Roles and
responsibilities
Scope
Overall process
to follow
Introduce yourself to the patient (if present) and explain your role
Locate all of the current medication chart(s), ideally kept with the patients
observation folder
Confirm the medication chart is for that patient
Patient demographics
Ensure all relevant patient details have been completed:
- Patient name, date of birth, sex
- Weight where appropriate
- Date of admission
- NHS number
- Consultant
- Ward
Ensure patient name has been written on the inside, when required and any
medicines reconciliation section of the chart
For charts used at Grays Court and in-patient units at King George hospital,
ensure the medicines reconciliation form has been fully completed with the
patients name, date of birth and NHS number
Allergies/sensitivities
Drug allergies/adverse drug reactions section to state:
- Name of drug
- Severity and type of reaction if known
- Source of information (patient, carer, relative, GP)
- No known Drug Allergies (NKDA) where appropriate
- Non-drug sensitivities/intolerance to be stated if relevant e.g.
peanuts/peanut (arachis) oil; lactose.
- Entry to signed, dated and designation of staff completing entry stated
Medicines reconciliation (see relevant SOP for full details)
Any annotation(s) on the medication chart by the Pharmacist must be in
indelible ink in a dark colour not already used on the chart e.g. green or
purple gel ink pens. The writing must be able to be photocopied and so it is
important that a suitable pen and colour of ink is used (usually green gel ink
pens).
Record medication history in the appropriate section of the medication chart.
If one is not present, annotate along the top edge of the inside of the chart.
CHS SOPs Clinical pharmacy screen of medication charts
Page 1 of 5
For charts screened at Grays Court and Foxglove ward at King George
Hospital, the medicines reconciliation form must be completed and
medicines reconciliation box on the front of the drug chart must have the
date and signature of the pharmacist doing this
Record the following information along with the medication:
- Source of information (ideally 2 sources should be used)
- Date
- Name and signature of pharmacist
If Patients Own Drugs (PODs) are to be used refer to the SOP for PODs
(including Monitored Dosage Systems). PODs should state:
- Name of the medicine
- Directions for use
- Date
- Quantity
- Origin of supply
Document clearly on the front of the chart that the medication history has
been checked e.g.
- Rio signature, date when electronic record checked
- S1
signature, date when electronic record checked
- GP signature, date when GP surgery fax checked
- PODs signature, date, when PODs checked
- MAR signature, date when MAR chart checked
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Antibiotics
The pharmacist must ensure that prescribed antibiotics are appropriate for
use
All prescribed antibiotics should clearly state the indication and duration of
use
The use of restricted antibiotics should be discussed with a consultant
microbiologist and if appropriate, the pharmacist should write Micro
approved.
All intravenous prescriptions must be reviewed after three days, unless
advised by the consultant microbiologist or stated in treatment guidelines
All antibiotic prescriptions must be reviewed after five days unless otherwise
indicated by the consultant microbiologist
Annotations
Annotate each medication with the generic or approved name
State brand names for non-bioequivalent drugs e.g.
- Lithium
- Clozapine
- Nifedipine MR/LA
- Theophylline MR
- Tacrolimus
- Ciclosporin
- Phenytoin
- Carbamazepine
- Diltiazem
- Mesalazine
- Transdermal strong opioids
- Duloxetine (different licensing between brands)
- Inhalers i.e. QVAR , Clenil Modulite
- Multi-ingredient products i.e. Oral contraceptives, creams
A more comprehensive list is available from the UKMI (attached below)
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Intravenous medication
- Check NPSA recommendations are met (attached)
- Instructions for reconstitution if unusual or caution is needed
- Check the diluent, flush is prescribed
Variable dose medication
Titration of drugs, including chlordiazepoxide, amiodarone , clozapine, etc
- Variable dose medication to be prescribed within that section of the
medication chart.
- This medicine must also be prescribed in the main section (Regular side)
of the medication chart by the prescriber and state See Variable dose
Warfarin
- Prescribe in the main section (Regular side) of the medication chart
- Must state Dose as per anticoagulation book
- State indication
- State target INR
- Date for next INR testing and results
- Anticoagulant book should be left in either the patients locker or securely
attached to the medical notes and the warfarin section should be
annotated to show where the book is kept
Thromboprophylaxis
- When applicable ensure that the VTE section of the chart has been
completed if not, the doctor on duty should be asked to complete this
as soon as possible
- Where a low molecular weight heparin has been prescribed, check that
the dose is appropriate in terms of the patients VTE risk and U&E results
- Clinically check to see if thromboprophylaxis is appropriate when the
patient is also being prescribed warfarin and/or other anti-coagulants and
antiplatelets
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Written by
Name
Emma Gardner
Job Title
Clinical pharmacy lead
community health services
Signature
Date
Date for revision
Revision Record
Revision
Date
March 2013
March 2015 or sooner if deemed necessary
Responsible Person
Description of change
Page 5 of 5