units/ml ampule it is indate. Your answer should include reference to risk management, legislation, and national guidelines. (Approximately400 words30 marks)

The patient is currently under dosage of insulin novorapid, and   I am responsible for administering the medication safely. Thus to ensure safe administration, my priority will be identifying the current dosage requirement, and the current dosage requirement is three units daily through Novopen  20 minutes before a meal. Currently, there 100 units of the respective insulin are in stock and within the expiry date; thus, considering the specification of the doses, I will dispense 3 units from 10 units stored just 20 minutes of the meal in Novopen and assist the patient to self-administer the medication. As per the 7 rights principles for the safe administration of medication, I will ensure following the prescription and double-check the pathway for the administration of medication. Next, I will focus on double checking the dosage requirement, and as directed, I will dispense it to ensure avoid any type of medication administration errors. As per the misuse of drugs act 1971 and drugs regulation 2001, I have to ensure that the right drug is administered at the right dose (Hoddereducation, 2022). As the patient is currently under treatment for pneumonia and she has other oral and IV medication going, there can be changes in the insulin dose as per the professionals’ decisions.   Apart from this insulin dosage, she is also under human-insulated medication. Thus it becomes necessary to monitor if any changes have been made by professionals considering dosages under treatment practice.

Further, as per the safe administration requirements of medications, I will ensure that all the details are recorded in the patient chat. During safe administration, I will cross-check the dose dispensed in Novopen with the assistance of other professionals. I will follow a safe disposal method after administering insulin; thus, after taking the required 3 units, I will return the rest insulin to the pharmacy.

Q4 supports Learning Outcome 4:Demonstrate skills and evidence-based knowledge to critically deliver safe administration and monitoring of medication via a range of delivery routes including essential health numeracy/calculation skills.

Q4 a) Regarding the intravenous fluids and IV medication prescribed, calculate the flow rate in mls per hour for the IV fluids to be delivered by a pump.  Show your formular and calculated answer in full (5 marks).

Currently, the patient is under IV medication of  Tazocin 4.5 gm diluted in 50 MLS 0.9% NaCl, and Gentamicin  385 mg diluted in 50 ml diluted in 0.9% NaCl. The formula for calculating flow rate in MLS  per hour is   “total volume/time * Drop factor”. The drop factor is generally considered to be  20.

Thus considering the formula, the flow rate of  Tazocin will be= 50*20/60= 16.66 gtts/min; thus, in one hour, it will be 16.66 gtts*60=999.6 gtts/hour.

Thus considering the formula flow rate of the Gentamicin will be the same, which is 999.6 gtts/hour, as both medications will be diluted in the 50 MLS 0.9% NaCl.

b) Critically evaluate and discuss the monitoring considerations for medications via this IV route.  Include reference to a range of relevant principles and guidance(Approximately 600 words 30 marks).

As IV medications can lead to serious complications if not administered as per the right dosage thus, it becomes necessary to cross-check the medication name and to avoid medication errors. It is needed to be checked that the medication disposed of is for IV purposes. It also becomes necessary to ensure that the medication is within its expiry dates to avoid any medication management error, as well as the patient needing to be observed after the application to identify any adverse condition. 7 rights principle of safe medication administration can be followed to ensure proper monitoring during medication administration through the IV route. These seven rights include the identification of the right patient, the identification of the right drug, the right dose and the right time.

Further, the rights per this principle also include identifying the right route, reason and documentation (Caringforcare, 2022). Thus based on these rights, it became evident that while administering any IV drug, it becomes necessary to cross-check the drug selected is right for the respective patient and that the dosage dispensed is according to the prescription. It is also necessary to ensure that the drug is administered at the right time.

Along with the administration of drug documentation, the details become necessary so that as per shift changes, no repetition-related medication management error occurs, as well as documentation of the symptoms of any changes in vitals is necessary to ensure patient safety. The monitoring requirement changes as per the age group of the patient, and the condition of the patient in case of children’s adverse impact of IV drug administration is higher than adults (Coté et al. 2019). Thus before administration of any drug via IV path, it becomes necessary to assess for allergy to medication which is not reported not known by the patient. If the result comes out clean, then only the IV medication can be applied, else the medication needs to be changed. Strict observation is needed to be maintained during and after the application of IV to immediately report any changes in health condition. As stated by Di Simone et al. (2018), while administering IV medication, certain factors lead to medication management errors, and these include noisy surroundings, answering assisting patients, answering phones, technical problems and missing information in patient charts. Thus for successful monitoring during drug administration via the IV route, it becomes necessary to ensure that all patient-related and medication-related details are present in the chart. Any changes in dose, as well as changes in medicines, needed to be mentioned, and the professional administering medication via the IV route needed to be focused on the process without being diverted by any patient communication or by phone calls. It becomes necessary to ensure a safe environment in case of any confusion, the professional take assistance from other professionals who are experienced in IV administration. Thus following the 7 rights and additional requirements is necessary to ensure the safe administration of IV medication.

Reference list:

AMCOP (2022) Medication Errors,https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/medication-errors

Caringforcare (2022) How to ensure your staff are administering medication safely,https://caringforcare.co.uk/ensure-staff-administering-medication-safely/

Coté, C. J., Wilson, S., American Academy of Pediatrics, & American Academy of Pediatric Dentistry. (2019). Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics, 143(6). doi.org/10.1542/peds.2019-1000

Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication errors in the emergency department: knowledge, attitude, behavior, and training needs of nurses. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(5), 346. DOI: 10.4103/ijccm.IJCCM_63_18

Dionisi, S., Di Simone, E., Franzoso, V., Caldarola, E., Cappadona, R., Di Muzio, F., … & Di Muzio, M. (2020). The application of the Theory of Planned Behaviour to prevent medication errors: a scoping review. Acta Bio Medica: Atenei Parmensis, 91(Suppl 6), 28. DOI: 10.23750/ABM.v91i6-S.9290

Government of UK (2022) The Human Medicines Regulations 2012,https://www.legislation.gov.uk/uksi/2012/1916/part/12/chapter/2/crossheading/prescription-only-medicines/made

Hodder education (2022) Administer medication to individuals and monitor the effects,https://www.hoddereducation.co.uk/media/Documents/City%20and%20Guilds/Unit-344-Administer-medication-to-individuals.pdf

NICE (2022) Controlled drugs: safe use and management, https://www.nice.org.uk/guidance/ng46/evidence/full-guideline-pdf-2427186353

Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2022). Medical error reduction and prevention. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499956/

Part Two:

Evidence of completion of summative Essential Skills SafeMedicate assessment with 30/30 grade.

Please insert a screenshot here as proof of successful completion of the SafeMedicate summative Essential Skills numeracy assessment.  This screenshot must clearly show your name and student ID and grade achieved.

Example of a screen shot of your safe medicate results please delete the example below and replace with your own evidence of successful completion.

To take a screen shot you need to access your results in the assessment feedback, hover your mouse over this top section and press prtscr (which is usually at the top right of your computer).

You need to have your workbook word document open and right click past the document in this section and save the document as evidence of passing this element of the workbook.

During the module you will be given formative practice using Safe Medicate essential skills questions for this section of the workbook and then a set period of time for you to achieve the summative pass evidence as seen above. You will be given instructions about when you can take this assessment to be included here by your module team.

By placing a tick (√) in the box below you are indicating the safe medicate assessment was undertaken by yourself and is no one else’s work

 Date competed:

I confirm this is my own work

Please remember to save this section of the workbook and ensure it is the one you want marked you do not need to submit the MAR below:

Appendix 1: Patient Specific Direction (PSD)/Medication Administration Record (MAR) chart

Greenwich University Hospitals

Surname: OKEKE   Forename(s): Prudence Date of birth: 7.7.2004 (currently 17years old)   Hospital Number:  777222	Height(m): not recorded on admission guestimate 156 CM   Weight(kg): 55 Kg
Ward: Surgical ward P transferred to Medical Ward Q	Consultant: Dr Pepper Senior
Date ofadmission: 1.1.22 transferred on 3.1.22	Time of admission: 09.00

ALERTS:Allergies/sensitivities/adversereaction
Medicine(s) or foods	Effect(s)
Shellfish	Swelling of the tongue
Penicillin	Urticarial rash and itch
IFNOKNOWNALLERGIESTICKBOX
Signature:	Dr pepper	BleepNumber: 123	Date:	1.1.22
AllergystatusMUSTbecompletedandSIGNEDbyaprescriber/pharmacist/nurseBEFOREanymedicinesareadministered.

Medicationriskfactors
Pregnancyo	RenalImpairmento	Impairedoralaccesso	Diabeteso √
Otherhigh-riskconditionso–specify	Patientself-medicatingo

Medicine   non-administration/self-administration:
Ifadoseisomittedforanyreason,thenurseshouldentertherelevantcodeontheadministrationrecord, sign,anddatetheentry.
1.Medicineunavailable	2.Patientoffward
3.Self-administration	4.Unabletoadminister
5.Statdosegiven	6.Prescriptionincorrect/unclear
7.Patientrefused	8.Nilbymouth(ondoctor’sinstructiononly)
9.Lowpulseand/orlowbloodpressure	10.Other–stateinnursingnotesincludingactiontaken

ONCEONLYMEDICINES,PREMEDICATION,ANTIBIOTICPROPHYLAXISANDPATIENTGROUPDIRECTIONS
Date	Drug	Dose	Route	Instructions	Timerequired	Prescriber’ssignature,printname &bleepnumber	Timegiven	Signaturegiven	Pharmacycheck
1.1.22   1.1.22	Oral morphine solution	10 mg	oral	For pain	09.00	Dr Will Sleep 321	09.05	Nurse K. AJA	√

HOSPITALMEDICATIONPRESCRIPTIONANDADMINISTRATIONRECORD
Surname:        OKEKE   Forename(s):    Prudence   Date of birth:7.7.2004   Hospital Number: 777222	Height(m):   Weight(kg): 55kg
Ward: MU	Consultant:
Date ofadmission:	Time of admission:

PRESCRIBEDOXYGEN
Formostchronicconditions,oxygenshouldbeprescribedtoachieveatargetsaturationof94-98%(or88-92%forthoseatriskofhypercapnicrespiratoryfailurei.e.CO2retainers). IsthepatientaknownCO2retainer?   No
Continuousoxygentherapy    √ TargetO2saturation94-98%   √   ‘Whenrequired’oxygentherapy   TargetO2saturation88-92%                          Othersaturationrange:                              Saturationnotindicatede.g.end-of-lifecare(statereason)	Checkandrecordflowrate(FR)anddevice(D)ateachmedicineroundorothertimesspecified.
Startingdeviceandflowrate:  N and 2 L/min	Start date: 3.1.22 Today	Date	Time	FR/D
3.1.22	09.00	Checked 2 L/min via N
Prescriber’ssignature: Dr R Pepper	Stopdate:
Printname: Dr R Pepper	Pharmacycheck:
Codesforstartingdeviceandmodesofdelivery
AirnotrequiringoxygenorweaningorPRNoxygen	A	Humidifiedoxygenat28%(add%forotherflowrate)	H28
Nasalcannulae	N	Reservoirmask	RM
Simplemask	M	Tracheostomymask	TM
Venturi24	V24	Venturi35	V35
Venturi28	V28	Venturi40	V40
Venturi60	V60	PatientonCPAPsystem	CP
PatientonNIVsystem	NIV	Otherdevice(specify)

Venous Thromboembolism Risk Assessment
Does this patient need thromboprophylaxis?	Y/N	Signature	Date
N	Dr R Pepper	today
If yes, please prescribe appropriate thromboprophylaxis on prescription chart. If contraindicated please state reason:     NB: reassess risk of bleeding and venous thromboembolism within 24 hours and if clinical situation changes

HOSPITALMEDICATIONPRESCRIPTIONANDADMINISTRATIONRECORD
Surname: OKEKE   Forename(s): Prudence   Date of birth: 7.7.2004   Hospital Number: 777222	Height(m): not recorded on admission 156Cm   Weight(kg): 55kg
Ward: transferred into medical ward	Consultant:  Dr Pepper senior
Date ofadmission: 1.1.22 surgical unit transferred on 3.1.22	Time of admission: 09.00

ANTIMICROBIALS
ReviewIV after 24-48 hours –Revieworal after 5-7 days
1.Drug	Tazocin®	Date and signature of nurse administering medicationsand code if not administered.
Date	Dose	Frequency	Route	Duration	Date/Time/sig	Date/Time/sig:	Date/time/sig:	Date/time/sig
3.1.22	4.5 g diluted in 50 mls 0.9% NaCl	Every 8 hours	IV infused over 30 mins	5 days	3.1.22 08.00 Tobi Xin
Startdate	3.1.22	Indication/Organism	For Hospital acquired pneumonia
Finishdate	8.1.22	Cultures sent?	Yes
Prescriber’ssignature andbleep	Dr R Pepper bleep 123	Print name	Dr R Pepper	Pharmacy Check

2.Drug	Gentamicin	Date and signature of nurse administering medicationsand code if not administered.
Date	Dose	Frequency	Route	Duration	Date/Time/ Sig	Date/time/sig	Date/time/sig	Date/time sig
Today	385 mg diluted in 50 mls 0.9% NaCl	Once daily	IV infused over 60 mins	3 days	3.1.22 09.00 PEvans
Startdate	3.1.22	Indication/Organism	For Hospital acquired pneumonia per dose 7 mg/kg
Finishdate	6.1.22	Cultures sent?	Yes
Prescriber’ssignature andbleep	Dr R Pepper bleep 123	Print name	Dr R pepper	Pharmacy Check

HOSPITALMEDICATIONPRESCRIPTIONANDADMINISTRATIONRECORD
Surname: OKEKE   Forename(s): Prudence   Date of birth: 7.7.2004   Hospital Number: 777222	Height(m):   Weight(kg): 55 kg
Ward: Medical ward	Consultant:Dr R Pepper
Date ofadmission: 3.1.22	Time of admission:

REGULARMEDICINES
VTE PRESCRIPTION ONLY. Preparation:	Date and signature of nurse administering medicationsand code if not administered.
Date	Dose	Frequency	Route	Duration	Time	Date:	Date:	Date:	Date:
Startdate		Instructions/indication
Finish Date
Pharmacy Check
Prescriber’ssignature and bleep		Printname

Drug	Insulin Novorapid ®	Date and signature of nurse administering medicationsand code if not administered.
Date	Dose	Frequency	Route	Duration	Time	Date: signature	Time	Date: signature
1.1.22	3 units	20 mins before meals	S/c	Ongoing	13.00	1.1.22 K. AJA	18.00	1.1.22 K. K. AJA AJA
Startdate	1.1.22	Instructions/indication Check peripheral Blood glucose levels via figure prick before meals give if blood glucose is between 4-7 mmols refer to Dr if above 7 mmols/l or needs adjusting for Carbohydrate coverage Withhold and consult Dr if below 4 mmols/l administer glyco stop as per hypoglycaemia policy
Finish Date
Pharmacy Check	yes
Prescriber’ssignature and bleep	Dr R Pepper bleep 123	Printname	Dr R Pepper

Drug	Insulin human (Insulatard®) 100 IU/ml	Date and signature of nurse administering medicationsand code if not administered.
Date	Dose	Frequency	Route	Duration	Time	Date: signature	time:	Date: signature
1.1.22	15 unit	Once a day	S/c	ongoing	07.00	2.1.22 K. AJA	07.00	3.1.22 A JA
Startdate	1.2.22	Instructions/indication
Finish Date
Pharmacy Check	yes
Prescriber’ssignature and bleep	Dr R Pepper bleep 123	Printname	Dr R Pepper

HOSPITALMEDICATIONPRESCRIPTIONANDADMINISTRATIONRECORD
Surname: Pepper   Forename(s): Prudence   Date of birth: 7.7.2004   Hospital Number: 777222	Height(m): 156 cm   Weight(kg): 55 kg
Ward: MUA	Consultant: Dr Pepper Senior
Date ofadmission: 1.1.22	Time of admission: 09.00

‘ASREQUIRED’MEDICINES
Drug	Paracetamol	Date and signature of nurse administering medicationsand code if not administered.
Date	Dose	Frequency	Route	Duration	Time date	Signature	Time date	Signature
1.1.22	1000mg	4-6 hours max 4 g in 24 hours	PO	3 days	1.1.22 22.00	Gale.Plage	2.1.22 07.00	Gale.Plage
Startdate	1.1.22	Instructions/indication for distress /discomfort with pain or fever	2.1.22 13.00	P Evans	2.1.22 21.00	Gale.Plage
Finish Date		3.1.22 06.00	Gale.Plage
Pharmacy Check
Prescriber’ssignature and bleep	Dr R Pepper bleep 123	Printname

Drug	Ibuprofen	Date and signature of nurse administering medicationsand code if not administered.
Date	Dose	Frequency	Route	Duration	Time Date:	signature	Date:	signature
1.2.22	300mg-400 mg	6-8 hourly max 2400 mg in 24 hours	Po		2.2.22 18.00	P Evans
Startdate	1.2.22	Instructions/indication   With food
Finish Date
Prescriber’ssignature and bleep	Dr R Pepper bleep 123	Printname	Dr R Pepper

HOSPITALMEDICATIONPRESCRIPTIONANDADMINISTRATIONRECORD
Surname: OKEKE   Forename(s): Prudence   Date of birth: 7.7.2004   Hospital Number: 777222	Height(m):   Weight(kg): 55kg
Ward: Medical ward	Consultant: Dr R Pepper
Date ofadmission: 3.1.22	Time of admission: 09.00

INFUSIONS
Bolus IMinjections should be prescribed on the standard section of the drug chart. If no additive is tobe used,enter ‘nil’ in the ‘drug added’ column.
Date	INFUSIONFLUID	Durationorrate	Prescriber’ssignature	Givenby	Checkedby	Starttime	Stoptime	Vol.given(ml)
Name/strength	Volume(ml)	Route(IV/SC)
3.1.22	0.9% NaCl with 10 mmols of KCl	500	IV	8 hour	Dr R Pepper bleep 123

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