Download NUH list of critical drugs which should not be omitted or delayed

NUH List of Critical Drugs which should not be omitted version 6, Feb 2017
NUH list of critical drugs which should not be omitted or delayed
To make sure that drugs are most effective and to prevent patients from suffering
harm, it is important for some drugs to be administered at specific times.
The following list of drugs are considered critical and must never be omitted or
delayed without a clinical reason which has been discussed with the medical team.
The reason for the omission and a plan of action must be documented on the
Medicines Management Plan found on the back pages of the Prescription Chart. If
you are unfamiliar with a drug name, you must check to find out what it is prior to
prescribing, ordering or administering the drug.
This list is not exhaustive. There will be other medicines that are only used in
specialist areas where timeliness of administration is also crucial. Also refer to
the local list in use in your specialist area where one exists.
 ALL medicines used in emergency situations
FOR EXAMPLE: resuscitation and anaphylaxis drugs, reversal agents /antidotes, glucagon,
oxygen, salbutamol, inotropes, fluids
 Anti-coagulants -prophylaxis and treatment
(enoxaparin, heparin, warfarin, rivaroxaban, apixaban, dabigatran, phenindione, nicoumalone
(acenocoumarol))
 Anti-epileptics
 Anti-infectives
(Antibiotics, Antivirals, Antifungals, Antiretrovirals, Antimalarials , MRSA decolonisation)




Anti-parkinson medicines
Insulin
Steroids (oral and parenteral)
Strong opioids prescribed regularly for acute or chronic pain
All drugs should also be given as close as possible to the
prescribed time & must be administered within half the dosing interval
e.g. If prescribed 6 hourly, must be given within 3 hrs of the prescribed time,
Obtaining supplies of critical medicines
Critical medicines are held as stock on wards that regularly use these medicines.
The flow diagram overleaf shows how to obtain supplies if the medicine is
unavailable on your ward.
Reporting omission of critical medicines
The omission or delay of critical medicines is a patient safety incident and
must be recorded on DATIX.
For further information please see the NPSA alert RRR009 and the NUH Medicines Policy chapters on
Prescribing, Administration and Supply of Medicines from Pharmacy.
Ratified by MMC February 2017 Review date February 2019 Not to be used after February 2020
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NUH List of Critical Drugs which should not be omitted version 6, Feb 2017
Flow chart for obtaining Critical Drugs at NUH
Yes
WARD STAFF- Is the critical medicine
available on the ward?
Correctly administer and
document all doses given
No
CHECK: Have Pharmacy signed the chart to indicate a
supply has been made or that the item is held as stock on
the ward or the patient’s own drugs are available?
Have all Pharmacy Envopaks been unpacked?
Has the patient recently changed wards?
Have non-stock medicines and patient’s own drugs been
transferred with the patient from the previous ward?
Yes
NCH Campus –has the Pharmacy locker been checked?
WARD STAFF- Is the critical medicine
available on the ward?
No
No
Yes
Is the Pharmacy open?
CHECK: Look on the Pharmacy homepage
on the intranet for opening times
No
Bleep the on call pharmacist via
switchboard and request an urgent
supply.
ONCALL PHARMACIST
Is the medicine available in the
Emergency Drug Cupboard?
Yes
Direct ward staff to obtain a
supply from the Emergency Drug
Cupboard
No
Bleep your ward pharmacist and
request an urgent supply.
CHECK: Look on the Pharmacy
homepage on the intranet for details
of the Ward Pharmacist Schedules
and the name & bleep number of the
person providing the clinical
pharmacy service to your ward today.
If unable to contact Ward Pharmacist,
then an escalation plan is available
on the Ward Pharmacist Schedule
page.
No
Is the medicine available
from other wards on the
same campus?
Make an urgent supply
from Pharmacy. Contact
the ward immediately
when the drug is ready.
Yes
Direct ward staff to obtain
a supply from a
stockholding ward on the
same campus
Ratified by MMC February 2017 Review date February 2019 Not to be used after February 2020
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