ADMESSION
IN PATIENT
DISCHARGE
ADMESSION :
An accurate medicine history is obtained by
ACPT (accredited check pharmacy technicion)
or junior pharmacist by printing ECR of the
patient
Medicine history should contain the following
-Current ,recently prescribed medicines
-OTC ,clinical trials,unlicinced drugs,
-Herbal remedies,recreational drugs
-Smoke and alchol consumptions
-Recent vaccination
-Any previouse adverse effects and known
allergies
IN PATIENT (PHARMACEUTICAL
CARE PLAN )
DISCHARGE :
Prior discharge pharmacist review current pcp and anticipates
any pharmaceutical care issues
Pharmacist ensures that all medicines prescribed at discharge
are clinically accurate and appropriate
Pharmacist check written or electronic information to primary
care health care detailing :
-current medication
-change to medicine and reason for change
-information needed to continue supply of medicine in primary care
-monitoring requirment ex:warfarin
Pharmacist ensures that the patient is dispensed an appropriate
quantity of medicines
Pharmacist ensures that the patient is educated on prescribed
medicines as appropriate and his adherence to the treatment
green
Allergies/medicines senseitivites
This section must be completed
Date
Medicine(generic)/
Allergen
Type of reaction
Signature
or
No known drug allergies
Signature: Ghada Hussein
date :7/9/2015
patient
Community pharmacy
Previouse discharge
relative
patient
kardex
MEDICATIONS
Medication review
STOP
PED
held
Dose
altered
comments
NAME
DO
SE
Freq
uenc
y
CONTI
NUED
Not yet
reconciled
Rantidine
150
mg
Q
8hrs
Continue as prescribed
metoclopra
mide
10
mg
Q
8hrs
Continue as prescribed
pantopraz
ole
40
mg
Q
24hr
s
Vitamine
b12
1
mg
Q
24hr
s
Continue as prescribed
trimebutin
e
200
mg
q8hr
s
Continue as prescribed
budesnoide
400
mg
Q6
hrs
Formetrol
fumerate
12
g
Q 12
hrs
continued as prescribed
ACC
200
Q12
hrs
Continued as prescribd
gentamycin
80
drug
dose
frequency
sulbacta
m/ampicil
lin
1.5mg
Q 8 hrs
Continued as
prescribed
saline
500
ml
Q 8 hrs
Continued as
prescribed
ringer
500
ml
Q 8 hrs
Continued as
prescribed
Medication review
comments