Part Two

- Policy for dealing with high-risk medications (including concentrated solutions)

Policy name

Handling high-risk medications (including concentrated solutions)

Policy number

Issue date and number

Review Date

Number of pages

Section

Artificial kidney unit

Policy for dealing with high-risk medications (including concentrated solutions)

Politics:

· Identifying high-risk medications by scientific names, collecting them in a separate list and distributing them to all medical service providers, and dealing with the medications included in the aforementioned list in the correct manner in accordance with the instructions for each preparation to ensure that the patient is not exposed to any therapeutic risks as a result of the incorrect use of concentrated solutions without diluting them.

The Purpose:

· Ensuring that high-risk medications are handled with due care in order to ensure that the patient’s health is not exposed to any therapeutic risks.

Identification:

· Dangerous medicines are medicines that cause serious danger to the patient when used incorrectly. Therefore, a list is prepared for them that explains what these dangerous medicines are that must be handled with care to avoid any error in their use.

Working procedures:

· The pharmacy director, with the help of hospital pharmacists, prepares a list of dangerous drugs and solutions with high concentrations, specifying the scientific name and instructions for dilution, administration, and observation.

· The pharmacy director distributes the list to all therapeutic departments and units in the hospital.

· These medications are not placed in regular departments, and their presence is limited to critical hot areas such as (care, operations, emergency, and kidney departments), and their presence is limited to departments inside the emergency vehicle.

· When using these medications, check with the doctor first and then do a double review by two nurses before giving them.

· When preparing these medications, it should be in a place with good lighting and away from any noise or interruptions.

When storing these medicines, a red sticker is placed on the box containing these medicines, and it is in a separate place from the regular medicines, provided that this sticker contains the following information:

- The scientific name of the drug

- The focus

- Pharmaceutical form

- Expiration date

· When dispensing these medications, the pharmacist places a red mark on each ampoule or bottle. In the event that the pharmacist dispenses large quantities, the nursing staff can be instructed to place this mark on each unit.

· When placing medications that are similar in pronunciation, shape, or both, the containers should be separated and not placed next to each other, in addition to writing clear addresses on the containers.

· A medication reference is placed in each section that includes (use of each medication - method of administration - doses - side effects - standards that must be followed regarding use and preparation).

When giving anticoagulants, the treating physician does the following:

o Use protocols that explain the initiation and continuation of anticoagulant therapy and the tests required for follow-up.

o Documentation of pre-treatment and current INR in the medical record.

o When anticoagulants are given, doses are linked to laboratory results.

o Use a pump if heparin is given continuously intravenously.

o Health education for the medical team, the patient and his family regarding:

(The importance of follow-up - adherence - drug and food interactions - negative reactions).

· When giving narcotic medications, the pain is evaluated by the doctor and the necessary measures are taken in the event of severe pain.

Administrator :

· Pharmacists

· The doctors

· Nursing staff

Models:

· List of high-risk medications

The Reviewer:

• International standards for patient safety.

• Egyptian accreditation standards 2013.

Preparation	Review	The trust

List of high-risk medications

High Risk Medications

Medicament name	M	Medicament name	M
Heavy Markin	22	Atracurium ( Atracurium)	1
Epanutin (Phenytoin)	23	Succinylcholine	2
Inderal (propranolol )	24	Izmeron (rocuronium)	3
Bisoprolol ( Concor)	25	Epinephrine (epinephrine)	4
Cordarone (Amiodarone)	26	Noradrenaline (Levovirin)	5
Digoxin (Cardexin )	27	Ephedrine	6
Heparin	28	leumethacin (indomethacin )	7
Klaxan(enoxaparin)	29	Atropine sulfate]	8
Marifan (Warfarin)	30	Povol (Propofol)	9
Sidonase (streptokinase )	31	Catalar(ketamine)	10
Potassium chloride	32	Isoflurane	11
Magnesium sulfate	33	Sevoflurane	12
Naloxone (Narcan)	34	Intraval (thiopental)]	13
Hypertonic salt solution	35	Xylocaine (lidocaine)	14
Glucose 25%	36	Markaine (bupivacaine)	15
Aminophylline	37	fentanyl	16
insulin	38	With breasts	17
Omnipack (radio dye)	39	Tramal ( Tramadol )	18
Cidophag (metformin )	40	Neoryl ( Diazepam)	19
Isobuten(verapamil)	41	SectionMidazolam(Midazolam)	20]
Tryptizol (acetriptyline )	42	Kalmibam (Bromazibam)	21
* These medications are highly dangerous if misused, so they must be handled with extreme caution and labeled red

The policy of obtaining a list of the treatment that the patient takes upon admission to the hospital and upon discharge

Politics:

· Obtaining a list of the patient’s current treatment so that it is complete and documented when the patient begins entering the hospital.

· Giving the patient a list of his entire treatment, explaining how to use it, upon his discharge from the hospital.

The Purpose:

· Achieving patient safety while in the hospital by ensuring that the patient receives a current treatment list so that the patient does not stop taking the medication, which may lead to his health condition being affected or the surgical operation for which he was admitted to the hospital being postponed.

· Ensuring the safety of the patient when he is discharged from the hospital or transferred to another place by giving the patient a list of his treatment so that he does not stop and his health condition is not affected.

The Definition:

· The doctor checks the patient’s current treatment upon admission.

Work procedures upon entry:

· The doctor evaluates the patient upon admission, asks him about the medications he is taking at home, and records this on the patient’s medical history form.

· The doctor performs a medical evaluation of the patient based on the results of x-rays, medical tests, and the patient’s current treatment.

Based on the doctor’s findings from the aforementioned examination and evaluation, he develops a treatment plan, taking into account the patient’s current medications to ensure continuity of health care, taking into account writing in Arabic and not using unknown or known abbreviations.

· The Pharmacy Department publishes a list of abbreviations that should not be used in writing medications, provided that it is reviewed every two years to add or delete any abbreviation.

Work procedures upon exit:

· The doctor provides a comprehensive explanation to the patient about the health condition upon discharge in a clear, simple and understandable manner.

· The doctor writes the patient’s discharge treatment in the medical record, follow-up card, and discharge summary, along with an explanation of the treatment to the patient.

· The department’s nursing staff delivers a follow-up card and a discharge summary to the patient.

· When a patient is transferred/transferred to another hospital, the treatment carried out in the hospital is written in the external transfer/referral form and the discharge summary.

Administrator :

· The doctors.

· Nursing staff.

· Pharmacy.

Models:

- A list of abbreviations that should not be used in writing medicines

- Discharge summary.

- External transfer/referral model.

The Reviewer:

· International standards for patient safety.

· Egyptian accreditation standards.

Preparation	Review	The trust

Policy on drugs that are similar in form and pronunciation

Policy: Separate medications that are similar in appearance and pronunciation to reduce risks.

Purpose: To achieve patient safety while in the hospital by adhering to the system of separating medications that are similar in form and pronunciation.

Working procedures:

· The pharmacy prepares a list of medications that are similar in appearance and pronunciation, and it is responsible for renewing and updating this list every 6-12 months.

· The pharmacy manager distributes the list to all therapeutic departments and units in the hospital.

· The pharmacist separates them and writes clear addresses on the containers containing each one in storage areas.

· Medicines that are similar in appearance and pronunciation are highlighted in green.

· When dispensing medications that are similar in appearance and pronunciation, the pharmacist alerts those who will receive the medication from the pharmacy of the need to separate them for the safety of the patient.

· Nursing supervisors in departments and roles separate and write clear addresses on the containers containing each of them in storage areas.

Administrator:

· Pharmacists.

· Nursing staff.

Models:

· A list of medications that are similar in name and pronunciation.

The Reviewer:

· International standards for patient safety.

· Egyptian accreditation standards

Preparation	Review	The trust

A list of medications that are similar in appearance and pronunciation

A list of medications that are similar in appearance and pronunciation

Sound alike drugs

Unit	DRUG names Drug names	Serial/
Ampoule	Atropine – Atrakium	1
Ampoule	Atropine – Atrovent	2
Ampoule	Atropine - Adrenaline	3
Ampoule	Ephedrine – adrenaline	4
Ampoule	Noradrenaline – Adrenaline	5
Ampoule	Dopamine – Dobutamine	6
Ampoule	Diprivan – Diclofen	7
Ampoule	Decadron – Cordarone	8
Ampoule	Neoryl – Nootropil	9
Vial	Intraval – Nitronal	10
Vial	Ceftriaxone – Cefotax]	11
Vial	Sigmazidime – Sigmataxime	12
tape	Carbon - Carbon	13
bottle	Aminoliban – amiparin	14

Preparation	Review	The trust

A list of abbreviations that should not be used in writing medications

A list of abbreviations that should not be used in writing medications

· U/ UI

·      Q.D, QD, q.d, qd

·      Q.O.D, QOD, q.o.d, qod

·      MS, MSO₄

·      Mg SO₄

·      Trailing zero

·      No leading zero

·      Dose x frequency x duration

·      › greater than

·      ‹ less than

·      Abbreviation of drugs names

·      cc

·      µg

1. The nursing staff responsible for receiving the patient for operations receives the patient’s medical record and verifies the patient’s basic data.