Ministry Of Health, General Directorate Of · PDF file2.6 To provide uniform guidelines for charting of medications and treatments utilizing the pharmacy generated medication ... IPP

Ministry Of Health, General Directorate Of Nursing

anual of

ursing

olicies and

rocedures

Prepared by:

Nursing Policies and Procedures’ Committee 2011

Supervised by:

Dr. Munira Al Oseimy

General Director of Nursing-MOH

2nd Edition MEDICATION ADMINISTRATION

Ministry of Health, General Nursing AdministrationFunctions and Duties Policies and Procedures______________________________________________GENERAL NURSING: MEDICATION ADMINISTRATION

TABLE OF CONTENTS

S.N POLICY TITLE INDEXNUMBER

1. MEDICATION ADMINISTRATION GNR-04-012. INPATIENT MEDICATION SYSTEM/NURSING RESPONSIBILITIES GNR-04-02

3. INTER-NURSING UNIT CONTROLLED/NARCOTICS BORROWINGGUIDELINES GNR-04-03

4. STORAGE OF MEDICATIONS IN PATIENT CARE AREAS GNR-04-045. STORAGE AND EXPIRATION: NURSING UNIT FLOOR STOCK GNR-04-056. MEDICATIONS BROUGHT FROM HOME GNR-04-067. TRANSCRIPTION AND VERIFICATION OF PHYSICIAN ORDER GNR-04-078. ADVERSE DRUG REACTION REPORTING SYSTEM GNR-04-089. FOOD – DRUG INTERACTION GNR-04-09

10. PHYSICIAN ORDER GNR-04-1011. PHYSICIAN ORDER REVIEW / NIGHT SHIFT GNR-04-1112. CYCLOPOSPORIN ADMINISTRATION GNR-04-1213. GENERAL OXYGEN THERAPY POLICY GNR-04-1314. UNIT DOSE DRUG ADMINISTRATION GNR-04-1415. INTRAVENOUS (IV) PUSH MEDICATIONS GNR-04-1516. ADMINISTERING MEDICATION BY METERED DOSE INHALER GNR-04-1617. ADMINISTERING ORAL MEDICATIONS GNR-04-1718. ADMINISTRATION OF MANITOL GNR-04-1819. INTRADERMAL INJECTION GNR-04-1920. ADMINISTERING TOPICAL MEDICATION GNR-04-2021. MIXED DOSE INSULIN ADMINISTRATION GNR-04-2122. SUBCUTANEOUS INJECTION GNR-04-2223. RECTAL SUPPOSITORIES GNR-04-2324. MEDICATED SHAMPOO ( HEAD LICE) GNR-04-2425. DRAWING UP TWO MEDICATION IN A SYRINGE GNR-04-2526. OXYGEN THERAPHY GNR-04-2627. NEBULIZER THERAPHY GNR-04-2728. WITHDRAWING MEDICATION FROM A VIAL GNR-04-2829. WITHDRAWING MEDICATION FROM AN AMPULE GNR-04-2930. INSTILLATION EYE OINTMENT GNR-04-3031. INSTILLATION OF EYE DROPS GNR-04-3132. PREPARING MEDICATION FROM AMPULES AND VIALS GNR-04-32


TABLE OF CONTENTS







TABLE OF CONTENTS







INTERNAL POLICY AND PROCEDURENURSINGAPPLIES TO:GNR-04-01POLICY NUMBER:

IPP MEDICATION ADMINISTRATIONTITLE:

EFFECTIVE DATE:APPROVAL DATE:

1 of 13NUMBER OF PAGESDUE FOR REVIEW:

1.0 DEFINITION1.1 Medication: is a substance administered for the diagnosis, cure, treatment, or relief of symptoms or

For prevention of disease.1.2 Medication Sheet: also known as medication administration records are used to record information

about the drugs a patient receives under a prescriber’s orders.1.3 High Risk medication: are drugs that bear a heightened risk of causing significant patient harm when

they are used in error. " by Institute for Safe Medication Practices"1.4 Single dose vials/ampoules: are medications that do not have preservatives, or are packaged for

single dose administration only.1.5 IV Push: is a specific amount of medication (diluted or undiluted) given directly into the vein over 30-

60 seconds, it should be given by trained registered nurse.(please refer to the attached list ofMedication Administered by IV Push).

2.0 PURPOSE2.1 To ensure safe and competent administration of Medications

2.2 To prevent error in medications.

2.3 To protect patients against unsafe and ineffective practices.

2.4 To implement the "Controlled Substance Act" and drug abuse dependence.2.5 To ensure safe and competent administration of medications.2.6 To provide uniform guidelines for charting of medications and treatments utilizing the pharmacy

generated medication and treatment record.

2.7 To delineate the standard administration times to be observed by the nursing staff in theadministration of medications ordered by the medical staff.

2.8 To ensure patient's safety by monitoring adverse effect of a first dose of medication.

MED-1






3.0 POLICY3.1 Medication will be administered by register nurse who complete the medication administrationcompetency successfully.3.2 Registered Nurse must know the following the seven rights of medication at all times:

3.2.1 Right Drug3.2.2 Right Dose3.2.3 Right Patient3.2.4 Right Route3.2.5 Right Time3.2.6 Right Frequency3.2.7 Right Documentation

3.3 All medications administered to patients shall have a physician’s order and nurses should expectthat:

3.3.1 The order shall be dated and timed and clearly state the medication’s name, dosage,frequency, Route and any special instruction as per hospital policy.

3.4 All medications shall be kept secure. The medication cart will not be left open and unattended.3.5 A nurse must be sure drug allergy documented in patient file.3.6 Administration of medications to female patients that involves exposure or touching of the body

mustbe carried out by a female nurse except in cases of extreme emergency.

3.7 Medications shall be checked against the physician’s order daily for validity and renewalrequirements according to pharmacy policy.

3.8 Medications brought to the hospital by the patient shall not be administered or left with the patientwithout the written order of the physician for continuation of any such drug. These medications shallbe sent to Pharmacy to check the integrity, expiration, date and re-labeling of the medications priorto administration if the attending physician order to continue the medication.

3.9 Near expire drugs shall be separated and given priority for administration

3.10 NPO Status: If the physician writes “NPO” on the physician's order the nurse shall clarify withdoctor about which, if any oral medications should be given.

3.11 Narcotics are to be checked on every shift change by the responsible nurse. All narcotics andcontrolled

MED-2






drugs will be kept under double lock system (refer to Narcotic Policy).3.11.1 The charge nurse or the appropriate nursing staff is responsible for the narcotic keythroughout the shift.

3.12 Since all pre-operative medications orders are cancelled when a patient goes to surgery, the nurseshould expect that each post-operative medication will be separately and newly ordered.

3.13 Medication preparation:3.13.1 Prior to administration, check the Medication Sheet / Flow sheet against the physicians

orders, ensure that the correct medication has been selected based on the medication orderand label, verify the medication is stable based on visual examination for particulates ordiscoloration, ensure the medication is not expired.

3.13.2 Medications must be prepared for one patient at a time. Prior to medication preparation, thenurse will perform hand hygiene using antimicrobial soap and water for a minimum of 15seconds. Medication preparation area should be clean, have good lighting, and located in aclosed area to avoid distraction.

3.13.3 Unit dose packages must be opened at the bedside. Medications that require preparation,i.e. measuring, crushing or bulk medication must be prepared in the medication preparationarea.

3.13.4 All drug containers taken to the bedside, (including syringes of line flushes and othermedications prepared from vials and ampoules on patient care units outside of the patient’sroom) must be labeled with the drug name, date, time, strength and dose.

3.13.5 Medications are not to be left on trays, bedside tables, etc, unless ordered by a physician.

3.13.6 The nurse should not administer medication prepared by other nurse.

3.13.7 A nurse is not to pour a medication from one bottle to another. A nurse is not to put amedication back into a bottle.

3.13.8 Nurses are not authorized to re-label medications bottles or containers. Medicationswhich loses its label or which lacks a legible label must never be administered to thepatients. In all circumstances when medication is withheld for the above reasons, the

MED-3






Head Nurse/designee must inform Pharmacy and secure the medication until areplacement medication dose received from the pharmacy.

3.13.9 Each nurse should know the common dose, maximum dose, and how to compute dosage.Drug Information Manuals and the Hospital Formulary are available on each unit. Ifuncertain the nurse can consult Pharmacy department.

3.13.10 All medications requiring refrigeration should be identified by Pharmacy Department andplace in the medication refrigerator i.e. reconstituted powder drugs.

3.13.11 The unit dose cart should be moved up to the door of the patient's room with drawer sidetoward the room during medication administration.

3.14 Medication Administration:3.14.1 At the patient's bedside, verify the patient's name and medical record number on the

Medication Sheet and the ID band. Advise the patient if appropriate, the patient's familyabout potential clinical adverse reactions, or other concerns when administering a newmedication and discuss any unresolved, significant concerns about the medication with thepatient's physician, and / or relevant staff involved with the patient's care, treatment, andservices.

3.14.2 Check for contraindications to patient receiving the medication (i.e. allergies).

3.14.3 The nurse shall remain with the patient until the medicine is actually swallowed.Charting of Medications:

3.16.1 Copying or transcribing of physician's order is NOT allowed. The responsible Staff Nursewill inform the physician's to re-write the order on the Medication Sheet as needed.

3.16.2 Document on the Medication Sheet the medication administered at the bedside

3.16.3 The Medication Sheet, Insulin and Anti coagulant Flow Sheet form shall reflect the correctphysicians' order for medication. The nurses who Administer the medication shalldocument such by initiating the time on the Medication Sheet / Flow Sheet as soon as

MED-4






possible following administration.

3.16.4 Missed Dose due to Diagnostic Procedures:5.9.4.1 When a medication time must be changed because of diagnostic procedures, etc.,

the nurse shall consult the Pharmacy as needed for missed medications doses andrearrange the medication schedule. Time shall be noted on the Medication Sheet /Flow Sheet i.e.

3.16.5 Withholding medications:5.14.5.1 Any medications that is withheld shall be initialed on the Medication Sheet /Flow

Sheet and write not given.3.14.5.2 The nurse shall document in the nurse's notes the reason the drug not given and,

ifapplicable, that the physician was notified.

3.16.6 Discontinued Medication - When a drug is discontinued the nurse shall:5.14.6.1 Ensure the physician write discontinued (Discontinued / DC) next to the last dosegiven.5.14.6.2 To discontinue a regular or a PRN drug, close appropriate section by oblique line

and sign your name.

3.16.7 PRN Medications:3.14.7.1 PRN medications shall be documented on the Medication Sheet with the date,

time,nurse’s name, signature & RN.

3.14.7.1 The patient's response to PRN medications is written in the nurse's notes.

3.16.8 On discharge, the Medication Sheet is included in the patient's file before sending toMedical

Record.

3.17 Standard Medication Administration Times:

3.17.1 First dose of parenteral medication (I.V. / antibiotics, etc) ordered round the clock must begiven within 3 hours after the order has been written. (Maximum).

MED-5






3.17.2 "Stat" orders will be given immediately upon receipt of the medication on the unit (within15minutes). The allowance of 1 hour is given from the time the order has been written to thepreparation and delivery of the medication to the ward.

3.17.3 Medication may be given 30 minutes before or after the scheduled time according toestablished Medication Administration Time.

3.17.3.1 Following schedules shall be observed in administering medications ordered bymedical staff unless otherwise specified by the physician:

FREQUENCY MEANING SCHEDULE

OD Daily 0800 H

BID Twice daily / every 12 hours 0800 H 2000 H

TID Three times daily 0800 H 1600 H 2400 H

QID Four times daily 0600 H 1200 H 1800 H 2400 H

Q4H Every 4 hours 0800 H 1200 H 1600 H 2000 H 2400 H 0400 H

Q6H Every 6 hours 0600 H 1200 H 1800 H 2400 H

Q8H Every 8 hours 0800 H 1600 H 2400 H

HS At bed time 2200 H

3.18 Intravenous Push Medications:3.18.1 Rapid IV Push is a specific amount of medication given directly into the vein over less than

30 seconds.3.18.2 Slow IV Push is a specific amount of medication given into the vein over 3 -5 minutes.3.18.3 Any medication administered for greater than 5 minutes must be given by Soluset.3.18.4 Prior to administering a drug by any type of IV push, the nurse will check the available drug

resource books, compatibility chart, online formulary or hospital drug information center toverify correct dosage and rate of administration.

3.18.5 Monitoring of Vitals Signs (VS):3.18.5.1 Baseline VS (blood pressure, O2 saturation levels, pulse and respirations) will be

obtained before an IV push narcotic is administered and after administration every

MED-6






15 minutes for one hour.

3.19 Floor-Stock Medications and Supplies:3.19.1 At the time of receiving medication from the pharmacy, the nurse is responsible to assure

that all drugs received match the original request form.3.19.2 Head Nurses will ensure that their area is not overstocked, but if this event occurs, he/she

will contact the pharmacy to coordinate the overstock return to the pharmacy.3.19.3 Medications will be stored and labeled in a manner which ensures security.3.19.4 The following pharmaceutical categories must be separated from each other when being

stored:External Preparations DisinfectantsInjectables Oral PreparationsEar Preparations Eye Preparations

3.19.4 High risk medications are identified by specialty labels or color marks and should be storedin separate locked cabinet.

3.19.5 A floor stock inspection for expired medications will be performed by pharmacy staff on amonthly schedule. An inspection form will be completed and signed by the Head Nurse / ordesignee and the pharmacist. A copy will be given to the area and the original will be kept inthe pharmacy.

3.19.6 Borrowing of medications from another patient’s supply, or from the Crash Cart is notallowed except in a life-threatening situation.

3.20 Single Dose Vials/Ampoules:5.20.1 Single dose vials/ampoules shall be discarded immediately after puncturing /drawing up / administering the medication.

3.21 Multiple dose Vials/Containers :3.21.1 Multiple dose vials shall be dated and refrigerated when they are opened unless otherwise

specified by the manufacturer.3.21.1.1 Discard when the manufacturer's expiration date is reached, provided the

manufacturer's storage conditions have been adhered to.3.21.1.2 Discard when suspected or visible contamination occurs.3.21.1.3 Discard after 30 days of opening if expiration dating is not referenced on the

MED-7






packaging or insert.3.21.1.4 Discard when empty.

3.21.2 Open multiple dose oral liquids should be properly labelled and kept in cool dry area with anexpiry date one month from date of opening. .

3.21.3 Other open multiple dose containers (e.g.: eye, ear, nose drops, creams, ointments,nebulization solution, etc.) should be properly labelled and kept in dry area, and should belabelled with an expiry date one month from date of opening.

3.22 Medication Refrigerators:322.1 Medication refrigerators will not be used for storing foods, specimens or blood fortransfusion.

3.22.2 Each unit /clinic must monitor and record the temperature daily in log sheet.

3.22.3 If temperature falls outside the range of 2 8 C notify Maintenance for repair within 30minutes.

( please refer to f Storage of medications policy)

3.22.4 Each unit/clinic is responsible to maintain a clean and functioning refrigerator.

3.22.5 Refrigerators need to be plugged into essential power.

3.23 Verification of Physicians Orders:3.23.1 It is within acceptable professional nursing practice for nurses to seek verification of a

physician’s order before administering medication, if their concerns are based on clinicalscientific knowledge and/or standards or practice.

3.23.2 Whenever an order needs verification (e.g. inappropriate dose, route of administration), thenurse shall consult with the charge or head nurse and discuss the concerns. This willprovide a second nursing opinion and possibly settle the issue at this point.

3.23.3 If the order is still not acceptable, the nurse and/or head nurse should contact the orderingphysician and discuss their concerns with him/her.3.23.3.1 The Nursing Supervisor then Nursing Director must also be notified if the issue

remains unresolved and requires further action.3.23.3.2 Additional specialists pertinent to the issue (Pharmacist, Respiratory Therapist

etc) may be consulted as needed.3.23.3.3 Pharmacy should be informed of the concerns surrounding the order, and will

MED-8






hold the questionable orders until the situation is resolved.

3.23.4 In the process of resolving the order in question, the nurse and/or head nurse should followthe chain of command in Contacting Physicians and Chain of Command – NursingAffairs:3.23.4.1 If the order was written by a junior resident and this issue is unresolved after

discussion, senior resident should be contacted for verification.3.23.4.2 If the order was written by the senior resident or remains unresolved after

discussion, the fellow, assistant and / or consultant will be contacted forverification.

3.23.4.3 If the order was written by the consultant, the nurse and/or head nurse shoulddiscuss the situation with the consultant. The medication and/or equipmentnecessary shall be made available for the consultant to administer the medicationhim/her self.

3.23.4.4 If the consultant refuses to give the medication and the nurse feels it is notappropriate for a nurse to administer or further verification is needed, theconsultant’s department chairman should be contacted by the NursingSupervisor.

3.23.4.5 If there is no resolution at the department chairman level, the Medical services should be notified

by Nursing Director. And an Occurrence Variance Report will be completed.

4.0 RESPONSIBILITIES4.1 Head Nurse4.2 Staff Nurse

5.0 MATERIALS & EQUIPMENT5.1 Medication Record/Sheet5.2 Medication Trolley5.3 Prescribed Medicines5.4 Medicine cups/straw/spoon5.5 Distilled water5.6 Sterile syringes5.7 Alcohol swabs5.8 Sharp containers

MED-9






6.0 PROCEDURES RATIONALE6.1 Review medication record/sheet at the

beginning of each shift and frequently forchanges during the shift. Check for:

6.1.1 Day/Month/Year and time order wasWritten

6.1.2 Patients' allergies

6.1.3 Automatic Stop Order (Reorder)

6.1 To ensure accurateadministration of orderedmedications

6.1.4 Medical Record Number

6.1.5 Medication dose, route, frequency andtime

6.2 Check medication label against medicationrecord for:

6.2.1 Correct Medication

6.2.2 Correct Dose

6.2.3 Expiration Date

6.3 Wash hands before medicationAdministration

6.4 While preparing medications, check againthe label for the medication name and dose.

6.5 Take medication and medication sheet topatient room

6.1 .4 To ensure accurate administration of orderedMedications

6.2 To ensure accuracy prior to administration ofmedication

6.3 To prevent contamination

MED-10






6.4.1 Medication are taken to the patients'room and opened at the bedside

6.4.2 Medications that needs preparation i.e.measuring, crushing, or bulk medicationsmaybe prepared at the medication cart

6.6 Do not take patient Medication record/sheetinto the room if patient is in isolation room.If applicable, stamp the patients'addressograph/patients' identification on apiece of paper and take into the patients'room for identification.

6.7 Check medical record number and name onpatients' wristband/armband against themedication record. Ask patient his/her nameand check medication name, dose, route andtime.

6.8 Explain procedure to the patient

6.9 Remain with the patient during the oralMedication

6.9.1 If patient refused to take medication,return unopened medication on theCassette

6.9.2 If medication was opened and refused,waste in sink and have another seniornurse witness and sign wastage onMedication Record/Sheet.

6.10 Record medications given in the MedicationRecord/Sheet

6.8 To relieve anxiety and gain cooperation

6.9 This ensures that medication has been taken.

6.9.2 To serve as a witness that the medicationwas discarded appropriately

MED-11






6.10.1 Time medication s given

6.10.2 Injection Code when applicable

6.10.3 Signature of Nurse

6.11 Encircle initials of staff nurse in time slot formedications held or not taken. Record in thecomment section the drug, date, time, reasonand initial of staff nurse.

6.12 Dispose sharps in the sharp disposalContainer

6.13 Record patients' response to PRNmedications or Internal Policy Reaction tomedication must be reported to the Physicianand an Adverse Drug Reaction Formcompleted and sent to Pharmacy.

6.14 Document and sign.

6.11 Establish accountability and for continuity ofpatient care

6.12 To avoid needle stick/sharps injury

7.0 ATTACHMENTS7.1 Medication Record/Sheet7.2 Doctors' Order Sheet7.3 Prescription7.4 Adverse drug Reaction Form

8.0 REFERENCES8.1 JoyceLeFever Kee & Evelyn R. Hayes (2003). Pharmacology: A Nursing Process approach. (4th Ed.)

Saunders, Philadelphia, New Yorkl.8.2 Uzanne C. Smeltzer & Brenda G. Bare. (2004). Textbook of Medical Surgical Nursing. (10th Ed.)

Lippincott Williamns & Wilkins, Philadelphia, New York.8.3 William & Wilkins (2006) Manual of Nursing Practice (8th Ed.) Lippincott Philadelphia, New York8.4 Nursing Role in Medication Administration NRS-IPP-PRC-0036E (2)16/01//1431

MED-12






NAME: DATE

PREPARED BY: Ma. Antonia B. de la Cruz-RN,BSN- KFH-J 2010

REVIEWED BY: Mrs. Ashwag O. Shibah - RN,BSN Head of Nursing EducationKFH-J 2010

APPROVED BY: Central Committee Of NPP 2010- General Directorate OfNursing- MOH.KSA 2010

MED-13



IPPINPATIENT MEDICATION SYSTEM/NURSING

RESPONSIBILITIESTITLE:


1 OF 15NUMBER OF PAGESDUE FOR REVIEW:

1.0 DEFINITION

Inpatient Medication System/Responsibilities outlines the responsibilities of theNursing staff working with the inpatient medication system in conjunction with thePharmacy Department.

2.0 PURPOSE

2.1 To provide an established guidelines with in-patient medication systemamong nursing staff; a multi-disciplinary policy with Pharmacy Department.

3.0 POLICY3.1 Admission:

3.1.1 All nursing must use a specific stamp patient demographic for allnew admissions into the hospital.

3.1.2 Medications brought in by the patient from outside are not to be usedby the patient during hospitalization, except when ordered by thephysician. The nurse will send medications home with the familymembers.

3.2 Medications Brought From Home:

See IPP for Medication Brought From Home.

MED-14







3.3 Medication Orders to Pharmacy:

3.3.1 Medications must be ordered by treating physician orother authorized prescriber. E.g.: Dentist

3.3.2 All Inpatient drug orders must be written clearly on a physician orderform.

3.3.3 Physician order must contain the following information:

3.3.3.1 Date and Time.

3.3.3.2 Patient name, Medical Record Number Allergies, Height andWeight (Especially Pediatric Patients).

3.3.3.3 All orders must be legible, and carry the strength, dose, route,duration and frequency of medications.

3.3.3.4 Whenever possible the generic name of the drug should beemployed in general the generic name of the drug should bewritten in full, only hospital approved abbreviations shall beused when writing a medication order.

3.3.3.5 Nurses are not allowed to write on the Physician order exceptrecord telephone.

3.3.3.6 Requests must be written on Physician orders and medicationsheet.

3.3.3.7 The nurse must review, sign, time and date all physician

MED-15







orders before sending them to the pharmacy.

3.4 STAT (Emergency) Orders:

3.4.1 Preparation time by Pharmacy is approximately thirty (30) minutes.

3.4.2 For medications required of life threatening situations, write ‘‘STAT’’on the original order before sending to the pharmacy.

3.4.3 All ‘‘STAT’’ physician orders MUST be hand-delivered to the pharmacyif the nurse needs the medication immediately.

All ‘‘STAT’’ orders sent through the routine messenger service will beprocessed as routine orders.

STAT medications may be picked up by the nursing staff asappropriate.

3.5 Take Home (Discharge) Medications:

3.5.1 Discharge medication cupboard should be locked at all times.

3.5.2 Medication orders need to be written twenty-four (24) hours inadvance and sent to outpatient pharmacy during working hours toallow adequate processing time prior to patient’s discharge.

3.5.3 STAT orders are not allowed for an unplanned discharge.

MED-16







3.5.4 Original copy of the physician’s orders must be sent to the mainpharmacy by routine pharmacy messenger rounds, or to outpatientpharmacy. Patient’s relative or hospital personnel can take a copy ofdischarged order to pick up medications from Outpatient Pharmacy.

3.5.5 Discharge orders may be sent to main/outpatient pharmacy accordingto hospital policy.

3.5.6 After comparing the medication to the physician’s order, the nursemust sign his/her name and ID number on the discharge medicationprescription slip at the time of receiving them. The medications areplaced in the locked cupboard until given to the patient.

3.5.7 Only a patient, patient’s relative with identification, may pick up signout Narcotic/ controlled medication(according to hospital policy)/APP

3.5.8 Any discharge medications not taken by the patient at the time ofdischarge will be returned to pharmacy within Twenty Four (24) hours.

3.6 Medication supply system:

3.6.1 Unit dose: is a single unit package containing one dosage form labeledwith a generic name, strength and expiration date. A twenty four hourssupply is stored in an assigned individual cassette for each patient.medications will be dispensed in unit dose form whenever possible.exceptions (bulk medications) such as: cough syrups, ointments,creams, eye drops, and nitroglycerine tablets, contraceptive agents,throat lozenges. These items will be stored separately not in thecassette to prevent their return when cassettes are changed daily.

MED-17







3.6.2 Bulk Medications: Medications refilled according to pharmacy/NursingProcedure.

3.6.3 Missing Doses: For any missing dose, fill out the form according to thePharmacy/Nursing Procedure.

3.7 Medication Administration Times:

The first administration dose for all medications will start at the nextscheduled administration time unless otherwise specified to meet patientneeds. In the unit dose system the nurse performs final check prior toadministering medication.

Following doses are scheduled time according to Hospital Internal Policy.

QOD Alternate Days 0900QD Daily 0900BID Q 12 HR Twice daily/every 12 hours 0900-2100TID Three times daily 0900-1500-2100TID AC Three times daily before meals 0700-1130-1630TID PC Three times daily after meals 0800-1230-1730Q8hr Every 8 hours 0600-1400-2200QID Four times daily 0900-1300-1700-2100Q6H Every 6 hours 0600-1200-1800-2400QHS or nocte Every night at Bedtime 2200

Once Daily Doses: Medication ordered for Once A Day (QD) and QHS, one(1) dose will be dispensed irrespective of the time the order is received.

MED-18







Corticosteroids: Unless otherwise specified, supplemental steroids will begiven as a single dose in the morning.

Iron preparations: These will be given with food according to meal times forthe particular service.

Other Drugs:

Examples:

Cyclosporine: 0800 hours (i.e. Daily 0800, BID: IV,08-2000,PO,0800-2000)Digoxin:0900 hoursPhenytoin:0900 hours (i.e.TID:0900-1500-2100;Q6h:0900-1500-2100-0300)Coumadin: 1700

3.8 Automatic Stop Order (ASO):

Pharmacy sends an ASO report with the cassettes forty-eight (48) hours priorto the stop date: Nurses will use this as a remainder for medication re-orders.

The following stop order guidelines are in effect:

3.8.1 Narcotics: will be automatically discontinued after the following timeperiods with no exceptions.

Oral, IM, or intermittent IV infusions 72 hoursContinuous infusions 24 hours

3.8.2 Anticoagulants: (Heparin, Warfarin)

MED-19







Continuous IV heparin 24 hoursIf ordered as ‘‘low dose heparin’’ or ‘‘low molecularweight heparin’’ 7 days

3.8.3 Primary IV infusions:

Unless ordered as a part of an approved protocol,e.g. chemotherapy 24 hours

3.8.4 Blood Products:

Such as albumin, immunoglobulin, clotting factors hours. 24 hours

3.8.5 All other drugs:

(Unless stated for a specified length of time) 7 days

3.9 Hold Orders:

Any medication placed ‘‘on hold’’ will be discontinued twenty-four hours later ifthere is no further order regarding the specified medication on ‘‘hold’’.

3.10 Renewals:

Any medication for renewal must be ordered by the physician according toDrug name, dose, frequency, route and duration of theraphy.

3.11 Patient Schedule for Surgery:

MED-20







3.11.1 All medication orders are cancelled when a patient is listed in the ORsurgery schedule. All medications must be re-ordered post op tocontinue theraphy. In the event of a cancellation of surgery, aphysician order should be sent to pharmacy immediately to resumeall previous medications.

This order is accepted only on the same day of OR cancellation.

3.11.2 Pre-op medications orders written by anesthesia are valid for theprocedure and dare for which they are written. Cancellation andscheduling of the operative procedure requires new pre-opmedication orders.

3.11.3 The following five procedures performed in the OR are not classifiedas surgeries and therefore, the medication orders of such patientsare not required to be written post operatively:

3.11.3.1 Insertion of invasive lines (i.e. Hickman catheter, PermicathVAD)

3.11.3.2 Bone marrow harvests.

3.11.3.3 Uncomplicated cast changes.

3.11.3.4 Uncomplicated dressing changes.

3.11.3.5 Tracheotomy tube changes.

3.12. Transferring Patients:

MED-21







3.12.1 Intra-Unit Transfer

3.12.1.1 Transfer all medications and label from previous cassetteto new cassette.

3.12.1.2 Change addressograph plate to reflect new room number.

3.12.1.3 Notify pharmacy of room change by completing theappropriate form (according to hospital policy).

3.12.1.4 Re-label any medications stored in refrigerator with correctnumber.

3.12.1.5 Re-label medication record with new number.

3.12.2 Inter-Unit Transfer

3.12.2.1 All medication orders are cancelled when a patient istransferred to or from a critical care area (i.e. ICU, NICU,CVT, MSICU) or changes from one service to another. Allmedications must be re-ordered to continue theraphy.

3.12.2.2 A physician’s order is required when transferring a patientfrom one unit to another and copy is sent to the pharmacy.

3.12.2.3 All the patient’s medications are collected and comparedwith the MAR.

3.12.2.4 Give medications to the patient’s primary nurse upon arrivalto the new unit.

MED-22







3.12.2.5 The receiving nurse checks all medications and placesthem in the new cassette according to room number.

3.13. Discontinued Medications:

Any discontinued medication may remain in the cassette for return to thepharmacy. When patients are discharged the nurse will bag the medication,label it with the patient’s addressograph, note ‘’discharged/discontinued’’ andplace in the pharmacy return bin. Refrigerated medications that arediscontinued will be labeled as discharged and kept there until picked up bythe pharmacy.

3.14. Patients Out On Pass:

3.14.1 Medications for patients going out on pass can be written on aninpatient physician order form and sent to Inpatient Pharmacy whenthe patient goes out of the hospital picked up by pharmacy.

3.14.2 The pharmacy will process such ‘pass’ medication orders anddispense sufficient medication to cover the time period of the passwithout discharging the patient from the hospital system.

3.15. Floor Stock Supplies & Inspection

See IPP Floor Stock Supplies and Inspection

3.15.1 Each unit has established a floor stock requisition form in coordinationwith the Pharmacy Supervisor of Inventory and Supply. There will bea minimum level to avoid overstocking. Floor Stock is checkedmonthly for expiration date and signs of deterioration by nursing staff.

MED-23







Each unit has a designated day to order stock, will be ready for pick-up the next day.

3.15.2 At the time of delivery of the floor stock supply from the pharmacystoreroom, the receiving nurse is responsible to ensure that all drugsdelivered match the original issued form. This should be done in orderto avoid discrepancy between drugs ordered and drugs issued.

3.15.3 Every effort should be made to avoid overstocking for costeffectiveness. In the event that overstocking does occur, contact thepharmacy storeroom to coordinate the overstock return. Complete aDrug Return slip to accompany items being returned.

3.15.4 Floor stock will be evaluated monthly by Pharmacy Inventory andSupply Section. Results of the unit will be shared with the HeadNurse.

3.15.5 Pharmaceuticals shall be stored in a manner which ensures adequatesecurity and proper conditions of sanitation, temperature, light,moisture and ventilation.

3.15.6 The following categories of pharmaceuticals require separate storage:

3.15.6.1 External preparations.3.15.6.2 Injectibles.3.15.6.3 Otic preparations.3.15.6.4 Disinfectants.3.15.6.5 Oral preparations.3.15.6.6 Ophthalmic preparations.

MED-24







3.15.7 Floor stock inspection will be performed by pharmacy staff on amonthly schedule. Inspection form will be completed and signed bythe head nurse or designee and the pharmacist performing theinspection. A copy will be given to the nursing unit and the original willbe kept at the pharmacy.

3.15.8 Each nursing unit/clinic has an emergency code box maintained andstock by the pharmacy staff. This box will be checked monthly during

the inspection by pharmacy staff. The nursing staff is responsible tocheck that the box remains locked. When receiving a new drug box, thenurse must write the serial lock number and box expiration date on thecrash car checklist. The nursing staff is not allowed to open the boxexcept during a code situation, If the box is opened for any other reasonor a drug has expired, notify pharmacy who will replace the code bowbow with a new immediately.

3.16. Envelope Replacement System: (per hospital policy)

An envelope replacement system is available for pre-operative/procedureMedications limited to the following drugs.

3.16.1Atrophine.3.16.2 Scopolamine.3.16.3 Promethazine.3.16.4 Nifedipine.

3.17. Multi-Dose Vials:

3.17.1 Multi-dose vials shall be dated at the time of opening in order toensure utilization within a stated period of time.

MED-25







3.17.2 Multi-dose vials containing preservatives shall be used within one (1)month of opening otherwise labeled by the manufacturer.

3.17.3 Multi-dose vials containing no preservatives or manufacturerinstruction concerning storage shall be discarded after first use.

3.17.4 Multi-dose vials have specific instructions from pharmacy regardingstability, storage, and discarding will be followed.

3.18. Narcotics and Controlled Medications:

3.18.1 See IPP for Narcotics and Controlled Medications: Daily Counts andReporting of Suspected Abuse/Misuse.

3.19. Medication Clarification Form:

3.19.1 Notice of Medication Clarification Form will be used by the pharmacy(only) to document amendments/corrections/changes to a physician’swritten order received from the nursing unit.

3.19.2 The form is used to document and confirm the physician’s order.

3.19.3 Notice of Medication Clarification Form will immediately be sent bypharmacy as a new order to the nursing unit along with themedication.

3.19.4 The nursing staff will tape (do not staple) the Medication ClarificationForm on the next available blank space of the physician order form inthe patient’s chart as part of the permanent record, note the order and

MED-26







administer the dose as ordered.

3.19.5 The Notice of Medication Clarification Form must be signed by thephysician, at the earliest possible time, but not later than twenty-fourhours.

3.20. Medication Refrigerators:

See IPP for Medication Refrigerator.

3.20.1 Medication refrigerators will not be used for storing foods orspecimens. Refrigerators labeled as ‘‘Drugs Only’’.

3.20.2 Each unit must monitor and record the temperature daily and notifyBiomedical if temperature falls outside the range of 2-8 C.

3.20.3 Each unit is responsible to maintain a clean refrigerator.

3.20.4 Review medications for out-dates, returning those to pharmacy aMinimum of thirty (30) days prior to the expiration date.

3.20.5 Narcotics stored in the refrigerator must be locked.

3.21. Patient’s Own Medication:

See IPP for Patient’s own medication.

4.0 RESPONSIBILITIESNursing Staff, Pharmacist , Physician

MED-27







NAME: DATE




MED-28


ADMINISTRATIVE POLICY AND PROCEDURENURSINGAPPLIES TO:GNR-04-003POLICY NUMBER:

APPINTER-NURSING UNIT CONTROLLED/NARCOTICS

BORROWING GUIDELINESTITLE:



1.0 DEFINITIONInter nursing unit refers to unit which belongs to other wards / area of assignment

2.0 PURPOSETo guide nursing staff on the proper procedure and documentation for borrowingnarcotic/controlled medications from the other nursing units.

3.0 POLICY3.1 The Head Nurse or the Nursing Supervisors shall be responsible for coordinatinginter-unit narcotics borrowing procedure.

3.2 The Head Nurse or the Nursing Supervisors shall be responsible for certifying theaccuracy of the Inter-Unit Controlled Drugs Borrowing Form.

3.3 The Head Nurse or the Nursing Supervisors shall limit-borrowing to the followingsituations:

3.3.1 Non-floor stock item requested for a one-time order or for a single patient.

3.3.2 A floor stock item that is unavailable.

4.0 RESPONSIBILITIESNursing

5.0 MATERIALS & EQUIPMENT5.1 Physician Order, Form5.2 Inter-Unit Controlled Drugs Borrowing Form.5.3 Narcotic-Psychotropic Control Form.

MED-29







6.0 PROCEDURES RATIONALE6.1 During working hours (0700-

1600 hours, Saturday throughWednesday), the Head Nurseshall be responsible forborrowing controlled medicationsfrom other units. Charge Nursemay substitute for the HeadNurse, if the latter is notavailable, however the HeadNurse must certify the borrowingform.

6.2 During other times, the chargenurse will contact the NursingSupervisor to coordinate theborrowing procedure.

6.3 Head Nurse or NursingSupervisor shall contact narcoticpharmacy (8AM to 5 PM Saturdaythrough Wednesday) or inpatientpharmacy (5PM to 8Am weekdays andduring weekends), to determine thelocation and availability of the controlledmedication on another nursing unit.

6.3 Head Nurse or Charge Nurseshall obtain and verify thephysician order for the controlledmedication. This order must becarried to the lending unit.

6.1 Establish accountability

6.2 For administration Support.

6.4 To establish accuracy of order

MED-30







6.5 One dose of the controlledmedication should be borrowed at atime.

6.6 The Head Nurse or the ChargeNurse of the lending unit shallverify the physician order; signout the requested controlmedication on the Narcotic-Psychotropic Control Form,entering patient location in thepatient name column.

6.7 Head Nurse or Charge Nursefrom the borrowing unit shall co-sign with the Head Nurse orCharge Nurse of the lending unitthe entry on the narcotic-Psychotropic Control Form forproper accountability andcomplete the Inter-UnitControlled Borrowing Form. APhotocopy of the form withcompleted must now be attachedto the Narcotic PsychotropicControl Form.

6.8 Head Nurse or the Charge Nurseshall take the borrowed dose tothe patient’s nurse to administerthe medication and to completethe borrowing form.

6.9 Any wastage shall be properly

6.5 To avoid over supplydrug/substance.

6.6 Establish accuracy.

6.7 For proper accountability

6.9 To determine exact amount of

MED-31







documented the Inter-Unit Control todetermine the exact amount of thenarcotic used. Borrowing Form andsigned by the patient nurse andwitnessed another nurse.

6.9.1 Any empty injectible narcoticcontainers should be returned by theHead Nurse or Charge Nurse to issuingunit immediately after administeringmedication.

6.9.2 The Head Nurse or NursingSupervisor shall complete Part of theborrowing form certifying the accuracyof the order.

6.9.3 Charge Nurse shall return thecompleted original Inter-Unit ControlBorrowing Form to the narcoticpharmacy the next business day.

6.9.4 If the medication is not availableon any nursing unit, inpatient pharmacywill either dispense the medication as atemporary issue or contact narcoticpharmacist to provide it.

narcotics used.

6.9.1 As per MOH and the hospitalinternal Policy.

7.0 ATTACHMENTSNA

MED-32







8.0 REFERENCES8.1 Joycele fever kee& Evelyn R.Hayes(2003),pharmacology A Nursing

Process Approach,(4thEd)Saunders,Philadelphia,New York.

8.2 Suzzanne c.smeltzer & Brenda G .Bare (2004) Textbook of MedicalSurgical Nursing.(10th Ed,)Lippincott Williams& Wilkins. Philadelphia,NewYork.

8.3 William& Wilkins (2006), Manual of Nursing Practice.(8th Ed) Lippincott.

NAME: DATE




MED-33



IPPSTORAGE OF MEDICATIONS IN PATIENT

CARE AREASTITLE:



1.0 DEFINITIONPatient care areas refer to specific wards/units according to service/Department whereinpatients are admitted for management and/or Therapeutic medical procedure.

2.0 PURPOSE2.1. To provide guidelines for safe storage of medication in the ward.

2.2 To Ensure appropriate patient care and improved patient safety.

3.0 POLICYThe policy for the storage of medications in patient care areas is detailed below:

3.1Medication will be stored on specialized compartments in the automated drug cabinets orsecured drawers at all times when not in use.

3.2Storage areas shall be accessible only to designated and authorized personnel.

3.3Products for internal use must be stored separately from products for external use.

3.4The proper environmental control (i.e. proper temperature, light and humidity, conditionsof sanitation, ventilation, and segregation) will be maintained wherever controlledsubstances and supplies are stored in patient care areas.

3.5Medications will be stored in an orderly manner in medication drawers and in carts ofsufficient size to prevent crowding or in separate compartments in the automated drugcabinet.

3.6Medications bearing/expiration date will not be dispensed or distributed beyond theexpiration date. Medication with the nearest expiry date must be dispensed first, andarrange at the front for most accessible to reach.

3.7Expired, discolored, damaged, or inappropriately labeled controlled substances shall bereturned to the pharmacy for for proper credit and/or disposal.

MED-34




CARE AREASTITLE:



3.8Pharmacy in coordination with the Head Nurses will perform monthly audits forunits/wards to ensure compliance with proper patient safety considerations regardingthe shortage of pharmaceuticals.

3.9Pharmacy will perform monthly audits of patient care areas to ensure compliance withproper patient safety considerations regarding the shortage of pharmaceuticals.Copies of reports will be submitted to the Director of the pharmacy. He/ She shallreview all the documentation and make spot check of the inspection. He/ She shallsign and date the inspection form.

3.9.1 The original copy remains a part of the pharmacy’s permanentinspection records. The monthly findings shall be reduced to astatistical report and presented to the Director of Nursing.

3.9.2 All deficiencies that the pharmacy can assist with shall beresolved with the Head Nurse of the respective unit NursingSupervisor of Nursing administration.

3.9.3 The unit inspector’s will conduct the inspection as un obstructivemanner as possible, keeping in mind that normal patient careactivity must proceed uninterrupted during the inspection.

4.0 RESPONSIBILITIESNursing ,pharmacy

5.0 MATERIALS & EQUIPMENT1. Medication Supplies.2. Monthly Audit Report Form.3. Pen Blue/Black.

6.0 ATTACHMENTSNA

MED-35




CARE AREASTITLE:




Process Approach, (4thEd)Saunders,Philadelphia,New York.

7.2 Suzzanne c.smeltzer & Brenda G .Bare (2004) Textbook of MedicalSurgical Nursing. (10th Ed,)Lippincott Williams& Wilkins. Philadelphia,NewYork.

7.3 William& Wilkins (2006), Manual of Nursing Practice. (8th Ed) Lippincott.

NAME: DATE

PREPARED BY: Ms. Prema Kumari -RN,BSN- KFH-J 2010



MED-36



IPPSTORAGE AND EXPIRATION: NURSING UNIT

FLOOR STOCKTITLE:



1.0 DEFINITIONNursing Unit Floor Stock- are hospital approved pharmaceuticals drug products thatcan be stored on the Nursing unit and other service care location of the hospital: usedONLY to treat hospitalized patients (includes patients being treated in the OutpatientClinics). Nursing Unit Floor Stock include but not limited to injectables, Oral tablets,capsules and liquids for ingestion, mouth-rinses, oral-topical mucosal anesthetics, rectalpreparations, metered dose inhalers, topical skin, nasal and Optic preparations,ophthalmic agents.

Before First time Use: - refers to when a Nursing Unit Floor Stock drug has not beenopened. This is a new product exactly as it arrived from the pharmacy store room.

After First Time Use: - refers to when a Nursing Unit Floor Stock drug has been openedor used for the first time. For example once a new bottle of oral liquid oral antacid isopened or a new injectable vial is punctured.

The following information needs to be written on or attached to the product :Label of the Nursing Unit Floor Stock drug.

After First Time Use.Date openedTime openedNew Expiration Date

Manufacturer Expiration Date- The date placed on the immediate container label ofdrug product that designates the date through which the product is expected to remainwith specifications. If the expiration date includes only a month and year, it is expectedthat the product will meet specifications through the last day of the month. Example12/2009, remains product will expire after December 31st, 2009.

New Expiration Date refers to the expiration date of the Nursing Unit Floor Stock Drugafter First Time Use. The new Expiration Date is based in the Manufacturer’sRecommendation. To ensure patient safely, the hospital may set a more stringent newExpiration Date than the manufacture. The New Expiration date, but CANNOT exceedthe Manufacturer Expiration Date.

MED-37




FLOOR STOCKTITLE:



Multi dose vial (MDV) - a drug product that can be administered more than once andthat can be stored for future use After First Time Use. Such drug products containpreservatives.

Single dose Vila (SDV) – a drug product that cannot be stored for future use After FirstTime Use. Such drug products do not contain preservatives. Any portions remaining in aSingle dose vial/ container After First Time Use must be immediately discarded.

Storage- describes the drug’s stability and storage requirements. The storage conditionterminology of the United States Pharmacopoeia, 24th edition, is used in this policy andprocedure.

2.0 PURPOSE

2.1 To provide guidelines for proper storage of medication in order to protectpatient from possible medication error or harmful effect that it might causeto the patient.

3.0 POLICY3.1 Nursing Unit Floor Stock policy provides a consistent nursing standard for

the proper storage and expiration of Nursing Floor Stock drugs.

3.2 Nursing Unit Floor Stock is exempt from prescription labeling requirements. Nursing UnitFloor Stock drugs are administered to the patient pursuant to a prescriber order.

3.3 To prevent the administration of an expired/deteriorated Nursing Unit Floor Stock drug toa hospitalized patient (includes patients being treated in the Outpatient clinics).

3.4 Recording the Date Opened, Time Opened, New Expiration Date, Initials or ID Numberafter First Time Use, is the responsibility of the individual who opens the multi- dosecontainer for the first time.

3.5 Maintaining updating, distributing and keeping available copies of the handbook titled‘’Storage &Expiration: Nursing Unit Floor Stock Drugs’’ is the responsibility of the

MED-38




FLOOR STOCKTITLE:



Pharmacy Department.

3.6 Ensuring that Nursing Unit Floor Stock drugs are stored appropriately and are notadministered or kept beyond their Expiration Date is the responsibility of the nursing staff.

3.7 Maintaining the refrigerator at the proper temperature is the responsibility of the nursingstaff.

4.0 RESPONSIBILITIESNursing, pharmacy

5.0 MATERIALS & EQUIPMENT5.1 Handbook titled ‘’Storage & Expiration :Nursing Unit Floor Stock Drugs’’

5.2 Nursing Unit Refrigerator with Thermometer.

5.3 Terminology of the United States Pharmacopoeia, 24th Edition.

5.4 Manufacturer drug Product Package Insert/Leaflet (On file PharmacyDepartment)

6.0 PROCEDURES RATIONALE6.1 New Supply of Nursing Unit Floor

Stock.

6.1.1 Upon receiving a new supply ofNursing Unit Floor Stock drug(s)check the ManufacturerExpiration Date and the storagerequirements for each drug. Ifthe Manufacturer Expiration Datecannot be determined, the drugproduct cannot be administeredto a patient and drug productmust be discarded.

6.1.1 The Manufacturer ExpirationDate & storage requirement isusually indicated on the drugproduct label. The manufacturerdrug product package insert/leaflet or by contacting thePharmacy Department. Productslike topical creams, ointments,and gels.

MED-39




FLOOR STOCKTITLE:



6.2 Assign a New Expiration Dateafter first Time Use.

6.2.1 Determine if the nursing unit floorstock drug can be stored AfterFirst Time Use.

6.3 Determine the New ExpirationDate

6.3.1 Injectables: Each multi-doseinjectable item has a differentstability characteristic, thereforea different expiration date AfterFirst Time Dose.

6.2 See definition

6.2.1 Only multi-dose vial preparations can bestored After First Time Use for futureuse, This information any be found onthe product label or in the handbook‘’Storage &Expiration: Nursing UnitFloor Stock Drugs’’ or by consulting themanufacturer product package insert/leaflet or by contacting the PharmacyDept.

6.3 Non-Injectables: Oral tablets,capsules and liquids forinjection, mouth-rinses, oraltopical, anesthetics,metered-dose inhaler,topical ski, nasal and opticpreparations, ophthalmicagents with preservativeswill expire 30 days After FirstTime Used days After FirstTime Use. Topical Irrigationsolutions are stable for 24.hours After First Time Use.

6.3.1 This information may befound in the handbook‘’Storage & Expiration: NursingUnit Floor Stock or byconsulting the manufacturerdrug product package

MED-40




FLOOR STOCKTITLE:



6.4 Record the New ExpirationDate on or near the product label. Thefollowing information MUST berecorded:

6.4.1 Date Opened

6.4.2 Time Opened

6.4.3 New Expiration Date

6.4.4 Your initials or ID Number

6.5 Proper storage of Nursing Unit FloorStock after First Time Use.

6.5.1 The storage requirement ofmany but not all Nursing UnitFloor Stock drugs may changeAfter First Time Use. To find outthe storage requirement of aNursing Unit Floor Stock drug,consult the product label or thehandbook titled: ‘’Storage &Expiration: Nursing Unit FloorStock Drugs’’ or consult themanufacturer drug productpackage insert/ leaflet or contactthe Pharmacy Department.

6.6 Before Administration of a Nursing UnitFloor Stock Drug

insert/leaflet or by contactingthe Pharmacy Department.

6.4 Record the informationCLEARLY. For date openedfollow the following format:Day/Month/Year e.g. May20,2002 = 20/05/2002

If the calculated NewExpiration Date is greaterthan the ManufacturerExpiration Date, record theManufacturer ExpirationDate. A drug product cannot

be used after theManufacturer ExpirationDate.

MED-41




FLOOR STOCKTITLE:



6.6.1 Check the expirationdate(s) and verify if the

Nursing Unit Floor Stockdrug is a multi-dose or

Single dose preparation.

6.6.2 Verify the Nursing Unit FloorStock drug was storedproperly.

6.6.3 Visually inspect the drug,whenever possible.

6.6.1 If the expiration date cannot bedetermined or the drug has expired. Itmust not be administered to thepatient and should be discarded.

6.6.2 Information regarding proper storage forbefore and After First Time Use isusually indicated on the product label.If unavailable on the product labelconsult handbook ‘’ Storage &Expiration: Nursing Unit Floor StockDrugs’’ or consult the manufacturerdrug product package insert/ leaflet orcontact the Pharmacy Department.

6.6.3 It may not always be possible tovisually inspect a drug due to thenature of the drugs’ container.Information about a drug’s visualappearance may be obtained byconsulting the manufacturer drugproduct package insert/ leaflet or bycontacting the Pharmacy Department.

7.0 ATTACHMENTSNA

MED-42




FLOOR STOCKTITLE:



8.0 REFERENCES

8.1 Joycele fever kee& Evelyn R.Hayes(2003),pharmacology A NursingProcess Approach,(4thEd)Saunders,Philadelphia,New York.



NAME: DATE




MED-43



IPP MEDICATIONS BROUGHT FROM HOMETITLE:



1.0 DEFINITIONSelf medications: Medications administered by the patient to him/her self per policy andprocedure. Self medications may or may not be a patient’s own medications and may or maynot be kept at bedside.

Medications Brought From Home: Medications brought into the hospital-a patient’s ownsupply. Medication brought from home may be used in the hospital upon physician’s order;may or may not be self administered and may or may not be kept at bedside.

Adulteration: A drug or medication container that is filthy, putrid, or decomposed and if ithas been under unsanitary conditions whereby it may have been rendered injurious to apatient’s health. Also includes a medication that has expired, or the drug identification isquestionable.

Misbranding: A drug is considered misbranded if its labeling is false or misleading, and ifthe directions on the bottle cannot be deciphered.

2.0 PURPOSE2.1 To provide guidelines on medications brought into the hospital from home.

3.0 POLICY3.1 Medications brought from home may be administered by a patient or a nurse during

hospitalization by written orders by a physician.

3.2 Medications brought from home are not to be administered until identified by thepharmacist, attending physician or another responsible prescribing practitioner.

3.3 The health care provider who verifies the identity of the medications brought from thehome is responsible for documenting such information on the progress notes/ nurse’snote.

3.4 Nurse may deny the use of medications brought from home, unless patient is on the self-medication program.

MED-44






3.5 If the medication is a controlled substance, contact the pharmacy service coordinator. Themedication must be securely locked in an automated dispensing unit or double lockedcabinet and be added to the narcotic inventory list.

4.0 RESPONSIBILITIESNursing , physician ,pharmacy

5.0 MATERIALS & EQUIPMENTNA

6.0 PROCEDURES RATIONALEIf doctor ordered the use of the medicationfrom home:

6.1 Review the doctors order sheet aboutthe patient’s medication from home.

6.2 Identify the patient by asking his name &check identification wrist band.

6.3 Explain to the patient/watcher about thehospital’s policy on medication broughtfrom home.

6.4 Request permission to patient beforechecking the medication.

6.5 Inspect the medication for:

6.5.1 Name of the drug/medication.

6.5.2 Expiry date.

6.1 To ensure doctor’s order on medication.

6.2 To establish identification.

6.3 Patient’s education.

6.4 Respect for patient’s right.

6.5 To establish efficacy of the medication.

MED-45






6.5.3 Evidence of adulteration ormisbranding.

6.6 Send the medication to the pharmacy orthe attending physician for identification.

6.7 Relabel the medication indicating‘‘Patient’s Owned’’.

6.8 If medication is a controlled substance,contact the Pharmacy service. Themedication must be securely locked in adouble locked cabinet and be added tothe narcotic inventory list.

6.9 Document on the MedicationAdministration Record:

6.9.1 Drug Name.

6.9.2 Dosage.

6.9.3 Time of Administration.

6.9.4 Own Medication.

6.10 . Medication brought from thehome not to be used in theHospital, without a doctor’s order.

6.10.1 Instruct family member totake the medication home.

6.10.2 If the medication cannotbe taken home, theyshould be treated as

6.6 To verify the authenticity of the drug.

6.7 To alert the nursing that the medicationhave been identified.

6.8 As per MOH and the hospital internalpolicy.

6.9 For legal documentation/information forthe health care team.

6.10 As per hospital internal policy.

MED-46






valuable (see hospitalPolicy for PatientBelonging).

6.10.3 Upon discharge from thehospital, the medicationshall be returned to thepatient.

6.11 Medication Brought from Homenot returned to the patient upondischarge. In the event patientforgets to take their medicationsbrought from home upondischarge:

6.11.1 The nurse is responsibleto inform the socialworker to contact thepatient or family caregiven to remind him/her topick up the medications.

6.11.2 If patient fails to pick upthe medications within 30days, medications will besent to the pharmacy fordestruction. Medicationswill be destroyedaccording to thepharmacy.

6.11.1 Social worker is the appropriateService to inform the patient.

6.11.2 As per hospital internal policy.

MED-47






7.0 ATTACHMENTSNA


Process Approach,(4thEd)Saunders,Philadelphia,New York.



NAME: DATE




MED-48






MED-49



IPPTRANSCRIPTION AND VERIFICATION OF

PHYSICIAN ORDERTITLE:



1.0 DEFINITION

Transcribe means to convert into written form / printed form.

Transcription is the action or process of transcribing.

2.0 PURPOSE

2.1 To provide a systematic method of carrying out and verification of Physician’s order.

2.2 To ensure that all Physician’s order are completed.

2.3 To provide safe and quality patient care.

2.4 To detect any error or omission of any order.

3.0 POLICY

3.1 Physician’s order which is not understood, incomplete or illegibly written must beclarified with the ordering Physician before the order can be carried out.

3.2 Only approved abbreviations can be used in transcribing Physician’s order.

3.3 When orders are transcribed they must be signed off by a Staff Nurse to signify that thenurse has checked for its completeness and accuracy.

3.4 A 24 hour check of related documents must be performed to assure that orders havebeen properly transcribed and completed.

MED-50







4.0 RESPONSIBILITIES

4.1 Nursing staff

5.0 MATERIALS & EQUIPMENT

5.1 Patient’s File

5.2 Medication Sheet

6.0 PROCEDURES RATIONALE

6.1 Read and check for completeness ofwritten order.

6.2 Confirm with the Doctor any orderwhich is not understood, incomplete orillegibly written.

6.3 Ensure Physician’s are Transcribe theorder in the appropriate document.

6.4 Ensure that the orders are correctlywritten.

6.5 Affix the Signature, Employee Number,Date and Time at the last part of thePhysician’s Order after the set of orderis completely transcribed.

6.6 Notify the assigned nurse immediately

6.2 To verify any ambiguous order.

MED-51







of orders requiring implementation.

6.7 Perform file check every shift on allpatients file.

6.8 Execute a 24 hour review on allpatient’s file by the assigned night shiftnurse to check for the completion oforders on the following documents:

6.8.1 Physician’s Order Sheet

6.8.2 Progress Notes

6.8.3 Medication Sheet

6.9 Correct any deficiencies noted in theperformance of 24 hour review.

6.8 To assure all orders were accuratelytranscribed and processed.

7.0 ATTACHMENTSN/A

8.0 REFERENCES

8.1 Shore Health System Administrative/Medical Staff Policy and Procedure.

8.2 East Riding of Yorkshire NHS, Primary Care Trust

MED-52







NAME: DATE

PREPARED BY: Ms. Hazel N. Sunga-RN,BSN- Nursing Supervisor, KAAH &OC 2010

REVIEWED BY: Mr. Nasser Al Zayedi-RN,BSN,Nursing Supervisor, QualityDepartment - KAAH & OC 2010


MED-53



IPP ADVERSE DRUG REACTION REPORTING SYSTEMTITLE:



1.0 DEFINITION

Any response to a drug which is noxious and unintended , and which occurs at doses normallyused in man for prophylaxis, diagnosis, or therapy of disease, or for the modification ofphysiological function. (World Health Organization)

2.0 PURPOSE2.1 To promote reporting of ADR’s

2.2 To facilitate the documentation of ADR’s

2.3 To provide a mechanism for monitoring the safety of medication used in the hospital.

2.4 To stimulate the education of health professionals regarding potential ADR’s

3.0 POLICY3.1 All nursing staff has the responsibility of reporting, documenting and monitoring

adverse drug reactions that occur within hospital.

3.2.3 Limitations and coverage of Adverse Drug Reaction

3.2.1 Serious Adverse Event

3.2.1.1 In which the patient’s death is suspected as being direct outcome of theadverse event.

3.2.1.2 In which the patient is at substantial risk of dying at the time of theadverse event or it is suspected that the use or continued use of theproduct would result in the patient’s death.

3.2.1.3 That prolongs the patient’s stay in hospital or was the reason for thepatient’s initial admission to hospital

3.2.1.4 That resulted in a significant, persistent or permanent change,

MED-54






impairment, damage, or disruption in the patient’s body function orstructure, physical activities or quality of life.

3.2.1.5 In which it is suspected that exposure to a drug prior to conception orduring pregnancy resulted in an adverse outcome in the child.

4.0 RESPONSIBILITIES4.1 Nursing Staffs

5.0 MATERIALS & EQUIPMENT5.1 Adverse Drug Reaction Form

6.0 PROCEDURES RATIONALE6.1 Once suspected the ADR is recorded by

filling out the ADR Report Form andsending it to the Pharmacy Dept’s DrugInformation Center . Head Nurse must beinformed.

6.1 The ADR Report Form will bestocked in all Nursing Units and canbe ordered from the PharmacyDepartment when more stock isneeded. The ADR Report Form canbe filled out by any member of thehealthcare team.

6.2 The suspected drug(s) should belisted and the reaction described.

6.3 The name of the person reportingthe suspected ADR and the

For easy access of form in case of emergency

It is necessary note the name of reporter toconfirm the incident as he is the first handperson who witness the incident.

MED-55






reporting date should be recorded.

4.1 6.2 Notify the physician prescriber/4.2 attending physician . Serious adverse4.3 drug reaction should be reported within4.4 24 hours.

6.2.1 The physician must be notified sothat he/ she can decide whatcourse of action is required.

To prevent delay to whatever action is neededto be done.

6.3 6.3 Forward the ADR Report Form to6.4 the Drug Information Center in the6.5 Pharmacy Dep’t. ( Person completing the6.6 ADR Report Form)

6.7 6.4 Follow-up of the reported ADR6.8 (coordinated by the DI Center Personnel)

6.5 Pharmacy & Therapeutics Committee willevaluate the ADR Report.

6.6 The P&T Committee will evaluate andtrend for situations that can be targetedfor prevention strategies (e.g. EducationalActivities).

6.7 Pharmacy Department will publish theADR Report.

6.8 Serious ADR are reported to the Ministryof Health.

7.0 ATTACHMENTS7.1 Adverse Drug Reaction Form

MED-56






8.0 REFERENCES8.1 Wolters Klumer Health (2010) Manual of Nursing Practice 9th Edition, Lippincott,

William & Wilkins.

NAME: DATE

PREPARED BY: MS. LEILANI B. NADAL -RN,BSN- KAAH & OC 2010



MED-57



IPP FOOD – DRUG INTERACTIONTITLE:



1.0 DEFINITIONA food – drug interaction can occur when the food you eat affects the ingredients in amedication you are taking, presenting the medicine from working the way it should. Food – druginteraction can happen with both prescription and over the counter medications includingantacids, vitamins and iron pills

2.0 PURPOSETo provide guidelines on Food and Drug Interactions; to protect patients from untoward foodand drug interactions that may cause harm to the patient due to change on the effectiveness ofthe medication

3.0 POLICY3.1 Medications must be taken properly to ensure that they are safe and effective3.2 Certain food, beverages, alcohol caffeine and even cigarettes can interact with the

medication, which may make them less effective or may cause dangerous side effects orother problems

3.3 Following are the guidelines to follow on certain drugs and medications:3.3.1 Antacid -Take antacid either one hour after or between meals. Avoid dairy food because

the protein in them can increase in the stomach. If taking antacids as a calciumsupplement, avoid foods high in fiber or oxalates (tea) because they can bind with thecalcium and decrease absorption.

3.3.2 Aspirin - Food helps to decrease GI irritation. Take with food.

3.3.3 Atorvastatin - Bioavailability in increase by grapefruit juice. To exclude grapefruit from thediet

3.3.4 Captopril - Food decreases absorption by 30 to 40%. Take on empty stomach.3.3.5 Ciprofloxacin - Bioavailability is reduced. Take one hour before or two hours after meals.

3.3.6 Cylosporine - Food may be delay, increase, or have no effect on absorption.Bioavailability in increased by grapefruit juice. Administrated consistent with regards tothe time of day and in relation to meals.

MED-58






Ibuprofen - Food helps reduce GI irritation. Take with food.

3.3.7 Indomethacin - Food helps reduce GI irritation. Take with food

3.3.8 Iron Products - Bioavailability is reduced by dairy products. Take one hour before or twohours after dairy products.

3.3.9 Ketoconazole - Bioavailability is reduced. Take one hour before or two hours after dairyproducts.

3.3.10 Metformin – Food decreases GI upset and helps increase compliance. Givingmetformin and contrast dye too closely together may cause renal failure. Take with foodmetformin should not be given within 48 hours before and after contrast media.

3.3.11 Mehtyl-prednisolone – food helps reduce GI irritation. Take with food.

3.3.12 Mycophenolate Motetil (Cellcept) – Bioavailability is reduced. Take one hour before ortwo hours after meals.

3.3.13 Nifedipine – Bioavailability is increased by grapefruit juice. Exclude grapefruit juice fromthe diet.

3.3.14 Nitrofurantoin - Food significantly increases absorption. Take with whole milk or food.

3.3.15 Omeprazole - Food decreases absorption. Take before eating.

3.3.16 Penicillamine - Bioavailability is reduced. Take one hour before or two hours after meals

3.3.17 Penicillin - Food, carbonated beverages and citrus juice decrease absorption. Take onempty stomach.

3.3.18 Phenytoin Suspension - Tube feeding decreases absorption of Phenytoin,Bioavailability is reduced. Hold tube feedings two hours before and two hours afterdose.

MED-59






3.3.19 Potassium chloride - Food helps reduce GI irritation. Take with food. Now doses shouldbe given as soon as possible do not wait for food.

3.3.20 Prednisone - Food helps reduce GI irritation. Take with food.

3.3.21 Ranitidine - Gastric acid production increases at night. If ordered once day give atbedtime.

3.3.22 Simvastatin - Bioavailability is increased by grapefruit juice. Exclude grapefruit juicefrom the diet.

3.3.23 Tetracycline – Calcium, Iron may bind and inactivate tetracycline. Take one hour beforeor two hours after meals or dairy products.

3.3.24 Warfarin - Drug effect is reduced. Avoid containing high Vitamin K content.

4.0 RESPONSIBILITIES1. Physician2. Pharmacist3. Nurse

5.0 MATERIALS & EQUIPMENT5.1 7 rights of medication administration

MED-60






6.0 PROCEDURES RATIONALE1. Read the prescription label on the

container. If you do not understandsomething, ask physician or pharmacist

2. Read directions, warnings and interactionprecaution printed in all medication labeland package insert

3. Take medication with a full glass of water

4. Do not stir medication into the food or takecapsules apart (unless directed by thephysician)

5. Do not take vitamins and pills at the sametime you take the medication

6. Do not mix medications into hot drinks

7. Never take the medicine with alcoholdrinks

8. Be sure to tell the physician andpharmacist about all the medications thepatient is taking both with prescription andnon-prescription

9. Follow the 7 rights in giving medications:9.1 Right patient9.2 Right drug9.3 Right time9.4 Right dose9.5 Right frequency9.6 Right Route of Administration9.7 Right Documentation

1. For confirmation

2. To avoid mistakes

3. To dilute medicine properly

4. This way change the drug works

5. Vitamins and minerals can interact withsame drug

6. It may destroy the effectiveness of the drug

7. It may destroy the effectiveness of the drug

8. For the guidelines of the doctor

9. To prevent error

MED-61






7.0 ATTACHMENTSNA

8.0 REFERENCES8.1 New York Online Access to Health Updated April 20108.2 Drug Formulary KAAH & Oncology Center 6th Edition 2010 - 2011

NAME: DATE

PREPARED BY: Ms. Jasmin L. Yanto -RN,BSN- Nursing Supervisor, KAAH& OC 2010



MED-62



IPP PHYSICIAN ORDERTITLE:



1.0 DEFINITIONPhysician Order – is a process of entry of medical practitioner instructions for the treatment ofpatient (particularly hospitalized patient) under his or her care. These orders are communicatedto the medical staff or to the medical departments (Pharmacy, Laboratory and Radiology)responsible for fulfilling the order.

2.0 PURPOSE2.1 To provide authority for and a plan of care to patient presenting themselves prior to being

examined or evaluated by a physician to ensure that such acts are carried out correctly

2.2 To ensure safe and competent drug administration based from the physician order

3.0 POLICY3.1 General Policy

3.1.1 Order must be written and signed by the attending physician responsible for thepatient care. Upon admission to the hospital or prior to scheduled anesthetics,appropriate laboratory testing, ECG testing and X-rays shall be performedaccording to individual department guidelines and condition of the patient. Nostanding order shall be allowed with respect to drug therapy.

3.2 Treatment Protocols Pre-Printed orders shall be approved by the Medical Records,Pharmacy and Therapeutic Committees

3.3 Repeat orders for diagnostic procedure or drug must be written with specific time framesbut not exceed seven days.

3.4 Written Order3.4.1 New Order – treatments, diagnostic, procedure and administration of medication

are carried out by a nurse upon written order of the physician. Procedure manualslocated on each nursing unit, specify aspects of various clinical procedures and

MED-63






whether a physician's order is necessary for implementation.

3.4.2 Blanket order - all orders that are consumption or continuation of orders previouslywritten in their entirety by the treating physician. All discharge order must also bewritten in their entirety. The use of "Blanket" orders is prohibited such as: Continueprevious medication, Resume pre-operative order, Resume order from the floor (ifpatient transferred to other floor), and Discharge on current medication.

3.5 Verbal and Telephone Order3.5.1 Verbal and telephone order are order for medications, treatment, intervention or

other patient care that are communicated as oral, spoken communication betweenan authorized provider and an authorized recipient.

3.5.2 Verbal communication of orders should be limited to urgent situation whereimmediate written or electronic communication is not feasible.

3.5.3 Recipient orders - verbal and telephone orders from authorized provider will beaccepted and entered on the physician order sheet by designated staff members.The staff members taking the order shall record the order and read the order backto the authorized provider and request confirmation. Designated staff membersincludes; Registered Nurse, Pharmacist Respiratory therapist

3.5 .4 Responsibility/ Documentation3.5.4.1 All diagnostic and therapeutic verbal and telephone order must be

transcribed, dated, timed and signed by the authorized recipient in thepatient medical record.

3.5.4.2 The authorized recipient must document that the transcribed verbal ortelephone order was read back and confirmed to the authorized provider.

3.5.4.3 The authorized recipient may abbreviate read back and confirmed withinitial " R&C".

3.5.4.4 Pharmacist and Respiratory Therapist must notify the responsibleregistered nurse of any verbal or telephone orders they transcribed.

MED-64






3.5.4.5 Verbal or telephone order for restraints must be countersigned as specifiedin the Medical Center Restraint Policy.

3.5.4.6 Verbal or telephone order must be countersigned, dated and timed by theprescribing provider or an authorized provider within 24 hours.

3.5.5 Monitoring and Compliance - compliance with countersignature of verbal andtelephone orders will be audited and reported by clinical service on a biweeklybasis. Any clinical service that does not meet 100% during a two weeks audit mayloose the ability to give telephone order up to four weeks.

3.6 Allied Health Practitioner Order - orders may also be written by the nurse practitioner,physician assistants and pharmacist who are functioning with their scope of practice andunder standardized procedure approved by the Committee and Medical Board.

3.7 Medical students order - It must be countersigned by a physician before the order can becarried out.

3.8 Interns and Unlicensed Resident order3.8.1 Orders for the care of hospitalized patient written by interns and unlicensed resident

will be carried out when written, except as specifically restricted (DNR andRestraints).

3.8.2 The attending physician shall write a note in the chart of each patient approving,correcting or reprimanding the recorded work-up of the intern or resident.

3.9 Medication orders3.9.1 Medications are available through hospital formulary system. Copies of formulary are

available on request and may be found in all nursing stations.

3.9.2 Drugs required for appropriate treatment that are not listed in the formulary may beordered with a non formulary request. This request may be approved by the chief ofpharmacy.

MED-65






3.9.3 Medication order Writing Policy3.9.3.1 All medication must contain the date and time order was written, drug name,

strength, dose, route and frequency.

3.9.3.2 No blanket orders such as resume all pre-op medication or continue homeMedication.

3.9.3.3 Hold / Discontinue - a HOLD order will be interpreted to meanDISCONTINUE.

3.9.3 4 Spell out medication names completely, correct abbreviation must befollowed as per hospital policy and procedure.

3.9.3 5 DO DON’T WHY0.4 mg .4 mg .4 can be interpreted as 4

4 mg 4.0 mg 4.0 can be interpreted as 40Unit U U can be interpreted as 0

4.0 RESPONSIBILITIES4.1 Physician4.2 Pharmacist4.3 Nurse4.4 Respiratory Therapist

5.0 MATERIALS & EQUIPMENT5.1 Patient file5.2 Medication sheet5.3 Kardex/Flow sheet

MED-66






6.0 PROCEDURES RATIONALE6.1 All orders must be written for the patient

upon each admission, return from surgeryor transfer to a new service.

6.2 All orders for treatment shall be writtenand signed by the physician with theexception of emergency situation thatany require the provider to issue an orderverbally or by telephone

6.3 Read and check for completeness ofwritten order

6.4 Confirm with the doctor of any orderwhich is not understood, incomplete orillegibly written

6.5 Ensure that the order are correctly writtenin the corresponding forms;

6.5.1 Medication in medication sheet6.5.2 Ultrasound, X ray CT scan in

Radiology request6.5.3 Consultation in consultation form6.5.4 Laboratory investigation in specified

laboratory request

6.6 Noted and affix the Staff signature IDnumber date and time at the last part ofthe physician’s order after the set iscompletely transcribed

6.7 Notify the assigned nurse immediately oforders requiring implementation within thehour

6.1 To evaluate patient condition and to givethe proper management and treatment

6.2 To start the patient treatment and beginImmediately

6.3 To carry out the order properly

6.4 To ensure that the order are carry outcorrectly

6.5 To make sure that the request will befilled-up properly

6.6 To make sure that all doctors order arecarried out completely

6.7 To carry out stat orders

MED-67






6.8 Perform file checking every shift in allpatient’s file

6.9 Execute a 24 hours review at 12 midnightin all patient’s file by the assigned nightshift staff

6.10 Correct any deficiencies noted in theperformance of 24 hours review

6.8 To assure all orders were accuratelytranscribed and processed

6.9 To check for the completion of orders onthe following documents: physician’sorder sheet, Progress notes, medicationsheet, nursing kardex/flow sheet

6.10 To assure that all doctors orders wascarried out within 24 hours

7.0 ATTACHMENTSNA

8.0 REFERENCES8.1 www.ucsfmedical center.org8.2 www.jmir.org/2010/1/es/html8.3 KAAH & OC P & P

NAME: DATE

PREPARED BY: Ms. Jasmin L. Yanto -RN,BSN- Nursing Supervisor, KAAH & OC 2010


APPROVED BY: Central Committee Of NPP 2010- General Directorate Of Nursing-MOH.KSA 2010

MED-68

www.ucsfmedical

www.jmir.org/2010/1/es/html



IPP PHYSICIAN ORDER REVIEW / NIGHT SHIFTTITLE:



1.0 DEFINITIONPhysician Order Review / Night Shift – this is the follow –up review of physician’s order by thenight shift to prevent and/or correct errors in transcription. To serve as checks and balancessystem to ensure the early detection of errors and omission of orders. This safeguard isaccomplished by conducting a review of all charts as a part of night shift duties.

2.0 PURPOSE2.1 To provide a systematic method of carrying out and verification of Physician’s order2.2 To ensure that all physician’s order are completed2.3 To provide safe and quality patient care2.4 To detect any error or omission of any order

3.0 POLICY3.1 All chart in the unit shall be check each night shift from newly written physician orders

and previous orders

3.2 The unit supervisor is responsible for ensuring the entire night shift audit procedure iscompleted nightly and correction are made daily

3.3 A staff member who discover a medication errors will notify the unit shift team leaderand initiate Special Incident Report. The unit shift team leader is responsible forensuring that the appropriate action and notification is taken clinically

3.4 Night shift personnel shall utilize “24 Hour Shift Audit Form” and continuation pagewhen conducting the audit review of the chart

3.5 The unit supervisor and nursing coordinator reviews “ 24 hours shift audit form” andcontinuation page and follow-up as needed

3.6 The following documents shall be reviewed of errors in transcription, omissions, initials,

MED-69






and/or lack of pertinent documentations in the ff:3.6.1 Physician order3.6.2 Medication and Treatment Record3.6.3 Diagnostic laboratory Specimen, Consultation and Radiology3.6.4 Medication Diabetic Record3.6.5 Supplement and Daily Care Flow Sheet3.6.6 ID numbers (Nursing Service and Physicians)3.6.7 Observation Record3.6.8 Behavioral Restraint Record3.6.9 NCP (Nursing Care Plan)3.6.10 Miscellaneous Laboratory Slip Request Form

3.7 Nursing staff shall review all charts on the unit of new and renewal order from theprevious day. All errors of transcription shall be immediately brought to the attention ofthe shift team leader and Nurse on duty for follow-up action as needed. The unitphysician and/or the Medical Officer of the day shall notified of any (IndividualInvolved) medication error

3.8 For “Individual Involved” and “Individual Uninvolved medication errors, a “SpecialIncident Report” shall be initiated by the staff person who finds error. Notify thephysician and follow the physician as directed

3.9 When an improperly transcribed order results in a medication error, initiate SpecialIncident Report. The staff person who finds the error shall take appropriate step toremedy the error (e.g. Noted and transcribed the physician order that had not beentranscribed). Obtain physician clarification for an unclean order

3.10 When preparing the medication and treatment record, the nursing staff shall also beresponsible for comparing the pre-printed MAR with the physician monthly orders.These shall be compared with the current physician orders and medications treatmentrecord. All variances shall be brought to attention to the unit physician for correction asneeded

3.11 As further safeguard to prevent medication errors to the individual, night shift nursingpersonnel are responsible for reviewing all the charts of the unit, to check and confirmthe accuracy of the transcription against the physician orders

MED-70






4.0 RESPONSIBILITIES4.1 Physician4.2 Nurse

5.0 MATERIALS & EQUIPMENT5.1 Patient file5.2 Medication sheet5.3 Kardex/Flow sheet5.4 24 hours shift audit form

6.0 PROCEDURES RATIONALE6.1 The medication Room person adds to

the medication room communicationlog the names of all individuals forwhom new order were written by thephysician within the past 24 hours

6.2 The employee reviews all unit charts fornew or renewed medications ordersfrom the previous 24 hours. Confirmaccuracy of the transcription. Notifyshift team leader of any transcriptiondiscrepancy for follow-up action asneeded

6.3 The employee indicate that the orderwas reviewed by drawing a red linedown the left hand side (i.e. date andtime, problem # column)and thenacross the physician order sheet, writein black ink “24 hours check” and signfull legal signature and title, followed by

6.1 The medication room communicationserves as a vehicle for maintainingcontinuity of care between themedication room staff of all 3 shiftsand serves to alert the staff of neworder

6.2 The nightly review of all charts of neworder serves as a safeguard measure toprevent medication errors to individual

6.3 Sign below the red line. This red 24hours line is a mark of assurance toother medication staff that thetranscribed order is complete, accurateand safe

MED-71






date and time reviewe.g.Date Time Problem # Physician order1-1-10 1400 1 Brufen 400 mg one tab.

p.o. BID x 3 daysDr. Kay John MD

NotedSN Jane FondaID#1231-1-2010 @ 1415

24 hours checked SN SarahJane ID# 456 2-1-2010@0030

6.4 All errors (transcribing, omission ofinitials and lack of documentation) areto be entered in audit form

6.5 The shift team leader will submit thecopy of the “24 hours shift audit form”to the unit supervisor every morning.

6.6 The nursing department will give a copyto any staff involved so that correctioncan be made or development of anyplans of action as needed

6.7 A copy is given to nursing coordinatorevery morning

6.4 All transcription are to be madeimmediately by the person who identifiesthe error and recorded as corrected inthe last column

6.5 Unit supervisor will review and takeappropriate follow-up action as neededas based on the findings of the audit

6.6 The nursing department retains theoriginal copy while the errors are beingcorrected

6.7 The unit supervisor will appraise theNCP (Nursing Care Plan) of actioninitiated based on the audit findings. Theunit supervisor will retain the originalcopy

7.0 ATTACHMENTSNA

8.0 REFERENCESCaldmh.files wordpress. Com/2007/11/524.pdf (Internet)

MED-72

mailto:2-1-2010@0030






NAME: DATE




MED-73






MED-74



IPP CYCLOPOSPORIN ADMINISTRATIONTITLE:



1.0 DEFINITION

A standard to correctly and safely administer intravenous Cylosporin A (CSA).CSA is an immunosuppressive agent.

2.0 PURPOSE2.1. To provide guidelines on Cyclosporine administration

3.0 POLICY3.1Follow recommended guidelines for monitoring of therapeutic CSA levels, as per laboratorymanual or unit protocol. The standard for obtaining serum CSA level is twelve (12) hours followingadministration of CSA.

Physicians may order levels two (2) hours following administration.

3.2 One lumen of the central venous catheter is to be delegated for CSA administration. Bloodsampling for CSA levels is to be taken from a separate lumen of the catheter that the CSA has notbeen administered through.

4.0 RESPONSIBILITIES4.1 General nursing

5.0 MATERIALS & EQUIPMENT5.1 Cyclosporine A intravenous solution in a glass bottle.5.2 Volume control IV pump.5.3 IV tubing with cassette.5.4 Secondary IV tubing (not needed for pediatric patients).5.5 Alcohol swab5.6 D5W flush bag 22 g. needle.

MED-75







6.1 Check the medication against the patient’s IDband and medication record. Administration.

6.2 Check the medication against the patient’s IDband and medication record. Administration.

6.3 Assemble all equipment at the patient’s bedside.

6.4 Explain the procedure to the patient.

6.5 Wash hands

6.6 Set up volume controlled IV pump, prime IVTubing with D5W flush solution.

Exception: with pediatric patientattach CSA to primary tubing, andflush tubing with CSA.

6.7 Connect CSA to secondary IV tubing andConnect into primary tubing.

6.8 Set rate of CSA administration on the volumeControl pump and begin infusion.

6.9 After the entire contents of CSA has infusedback, prime into the secondary line with D5WFlush.

Exception: with pediatric patients,when CSA infusion is completed,replace bottle with D5W flush, flushat least 20cc.

6.10 Document on the medication record that CSwas given.

1. To ensure the 7 Right medication,correct patient, dose, and time

2. To ensure the 7 Right medication,correct patient, dose, and time

4. To relieve and anxiety.

5. To prevent cross contamination

8. Drug is to be infused over prescribedtime of period.

MED-76






11.Chart on the appropriate nursing on therapyfollowing :

11.1 Patient’s tolerance on therapy11.2 Nursing intervention

7.0 ATTACHMENTSNA

8.0 REFERENCES8.1 General Directorate of Policy & Procedure

NAME: DATE

PREPARED BY: Ms. Chandra Vijicomar-RN,BSN Renal Ward Head Nurse - KFH-J 2010



MED-77


INTERNAL POLICY AND PROCEDURENURSING

PHARMACY STAFFMEDICAL STAFF

APPLIES TO:GNR-04-13POLICY NUMBER:

IPP GENERAL OXYGEN THERAPY POLICYTITLE:

EFFECTIVE DATEAPPROVAL DATE:


1.0 DEFINITION

2.0 PURPOSEGeneral oxygen policy defines policies for the administration of oxygen inconcentrations greater than ambient air, via delivery devices of modes other thanmechanical ventilators and hypebaric chambers. The specific intent is the treatment orprevention of hypoxia and related symptoms. Policies are applicable to oxygenadministration in the acute care (hospital) setting by respiratory care practitioner (RCP)and nurse.

3.0 POLICY3.1 Patient and others in the room should be cautioned NOT TO SMOKING.3.2 Oxygen delivery system may be categorized as low flow or high flow system.

Low flow systems deliver 100% oxygen at flow rates less than the patient’srespiratory demand. The delivered oxygen is diluted with ambient air and this theF102 may vary widely, depending on the device used and the patient’s aspiratoryflow rate.

Low Flow System: nasal cannula, simple mask, partial re-breathing mask.

High flow system deliver a prescribed oxygen concentration at flow rates that exceedthe patient’s aspiratory demand.

High Flow System: Venturi mask, aerosol face mask, manual resuscitation.








1.0 DEFINITION














1.0 DEFINITION







MED-78








3.2 Oxygen therapy should be promptly initiated for patients who are dyspneic orsuspected of hypoxemia. This may be accomplished effectively though theapplication if either nasal cannula @ 1-5Lpm (for low Fi020) or simple mask at 6-8LPM, (for moderate (Fi02) pending assessment of oxygenation by pulse oximetryand or arterial blood gases. (Oxygen delivery nay then adjusted as indicated.

3.3 A Respiratory Therapist must be called to assess any patient (outside a designatedcritical care area) on oxygen >/-4 0% examples: simple mask/partial re-breathingmask.

3.4 A humidifier must be used with all Pediatric nasal cannula, and all adult nasalcannula at flow above 4LPM, as well as all aerosol/ nebulizer systems.

3.5 A humidifier is RARELY used with a Venture mask and is technically complicated toset up.

3.6 A humidifier IS NOT used with a simple mask, partial re-breathing mask, or manualresuscitator.

3.7 The humidifier water level and correct oxygen liter / FI02 shall be checked at leastonce per shift by the nurse responsible for the care of the patient.

3.8 Respiratory therapist do not routinely monitor 02 use outside of intensive care.

3.9 Low flow 02 devices could be used up to 14/7 as long as they are functional andclean. All 02 deliver using aerosol nebulizer should be changed every 72hrs.

Infection Control and Equipment Out Intervals.

1. Pre-filled humidifier (500 ml) and nebulizer (1000ml) may be used for extended



































MED-79








periods of time without contamination in normal use, these devices should bedated on initial used and used for a period no to exceed fourteen (14) days.Discard replace remaining humidifiers/nebulizers of fourteen (14) days.Reserviors should also be replaced when the water level reaches ½ inch fromthe reservoir bottom. This is the responsibility of allocated nurse.

2. Filled humidifiers and nebulizers may be used foe single patient use only. Thenebulizer/humidifier adapter are disposable and can be discarded followingsingle patient use.

3. Corrugated (wide bore) aerosol tubing (only) should be replaced every seventy-two (72) hours by the allocated nurse.

4. Aerosol drainage bags should placed in the dependent portion of corrugatedtubing and drained periodically to prevent buildup of liquid condensate in thedelivery tubing.

5. Replacement O2 cylinder are to be ordered by phoning the Medical GasDepartment. Regulators are a warehouse stock item.

6. Low flow oxygen devices (including cannulae). And face masks do net present asignificant infection control risk and need not to be routinely changes. Theyshould, however, be replaced whenever they are visibly of fuction of the device iscompromised.

7. Liquid condensate should not be allowed to enter and thus contaminate theaerosol nebulizer.

4.0 RESPONSIBILITIESNURSINGPHARMACY STAFFMEDICAL STAFF


































MED-80









7.0 ATTACHMENTSNA

8.0 REFERENCES

NAME: DATE


REVIEWED BY: Mrs. Ashwag O. Shibah - RN,BSN Head of NursingEducation KFH-J 2010

APPROVEDBY:

Central Committee Of NPP 2010- General Directorate OfNursing- MOH.KSA 2010









7.0 ATTACHMENTSNA

8.0 REFERENCES

NAME: DATE



APPROVEDBY:










7.0 ATTACHMENTSNA

8.0 REFERENCES

NAME: DATE



APPROVEDBY:


MED-81



IPP UNIT DOSE DRUG ADMINISTRATIONTITLE:



1.0 DEFINITIONUnit dose drug - is a prescribed amount of medication dispensed at a specified time.Unit dose system – involves the pharmacy or manufacturer in pre-packaging and pre-labelingan individual client dose.

2.0 PURPOSE2.1 To have a uniform standard of administering medications in the ward2.2 To ensure that medications are distributed correctly and safely2.3 To go with internationally recognized standards of practice.

3.0 POLICY3.1 physician prescription is transcribed by doctors only3.2 Injections are prepared on time of administration not in advance3.3 medication trolley has to be attended all times3.4 For the medications that are refused to be taken by patient should be returned anddocumented in medication sheet as well as nurses notes.3.5 Giving of medication according to standard time of administration of medicine.

4.0 RESPONSIBILITIESNursing

5.0 MATERIALS & EQUIPMENT5.1 Prescription slip form for in-patient5.2 Medication sheet5.3 Medication trolley5.4 Mortar and pestle, if required5.5 Medicine cup5.6 Glass of water5.7 Tissue paper5.8 Disposable waste bag5.9 Metal tray5.10 prescribed drug

MED-82






6.0 PROCEDURES RATIONALE6.1 The charge nurse will accompany thedoctors during the rounds with the patient file,medication sheet and prescription slip.

6.2 The consultant or his resident will write theprescription slip for newly ordered drugincluding medication sheet.

6.3 After completion of all doctors round , thecharge nurse will gather all prescription slipsand send it to pharmacy or to be placed insidethe respective compartment of the medicinetrolley.

6.4 Send the medication trolley to thepharmacy or vice versa.

6.5 Charge nurse will counter check togetherwith the pharmacist that prescribed drugs arecorrectly placed.

6.6 The nurse who prepare the medicine willbe the one to give the medicine , takemedication trolley to the patient's bed side

6.7 Wash and dry hands thoroughly.

6.8 Check the patient's identity ( 7rights)

6.9 Complete any pre drug administrationassessment (i.e. blood pressure, pulse)

As per hospital internal policy.

As per prescription / physician order



To make sure the amount of medication iscomplete.

Establish accountability and to avoidmedication error.

To maintain asepsis / avoid contamination ofthe medicine.

To avoid medication error.

Some medications require assessment todetermine if the medication can be givensafely at that time.

MED-83






required for the specific medication to begiven.

6.10 Each drug will be dispensed by themedication nurse and sign in the medicationrecord sheet after giving , then the nursehas to stay at the patient's bedside until thedrug is taken.

6.11 At the completion of giving medicationcheck that the trolley is kept clean ,tidy andsecured.dispose of soiled supplies and washhands.

6.12 Lock the medicine trolley and place itinside the preparation room

6.13 Record the time of administration ofmedication and any pre administrationassessment data collected.

To make sure the drug is taken and to avoidmisplacing.

For security purpose

Maintain legal record and prevents potentialmedication error.

7.0 ATTACHMENTS7.1 physician order sheet7.2 medication sheet

8.0 REFERENCES8.1 William & wilkins (2006). Manual of nursing practice.(8th ED) , Lippincott , Philadelphia, NewYork

NAME: DATEPREPARED BY: Ms. Jasmin L. Yanto -RN,BSN- Nursing Supervisor, KAAH & OC 2010



MED-84



IPP INTRAVENOUS (IV) PUSH MEDICATIONSTITLE:



1.0 DEFINITIONPush medication are defined as:

1. IV Push: A specific amount of medication (diluted or undiluted) given directly intovein over thirty to sixty (30-60) seconds.

2. Slow IV Push: A specific amount of medication given into the vein over three tofive (3-5) minutes must be given by piggy back (IVPB).

3. Rapid IV Push: A specific amount of medication given directly into the vein overless than thirty (30) seconds.

2.0 PURPOSE1. To define which medication may be administered by IV push method.2. To achieve a high blood levels of a medication into a short period.3. To achieve immediate and maximal effects of a medication.4. To administer the correct intravenous injection following the seven (7) rights.

3.0 POLICY1. A written doctor’s doctor order must be secured.2. Review of medication should be done every Monday.3. Medication must be kept in the medication trolley.4. Medication key are kept with the Charge nurse or the appropriate designee.5. A nurse should not administer medication prepared by someone except those

prepared by the Pharmacist and requires name and signature of the Pharmacist.6. Two Staff Nurses are required to administer the medication.7. Ensure that the medication room is clean and have a good lighting.8. Patient identification is checked by patient name and medical record number

through the ID band and using the seven rights.9. Medication brought to hospital by patient should not be administered or left with

patient without written order by the physician for continuation and medicationsent to pharmacy for proper labeling.





























MED-85






4.0 RESPONSIBILITIES4.1 Registered Nurse

5.0 MATERIALS & EQUIPMENT1. Watch with second hand2. Medication administration record (MAR)3. Antiseptic swabs4. Clean gloves5. Vial, ampoule, or prefilled cartridge syringe of medication6. Syringe7. Needle device or sterile needle ( 21- to 25- gauge)

6.0 PROCEDURES RATIONALE6.1 Assess patient for the following:

6.1.1 The patient medical history,history of allergy and medicationhistory.6.1.2 Patients intravenouscannulation site for signs ofinflammation, displacement of needleor phlebitis and patient’s body weight.Body.6.1.3 Patient condition for anycontraindication for intravenousinjection example muscle atrophy

6.1 Assessing the patient will helpfacilitate proper site for injection.





















MED-86






decreased blood flow, circulatoryshock.6.1.4 The patient’s knowledgeregarding medication to be received.

6.1.5 Observe patient’s verbal andnon- verbal response towardsinjection.

6.2 Check medication order.6.3 Assembles supplies in medication

room.6.4 Check name of medication on

vial/ampoule label against MAR.

6.5 Check medication’s expiry dateprinted on the vial/ampoule.

6.6 Check accuracy and completeness ofthe MAR for:6.4.1 Doctor’s order6.4.2 Patient’s name6.4.3 Medication name6.4.4 Medication dosage6.4.5 Route of medication

Frequency of medication6.4.6 Time of medication

6.7 Check patient’s identification bylooking at arm bracelet and askingname and re-check the 7 rights.

6.2 To ensure right medication6.3 Ensures sterile preparation of

medications.6.4 Ensure the patient receives correct

medication.

6.5 Medication that have expiredshould not be used.

6.6 Verifies correct medication.

6.7 Ensure that the drug isadministered to the correctpatient. At least two patientidentifiers are to be used whenadministering medication.

















medication.




















medication.




MED-87






6.8 Wash and dry hands

6.9 Don gloves

6.10 Administering Medication Into anExisting Intravenous Line6.10.1 Select injection port or “Y”” site

in IV tubing closest to the IVinsertion site.

6.10.2 Clean injection port withantiseptic swab. Allow to dry

6.10.3 Connect syringe to IV lineinsert needleless blunt cannulatip syringe or a small gaugeneedle containing drug throughcenter of port.

6.10.4 Occlude IV line by pinchingtubing just above injection portgently on syringe’s plunger toaspirate for blood return.

6.10.5 Inject the medication slowlyinto the IV port at theprescribed rate. Use a watchto time administration rate.

6.10.6 If IV medication and IV solutionin tubing are incompatible,

6.8 Reduces the transfer of microorganism from one hand tomedication.

6.9 Barrier such as gloves arenecessary to comply withStandard PRECAUTION.

6.10.1 Minimizes dilution of themedication and increasestransit of medication intoprimary tubing.

6.10.2 Prevent introduction ofmicroorganism duringneedle insertion.

6.10.3 Prevent introduction ofmicroorganisms. Preventsdamage to port diaphragm.

6.10.4 Final check ensures thatmedication is beingdelivered into bloodstream.

6.10.5 Timing ensures safeinfusion of drug. Too rapidinjection of some IVmedications can be fatal.







6.9 Don gloves





















6.9 Don gloves















MED-88






flush line with normal solutionwhile occluding catheter aboveport. Administer medication atprescribed rate, re-flush with10ml of sterile normal salinesolution, and releaseocclusion.

6.10.7 After injecting medication,withdraw syringe and recheckfluid infusion rate.

6.11 Intravenous push (Intravenouslock):

6.11.1 Don gloves.6.11.2 Prepare flush solution. Saline

flush6.11.2.1 Prepare 2 syringes filled

with 2 to 3 ml of normalsaline (0.9%).

6.11.3 Heparin flush method(traditional method)

6.11.3.1 Prepare 1 syringe withordered amount ofheparin flush solution.

6.11.3.2 Prepare 2 syringes with2 to 3 ml of normalsaline (0.9%).

6.10.6 Flushing before and afterwith normal saline keepsincompatible solutionsfrom mixing.

6.10.7 Injection of bolus may alterrater of fluid infusion.Rapid fluid infusion cancause circulatory fluidoverload.

6.11.1 Maintain asepsis.

6.11.2.1 Normal saline iseffective in keeping IVlocks patent and iscompatible with wide rangeof medication.





































MED-89






6.11.4 Administer medication:6.11.4.1 Clean lock’s injection

port with antisepticswab.

6.11.4.2 Insert syringe withnormal saline 0.9%through injection port ofIV lock.

6.11.4.3 Pull back gently onsyringe plunger, andcheck for blood return.

6.11.4.4 Flush IV site withnormal saline bypushing slowly onplunger.

6.11.4.5 Clean lock’s injectionport with antisepticswab.

6.11.4.6 Inject medication withinamount of time.

6.11.4.7 After administering themedication clean locksof the injection site withantiseptic swab.

6.11.4.8 Attach syringe with 1 to

6.11.4.1 Cleaning preventsintroduction ofmicroorganism duringneedle insertion.

6.11.4.3 Indicates if needle orcatheter is in vein.

6.11.4.4 Cleans needle andreservoir of blood.Flushing withoutdifficulty indicatespatent IV.

6.11.4.5 Prevent transmissionof infection.

6.11.4.6 Careful timing ensuresafe medicationinfusion. Too rapidinjection of some ivmedications can befatal.


6.11.4.8 Maintains patency ofthe IV site.











































MED-90






3 ml of Normal Salineinto injection port andflush the port withsaline.

6.11.4.9 Dispose of usedsyringes properly andwash hands.

6.11.4.10 Document medicationadministration

6.11.4.11 Evaluate the patient thepatient’s response tomedication therapy.

6.11.4.9 Maintain asepsis

6.11.4.10 Accuratedocumentation ismandatory to preventmedication error.

6.11.4.11 Careful and timelyassessment isnecessary becausemedications isgiven by IV boluscan have a rapidaction.

7.0 ATTACHMENTS7.1 Medication administration record

7.2 Physician order sheet

8.0 REFERENCES8.1 Perry & Potter (2007). Mosby’s Basic Skills and Procedure (6th ED) Mosby, Inc

8.2 Sandra F. Smith, Donna J. Duell & Barbara C. Martin (2002) Photo Guide of

8.3Nursing Skills. Upper Saddle River, New Jersey William & Wilkins (2008).Manual of Nursing Practice (9TH ED) Lippincott, Philadelphia . New York

8.4 MOH Policy


















8.4 MOH Policy


















8.4 MOH Policy

MED-91






NAME: DATE

PREPARED BY: Ms. Jacqueline M. Memeje -RN,BSN-, KAAH & OC 2010








NAME: DATE









NAME: DATE




MED-92



IPPADMINISTERING MEDICATION BY METERED

DOSE INHALERTITLE:



1.0 DEFINITIONA process of giving medication from a small, handled device that a client presses beforeinhaling a set dose of medication released from the cartridge.

2.0 PURPOSE2.1 To deliver a pre-measured dose of medication to the bronchial airways and lungs.

2.2 To administer the correct medication through metered dose following the seven (7)rights.

3.0 POLICY3.1 Medication is prescribed by the physician.3.2 Medication brought by the patient from outside should not be administered without

written order by the physician for continuation and medication should be sent topharmacy for proper labeling.

3.3 Medication administration must be performed by a qualified nurse with adequateknowledge on the procedure and the effect of medication.

4.0 RESPONSIBILITIESRegistered Nurse




DOSE INHALERTITLE:













DOSE INHALERTITLE:










MED-93




DOSE INHALERTITLE:



5.0 MATERIALS & EQUIPMENT5.1 Medication administration record (MAR)5.2 MDI with medication canister5.3 Inhaler mouthpiece5.4 Stethoscope5.5 Spacer device

6.0 PROCEDURES RATIONALE6.1Assess patient for the following:

6.1.1 The patient medical history,history of allergies andmedication.

6.1.2 respiratory pattern andauscultate breath sounds.

6.1.3 Readiness and ability to learnthe purpose and action ofprescribed medication.

6.1.4 Patient technique in using aninhaler, if previously instructedin self administration of inhaledmedicine.

6.2Wash hands

6.3Check medication order. Arrangeequipment and materials. Make sureMAR is next to medication cart orcabinet.

6.1 Assessing the mental or physicalaffect patient’s ability to learn andmethods nurse uses for instruction.

6.2Reduces transfer of microorganismsfrom hands to medication.

6.3 Organizes work space to save timeand reduce the chance of error.




DOSE INHALERTITLE:









6.2Wash hands








DOSE INHALERTITLE:









6.2Wash hands





MED-94




DOSE INHALERTITLE:



6.4 Prepare medication for only one clientat the time.

6.5Remove ordered medication from thecart or shelf. Compare label onmedication with the MAR for:

6.5.1 Doctor’s order6.5.2 Patient’s name6.5.3 Medication name6.5 .4 Medication dosage6.5.5 Route of medication


6.6 Calculate correct drug dosage, ifnecessary.

6.7 Assemble medication canisterinhalation mouth piece, andspacer device if needed. Attachthe medication canister to theinhaler mouthpiece by insertingthe metal stem into the long endof the mouthpiece. Shake thecanister several times.

6.8 Explain the procedure and itspurpose to the patient.

6.9 Assist the patient to sitting orstanding position. Perform thesecond medication check of the

6.4 Prevents error during preparation.

6.5 Prevent medication error.

6.6 Prevents dosage errors.

6.7 Shaking the canister mixes themedication and ensures uniformdelivery of dosage.

6.8 To get patient cooperation

6.9 Sitting or standing enhances fullchest expansion allowing deeperinhalation of the medication. these3cond check occur before




DOSE INHALERTITLE:




















DOSE INHALERTITLE:

















MED-95




DOSE INHALERTITLE:



seven rights.

6.10 Asked the patient’s to breathe outthrough his or her mouth.

6.11 Position the mouth piece 1 to 2inches from the patient openmouth. Instruct the patient tobreathe in slowly through themouth. As the patient startsinhaling, press the canister downto release one dose of themedication.

6.12 Instruct the patient to hold his orbreath for 10 seconds(if possible.)

6.13 Wait at least 1 minutes beforeadministration of a second doseor inhalation of differentmedication by metered doseinhaler (MDI). Administerbronchodilators by MDI beforemedication.

6.14 If the medication ends up in thepatient’s tongue or in the back ofhis throat or only in the air use a

administration of the patient.Checking the seven rightsminimizes potential medicationerrors.

6.10 Empty lungs enhance subsequentdeeper inhalation.

6.11 Releasing the medication 1 to 2inches away from the mouthallows medication to form a mistand to be delivered moreaccurately by inhalation to thebronchial airways rather thanbeing trapped in the oropharynxand then swallowed.

6.12 Enhances complete absorption ofthe medication.

6.13 Waiting allows medication fromthe first dose to be distributed andabsorbed. Administer thebronchodilator first. Opening theairway and enhances greateradsorption of subsequent inhaledmedication.

6.14 A spacer to the inhalationattached to the inhalermouthpiece traps the dose of




DOSE INHALERTITLE:



seven rights.















DOSE INHALERTITLE:



seven rights.












MED-96




DOSE INHALERTITLE:



spacer or a holding canister.6.14.1 Attach the spacer to the

inhalation mouthpiece.Instruct the patient toinhale and then place themouthpiece in the mouth,closing his or her lipsaround the mouthpiece.

6.15 Wash hand and cleanmouthpiece If steroid medicationwas administered, have clientrinse mouth.

6.16 Reassess ease of breathing,respiratory rate , accessorymuscle use, and breath sounds.

6.17 Document medicationadministration and client statusbefore and after administration.

medication and helps ensureadequate inhalation of medicationfor patients who have difficultyinhaling slowly and deeply or whocannot coordinate pressing on thecanister while simultaneouslyinhaling the medication.

6.15 Washing hands and equipmentminimizes spread of infection andmaximizes inhaler efficiency. Oralfungal infections can occur ifinhaled steroid medicationremains in the oral cavity.

6.16 Follow-up assessment providesdata to evaluate the effectivenessof inhaled medication.

6.17 Documentation helps maintainaccurate client records, includingeffectiveness of the medications,and prevents medication errors.

7.0 ATTACHMENTS7.1 Doctors Medication Order

7.2 Medication Administration Record




DOSE INHALERTITLE:

















DOSE INHALERTITLE:














MED-97




DOSE INHALERTITLE:






8.4 MOH Policy

NAME: DATE


REVIEWED BY: Mr. Nasser Al Zayedi-RN,BSN,Nursing Supervisor,Quality Department - KAAH & OC 2010

APPROVED BY: Central Committee Of NPP 2010- GeneralDirectorate Of Nursing- MOH.KSA 2010




DOSE INHALERTITLE:






8.4 MOH Policy

NAME: DATE







DOSE INHALERTITLE:






8.4 MOH Policy

NAME: DATE




MED-98



IPP ADMINISTERING ORAL MEDICATIONSTITLE:



2.0PURPOSE2.1 To provide a safe, effective, economical route for administering medication.2.2 To provide a sustained drug action with minimal discomfort.2.3 To administer the correct oral medication following the seven (7) rights.

3.0 POLICY

3.1 Medication is prescribed by the physician.3.2 There must be a complete written legibly on the physician’s order and medication sheet.3.3 Administration of medication must be done by a registered nurse.3.4 All medication is kept secured in the medication trolley.3.5 Medication key are kept with the Charge nurse or the appropriate designee.3.6 A nurse should not administer medication prepared by someone except those prepared by

the Pharmacist and requires name and signature of the Pharmacist.3.7 Two Staff Nurses are required to administer the medication.3.8 Check patient’s name and medical record number through ID band and using the seven (7)

rights before administering the medication.3.9 Medication brought by the patient from outside should not be administered without written

order by the physician for continuation and medication should be sent to pharmacy forproper labeling.

3.10 Pre-administration assessment must be done like checked for BP, pulse and respirationor any factor indicated before medication administration.

3.11 Standard precaution must be observed at all times.








3.0 POLICY














3.0 POLICY








MED-99






5.0 MATERIALS & EQUIPMENT5.1Medication sheet5.2Medication trolley5.3Disposable medication cup.5.4Water, juice or milk5.5Mortar and pestle or other drug-crushing device (optional)


6.1.1 The patient medical history,history of allergy and medicationhistory.6.1.2 Patient condition for anycontraindication receiving oralmedication example dysphasia nauseaand vomiting and level ofconsciousness.6.1.3 The patient’s knowledgeregarding medication to be received.6.1.6 Observe patient’s verbal and non-verbal response towards injection.

6.2 Check medication order, arrangedequipment.MAR should be next tomedication trolley or cabinet.

6.3 Check accuracy and completeness ofthe MAR for:6.4.1 Doctor’s order6.4.2 Patient’s name6.4 3 Medication name

6.1 Assessing the patient will preventmedication reaction.

6.2 Organizes work space to save time andreduces the chances of error.




























MED-100






6.4.4 Medication dosage6.4.5 Route of medication


6.4 After confirming order, recopy or reprintany portion of MAR that is illegible.


6.6 Prepare medication:

6.6.1 Arrange medication tray andcups in medication tray and cupsin medication preparation area.

6.6.2 Check expiration date on allmedications.

6.6.3 Prepare medication for one clientat a time. Keep all pages of MARfor one client together.

6.6.4 Select drug from stock supply orunit dose drawer. Compare labelof medication with MAR.

6.6.5 Calculate drug dose asnecessary. Double-checkcalculation.

6.6.6 Pour required number oftablets/capsule directly into themedication cup without touchingthe tablets.

6.4 Soiled or illegible Mar forms can besource of drug error.

6.5 Reduces the transfer of micro organismfrom one hand to medication.

6.6.1Organization of equipment savestime and reduces error.

6.6.2 Medication used past expirationdate may be inactive or harmfulto client.

6.6.3Prevent medication errors.

6.6.4 Reading label first time andcomparing it against transcribedorder reduces errors.

6.6.5 Double-checking reduces risk oferror.

6.6.6 Drugs are very expensive avoidwaste. Tablets that are notprescored cannot be broken intoequal halves, and result will beinaccurate dose.

















































MED-101






6.6.7 To prepare unit dose tablets orcapsules, place packaged tabletor capsule directly into medicinecup.

6.6.8 All tablets or capsules to be givento client at same time may beplaced in one medicine cupexcept for those requiring pre-administration assessment (e.g.pulse rate,, blood pressure).

6.6.9 If client has difficulty swallowing,use pill-crushing device such asmortar and pestle to crush pills.

6.7 Liquid preparation:6.7.1 Gently shake syrup /suspension

solution if necessary.

6.7.2 Hold bottle with label againstpalm of hand while pouring. Holdmedication cup at eye level, andfill to desired level on scale.

6.7.3 Compare MAR with all prepareddrugs, and continue preparation.

6.7.4 Return stock containers orunused unit – dose medicationsto shelf or drawer, and read labelagain.

6.6.7 Wrapper maintains cleanliness ofmedication and identifies drugname and dose.

6.6.8 Keeping medications that requirepre-administration assessmentsseparate from others makes iteasier for nurse to with hold drugsas necessary.

6.6.9 Large tablets can be difficult toswallow. Ground tablets mixedwith palatable soft food areusually easier to swallow.

6.7.1 Prevents contamination of insideof cap.

6.7.2 Spilled liquid will not drip and soilor fade label. Ensure accuracy of

measurement.

6.7.3 Reading label second timereduces errors.

6.7.4 Third check of label reducesadministration errors.

6.14.2 Nurse is responsible for



















measurement.






















measurement.




MED-102






6.7.5 Do not leave drugs unattended.

6.8 Take medication to appropriate patientat correct time. Identify client bycomparing name on client’sidentification bracelet. Ask client tostate name.

6.9 Explain to client the purpose of eachmedication and its action. Allow clientto ask any questions about drugs.

6.10 Assist client to a seated or side-lyingposition if sitting is contraindication byclient’s condition.

6.11 If patient is unable to hold themedications, place medication cup tolips and gently introduce each druginto mouth, one at the time. Do notrush.

6.12 Stay until client has completelyswallowed each medication.

6.13Dispose of soiled supplies and washhands.

6.14 Record time at which medication wasadministered and any pre-administration assessment datacollection.

safekeeping of drugs.

6.8 Ensure the correct client receivesmedication. At least two patientidentifiers (neither to be patient’s roomnumber) are to be used wheneveradministering medication.

6.9 Client has right to be informed, andclient’s understanding of purpose ofeach medication improves compliancewith drug therapy.

6.10 Decrease risk of aspiration duringswallowing.

6.11 Administering single tablet or capsuleeases swallowing and decreases risk ofaspiration.

6.12 The nurse is responsible for ensuringthat client receives ordered dosage.

6.13 Maintain legal record and prevent spotential medication errors.









































MED-103











8.4 MOH Policy

NAME: DATE














8.4 MOH Policy

NAME: DATE














8.4 MOH Policy

NAME: DATE




MED-104



IPP ADMINISTRATION OF MANITOLTITLE:



1.0 DEFINITIONMannitol is an osmotic diuretic drug that provides chemical and therapeutie effect.It reduceintraocular pressure and used as fist-tier therapy for reducing intracranial pressure after braininjury.

2.0 PURPOSE2.1 To provide a guideline for nursing personnel for the requirement of Mannitol

administration.

2.2 To provide a general information on the indication, action, contraindication andprecaution for Mannitol administration.

3.0 POLICY3.1 A physician`s order for mannitol is required before administration.

3.2 A patient is required to submit for investigations of blood serum for renal functiontest. Osmolarity and electrolyte chest x- ray and E.CG. per hospital protocol.

3.3 The patient weight is required to calculate the dose.

3.4 Mannitol may be crystallized if exposed to low temperature. Warm bottle in hot waterbath and shake vigorously. Cool to body temperature before giving.

3.5 Do not use solution with unresolved crystals or when it turned yellow in color.

3.6 Mannitol will be administered using in line filter and infusion pump.

3.7 Nursing judgment is required before and during administration.

4.0 RESPONSIBILITIES4.1 Nursing staff

MED-105






5.0 MATERIALS & EQUIPMENT5.1 Mannittol solution 20%

5.2 Piggyback administration set

5.3 Filter set

5.4 Alcohol swabs

5.5 Tape

5.6 20 G needle

5.7 Infusion pump

6.0 PROCEDURES RATIONALE6.1 Check the physician's order and

calculate the dose.

6.2 Wash the hand

6.3 Assemble the equipments

6.4 Check the Mannitol solution for theexpiry date, color and presence ofcrystal.

6.5 Clean the Mannitol cap with an alcoholwipe.

6.6 Connect the IV filter set to the piggybacktubing. Close the tubing clamp andconnect to Mannitol container.

6.1 Rechecking before administratingmedication to prevent error.

6.2 Maintain asepsis.

6.5 To prevent spread of microorganism.

6.6 Filters help to minimize the presenceof particular matter.

MED-106






6.7 Place an IV tag label to Mannitolsolution.

6.8 Identify the patient.


6.10 Record the vital signs prior toadministration.

6.11 Check the main line infusion with theinfusion pump setup is patent andinfusing satisfactorily via the saline lock.

6.12 Clean the upper part on the mainlinetubing and connect the Mannitol infusionwith a 20 gauge needle.

6.13 Monitor vital signs during the infusion

6.14 Turn off the infusion pump and close themain line clamp.

6.15 After completion of Mannitol infusion,reset the mainline D5 W rate to allow atleast 10 ml flush.

6.16. Prior to termination of infusion,disconnect the main line tubing flush thesaline lock with 3 ml of saline

6.17 Dispose the equipment safely.

6.18 Document in the medication sheet andnurses progress record patient responseto procedure.

6.7 Labeling helps to prevent medicationerrors.

6.8 Prevent medication administration to awrong patient.

6.9 To minimize the patient's anxiety.

6.10 Vital signs are taken as a base linedate.

6.11 Patency must be secured and thatinfusion must be satisfactory.

6.15 To prevent drug in compatibility ofsucceeding medication/ fluid to beinfused.

6.17 Ensure compliance to disease control

6.18 Provides continuity of care

MED-107






7.0 ATTACHMENTS7.1 Medication sheet

7.2 Vital signs record sheet

7.3 Nurses notes

8.0 REFERENCES8.1 Lippincott Williams & Wilkins 2005, Critical care of nursing a holistic approach.

8.2 Patricia Gonce Morton. Eight edition, Part 7 nervous system chapter 32.

NAME: DATE




MED-108



IPP INTRADERMAL INJECTIONTITLE:



1.0 DEFINITIONIntra dermal Injection- use mainly for diagnostic test.

e.g. Mantoux test or tuberculin screening or allergy test.

2.0 PURPOSE2.1 To bring out reaction in skin cells and embryological related tissue in the treatment

of infectious condition of the skin, mucus and synovial membranes.2.2 For diagnostic purpose as in Mantoux test for tuberculosis and Schick test.2.3 To administer the correct intr dermal injection following the seven (7) rights.



through the ID band and using the seven rights.

9. Medication brought to hospital by patient should not be administered or left withpatient patient without written order by the physician for continuation andmedication sent to pharmacy for proper labelin



























MED-109







5.0 MATERIALS & EQUIPMENT5.1 Medication administration record (MAR)5.2 Antiseptic swabs5.3 Vial, ampoule, or prefilled cartridge syringe of medication5.4 Tuberculin syringe with attached 25- or 27-gauge needle5.5 Sterile gauze5.6 Skin pencil (optional)


6.1.1 The patient medical history,history of allergy and medicationhistory. .6.1.2 The patient’s knowledgeregarding medication to bereceived.6.1.3 Observe patient’s verbal andnon-verbal response towardinjection.

6.2 Assemble supplies in medicationroom.

6.3 Check accuracy and completenessof the MAR for:6.4.1 Doctor’s order6.4.2 Patient’s name


6.2 Reduces transfer of microorganism.

6.3 Verifies correct medication





























MED-110






6.4 3 Medication name6.4.4 Medication dosage6.4.5 Route of medication


6.4 Check name of medication onvial/ampoule label against MAR.


6.6 Wash hands thoroughly and dry.

6.7 Prepare correct dose from vial/ampoule. Check dose carefully andcompare MAR with prepared druglabel.

6.8 Identify patient by name, roomnumber, bed number, file number onthe wrist band.


6.10 Inspect the chosen injection forabrasions, localized inflammation,redness, scarring, itching or burningand avoid using such sites.

6.4 First check of label ensures tthat client receives correctmedication.

6.5 Medication that has

6.6 Reduces the transfer of microorganism from one hand to themedication.

6.7 Ensure that the medication issterile, correct label, accuratedose and correct patient.

6.8 To confirm patient identity.

6.9 To allay fear and anxiety.

6.10 Injection into skin areas withabnormal characteristics couldimpair drug absorption orinterfere with subsequentinterpretation of the skin.











































MED-111






6.11 Assist patient in comfortableposition. Extend and support elbowand forearm.

6.12 Clean the site with an alcohol swaband allow the site to dry thoroughly.

6.13 Remove needle cap while waitingthe site to dry thoroughly.

6.14 Expel any air bubbles from thesyringe by inventing the syringe andpush the plunger of syringe.

6.15 Hold syringe between thumb andforefinger of dominant hand withbevel of needle pointing up.

6.16 Grasp the syringe in your dominanthand, holding it between thumb andfour fingers with your palm upward ,hold the needle at a 15 degree angleto the skin surface with the bevel ofthe needle cup.

6.17 With the non dominant hand pull theskin at the site until it is taut andthrust the tip of the needle firmlythrough the epidermis into thedermis.

6.11 Stabilizes injection site foreasiest accessibility.

6.12 Mechanical action of swabremoves secretions containingmicroorganism.

6.15 Smooth injection requireproper manipulation of syringeparts. With bevel up,medication is less likely to bedeposited into tissue belowdermis.

6.16 Accurate delivery ofmedication into dermaltissue is very important. Anangle >15 degrees willinadvertently delivermedication intosubcutaneous tissue.

































MED-112






6.18 Inject the medication carefully sothat it produces a small bleb orwheal on the skin.

6.19 Withdraw the needle quickly whileproviding counter traction on theskin and wipe injection site gentlywith a dry sterile gauze. Do notmassage the area.

6.20 Circle the bleb with a pen andinstruct not to wet the site ofinjection until the time of reading.

6.21 Assess the patient at the time thedrug is expected to act. Observe forany adverse reaction.

6.22 Discard syringe and needle in sharpcontainer.

6.23 Instruct patient when to return forreading.

6.18 Visualization of wheal willoccur with needle bevel upand barely covered bydermis.

6.19 A dry sterile gauze is suedsince alcohol interfere withsome diagnostic skin tests.Massage can disperse themedication into the tissue orout through the needleinsertion site.

6.20 To identify the site andlocation of the wheal.

6.22 Proper disposable protectsnurse and other healthcareworkers from accidentalneedle injury.

6.23 Appropriate timing of siteassessment is necessary toaccurately interpret antibodyresponse.

































MED-113






6.24 Document the medication givenincluding the time, dosage, route,site and nursing assessment.

6.24 Maintains legal record andcommunicate health careteam.






8.4 MOH Policy

NAME: DATE



APPROVED BY: Central Committee Of NPP 2010- General DirectorateOf Nursing- MOH.KSA 2010













8.4 MOH Policy

NAME: DATE
















8.4 MOH Policy

NAME: DATE




MED-114



IPP ADMINISTERING TOPICAL MEDICATIONTITLE:



1.0 DEFINITIONTopical preparation which are applied into the skin which could be in form of cream or ointment-applied to a certain area of the skin and affecting only the area to which it is applied.

1.1 Creams: Semi solid emulsions containing a high proportion of water and absorbed quicklyinto the skin leaving no residual.

1.2 Ointment: Similar to cream but contain high proportion of oil, absorbed more slowly into theskin and leave a greasy residue.

2.0 PURPOSE2.1 To soothe and soften the skin.2.2 To be use as an antimicrobial or astringent to dry skin lesion.2.3 To protect the skin.2.4 To reduce friction.

3.0 POLICY3.1 Always observe sterile technique for open skin lesion.3.2 To administer the correct topical application medication following the seven (7) rights.


5.0 MATERIALS & EQUIPMENT5.1 Sterile gauze, clean towel or cotton balls5.2 Prescribe drugs5.3 Tongue blades5.4 Gloves5.5 Medication sheet5.6 Sterile dressing

























MED-115







6.1.1 The patient medical history,history of allergy andmedication history.

6.1.2 Condition for patientskin and the amount of

required for application.6.1.3 The patient’s knowledge

regarding medication toreceived.

6.1.4 Patient’s physical ability to applythe medication.

6.2 Prepare for the completeness ofequipment.

6.3 Check accuracy and completeness ofthe MAR for:6.3.1 Doctor’s order6.3.2 Patient’s name6.3 3 Medication name6.4.4 Medication dosage6.4.5 Route of medication


6.4 Assess the skin condition of the patient.



6.2 To ensure a smooth orderly procedure.


6.4 Provides baseline to later determine iflocal response to medication occurs.

6.5 Promotes cooperation and reducesanxiety. Improves knowledge levelregarding topical medication.











































MED-116







6.7 Determine that the body part to betreated is clean. If not wash it with warmwater or other skin solution as directedthen pat it with a sterile gauze or cottonballs.

6.8 Apply small amount of lotion to smallgauze dressing or pad and apply to skinby stroking evenly in direction of hairgrowth.

6.9 Assess the affected area for redness,rashes, swelling and discharges.

6.10 Place a small amount of cream on thetongue blade and spread it evenly onthe skin or pour some lotion on thegauze and pat the skin area with it. If aliniment is to be sue, rub into skin withthe hands using long, smooth strokes.

6.11 Removes gloves and disposeequipment safely.

6.12 Wash hand

6.13 Evaluate patient’s response and skincondition.

6.14 Record time, date dosage and route ofadministration and sign.

6.15 Document in the nurse’s progress notesand medication.

6.6 Reduces the risk of contamination

6.7 Cleansing site thoroughly allow2s nurseto properly assess skin surface.

6.8 Method of application leaves protectivefilm of powder on skin after water basesuspension dries. Technique preventsirritation of hair follicles.

6.9 To determine the signs of infection.

6.10 Ensure even distribution and sufficientdosage of medication. Techniqueprevents irritation of hair follicles.

6.11 Observe for precautionary measure.

6.12 Maintain asepsis

6.13 To assess for any drug reaction afterapplication of medicine.

6.14 For proper documentation.

6.15 Maintain legal record andcommunicates health team.












6.12 Wash hand

























6.12 Wash hand














MED-117











8.4 MOH Policy

NAME: DATE














8.4 MOH Policy

NAME: DATE














8.4 MOH Policy

NAME: DATE




MED-118



IPP MIXED DOSE INSULIN ADMINISTRATIONTITLE:



1.0 DEFINITION

1.1 Mixed dose - Administering mixed dose insulin in one syringe.

2.0 OBJECTIVE

2.1 To be able to acquire the technique of administering mixed dose of insulin in one syringe.

3.0 POLICY

3.1 No other medication or diluent should be mixed with any insulin product unless approved by the prescribingphysician.

3.2 Currently available NPH and short acting insulin formulations when mixed may be used immediately orstored for future use.

3.3 Rapid acting insulin can be mixed with NPH.

3.4 When rapid acting insulin is mixed with either an intermediate or long acting insulin is mixed with either anintermediate long acting insulin. The mixture should be injected within 15 min. before a meal.

3.5 If the medication is available in pre-filled syringes, administer medication directly without mixing, rotatinginjection sites for insulin should be observed


4.1 Head Nurse

4.2 Charge Nurse

4.3 Staff Nurse

MED-119






5.0 MATERIALS & EQUIPMENT

5.1 NPH insulin & REGULAR insulin

5.2 Insulin syringe with needle

5.3 Alcohol swab 7%

5.4 Medication sheet

5.5 Medication tray


6.1 Check the medication sheet ordered byphysician and name of the drug, its dosage,frequency, time and route.


6.3 Clean rubber stopper with alcohol swabs

6.4 Take the insulin which is cloudy looking, likeNPH.

6.5 Mix insulin by either rolling between hands or byturning bottle slowly up & down. Do not shake.

6.6 Pull plunger back to the number of units ofinsulin you are to take. Push the air in thesyringe into the bottle and then remove thesyringe from the bottle but do not withdraw anyinsulin at this time.

6.1 To avoid any occurrence of medication error.

6.2 To avoid cross infection.

6.3 To maintain aseptic technique.

6.4 NPH Insulin is long acting.

6.5 Mixes the insulin.

6.6 Air is injected into the vial to keep its contentsunder slight positive pressure making it easier towithdraw the insulin.

MED-120






6.7 Take the clear insulin (marked R)

6.8 Draw air into the syringes before equal to theamount of clear insulin prescribed.

6.9 Inject air into the bottle of clear insulin. Do notremove the syringe from the bottle.

6.10 Turn the bottle upside down. Draw theprescribed clear insulin plus 2 units more.

6.11 Invert the syringe and expel any excess air, itmay be necessary to flick the syringe to push thebubbles up.

6.12 Gently draw the milky insulin (N) on top of theclear insulin (R) to the total amount of insulinprescribed. Removed the syringe from the bottle.

6.13 Check once more for bubbles and again checkthat you have the correct dose.

6.14 Clean the site of injection with a cotton swab.

6.15 Pinch up skin while holding barrel, insert needleat 90 degrees angle (straight in).

6.16 Make sure the needle is all the way in. If you arethin you may need to inject a 45 degrees angle.

6.17 Immediately place a gauze on the insertion sitefor 30 seconds. ( do not rub area)

6.18 Discard used supplies according to infectioncontrol policy.

6.7 Regular Insulin is the short acting type of insulin.

6.8 To get the right amount to be introduced into thebottle.

6.9 Injection of air into the airspace preventscreation of negative pressure within the vial,allowing easy withdrawal of the medication.

6.10 Extra insulin will fill up the needle and expel theair bubbles.

6.11 To assure the correct amount of insulin.

6.12 To assure the correct amount of insulin.

6.13 Bubbles may interfere with withdrawing anaccurate dose of medication.

6.14 Cleanse site from cleanest towards morecontaminated areas.

6.17 To prevent insulin from leaking out and promoteabsorption.

6.18 Proper disposal protects the nurse and otherstaffs from injury and contamination.

MED-121






6.19 Document the medication given, according toseven rights of administration.

6.20 Assess the effectiveness of the medication &side effect.

6.19 Maintains legal record and communication toHealthcare Team.

6.20 To see any signs of hypoglycemia

7.0 ATTACHMENTS

7.1 Doctor’s order

7.2 Insulin Medication Sheet

8.0 REFERENCES

8.1 MOH Policy

8.2 American Diabetes Association, Diabetes care, Volume 27.

NAME: DATE

REVISED BY: Ms. JEBBY K. JOHN -RN, KAAH & OC 2010



MED-122



IPP SUBCUTANEOUS INJECTIONTITLE:



1.0 DEFINITIONSubcutaneous Injection- is a process of giving medicines into the subcutaneous

tissues which deposit into the loose connective tissue underlying the dermis

2.0 PURPOSE2.1 To administer medication into the subcutaneous tissue without injury to the patient2.2 To administer the correct subcutaneous injection following the seven (7) rights.

3.0 POLICY1. A written doctor’s doctor order must be secured.2. Review of medication should be done every Monday.3. Medication must be kept in the medication trolley.4. Medication key are kept with the Charge nurse or the appropriate designee.

5. A nurse should not administer medication prepared by someone except thoseprepared by the Pharmacist and requires name and signature of the Pharmacist.

6. Two Staff Nurses are required to administer the medication.

7. Ensure that the medication room is clean and have a good lighting.8. Patient identification is checked by patient name and medical record number


9. Medication brought to hospital by patient should not be administered or left withpatient without written order by the physician for continuation and medicationsent to pharmacy for proper labeling

MED-123







5.0 MATERIALS & EQUIPMENT5.1 Medication administration record (MAR)5.2 Antiseptic swabs5.3 Vial, ampoule, or prefilled cartridge syringe of medication5.4 Syringe (1 or 3 ml with attached 25- or 27-gauge needle)5.5 Sterile gauze5.6 Disposable gloves




6.3 Check accuracy and completenessof the MAR for:




MED-124






6.4.1 Doctor’s order6.4.2 Patient’s name6.4 3 Medication name6.4.4 Medication dosage6.4.5 Route of medication






6.8 Identify patient by name, roomnumber, bed number, file numberon the wrist band.









6.10 Injection into skin areas withabnormal characteristics couldimpair drug absorption or

MED-125










6.15 Removed safety sheath from needleby pulling it straight off

6.16 Hold syringe between thumb andforefinger of dominant hand as ifgrasping dart, holding syringe

interfere with subsequentinterpretation of the skin.



6.13 To get ready for injection

6.14 To remove air

6.15 Preventing needle fromtouching sides of sheathprevents contamination

6.16 Quick, smooth injectionrequires proper manipulation

MED-126






across tops of fingertips

6.17 Administer injection for about 45 to90 degrees angle Inject themedication carefully so that itproduces a small bleb or wheal onthe skin.

6.18 After needle enters the site, grasplower end of syringe barrel with nondominant hand. Move dominanthand to end of plunger and slowlyinject medication. Avoid movingsyringe

6.19 Withdraw needle quickly whileplacing antiseptic swab or sterilegauze gently above or ever site

6.20 Apply gently pressure to site. Do notmassage site. (If heparin is given,press alcohol swab or gauzecontinuously to site for 30 to 60second)

of syringe parts

6.17 Needle penetrates tight skinmore easily than loose skin.Pinching skin elevatessubcutaneous tissues

6.18 Properly perform injectionrequires smoothmanipulation of syringe part.Movement of syringe maydisplace needle and causediscomfort

6.19 Supporting tissue aroundinjection site minimizesdiscomfort during needlewithdrawal. Dry gauze mayreduce discomfortassociated with alcohol onnon intact skin

6.20 Aids absorption. Massagecan damage underlyingtissues

MED-127






6.21 Assist client to comfortable position


6.23 Complete post procedure protocol


6.21 Gives client sense of wellbeing

6.22 Prevent injury to client &health care personnel

6.23 To document

6.24 Maintains legal record &communicate healthcare






8.4 MOH Policy

MED-128






NAME: DATEPREPARED BY: Ms. Jacqueline M. Memeje -RN,BSN-, KAAH & OC 2010



MED-129



IPP RECTAL SUPPOSITORIESTITLE:



1.0 DEFINITIONA suppository is a cone shape or cylinder of a medical substance which can be introduced intothe rectum and will eventually dissolve if used.

2.0 PURPOSE2.1 To relieve constipation and to evacuate the bowel prior to surgery or certain investigation.2.2 To administer medication e.g. antibiotics bronchodilators analgesia.

3.0 POLICY3.1 To lubricate dry stool and have a mild stimulant effect in the rectum and absorb by through

the rectal mucosa3.2 To administer the correct medication through rectal suppositories following the seven (7)

rights.


5.0 MATERIALS & EQUIPMENT5.1 MAR5.2 Disposables wipes5.3 Water soluble lubricant5.4 Protective covering5.5 Receptacle for soiled disposable5.6 Disposable gloves5.7 Prescribed suppositories










rights.












rights.



MED-130







6.1.1 The patient medical history,history of allergies and medication.

6.1.2 Readiness and ability to learn thepurpose and action of prescribedmedication.

6.1.3 Patient knowledge regardingmedication to be received.

6.2 Review prescriber’s order includingpatient’s name, drug name, dosage,form, route and time of administration.

6.3Review medical record for history of rectalsurgery or bleeding.

6.4Assess client ability to hold suppositoryand to position self insert medication.

6.5Review patient’s knowledge ofpurposeofdrug therapy and interest in selfadministering suppository.

6.6Check accuracy and completeness of theMAR for:



6.7 Check patient‘s identification bracelet, and


6.2 Ensures safe and correct administration ofmedication.

6.3 Condition contraindication use ofsuppository.

6.4Mobility restriction indicates need for nurseto assist with drug administration.

6.5May indicate need for health teaching.Level of motivation influences teachingapproach.

6.6Order sheet is most reliable source andonly legal record of drugs patient receive.Ensure that right medication isadministered.

6.7Ensure that correct client receives

















































MED-131






ask name.

6.8Explain the procedure to the patient.

6.9Ensure the patient’s privacy and assist thepatient into the left lateral position with hisbuttocks near the edge of the bed.

6.10 Place the protective covering under thepatient’s buttocks.

6.11 Examine condition of anus externally,and palpate rectal walls as needed ( ifimpaction is suspected).

6.12 Dispose of gloves by turning theminside out and placing them in properreceptacle if they become soiled.

6.13 Check with drugs prescription sheetagainst the suppository if matched.

6.14 Remove suppository from foil wrapper,and lubricate rounded end with watersoluble lubricant.

6.15 Ask patient’s to take slow, deepbreaths through mouth and relax analsphincter.

6.16 Retract patient’s buttocks with non-

medication. At least two identifiers (neitherto be the room the number) are to be usedwhenever administering medication.

6.8To gain his consent and cooperation.

6.9 Respect of patient’s privacy andrelaxation.

6.10 To avoid bed sheet from soiling.

6.11 Determine presence of active bleeding.Palpitation determine whether rectumis filled with feces, which may interferewith suppository placement.

6.12 Reduces transmission of infection.

6.13 Provide accuracy of medication.

6.14 Lubricant reduces friction assuppository enters rectal canal.

6.15 Forcing suppository throughconstricted sphincter causes pain.

6.16 Suppository must be place3d in rectal






ask name.

























ask name.




















MED-132






dominant hand. With gloved indexfinger of dominant hand, insertsuppository gently through anus, pastinternal sphincter, and against therectal wall.

6.17 Withdraw finger, and wipe patient’sanal area.

6.18 Discard gloves by turning them insideout, and dispose of in appropriatereceptacle.

6.19 Ask client to remain flat or side for 5minutes.

6.20 Dispose of all the equipment safely.

6.21 Evaluate patient for relief of symptomfor which medication was prescribed.

6.22 Document in the nurse’s progressnotes and medication.

mucosa for eventual absorption andtherapeutic action.

6.17 Provide comfort.

6.18 Reduces transfer of microorganisms.

6.19 Prevent expulsion of suppository.


6.21 Determines medication’s effectiveness.




















































MED-133







8.4 MOH Policy










8.4 MOH Policy










8.4 MOH Policy




MED-134



IPP MEDICATED SHAMPOO ( HEAD LICE)TITLE:



1.0 DEFINITIONMedicated shampoo- shampoo which contain medicinal substance primarily to treat hair/ bodyhair infestation specifically head lice.

2.0 PURPOSE2.1 To remove lice completely from patient’s head.2.2 To remove dirt and oils.2.3 To stimulate hair follicles to produce oil for healthy hair.2.4 To assess or monitor hair or scalp problem.

3.0 POLICY3.1 To maintain a healthy scalp and hair and free from lice and nits.

4.0 RESPONSIBILITIESNursing Staff

5.0 MATERIALS & EQUIPMENT5.1 Prescribed medicated shampoo5.2 Unsterile gloves5.3 Comb5.4 2 Towel5.5 Basin5.6 Draw sheet5.7 Linen saver pad5.8 1 Basin5.9 Gown





















MED-135






6.0 PROCEDURES RATIONALE6.1 Assembles the necessary equipment and

supplies near the bedside of the patient.

6.2 Before shampooing the patient’s, hair,adjust room temperature and close offdrafts.

6.3 Explain the procedure to the patient

6.4 Adjust the bed to a comfortable workingheights.

6.5 Provide privacy and drape towel over thepatient’s pillow and shoulder.

6.6 Cover the patient with a liner or blankerthen fanfold the lines to the foot of the bedor remove if changing is necessary.

6.7 Place a pail or plastic container on a linensaver pad on the floor or on an footstoolnear the head of the bed.

6.8 Fill large pitcher or containers withcomfortable warm water and place themon the over bed tables.

6.9 Lower the head of the bed until it ishorizontal and remove the patients pillow.

6.10 Cover head part of the bed with a linensaver pad.

6.1 For easy administration of the procedure.

6.2 To prevent chills

6.3 To gain cooperation

6.4 To prevent back strain

6.5 To catch loose hair, dirt and lice

6.6 The folded bedding will stay dry, and thebath blanket, which can be discarded

after the shampoo, will keep the clientwarm.

6.7 To catch waste water from the shampootray.

6.10 To protect them from moisture.



















































MED-136






6.11 Place a towel and linen saver padtogether and place it around the patient’sneck and over his shoulder.

6.12 Place the shampoo tray under thepatient’s head, positioning the neck in theU-shaped opening.

6.13 Place a rubber linen saver pad down tothe pail.

6.14 Apply head lice shampoo and do notrinse for 30mins. Repeat sameprocedure.

6.15 Place wash cloth over the patient’s eyes.

6.16 Place cotton in patient’s ears.

6.17 Wash thoroughly at correct time intervals.Pour water carefully over the patient’shair and do not overload the basin orpitcher.

6.18 With your finger tips, rub lice shampoointo the patient’s hair. Message his scalpwell to emulsify hair oil and nits.

6.19 Rinse hair thoroughly.

6.20 Wrap the patient’s hair in a towel.Remove the linen saver pad from thebed and return bed to its initial position.

6.21 Dry the patient’s hair by gently rubbing it

6.11 To protect the patient from moisture andpads his neck against the pressure of ashampoo tray.

6.12 To drain waste water away from thepatient’s head.


6.14 To allow appropriate time to kill all lice.

6.15 Keeps shampoo from eyes.

6.16 Prevent entrance of water into the ears.

6.17 To avoid spillage.

6.18 Vigorous rubbing stimulates the scalpand also helps the patient to relax.

6.19 Medication can cause scalp irritation.



















































MED-137






with a towel.

6.21 Dispose all the equipment safely.

6.22 Comb and brush the patient’s hair.

6.23 Remake the bed and change all linesincluding pillow case and hospital gown.

6.24 Make patient comfortable.

6.25 Re-examine patient and takeinstructions from the doctor aboutfurther treatment.

6.26. Document in the nurse’s progress notesand medication.


6.23 To reduce the spread of infection.








8.4 MOH Policy






with a towel.
















8.4 MOH Policy






with a towel.
















8.4 MOH Policy

MED-138






NAME: DATE









NAME: DATE









NAME: DATE




MED-139



IPPDRAWING UP TWO MEDICATION IN A

SYRINGETITLE:



1.0 DEFINITION

A process of moving two (2) types of medications into a syringe from a vial.

2.0 PURPOSE2.1 To minimize the number of injections a patient’s receives.

2.2 To prevent contaminating one vial of medication with medication from the othervial.

2.3 To withdraw an accurate amount of medication from two (2) vials whilemaintaining aseptic technique.

3.0 POLICY3.1 The doctor's order must be reviewed and the intended medication administration

route (e.g. subcutaneous, intramuscular, intravenous) must be assessed beforeselecting the needle and syringe.

3.2 Withdrawal of two medications in a syringe from a vial must be performed byqualified nurse with adequate knowledge on the procedure and the action of themedication.

3.3 Drug literature must be reviewed to ensure compatibility of the two medications.

MED-140




SYRINGETITLE:



3.0 POLICY

3.4 The ordered medication must be checked for clarity, crystals and expiration datebefore withdrawing medication from vial.

3.5 Standard precaution must be observed.

3.6 Prepare medication for only one patient at a time.


5.0 MATERIALS & EQUIPMENT5.1 Medication administration record (MAR)5.2 Two vials of ordered medication5.3 Alcohol wipes or antiseptic swabs5.4 Sterile syringe with appropriate size, gauge and length needle

6.0 PROCEDURES RATIONALE6.1 Wash hands. Reduce transfer of microorganisms from

hands to medication.4.1 6.2 Prepare for the completeness of4.2 equipment. Organizes work space to save time.

4.3 6.3 Check medication's expiry date printed4.4 on vial.

4.5 6.4 Check medication sheet for: Prevents medication errors.

MED-141




SYRINGETITLE:



4.6 6.4.1 Doctor's order4.7 6.4.2 Patient's name4.8 6.4.3 Medication name4.9 6.4.4 Medication dosage4.10 6.4.5 Route of medication4.11 6.4.6 Frequency of administration4.12 6.4.7 Time for medication

4.13 6.5 Assemble supplies at work area or4.14 medication room.

4.15 6.6 Select the correct medication vials from4.16 stock supply.

4.17 6.7 Calculate the correct dosage of4.18 medication. Prevents medication dosage errors.

4.19 6.8 Cleanse top of both vials with antiseptic.Maintains asepsis and prevents possibleintroduction of organisms into vials.

4.20 6.9 Obtain appropriate size of syringe and4.21 draw up enough air equal to the4.22 medication dose from first medication4.23 (Vial A).

4.24 6.10 Inject air into Vial A without dipping4.25 needle into the solution. Air in vial creates positive pressure to facilitate

solution withdrawal.

4.26 6.11 Remove syringe from Vial A. Aspirate4.27 enough air equal to the medication dose4.28 from second medication (Vial B). Inject4.29 air into Vial B.

Air in vial creates positive pressure to facilitatesolution withdrawal.

4.30 6.12 Invert Vial B and withdraw the required Expelling air permits accurate dosage

MED-142




SYRINGETITLE:



4.31 volume of medication into syringe. Expel4.32 all air bubbles and withdraw needle from4.33 Vial B.

measurement.

4.34 6.13 Insert needle into Vial A, invert vial and4.35 carefully withdraw required volume of4.36 medication.

4.37 6.14 Withdraw needle from Vial A and4.38 replace needle guard. Prevents injury to healthcare workers.

6.15 Check medication and dosage beforereturning or discarding broken used vialsand used needles in puncture-proof andleak proof container.

6.16 Wash hands.

7.0 ATTACHMENTS7.1 Medication administration record (MAR)

8.0 REFERENCES8.1 JoyceLeFever Kee & Evelyn R. Hayes (2003). Pharmacology: A Nursing Process

Approach. (4th Ed.). Saunders, Philadelphia, New York.

8.2 William & Wilkins (2006). Manual of Nursing Practice. (8th Ed.). Lippincott, Philadelphia.New York.

8.3 Suzzane C. Smeltzer & Brenda G. Bare (2004). Textbook of Medical-Surgical Nursing. (10th Ed.). Lippincott Williams & Wilkins, Philadelphia, NewYork.

MED-143




SYRINGETITLE:



NAME: DATE

REVISED BY: Mr. Majed Al Malki RN, Staff Nurse-, KAAH & OC 2010



MED-144



IPP OXYGEN THERAPHYTITLE:



1.0 DEFINITION1.1 Oxygen therapy is the introduction of increased oxygen to the air available for respiration to

prevent hypoxia, a condition where insufficient oxygen is available for the cells of the bodyespecially these in the brain and vital organs.

1.2 Oxygen mask are designed to give an accurate percentage of oxygen by entering onappropriate amount of air as a specific flow rate of oxygen. Instructions are available foreach type of mask and they should be used accordingly.

1.3 The effectiveness of the oxygen therapy may be monitors by the medical practitioner byassessing the anterior blood gases at intervals as appropriate. The results are recorded inrelation to the percentage of oxygen administered to the patient and changes in percentageof oxygen or methods of administration may be ordered accordingly. Samples of arterialblood are usually obtained from the radial artery either from an indwelling arterial cannula orby individual sampling performed by Medical Practitioner. The nurse should maintainobservation of the arterial puncture site.

2.0 PURPOSE2.1 To improve tissue oxygenation.2.2 To decrease work of breathing in dyspniec patients.2.3 To decrease work of the heart in patients with cardiac disease.

3.0 POLICY3.1 Oxygen is a medication it decreases the work of breathing.3.2 To correct hypoxemia.3.3 Administration of oxygen needs a written order from the physician.3.4 “No Smoking” sign must enforced during administration of oxygen.3.5 Standard precaution is to observed at all time.

4.0 RESPONSIBILITIERegistered Nurse

























MED-145






5.0 MATERIALS & EQUIPMENT5.1 Oxygen delivery device as ordered by the physician.

5.1.1 Nasal Cannula5.1.2 Oxygen Mask5.1.3 T-tube5.1.4 Tracheostomy Collar

5.2 Oxygen tubing5.3 Humidifier, if indicated5.4 Sterile water for humidifier5.5 Oxygen source5.6 Oxygen flow meter



6.1.2 Respiratory pattern andauscultate breath sounds.

6.1.3 Patient’s knowledge regardingabout oxygen therapy.

6.2Wash hands

6.3Prepare for the completeness of theEquipment

6.4Identify and check the prescription foroxygen therapy.

6.5Explain the nursing procedure to thepatient with his current and cooperation.


6.2Prevents the spread of microorganism.6.3Facilitate flow of procedure

6.4To ensure accuracy of doctor’s order.

6.5Proper explanation of the procedurehelps to ensure the patient’s

cooperation and effectiveness of thetreatment.













6.2Wash hands





















6.2Wash hands









MED-146






6.6Explain the danger of smoking to thepatient and his visitors and display “NoSmoking” signs.

6.7Fill the humidifier with sterile water to thecorrect level.

6.8Adjust the flow meter and oxygen sourcefor proper setup and prescribed flow rate.

6.9 Check oxygen delivery device every 8hrs.Keep humidification jar filled at all times.

6.10 Observe for decreased anxiety ,improved level of consciousness andcognitive abilities, decreased fatigue,absence of dizziness, decreasedrespiratory rate, improved color, improvedoxygen saturation, and return to client’sbaseline vital signs.

6.11 Monitor ABG levels, or observe pulseoximetry for oxygen saturation.

6.12 Document the nursing procedureappropriately monitor after effects andreport abnormal findings immediately.

6.6Safety issue

6.7Humidify prevents drying of nasal and oralmucous membranes and airway secretion.

6.8 Ensures delivery of prescribed oxygentherapy in conjuction with specificcannula/mask.

6.9Ensure patency of cannula and oxygenflow. Maintains inhalation of humidifiedoxygen.

6.10 Evaluate patient’s response tosupplement oxygen. As patient’s oxygenlevel improves, so too should vital signs,pulse oximetry, and other physicalassessment parameters associated withdecreased oxygen levels.

6.11 Document patient’s level ofoxygenation.

6.12 Documentation helps maintainaccurate client records, includingeffectiveness of the oxygen therapy.

7.0 ATTACHMENTS7.1 Physician order













6.6Safety issue




















6.6Safety issue








MED-147









8.4 MOH Policy

NAME: DATE












8.4 MOH Policy

NAME: DATE












8.4 MOH Policy

NAME: DATE




MED-148



IPP NEBULIZER THERAPHYTITLE:



1.0 DEFINITIONNebulization therapy is an established component of respiratory care that helps patientrelieved of their asthmatic attack or difficulty of breathing.

2.0 PURPOSE2.1 To aid bronchial hygiene by restoring and maintaining mucous blanket continuity,hydrating dried retained secretion and promoting expectations of secretions.2.2 To reduce bronchospasm, decrease thickness of mucus and sputum and combatedema of the bronchial walls, thereby enhancing secretion removal.





5.0 MATERIALS & EQUIPMENT5.1 Oxygen supply or air supply (either piped or cylinders)5.2 Oxygen tubing5.3 Oxygen flow meter with humidifier or compressor5.4 Nebulizer set5.5 Mouthpiece or appropriate oxygen mask5.6 Prescribed medication and saline

























MED-149









6.1.3 Patient’s knowledge regardingmedication to be received.


6.3 Check the medication sheet for:6.3.1 Doctor’s order6.3.2 Patient’s name6.3 3 Medication name6.3 .4 Medication dosage6.3.5 Route of medication


6.4 Monitor the heart rate before andafter the treatment for patientsusing bronchodilator drugs.

6.5 Explain the procedure to thepatient.


6.2Facilitate flow of procedure

6.3Prevent medication error.

6. 4 Bronchodilators may causetachycardia, palpitation, dizziness,nausea or nervousness.

6.5 Proper explanation of the procedurehelps to ensure the patient’scooperation and effectiveness of thetreatment.







































MED-150






6.6 Place the patient in comfortablesitting position or semi-fowlersposition.

6.7 Place the prescribed amount ofmedication and saline to nebulizerjar. Attach the nebulizer to theflow meter and then adjust theflow at least 10L/min but notexceed 14L/min.

6.7.1 Check the outflow part.

6.8 Instruct older children to take adeep breath from the mouth pieceand hold breath briefly thenexhale.

6.9 Instruct patient to breath slowlyand deeply until all the medicationis nebulized.

6.10 Remain with the patient duringtreatment and take vital signs.

6.11 Clean and wash the nebulizer capevery after used and should bechanged every 24 hours.

6.6Diaphragmatic excursion and lungcompliance are greater in this positionand this ensures maximal distributionand deposition of aerosolized particlesto basilar areas of the lung.

6.7To ensure adequate functioning and toprevent excess vesting.

6.7.1 To ensure adequate misting.

6.8This encourages optimal dispersion ofthe medication.

6.9 This will ensure medication isdeposited below the level of theoropharynx. Medication will usually benebulized within 15mins at a flow of 6-8L/min.

6.10 To detect any adverse reaction tomedication.

6.11 To prevent bacterial contamination.







































MED-151






6.12 Record the date, time, duration oftherapy, type and amount ofmedication, baseline subsequentvital signs, description ofsecretions and breath sound.

6.13 Document medicationadministration and client statusbefore and after administration

6.12 To determine the patient’stolerance/ response to thetreatment.







8.4 MOH Policy















8.4 MOH Policy















8.4 MOH Policy

MED-152






NAME: DATE









NAME: DATE









NAME: DATE




MED-153



IPP WITHDRAWING MEDICATION FROM A VIALTITLE:



1.0 DEFINITION

A process of taking out medication from a plastic or glass container that holds a medication.

2.0 PURPOSE2.1 To withdraw an accurate amount of medication from a vial while maintaining

aseptic technique.



3.2 Withdrawal of medication from a vial must be performed by qualified nurse withadequate knowledge on the procedure and the action of the medication.

3.3 The ordered medication must be checked for clarity, crystals and expiration datebefore withdrawing medication from vial.




MED-154






5.0 MATERIALS & EQUIPMENT5.1 Medication administration record (MAR)5.2 Vial with medication5.3 Alcohol wipes or antiseptic swabs for cleaning vial sterile and needle5.4 Solvent (sterile water or normal saline solution) for reconstituting medication if it is

in powder form (optional)



4.3 6.3 Check medication's expiry date printed4.4 on vial.

4.5 6.4 Check medication sheet for:4.6 6.4.1 Doctor's order4.7 6.4.2 Patient's name4.8 6.4.3 Medication name4.9 6.4.4 Medication dosage4.10 6.4.5 Route of medication4.11 6.4.6 Frequency of administration4.12 6.4.7 Time for medication

Prevents medication errors.


4.15 6.6 Select the correct medication vial from4.16 stock supply.

4.17 6.7 Calculate the correct dosage of4.18 medication. Prevents dosage errors.

MED-155






4.19 6.8 Vial containing solution:4.204.21 6.8.1 Remove cap-covering top of4.22 unused vial to expose rubber seal. Keeping rubber seal sterile

6.8.2 Pick up syringe, remove needle capand pull back on plunger to drawamount of air into syringeequivalent to volume of medicationto be aspirated from vial.

6.8.3 With vial on flat surface, insertneedle through the rubber stopper.

Apply pressure to tip of needleduring insertion.

6.8.4 Inject air into vial's airspace andhold plunger with firm pressure. Plunger may be forced backward by air

pressure within the vial.

6.8.5 Invert the vial and withdraw theordered dose of medication bypulling back on the plunger. Makesure that the needle is in thesolution to be withdrawn.

Inversion of the vial brings the needle incontact with the solution so that medicationcan be withdrawn by allowing air pressurefrom vial to fill the syringe.

6.8.6 When prescribed volume has beenobtained, position needle into vial'sairspace, expel air bubbles andadjust dose if necessary.

Eject any air remaining at top of syringe intovial.

6.8.7 Remove needle from vial and coverthe needle with guard.

6.8.8 If medication is to be injected intoclient's tissue, change needle toappropriate gauge and lengthaccording to route of medication.

MED-156






6.8.9 For multidose vial, make label thatincludes date and time of opening,signature and ID number.

4.23 6.9 For a vial containing a powder:4.244.25 6.9.1 Remove cap covering vial of4.26 powdered medication and cap4.27 covering vial of proper diluents.

6.9.2 Pick up syringe, remove needle capand pull back on plunger to drawamount of air into syringe equivalentto volume of diluents to be aspiratedfrom vial.

6.9.3 With vial on flat surface, insertneedle through the rubber stopper.Apply pressure to tip of needleduring insertion.

6.9.4 Inject air into vial's airspace andhold plunger with firm pressure.

6.9.5 Invert the vial and withdraw thedesired volume of diluents bypulling back on the plunger. Makesure that the needle is in thesolution to be withdrawn.

6.9.6 When prescribed volume has beenobtained, position needle into vial'sairspace, expel air bubbles andadjust dose if necessary.

MED-157






6.9.7 Remove needle from vial by pullingback on barrel of syringe

6.9.8 Hold syringe at a 90-degree angleat eye level and expel any airbubbles. Draw back slightly onplunger, then push plunger to ejectair.

To ensure correct volume and absence of airbubbles.

6.9.9 Insert tip of needle through center ofrubber seal of powderedmedication. Inject diluents into vial.Remove needle.

6.9.10 Mix medication thoroughly byrolling vial in palms back and forth,do not shake.

The rolling motion mixes and dispenses themedication. Shaking can cause bubbles thatinterfere with accurate measurement.

6.9.11 Withdraw medication followingsteps for a vial containing a solution.

6.10 Dispose of soiled supplies. Place brokenused vials and used needles inpuncture-proof and leak proof container.

6.11 Wash hands.



Approach. (4th Ed.). Saunders, Philadelphia, New York.8.2 William & Wilkins (2006). Manual of Nursing Practice. (8th Ed.). Lippincott, Philadelphia.

New York.8.3 Suzzane C. Smeltzer & Brenda G. Bare (2004). Textbook of Medical-

Surgical Nursing. (10th Ed.). Lippincott Williams & Wilkins, Philadelphia, New york.

MED-158






NAME: DATE




MED-159



IPP WITHDRAWING MEDICATION FROM AN AMPULETITLE:



1.0 DEFINITIONA process of moving medication from a thin-walled container that holds a single dose of liquidmedication.

2.0 PURPOSE2.1 withdraw the full dose of medication from an ampoule safely while

maintaining asepsis.



3.2 Withdrawal of medication from an ampoule must be performed by qualified nursewith adequate knowledge on the procedure and the action of the medication.

3.3 The ordered medication must be checked for clarity, crystals and expiration datebefore withdrawing medication from ampoule .




MED-160






5.0 MATERIALS & EQUIPMENT5.1 Medication administration record (MAR)5.2 Ampoule with medication.5.3 Sterile syringe and needle (or a filter needle if indicated by agency policy)5.4 Sterile gauze pad or alcohol wipe.



4.3 6.3 Check medication's expiry date printed4.4 on ampoule

4.5 6.4 Check medication sheet for:4.6 6.4.1 Doctor's order4.7 6.4.2 Patient's name4.8 6.4.3 Medication name4.9 6.4.4 Medication dosage4.10 6.4.5 Route of medication4.11 6.4.6 Frequency of administration4.12 6.4.7 Time for medication

Prevents medication errors.


4.15 6.6 Select the correct medication ampoule4.16 from stock supply.

4.17 6.7 Calculate the correct dosage of4.18 medication. Prevents dosage errors.

4.19 6.8 Pick up ampoule and flick its upper stem4.20 Several times with a fingernail.

The sharp, flicking motion releases medicationTrapped in the ampoule’s chamber.

MED-161






6.0 PROCEDURES RATIONALE6.8.2 Place small gauze around the neck

of ampoule.

The gauze barrier protects the fingers frombroken glass , possibly trapping sharpfragments and preventing accidental injury tothe hand.

6.8.3 Snap neck of ampoule quickly andfirmly away from the ampoule.

6.8.4 Discard the broken neckAppropriately, and prepare towithdraw medication from theampoule using one of the followingMethods

6.8.4.1 Place the ampoule upright ona Flat surface , insert theneedle In the solution , andwithdraw the correct amountof medication by pulling upon the plunger. Do not touchthe needle to the glass rim.

Contact between needle and ampoulecontaminates the needle.

6.8.4.2 Invert the ampoule or tilt itsideways. Insert the needleinto the solution ; pull backon the plunger , and withdrawthe proper dose of medication.

Keeping the needle in the solution keeps airout of the dose of medication.

6.8.6 Remove the needle from thesolution. Hold the needle upright ,inspect the syringe , and dispel anyair that may have been drawn intothe syringe. Make sure that thesyringe contains the right amount ofmedication. Expel extra into acontainer.

MED-162






6.8.7 Cover the needle with guard andchange needle if a filter needle wasused. Discard ampoule in sharpscontainer.

Proper disposal protects healthcare personnelfrom injury. A filter needle is used to trap glassparticles and should not be used for injection.

6.8.8 Wash hands Maintains asepsis and minimizes risk forinfection transmission.



Approach. (4th Ed.). Saunders, Philadelphia, New York.

8.2 William & Wilkins (2006). Manual of Nursing Practice. (8th Ed.). Lippincott, Philadelphia.New York.

8.3 Suzzane C. Smeltzer & Brenda G. Bare (2004). Textbook of Medical-Surgical Nursing. (10th Ed.). Lippincott Williams & Wilkins, Philadelphia, NewYork.

NAME: DATE


REVIEWED BY: Mr. Nasser Al Zayedi-RN,BSN,NursingSupervisor, Quality Department - KAAH & OC 2010


MED-163


INTERNAL POLICY AND PROCEDURENURSINGAP P LIES TO:GNR-04-30POLICY NUMBER:

IPP INSTILLATION EYE OINTMENTTITLE:



1.0 DEFINITION

Administration of ointment into the eyes.

2.0 PURPOSE2.1 To apply ophthalmic antibiotic ointment in pressure patching for a corneal abrasion.2.2 To form a protective film over the corneal surface of an eye.2.3 To act as a soothing agent for the patient suffering from an inflamed eye or lid margin.

3.0 POLICY3.1 To ensure there is a physician’s order prior to instillation of eye drops.3.2 Ensure that the medication room is clean and have proper lighting.3.3 Two qualified staff nurse are required to administer the medication.3.4 Patient must be identified and the site of administration using the seven (7) rights.


Registered Nurse

5.0 MATERIALS & EQUIPMENT5.1 Desired ophthalmic ointment per physician order.5.2 Small cotton or gauze pad5.3 Trolley or tray






1.0 DEFINITION





Registered Nurse







1.0 DEFINITION





Registered Nurse


MED-164








6.1.2 Patient condition for anycontraindication receiving theeye drop medication.

6.1.3 The patient’s knowledgeregarding medication to bereceived.

6.1.6 Any inflammation or dischargesfrom the eye.




6.4 Assess the eye condition of the patient.




6.4 Provides baseline to later determine iflocal response to medication occurs.Also indicates need to clean eye beforedrug application

6.5 Promotes cooperation and reduces







































MED-165






6.5 Explain to the patient the need andreason for instilling ophthalmic drops.

6.6 Wash Hands.

6.7 Place patient in comfortable position,sitting or lying. Ask the patient to lookup.

6.8 With the thumb and forefinger of onehand, gently pinch the lower lid awayfrom the globe so that the inferior cul-de-sac forms a small pouch.

6.9 Simultaneously squeeze a small bolusof ointment into the cul-de-sac from theinner canthus to the outer canthus whilereminding the patient to keep lookingupwards. Release the lower lid.

6.10 Gently grasp the lashes of the upper lidbetween the thumb and forefinger ofone hand while the patient is lookingup.

6.11 Inform the patient that he/she mayexperience blurred vision for a fewminutes following the instillation of theointment.

6.12 Evaluate patient’s response and eyecondition.

6.13 Dispose equipment safely.

anxiety. Improves knowledge levelregarding need for instilling drops.

6.6 Reduces the risk of contamination.

6.7 Positioning facilitates proper instillationof medication.

6.8 Prevent medication from hittingsensitive cornea.

6.9 To evenly distribute the ointment intothe cul-de-sac.

6.10 To retain excluded ointment with theconjunctiva sac.

6.11 To relieve patients anxiety.

6.12 To assess for any drug reaction afterinstillation of medicine.








6.6 Wash Hands.























6.6 Wash Hands.

















MED-166













8.4 MOH Policy

NAME: DATE
















8.4 MOH Policy

NAME: DATE
















8.4 MOH Policy

NAME: DATE




MED-167



IPP INSTILLATION OF EYE DROPSTITLE:



1.0 DEFINITION

Administration of a solution drops by drops into the eye.

2.0 PURPOSE2.1 To dilate or constrict the pupil2.2 To relieve pain, discomfort, itching and inflammation.2.3 To act as an antiseptic in cleaning the eye.2.4 To combat infection.



Registered Nurse

5.0 MATERIALS & EQUIPMENT5.1 Desired ophthalmic drops per doctors order5.2 Cotton balls or gauze swab5.3 Trolley or tray5.4 MAR






1.0 DEFINITION





Registered Nurse







1.0 DEFINITION





Registered Nurse


MED-168














6.4 Assess the eye condition of thepatient.


6.2 To ensure a smooth orderlyprocedure.


6.4 Provides baseline to laterdetermine if local response tomedication occurs. Also indicatesneed to clean eye before drug





































MED-169







6.6 Wash Hands.

6.7 Place the patient in a comfortableposition.

6.8 Ask the patient to lie supine or sitback in chair tilt the head backslightly so the chin is slightly elevatedand to look up.

6.9 Using the forefinger of one hand,evert the lower lid slightly so that atrough is formed by the inferior cul-de-sac.

6.10 Hold the opened bottle in theopposite hand and stabilizing it byresting the little or ring finger on thepatients cheek or nose asappropriate, squeeze a drop into theexposed cul-de-sac.

6.11 Release the lower lid and gently blotaway the excess solution with acotton or gauze pad from the lid

application.

6.5 Promotes cooperation andreduces anxiety. Improvesknowledge level regarding needfor instilling drops.


6.7 To ensure safety.

6.8 Position provides easy access toeye for medication instillation andminimizes drainage of medicationthrough tear duct.

6.9 It exposes the inner surface of thelid and cul-de-sac.

6.10 The cul-de-sac retains a singledrop and the excess overflow.

6.11 Prevent possible skin irritation.







6.6 Wash Hands.






application.














6.6 Wash Hands.






application.








MED-170






area.

6.12 Advise the patient to keep the lidsclosed for a few seconds.



6.15 Document in nurse’s notes andmedication sheet.

6.12 To allow time for absorption ofmedication and waiting for anyassociated barring sensation tosubside.

6.13 To assess for any drug reactionafter the instillation of medicine.

6.14 Observe standard precaution.







8.4 MOH Policy






area.














8.4 MOH Policy






area.














8.4 MOH Policy

MED-171

























MED-172



IPPPREPARING MEDICATION FROM AMPULES

AND VIALSTITLE:



1.0 DEFINITIONAmpoule is a small or plastic container capable of being seated so as to preserve its contents ina sterile condition used principally for containing sterile parenteral solution.

Vial is a small bottle containing sterile parenteral solution.

Injection is the act of giving medications by use of syringe and needle.

2.0 PURPOSE2.1 To ensure the drugs are prepared appropriately according to route prescribe.2.2 To maintain the sterility of ampoules and vials during preparation.

3.0 POLICY3.1 maintain the sterility of the medication and the syringe needle during the procedure.3.2 Concentrate on the task and use the seven “7” rights as a guide to avoid errors while

preparing.3.3 Recapping of needle must be done with care to prevent accidental pricks.


5.0 MATERIALS & EQUIPMENT5.1 Medication sheet5.2 Medication prescription5.3 Medication card5.4 Sterile gauze5.5 Needle and syringe5.6 Alcohol swab5.7 Sterile water, if necessary5.8 File5.9 Medication tray




AND VIALSTITLE:














AND VIALSTITLE:











MED-173




AND VIALSTITLE:




6.1.1 The patient medical history,history of allergy and medicationhistory.6.1.2Patient body build, muscle size,weight and the desired site foradministration.6.1.3 Patient condition for anycontraindication for intramuscularinjection example muscle atrophydecreased blood flow, circulatory shock.6.1.4 The injection site for any bruises,inflammation or edema.6.1.5 The patient’s knowledgeregarding medication to be received.6.1.6 Observe patient’s verbal andnon-verbal response towards injection



6.3 Assess patient body build, muscle sizeand weight and desired route ofadministration.

6.1 Assessing the patient will help facilitateproper site for injection.


6.3 Determine type and size of syringe andneedles to be used for injection.




AND VIALSTITLE:














AND VIALSTITLE:











MED-174




AND VIALSTITLE:



6.4 Assemble medication and supplies atwork area in medicine.

6.5 Check medication on vial/ ampoulelabel against MAR when removingmedication from supply.

6.6 Check medication’s expiry date printedon the vial/ampoule.

6.7 Calculate drugs dose necessary.Double-check calculation.


6.9 Ampoule preparation:6.9.1 Tap top of ampoule lightly and

quickly with finger until fluidmoves from neck of ampoule.

6.9.2 Place small gauze pad orunopened alcohol swab aroundneck of ampoule.

6.9.3 Snap neck of ampoule quicklyand firmly away from hands.

6.9.4 Draw up medication quickly, uselong needle enough to reach thebottom of the ampoule.

6.4 Organization saves time and reducesrisk for error.

6.5 Reading label first time and comparingit against transcribe order reduceserrors and ensures that patient receivescorrect medication.

6.6 Medication that has been expiredshould not be used because potency ofmedication changes when medicationbecome outdated.

6.7 Reduces risk of error.


6.9.1 Dislodge any fluid that collectsabove neck of ampoule. Allsolution moves into lowerchamber.

6.9.2 Placing pad around neck ofampoule protects nurse’s fingersfrom trauma as glass tip isbroken off.

6.9.3 Protects nurse’s fingers and facefrom being cut by glass.

6.9.4 System is open to airbornecontaminant. Needle must belong enough to access




AND VIALSTITLE:

























AND VIALSTITLE:






















MED-175




AND VIALSTITLE:



6.9.5 Aspirate medication into syringeby gently pulling by gently pullingthe plunger.

6.9.6 Expel excess air bubbles, removeneedle from ampoule .Holdsyringe with needle pointing up.Tap side of syringe to causebubbles to rise toward needle.Draw back slightly on the plungerupward to eject air.

6.9.7 Cover needle with its safetysheath or cap. Replace filterneedle with needle for injection.

6.10 Vial containing solution:6.10.1 Remove the protective metal

Cap and clean the rubber capwith alcohol swab, and allow it todry.

6.10.2 Remove the cap from theneedle then draw up into thesyringe the amount of air equalto the volume of the medicationto be withdrawn

6.10.3 Mix solution if necessary byrotating the vial between the

palms of the hand not byshaking

6.10.4 Insert needle into upright vialand inject air into vacant area ofvial, keeping needle bevelabove surface of medication.

medication.6.9.5 Withdrawal of plunger creates

negative pressure within syringebarrel, which pulls fluid intosyringe.

6.9.6 Holding syringe vertically allowsair bubbles to rise to top of barreland fluid to settle in bottom ofbarrel. Pulling back on plungerallows fluid within needle to enterbarrel so fluid is not expelled. Airon top of barrel and within needleis then expelled.

6.9.7 Prevents contamination of needle.Filter needles cannot be used forinjection.

6.10.1The antiseptic cleans the cap sothat the needle will remains sterilewhen inserted.

6.10.2 Air must first injected into vial toprevent build up of negativepressure in vial when aspiratingmedication.

6.10.3 Some vials contain aqueoussuspensions which settle whenthey stand. Shaking iscontraindicated because it maycause the mixture to foam.

6.10.4 If air is injected into themedication, bubbles may form,making drug withdrawal more




AND VIALSTITLE:























AND VIALSTITLE:




















MED-176




AND VIALSTITLE:



6.10.5 Recheck amount of medicationin syringe, turn vial upright andremove needle.

6.10.6 Replace needle guard using thescoop method.

6.10.7 Recheck medication label anddosage against medicationrecord and any dose calculation.

6.10.8 Dispose of or replace equipmentappropriately.

6.10.9 For multi dose vial, make labelthat includes date of opening,mixing, concentration of drug perml and nurse’s initial.

6.11 Vial containing powder:6.11.1Remove cap covering vial of

powdered medication and capcovering vial of proper diluents.Firmly swab both rubber sealswith alcohol swab, and allowalcohol to dry.

6.11.2 Draw up diluents into syringe.

6.11.3 Mix medication thoroughly by

difficult. Air create positivepressure in the vial, allowingwithdrawal of medication.

6.10.5 Prevent medication error.

6.10.6 The scoop method is notnecessary when recapping asterile needle, but encouragesdevelopment of a safe habit.

6.10.7 Reduces risk of error.

6.10.8 Glass, needles, and syringes aredisposed of in biohazardpuncture-resistant containers toprevent injury.

6.10.9 Ensure that future doses will beprepared correctly. Some drugsmust be discarded after certainnumber of days after opening ormixing of vial.

6.11 1 Vials come packaged with capthat cannot be replaced afterremoval.

6.11.2 Prepares diluents for injection intovial containing powderedmedication.




AND VIALSTITLE:























AND VIALSTITLE:




















MED-177




AND VIALSTITLE:



rolling in between palms. Do notshake.

6.11.4 Reconstituted medication in vialis ready to be withdrawn intosyringe. Read label carefully todetermine concentration afterreconstitution

6.11.5 Withdraw the desired amount ofmedication needed. Removeneedle from the vial.

6.12 Compare MAR with prepared drugs andcontinue.

6.13 Compare dose in syringe with desireddose on MAR.


6.15 Document medication administration.

6.16 Evaluate the patient’s response tomedication therapy.

6.11.3 Ensures proper dispersal ofmedication throughout solution.

6.11.4 Once diluents has been added,concentration of medication(mg/ml) determine amount to begiven.

6.11.5 Injection of diluents createpressure needed to withdrawmedication.

6.12 Reading label second time reduceserror.

6.13 Third check ensures that accurate dosehas been prepared.

6.14 Proper disposable protects nurse andother healthcare workers fromaccidental needle injury.

6.15 Accurate documentation is mandatoryto prevent medication errors.

6.16 Careful and timely assessment isnecessary because of the action of themedication..








AND VIALSTITLE:


























AND VIALSTITLE:























MED-178




AND VIALSTITLE:




8.4 MOH Policy

NAME: DATE







AND VIALSTITLE:




8.4 MOH Policy

NAME: DATE







AND VIALSTITLE:




8.4 MOH Policy

NAME: DATE




MED-179

Documents

Ministry Of Health, General Directorate Of · PDF file2.6 To provide uniform guidelines for charting of medications and treatments utilizing the pharmacy generated medication ... IPP