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Guidelines Inpatient Pharmacy Practice PDF
Guidelines Inpatient Pharmacy Practice PDF
GUIDELINES FOR
INPATIENT
PHARMAC Y
PRACTICE
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 1
MINISTRY OF HEALTH MALAYSIA
2 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
PREFACE
Director
Pharmacy Practice and Development Division
Ministry Of Health Malaysia
Pharmacy Practice and Development Division has been evolving and this is evidenced
through years of excellence in performance. Primarily focussed on patient safety, we
are responsible for the optimisation of drug therapy and prevention of medication errors.
I would like to convey my gratitude to the Clinical & Technical Pharmacy Working
Committee in the success of producing this guideline. Also, a special thanks to all
parties that contributed during all stages of development and publication of this
guideline.
Thank you
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 3
Table of Contents Page
Preface 3
Table of Contents 4
Editorial Board 5
5.0 Documentations 34
6.0 Reference 40
7.0 Appendices 41
8.0 Glossary 67
4 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Editorial Board
Advisors
Eisah A Rahman
Senior Director of Pharmaceutical Services,
Ministry of Health Malaysia
Hasnah Ismail
Director of Pharmacy Practice and Development
Pharmaceutical Services Divison, MOH
Editors
Rabi'ah Mamat
Principal Assistant Director
Pharmaceutical Services Division, MOH
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 5
6 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
GUIDELINES FOR
INPATIENT PHARMA
INPA PHARMACCY
PRACTICE
PRACTICE
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 7
8 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Inpatient Pharmacy Services 1.0
Inpatient Pharmacy
Services
Pharmaceutical care is an area in the health care system which has yet to be fully
developed in Malaysia although it has generated tremendous impact worldwide. Since
its inception in the 1990's, Malaysian pharmacists have embarked on a bold and
dramatic leap forward to embrace its philosophy in all areas of pharmaceutical care
services. Much effort has been put into exploring ways in which to instil and initiate
pharmaceutical care activities in both the outpatient and inpatient settings.
The pharmaceutical needs of a patient refer to his or her requirements for pharmaceutical
products or services. Pharmaceutical needs may be identified by any member of the
health care team or by the patient him/herself. Once a targeted patient group has been
assigned to the responsibility of a clinical pharmacist, a function of the delivery of the
service is to prioritise the individual patient in the group according to his/her potential
pharmaceutical care issues (PCI).
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 9
2.0 Drug Distribution Activities
Objectives
The pharmacy department should implement a distribution system that meets the
Activities
Drug Distribution
following objectives:
i. To dispense prescribed drugs to patients in wards in a timely and efficient
manner
ii. To avoid occurence of medication error
iii. To minimise drug wastage
iv. To minimise opportunities for drug diversion
v. To maintain information on drug utilization and rational drug use
vi. To identify unusual patterns of drug usage
Currently, three types of drug distribution systems are being practiced i.e. the
traditional system, unit-of-use system and unit dose system. The unit dose system
(UDS) should be encouraged due to its many advantages. The UDS involves dispensing
of drugs to individual patients on a daily basis and for 24 hour duration only. The unit-
of-use system (UoU) is similar to UDS in many ways except to the duration of supply.
Drug distribution system may be centralised or decentralised depending on location
and facility itself.
All medications dispensed to patients in the wards should be kept in individually labelled
drawers or trays in the medication trolleys for patients. The amount of medication
dispensed should be according to the dosage regimen and placed in compartments
within the patient drawers. The medication trolley must be lockable and the keys kept
by a registered nurse in the specific ward and another by an authorised pharmacy
staff.
10 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Drug Distribution Activities 2.0
2. The trolley has to be collected by ward staff before the next dose
administration time at 12.00 noon.
Drug Distribution
2.1.2 Medication Order
Activities
1. The medication order for ward patients must be completed in the
self-carbonised Medication Chart and signed by the prescriber
according to the categories set by the Ministry of Health Malaysia
Drug Formulary (FUKKM).
6. For patients who have just been admitted into the ward, the
prescription has to be sent with the patient's Cumulative Medication
Record (Appendix 2).
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 11
2.0 Drug Distribution Activities
4. Any changes made to the prescription can only be made with the
prior consent of the prescriber concerned and recorded into the
'Notes' column of the CMR. If the countersignature for Category A
medications has not been obtained, the prescription should be
copied into the CMR and the medication supplied first while waiting
for the countersignature. The Intervention Note that states the
necessity for the specialist's signature should be sent to the ward
with the prescription. After it is signed, the prescription will be
returned to the pharmacy to be pasted on the CMR.
12 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Drug Distribution Activities 2.0
For example:
Drug Distribution
PATIENT'S NAME Date Start
C16-B2 Ooi Chooi Seng 12/10/09
Activities
DRUG Prescriber's
Tab. Allopurinol 300mg signature &
stamp
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 13
2.0 Drug Distribution Activities
12/10/09 2X4
7. One bin is allotted per patient. Each bin must be filled with the
medication prescribed, with the correct quantity based on the CMR
and in accordance with the administration times. Examples of
administration times are as follows:
Frequency Time
4 hourly 6 am, 10 am, 2 pm, 6 pm, 10 pm, 2 am
QID 6 am, 12 noon, 6 pm, 10 pm
TDS 8 am, 2 pm, 8 pm
BD 8 am, 8 pm
ON 10 pm
OM 8 am
Before meal 6 am
Before meal BD 6 am (before breakfast), 6 pm (before dinner)
prn Placed at the furthest end of the patient's bin.
14 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Drug Distribution Activities 2.0
Drug Distribution
12/10/09 1 x 5ml
TELAH DIBEKAL PADA
1 x 30g
Activities
atau ...............................................................
...............................................................
10. Use the "SELESAI" stamp after the prescriptions have been
supplied in full.
11. For prescriptions where dosage forms of the medication are changed
from injection to oral, the CHANGE TO ORAL stamp should be used
and vice versa.
12. For PRN doses, the medications are placed at the back of the
individual bin. On the first day, the amount of doses supplied should
be recorded and for subsequent days, only the amount of doses
added needs to be recorded.
DATE AMOUNT
12/10/09 +8
13/10/09 +6
14/14/09 +2
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 15
2.0 Drug Distribution Activities
DATE AMOUNT
12/10/09 1x3+3
14/14/09 1x3+2
The staffs filling the bins have to sign the Unit Dose Dispensing
Checklist (Appendix 5).
3. The nurse on duty should check the supply received and inform the
pharmacy if there are any discrepancies.
4. After checking the supply, the nurse on duty should receive the
medication trolley and acknowledge receipt in a form according to
the requirements of individual hospitals
5. All the filling errors need to be corrected and recorded for the
purpose of QAP Monitoring.
16 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Drug Distribution Activities 2.0
The procedures for supplying Floor Stock / Emergency Trolley Medications are as
follow:
1. Receive medication order book from the ward / unit
2. Check balance of floor stock / emergency trolley medications
3. Record the quantity supplied in the order book
4. Supply medication according to the recorded quantity
Drug Distribution
5. File the original copy of the order book
Activities
2.3 AFTER OFFICE HOURS SUPPLY
Drugs prescribed after normal working hours will be supplied according to the amount
requested to the pharmacy staff on-call.
Wards may only keep psychotropic medicines in the amount permitted in a medication
list. A copy of the medication list as agreed upon by the pharmacy and the ward / unit
should be kept in the ward / unit and pharmacy. Record books must be updated each
time psychotropic medications are used based on valid prescription (order form).
Supplies for discharged patients should follow the same procedures as that of
dispensing at the counter. However for medication counselling (refer Chapter 3.5) and
bedside dispensing (refer Chapter 3.6), should ideally be carried out for the following
category of patients:
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 17
2.0 Drug Distribution Activities
1. Patients using devices (inhalers, insulin pen); to reinstate what has been taught
during ward stay.
2. Patients with several debilitating conditions who are on many different
medications.
3. Patients newly diagnosed with chronic illnesses
4. Patients on medications with narrow therapeutic index.
Activities
Drug Distribution
The policy of Ministry of Health Malaysia stated that stable patients can be referred to
nearby health facilities (hospital or health clinic) by using referral letter, for the purpose
of continuing treatment. Proper handling of referral letter (second copy) and supply of
medications to referred patients are important since not all facilities keep certain
medicines. Pharmacy Department is responsible in ensuring that there is a policy/
procedure regarding the submission of referral letter (second copy) to Pharmacist at
the facility where the patient is referred to.
1. The Medical Officer will fill in three copies of the referral letter
(Appendix 6).
• The first copy is for the patient to bring to the referred facility
• The second copy is to be given to the Pharmacist at the
referring facility
• The third copy is to be kept in patient file at the referring facility
18 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Ward Pharmacy Activities 3.0
3. Pharmacist at the referring facility must fax or post the second copy
of the referral letter to the Pharmacist at the referred facility, and if
necessary supply the medications to the referred facility before the
next appointment date
Drug Distribution
4. A copy of the second copy of the referral letter should be filed for
reference purposes
Activities
2.6.2 Receiving Second Copy at referred facility
1. Inform the referring facility upon receiving the second copy (and
supplied medications from the referring facility if necessary)
3. Register the patient's particulars into the Drug Supply Registry Book
(Appendix 7)
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 19
2.0 Drug Distribution Activities
20 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Ward Pharmacy Activities 3.0
Ward Pharmacy activities should be in line with the concept of Pharmaceutical Care
i.e. patient-centred, outcomes-oriented pharmacy practice. It requires the pharmacist
to work in concert with other healthcare providers to promote health, to prevent
disease, and to assess, monitor, initiate and modify medication towards ensuring that
drug therapy regimens are safe and effective.
The goal of ward pharmacy activities is to optimise the patient's pharmacotherapy and
achieve positive clinical outcomes within realistic economic expenditures. Four types
of forms are designed to document ward pharmacy activities:-
i. Medication History Assessment Form (CP1)
Ward Pharmacy
ii. Pharmacotherapy Review (CP2)
iii. Clinical Pharmacy Report Form (CP3) and
Activities
iv. Discharge Referral Note (CP4)
♦ Establish and maintain professional relationships with patients and other healthcare team
members.
♦ Evaluate patient-specific medical information and develop good rapport with patients.
♦ Ensure that the patient has all supplies, information and knowledge necessary to carry
out the drug therapy plan.
♦ Review, monitor and modify therapeutic plan when necessary and in concert with the
patient and healthcare team.
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 21
3.0 Ward Pharmacy Activities
The Medication History Assessment Form (CP1) should be used as a guide for effective
medicine history taking. The form should be kept with the patient's case notes to serve
as a reference for other healthcare providers.
♦ List
3.4 all current medications,
MEDICATION REVIEWING including self-prescribed medication supplements and herbal
preparations with dosages and dates of commencement.
Medication orders should be reviewed for incomplete prescriptions, inappropriate drug
♦ Write
use, down
unclear the medication
instructions, history of previous
authenticity of the treatment
prescriber,thatadministration
may be relevanterrors,
to the present
appro-
priatetreatment
drug storage and other issues related to patient's drug management
and any reason for changes or alterations in the regimen. in the ward
to determine the pharmacotherapeutic appropriateness of each order for the individual
patient.
♦ Note history of allergy or adverse drug reactions to any particular drug / food.
3.5 MEDICATION
♦ Assess RECONCILIATION
compliance.
♦ Record any problem related to medications (e.g.: storage, supply, containers, labelling etc).
Case clerking and medication review are often done concurrently. Most PCIs and
potential pharmaceutical interventions are identified during these two activities.
Pharmacists should play an active role in recognising these issues and documenting
them into the case notes. If the PCI is significant to the patient's current medication
plan, the issue should be highlighted to other healthcare providers during ward rounds
or wherever necessary. Efficient case clerking and reviewing require skills to keep
pharmacists focused on the active pharmaceutical care plans and interventions.
22 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Ward Pharmacy Activities 3.0
Case clerking should be done for all new admissions as far as possible. The subsequent
revision of the case is known as case reviewing. Recurrent admissions should be
treated as new admissions, thus requiring new case clerking to be performed. All
findings, suggestions and interventions performed pertaining to PCIs during case
clerking / reviewing should be documented in the Pharmacotherapy Review Form (CP2)
for continuous follow-up to achieve targeted pharmaceutical outcomes.
Once the form is completed, the case should be reviewed and updated on a daily
basis until the patient is discharged. Patient's progress should be monitored by
analysing objective and subjective parameters, updating current pharmaceutical care
issues and intervening accordingly when necessary.
Ward Pharmacy
♦ Able to extract relevant information from medication chart, case notes, laboratory data,
Medication History Assessment Form and relevant details from patient interview
Activities
♦ Identify PCI
Active participation in ward rounds requires good rapport with other healthcare teams,
up to date knowledge on drugs and information on drug availability and dosage forms.
The following 4P easy steps should be adapted to get started: Prepare, Participate,
Perform and Prove.
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 23
3.0 Ward Pharmacy Activities
STEP 1: PREPARE
♦ Familiarise oneself with drugs commonly used in the ward. Create your own pocket-size
drug reference
e.g.: drug list, normal dose, dosage adjustment in renal/hepatic failure
♦ Bring along necessary forms, documents, references and other helpful tool, e.g.: calculator,
PDA, stamp
♦ Review medication chart and patient's progress notes to identify cases that need to be
monitored
Activities
Ward Pharmacy
STEP 2: PARTICIPATE
♦ Be discreet about what is discussed in the presence of the patient and caregivers.
STEP 3: PERFORM
STEP 4: PROVE
24 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Ward Pharmacy Activities 3.0
♦ Ensure that medication order is comprehensible and in accordance with local requirements
♦ Ensure that any drug / food allergens are documented / displayed prominently in the
Ward Pharmacy
patient's case notes / records
Activities
♦ Ensure appropriateness of medication order and administration times.
♦ Ensure that all ceased orders are cancelled in patient's drug profile drug order form
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 25
3.0 Ward Pharmacy Activities
26 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Ward Pharmacy Activities 3.0
STEP 1: PLAN
Ward Pharmacy
♦ Prioritise potential patient for counselling based on:
Activities
♦ Complexity of therapeutic plan
♦ Compliance status
♦ Patient with special device needs
♦ Decide the type of counselling needed for each individual patient. For those with similar
medical problems / drug therapy, group counselling can be recommended.
STEP 2: PREPARE
♦ Study the patient medication profile, relevant medical history, social history and other
related information prior to counselling.
♦ Select counselling tools (eg. flip chart, pamphlet, sample device etc).
STEP 3: CONDUCT
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 27
3.0 Ward Pharmacy Activities
Follow-up counselling sessions may be necessary during ward stay and upon
discharge. Information provided during the counselling sessions should be documented
in the case notes and Pharmacotherapy Review form (CP2) by the ward pharmacist.
Counselling statistics should be recorded in the Clinical Pharmacy Report form (CP3).
Patients who require continuity of care in other healthcare setting should be referred
using the Discharge Referral Note (CP4).
Ensuring continuity of care when patients are transferred from one hospital to another
Activities
Ward Pharmacy
28 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Ward Pharmacy Activities 3.0
screening and counterchecking for any errors. If any error is detected, the
inpatient / satellite pharmacist should call the ward pharmacist to do the
intervention. Discharge medication will be prepared by the inpatient / satellite
pharmacist and sent to the ward for bedside dispensing.
Ward Pharmacy
Activities
3.7.4 Bedside Dispensing and Discharge Counselling
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 29
4.0 Other Activities
30 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Other Activities 4.0
Other Activities
All entertained enquiries should be properly documented to serve as future references.
It is the pharmacist's responsibility to monitor and report any suspected adverse drug
reactions (ADR).
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 31
4.0 Other Activities
A description of the adverse reactions and the suspected drug should be recorded in
the patient's bed head ticket / case note. The patient should be informed of the reaction
and adequate advice given taking care to avoid legal implications. An allergy card should
be given to the patient for documentation and as a form of alert for future drug use. The
number of Adverse Drug Reaction events should be recorded in the Clinical Pharmacy
Report Form (CP3). The data should be analysed to study trends in the occurrence of
ADRs to identify drugs which are commonly implicated, changes in the frequency of
occurrence and at risk groups. This information should be presented to the Drugs &
Other Activities
A medication error is defined as any preventable event that may cause or lead to
inappropriate medication use or patient harm while the medication is in the control of
the health care professional, patient, or consumer. Such events may be related to
professional practice, health care products, procedures and systems, including
prescribing, order communication, product labelling, packaging and nomenclature,
compounding, dispensing, distribution, administration, education, monitoring and use.
32 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Other Activities 4.0
Pharmacist can refer to Guideline on Medication Error Reporting and submit the ME
report form (Appendix 12) to Pharmaceutical Services Division.
Other Activities
Each hospital / institution should have its own drug formulary adapted from the MOH
drug formulary based on local needs and functions. The hospital formulary may not
include all drugs in the MOH formulary. Newly-approved MOH drugs should follow the
local hospital policy for inclusion into the hospital formulary. Formulary drugs should
be the preferred choice of use at all times.
Drugs not listed in the MOH formulary are called Non-MOH Formulary Medications and
should not be prescribed before getting prior approval from the Director General of
Health. However, when non-hospital formulary drugs are strongly indicated (in
circumstances such as life-threatening situations or no other alternatives are available),
it should go through the proper procedure for approval before it can be obtained.
Ward Pharmacists in collaboration with the DIS pharmacist should ensure that non-
MOH formulary drug requests for inpatients are rational and based on current evidence.
The prescriber should submit the request by using the 'KPK 01' Form with justification
by the respective Head of Department. All requests should be submitted to the
Pharmaceutical Services Division, MOH for approval by the Director General of Health.
The pharmacy department should monitor the non-MOH formulary drug usage once it
is available in the hospital.
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 33
5.0 Documentation
5.0 DOCUMENTATION
Data collection through systematic documentation can be used for future planning
and expansion of pharmacy services in the country. Drug information enquiries during
the ward rounds should also be recorded in the Clinical Pharmacy Report Form. Areas
of national importance such as cost savings and medication error reduction can be
utilised to enhance a particular service. Please refer appendices for types of forms
used in Inpatient Pharmacy Practice.
Please refer to Chapter 2.1 for the use of the UDS forms.
Introduction
As patients who are admitted to the ward may already be on some form of
Documentations
Objectives
34 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Documentation 5.0
A. Patient Biodata
Documentations
• Record all confirmed, suspected and possible allergies and adverse
drug reactions
• Record No Known Drug Allergy or NKDA if the patient has no history
or unknown drug allergy and adverse drug reaction
D. Drug History
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 35
5.0 Documentation
E. Pharmacist’s Notes
Introduction
Objectives
Form Contents
• Section 1
Obtain information from patient's BHT and Medication History
Assessment Form (Form CP1). If required interview patients for
further information.
36 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Documentation 5.0
• Section 2
Obtain information of medications which the patient has been
prescribed / is on from the Medication Chart. Record complete drug
regimen, date start and date stopped.
• Section 3
Obtain information from BHT or Hospital Laboratory Data Retrieving
System. Record significant lab values related to the pharmaceutical
care plan and treatment goal.
• Section 5
Record all discharged medication, and write the next appointment
date.
Introduction
Data collection is critical towards justifying for the future expansion of clinical
pharmacy services and professional development and recognition in this country.
Documentations
Objectives
Forms Contents
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 37
5.0 Documentation
38 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Documentation 5.0
D. Follow Up Required
Introduction
The ward pharmacist identifies patients who require further monitoring for
referral. The patient's diagnosis, medication list and discharge instructions in
the patient's case notes should be reviewed. Pharmacists should fill in the
Discharge Referral Note (CP4 - Appendix 10) to ensure further reviewing or
counselling by the pharmacist in other healthcare setting takes place. All PCIs
Documentations
and action taken should be documented in the patient's case notes.
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 39
6.0 References
6.0 REFERENCES
Kok Thong Wong, Siang Kwang Lim, Ruhaiyem Yahaya et al. 2001.
Guidelines Towards Excellence in Clinical Pharmacy Practice. Petaling
Jaya: Pharmaceutical Services Division, Ministry of Health.
Mohd Syafiq Abdullah, Kok Thong Wong, Rosnani Hashim et al. 1996.
Clinical Pharmacy Practice in the Malaysian Health Service: Concept
and Manual. Petaling Jaya: Pharmaceutical Services Division, Ministry
of Health.
40 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendices 7.0
7.0 APPENDICES
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 41
Appendices
Appendices
42 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 1
MEDICATION CHART
NAME : ................................................... AGE : ……………………………
DRUG Prescriber's
signature & stamp
DRUG Prescriber's
signature & stamp
DRUG Prescriber's
signature & stamp
DRUG Prescriber's
signature & stamp
DRUG Prescriber's
signature & stamp
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 43
Appendix 2
PATIENT PARTICULAR
NAME : ................................................... AGE : ……………………………
44 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 3
Inpatient Pharmacy
Hospital ________________
ADVICE NOTE
Patient : _________________________________________________________________________
R/N : ______________________
Diagnosis: _____________________________________________________
New admission
Discharged / Deceased
______________________________________________________________________
Other ___________________________________________________________________
______________________________________________________________________
__________________________
Sign & Stamp
Appendices
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 45
Appendix 4
Inpatient Pharmacy
Hospital ________________
INTERVENTION NOTE
__________________________________________________________________________________
No CMR
Other: ________________________________________
________________ ____________________________
Date Sign & Stamp
Appendices
46 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 5
Received by:
Charted:
No. Errors:
Checked:
Dispensed:
Received by:
Charted:
No. Errors:
Checked:
Dispensed:
Received by:
Date
Charted:
No. Errors:
Checked:
Dispensed:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Appendices
26
27
28
29
30
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 47
Appendix 6
Tarikh : Masa :
No.K/P : Jantina :
Results of Investigations :
Diagnosis :
Treatment :
Purpose of Referral :
Nama : Tandatangan :
Salinan Pertama : Diberi kepada pesakit (untuk diberi kepada doktor di institusi yang dirujuk)
Salinan Kedua : Diberi kepada Pegawai Farmasi hospital merujuk (untuk difaks/ pos
48 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 7
BUKU DAFTAR PEMBEKALAN UBAT
(Drug Supply Registry Book)
BAGI PESAKIT YANG DIRUJUK BAGI MENERUSKAN RAWATAN KE
FASILITI KESIHATAN LAIN
Tahun : _______________
Appendices
Jumlah
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 49
Appendix 8
Inpatient Pharmacy
Hospital ________________
DISCHARGE SUMMARY
Date : _____________
Appendices
50 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 9a
Appendices
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 51
Appendix 9b
Appendices
52 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 10a
ALLERGY
Chief Complaint:
PR: p/min T: O
C
Alcohol
Drug
Abuse
Pregnant
Diagnosis/Surgical Procedure:
Appendices
Pind 1//10
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 53
Appendix 10b
WARD MEDICATION
54 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 10c
WARD MEDICATION
DATE
INFUSION CHART
Dopa
Dobu
Norad
Mida
Morp
Mida/Morp
Appendices
Insulin
INPUT
CHART
I/O
OUTPUT
BALANCE
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 55
Appendix 10d
RBC 4.5-6.3x106
HCT 0.4/0.37-0.52/0.48
Platlet 150-400 x10/L
Na 135-145 mmol/L
K 3.5-5.0 mmol/L
Cl 96-106 mmol/L
Ca 2.1-2.6 mmol/L
Mg 0.7-1.3 mmol/L
PO4- 0.8-1.45 mmol/L
SCr 64-122 umol/L
ClCr 105-150 mL/min
Albumin 35 - 50 g/L
T.Bilirubin <20 umol/L
profile
Liver
T.Protein 66 - 87 g/L
ALP 53 - 141 u/L
ALT <32 u/L
PT 10-13.5 sec
profile
Coag.
APTT 26 - 42 sec
INR <1.5
enzymes
CK 24 - 195 u/l
Cardiac
pH 7.35-7.45
pCO2 35-45mmHg
ABG
pO 2 72-100mmHg
HCO3 22-29mmol/L
O2 sat 90-95%
BP
Vital signs
Appendices
TEMP
RR 12 - 18 b/min
PR 60 - 100 p/min
56 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 10e
8 9 10 11 12 13 14 15 16 17 18 19 20
Appendices
Date
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 57
Appendix 10f
58 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 10g
Appendices
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 59
Appendix 10h
DISCHARGE MEDICATION
Appendices
NEXT TCA:
60 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 11a
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 61
Appendix 11b
D: FOLLOW-UP REQUIRED
…………………………..
Pharmacist Sign & Stamp
Date:
Pin. 1/10
62 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 12
DISCHARGE REFERRAL NOTE
Appendices
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 63
Appendix 13
Appendices
64 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
Appendix 14
Appendices
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 65
Appendix 15
i. MAKLUMAT PRODUK
Particulars of Product
NAMA PRODUK:
Name of Product
NO. PENDAFTARAN PBKD/MAL: NO. KELOMPOK:
Registration Number Batch Number
TARIKH DIKILANGKAN: TARIKH LUPUT:
Manufacturing Date Expiry Date
ADUAN EFIKASI:
Complaint on product efficacy
Bagi masalah efikasi, kerjasama tuan/puan diminta supaya memberi maklumbalas objektif seperti:-
- % pesakit yang menghadapi masalah
- Adakah masalah berlaku selepas “brand switching”
- “Objective findings” seperti BP reading, RBS dll yang boleh menyokong aduan bahawa produk
kurang berkesan.
Kindly provide us with objective feedback such as:
- % patients having similar problems
- Was the problem occurring after brand switching
- Objective findings such as BP reading, RBS etc to support the complaint on the efficacy of the product
........……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….……
…………………………………………………………………………………………………...........................
NAMA: JAWATAN/PEKERJAAN:
Name Designation/Occupation
ALAMAT LENGKAP TEMPAT KERJA:
Address
Appendices
TELEFON: FAX:
Telephone Fax
TANDATANGAN: TARIKH:
Signature Date
66 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia
8.0 GLOSSARY
2. Compliance aid - Any device such as pillbox, pamphlet or timetable guide that
helps to improve the patient's compliance to medication
11. Routine round - Daily ward round between the ward pharmacists, medical officer
with or without the specialist or consultant.
12. Grand round - Scheduled departmental round participated by the ward pharmacists
with the consultants, specialist, medical officer and nursing staff.
13. Pharmacists round - Pharmacotherapy ward round involving the ward pharmacist
with other fellow pharmacists.
14. No. of cases clerked - Cases clerked for the first time during the current admission
15. No. of cases reviewed - Clerked cases that are reviewed on the following days
16. Chief complaints (CC) - Main complaints made by the patients during admission. It
should be documented as layman term
Glossary
Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia 67
17. History of present illness (HPI)
• Presenting symptoms and time scale of their occurrence
• Date of presentation to hospital or clinic
• Mode of admission eg. Acute emergency or referral
22. Health Facility - Hospital, Health Clinic and Health Institution under Ministry of
Health
23. Second Copy - a referral letter that is used to refer patient from one facility to
another
68 Guidelines for Inpatient Pharmacy Practice : Pharmaceutical Services Division Ministry of Health Malaysia