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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.