Download Measuring and recording supplies of Schedule 8

Measuring and recording supplies of Schedule 8 and Restricted Schedule 4
recordable oral liquids
Footage description: Title slide: Measuring and recording supplies of Schedule 8 and Restricted
Schedule 4 recordable oral liquids, 7.20 minutes with photos of health professionals.
Voiceover: There are new mandatory procedures in place in WA public hospitals for
measuring and recording supplies of liquid medicines. The following training video has been
developed to show you what you need to do to fulfil your responsibilities when supplying
liquid medicines. Once you have watched the video you can join the conversation on loss
prevention by clicking on the survey link on the webpage.
Footage description: Chapter slide: Measurement
Footage description: Bottles of liquid medicine. A frame with images of empty bottles appears
and a red cross is drawn over the top.
Voiceover: When S8 and S4R medicine supplies are received they should be in their original
bottle. Methadone syrup for the treatment of opioid dependence is an exception. This must
be prepared by the pharmacy department and supplied in unit doses for the patient. Only
one bottle of each drug and strength should be in use at any one time.
Footage description: Oral dosing syringes and bottle with a calibrated bottle top dispenser in
the top.
Voiceover: Bungs and oral dosing syringes must be used to measure oral liquid medicine
doses unless your hospital has a written policy that allows the use of a different method
such as a calibrated bottle top dispenser.
Footage description: Nurse fitting a bung to a medication bottle.
Voiceover: Bungs must be available in all clinical areas handling liquid medicines. Fit the
bung after opening the bottle. This must remain in the same bottle for the entire time the
bottle is in use.
Footage description: Two medication bottles are displayed both with marked up scales on
the side. The scale written one of the bottles is circled in red.
Voiceover: Before you issue the first dose from a bottle, make sure you record the level of
medicine either by using the scale on the label or by marking up tape or stickers that have
been fitted to the side.
Footage description: Person’s hands holding a medication bottle and affixing tape to the
side.
Voiceover: Tape must be placed on the edge of the original bottle label being careful not to
obscure information such as drug name, strength, expiry or batch number.
Footage description: Person holding a medication bottle and using an oral dosing syringe to
extract medicine. Images of a person pouring straight from a bottle into a small container
and a syringe extracting liquid directly from the bottle is crossed out in red marker.
Voiceover: To measure a dose from a bottle with a bung, use a new oral dosing syringe to
measure every patient’s dose. Don’t pour directly from the bottle and don’t use IV syringes.
Footage description: Picture of a person marking the scale on the side of a medication
bottle in pen.
Voiceover: When you have withdrawn the dose, mark the remaining volume of liquid and
the date on the scale.
Footage description: Two nurses signing the register.
Voiceover: Each S8 or S4R dose must be entered into the correct page in the relevant
register. Details which must be documented include the patient name, unit record number,
doctor prescribing the medicine, dose and time of administration. It is important that the
prescription, administration and documentation is observed and checked by a second
person – a registered nurse, pharmacist or doctor, (depending on your hospital policy).
Footage description: Chapter slide: Inventory – Balance check
Footage description: Two nurses looking at the scale on a liquid medication bottle.
Voiceover: Balances checks must be performed at least once daily (in accordance with
hospital policy). Registers and drug levels must be checked at the time of transfer between
the pharmacy department and the ward.
Footage description: Photo of a medication bottle indicating on the marked scale how much liquid
is left in the bottle. The scale marked on the side of the medication bottle is circled in red.
Image of liquid being poured from a bottle into a small container is crossed out in red.
Voiceover: To conduct a balance check you visually inspect the bottle, checking that the
volume of medicine matches the marked up scale. You must not decant the liquid when
performing a balance check; it’s a visual check only.
Footage description: Two nurses signing the register.
Voiceover: Compare the visual volume to the balance recorded in the register.
Footage description: Table – Record of drugs: received, administered or supplied showing
how to enter a balance check on a separate line in the register.
Voiceover: After each balance check make an entry on a separate line in the register.
Footage description: A line is highlighted in yellow on the table.
Footage description: Nurse talking on the phone.
Voiceover: If a discrepancy is suspected, contact Pharmacy who will assist in performing a
stock reconciliation.
Footage description: Chapter slide: Reconciliation
Footage description: Nurse using an oral dosing syringe to extract liquid from a medication
bottle.
Voiceover: When you withdraw the last dose from a bottle, you must perform a stock
reconciliation. The reconciliation ensures that the register correctly reflects the actual
amount of liquid on hand.
Footage description: Table – Record of drugs: received, administered or supplied
demonstrating how to record the dose administered and what the balance should be after
the dose.
Voiceover: Enter the information about the final dose to be administered from the bottle in
the register and what the balance should be after this dose.
Footage description: Table – Record of drugs: received, administered or supplied
demonstrating how to enter a stock reconciliation in the register.
Voiceover: The stock reconciliation is entered on a separate line. Check the balance of stock
on hand and enter in the register. Work out if there is an excess or shortage by taking the
register balance away from the balance of stock on hand. In this case there should have
been enough in the bottle to draw the last 10 millilitres dose. But there’s 3 millilitres less
than there should be.
Footage description: Table – Record of drugs: received, administered or supplied showing
an example of entering details in the register when there’s an excess in the bottle.
Voiceover: You follow the same process if there’s an excess in the bottle. In this example, using
hydromorphone, there shouldn’t be enough stock in the current bottle to issue the whole dose. The
register balance should be 471 millilitres after the dose, but the stock balance is 473 millilitres.
There’s an excess of 2millilitres.
Footage description: Two nurses signing register.
Voiceover: Two authorised staff must sign the reconciliation. Authorised staff may be a
nurse, pharmacist or a doctor depending on your hospital policy. Don’t forget to follow up
and report discrepancies.
Footage description: Chapter slide: What to do when there is a discrepancy
Footage description: Two nurses signing register.
Voiceover: At the end of the bottle write up the stock reconciliation and document the
discrepancy. Go back through the register and count the number of doses since the previous
stock reconciliation.
Footage description: Table – Record of drugs: received, administered or supplied
demonstrating how to calculate the discrepancy per dose.
Voiceover: To calculate the discrepancy per dose, divide the discrepancy volume by the
number of doses since the last reconciliation. Record the discrepancy per dose as part of the
most recent Stock Reconciliation. Two authorised staff must sign the reconciliation. If the
discrepancy per dose is zero point two millilitres or less – no report is required.
Footage description: Table – Record of drugs: received, administered or supplied showing
an example of a discrepancy more than 0.2 millilitres per dose.
Voiceover: In this example when the discrepancy volume is divided by the number of doses
since the last stock reconciliation, we see that the discrepancy is more than zero point two
millilitres per dose. You must follow up and report on all discrepancies more than zero point
two millilitres per dose.
Footage description: Schedule 8 and restricted Schedule 4 Medicine discrepancy/loss report
form.
Voiceover: If the discrepancy is more than zero point two millilitres per dose, follow-up on the
discrepancy and submit a report to the Corporate Governance Directorate within 24 hours.
Reporting helps to improve measurement practice and to identify possible theft. You should also
report any concern about the quality or integrity of an S8 or S4R oral liquid medicine.
Footage description: Thank you for watching
Voiceover: Now that you’re the full bottle on liquid medicines, we would love your feedback on this
project. Click the survey link on the webpage below – 3 quick questions is all it takes!
Footage description: For more information
Voiceover: For further information you can talk with your Medication Incident Coordinator, read
the Operational Directive or visit the Health Department website, health.wa.gov.au and search
pharmacy.