Drug record keeping in RCH

(supplementary)
HAS 4943 Lecture 2

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 Common sources of medication
• Hospitals
• HA clinics (GOPC, specialty clinic)
• Private clinics (GP)
• Visiting medical officer (VMO)
• Outreach services offered by HA – CGAT, PGT

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 Outreach services
• CGAT – Community Geriatric Assessment Team 社區老人評估小組
• PGT – Psychogeriatric Team 社區老人精神科
• Visit to RCHE by geriatric or psychiatric doctors
• Mainly for elderly patients with limited mobility e.g. chairbound, bedbound
• Medications are usually delivered to RCHE a few days AFTER doctor visit
• Remarks: difference in prescription “start date”; usually receive 1-week extra supply

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Medication Administration Record (MAR)
• Contrary to information on dispensing labels, time of administration is
usually stated clearly on MAR.
• Determined based on medical order and operation need of RCH
• Common hour: 8A (QD or OM), 12noon, 5P, 8P
• If before meal: 7A, 11A, 4P
• May alter in case of drug interaction

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 Drug management and disposal in
RCH
HAS 4943 Lecture 3

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 Drug Management
• RCHEs shall arrange for staff with relevant training (RN, EN, HW) to be
responsible for drug preparation, check and administration.
• RCHEs shall strictly follow the prescriptions and the related instructions of
medical practitioners to assist residents in using drugs.
• No dispensing shall be performed based on the staffs’ own diagnosis or
opinion.

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 Drug Management
• Any person shall NOT arbitrarily cease or change the dosages or routes
of using drugs without authorization.
• Nurses can stop using a certain drug based on their professional
judgement, if severe adverse effect happens on a resident. Still, the case
should seek medical advice as soon as possible. Also, such intervention
should be clearly marked and justified in the Nursing Record.
• Unless a special drug preparation system is used, an RCHE can only prepare
drugs for a maximum period of 24 hours in advance.

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 Drug Management
• An RCHE shall ensure that drugs are used on designated residents (i.e. the
ones prescribed of the drugs) and shall NOT arbitrarily re-distribute the
drugs among other residents.

• If an automated drug packaging system is used, the RCHE shall comply with
the guidelines and requirements from SWD.

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 Drug Storage
All medicine and drugs shall be kept in a secure place.
• All drugs (incl. oral, topical, injectable) shall be clearly labelled and stored in a
secured place (locked drug cabinet and/or room), under the monitoring of
nurses.
• The drugs of every resident shall be stored individually in a compartment
bearing the resident’s name. Each compartment shall only store the drugs of
ONE resident.

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 Drug Storage
• Drug cabinets (including medical refrigerators) should only keep medications.
No other objects (e.g. food) should be kept in drug cabinets.
• Oral, topical and injectable drugs shall be stored separately.
• All drugs shall be stored appropriately according to the directions on drug
labels (e.g. temperature, away from direct light, etc.)

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 Drug Storage
• Some medicines will need to be kept refrigerated. They should be kept in a
secured medical refrigerator.
• The refrigerator should be kept at correct temperature. Also, regular
temperature log should be maintained.

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 General Stock Management
Principles of good stock management:
• Appropriate ordering of stock quantity
• Monitor and inspect conditions of pharmacy storage areas regularly
• Apply ‘First Expired, First Out’ principle
• In some circumstance ‘First In, First Out’ principle
• Review and update emergency stand‐by drug items regularly
• Establish good mechanism for expiry dates checking on regular basis
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 Cold Chain Management of Pharmaceutical
Product
• Cold chain refers to the management of temperature‐sensitive products from
receipt, storage and distribution before administration.
• Normally refer to the continuous maintenance of low temperature (2°C –
8°C) required for pharmaceuticals e.g. vaccines, biologicals, insulins

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 Receiving cold products
• In RCHE setting, cold chain management may apply to reception of
vaccines from DH (e.g. seasonal flu vaccines, COVID-19 vaccines)
• Staff must ensure that the goods have been transported under appropriate
storage conditions.
• Medicines are then stored in refrigerators immediately upon receipt.

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 Storage of cold products
• The refrigerator should be preferably a medical refrigerator. If
a domestic one is used, lock and thermometer shall be installed.
• Always lock the refrigerator unless preparing drugs.
• Temperature should be maintained between +2°C to +8°C.
• Store in an orderly fashion – do NOT place near the fridge
door or block the air vent.
• DO NOT over pack to ensure air circulation and consistent
temperatures throughout.
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 Equipment
• Pharmaceutical refrigerator or cold room
• Temperature Setting
• Maintaining temp: +5°C
• High Alarm : +8°C Low Alarm : +2°C
• Power Source
• Preferably essential power supply
• Properly fused
• Ensure electric plug not accidentally pulled, and switch will not be turned off
• Temperature Recording Device (e.g. Data logger) 16

• Insulated Receptacles and Cold Packs (e.g. Cold box)

 Temperature Monitoring
• Record temperature of temperature recording device (e.g.
refrigerator’s integral thermometer and/or data logger)

• Record the minimum, maximum and current

temperatures at least once per day.

• Inform supervisor if temperature is out of range i.e. <

2°C or > 8 OR if there is an alarm
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 Dispensing & Administration
• Identify the refrigerated medicines

• e.g. affix auxiliary label “Fridge Item” and /or “有雪貨” and /or “必須冷
藏勿放冰格”during routine handling so that they would be promptly
handled and not left accidentally unattended outside the required storage
condition

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 Transportation
• Insulated Receptacles and Cold Packs should
be used during transportation to ensure cold
chain is maintained.

• The equipment should be cleaned and

maintained according to manufacturers’
recommendations

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 Handling of Chemical Waste
• All expired (過期) and surplus (剩餘) drugs should be regarded as chemical
wastes.
• An RCHE shall comply with the requirements of:
• Waste Disposal Ordinance (Chapter 354)
• Waste Disposal (Chemical Waste) (General) Regulation (Chapter 354C)

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 Pharmaceutical Chemical Wastes
• Under the Waste Disposal (Chemical Waste) (General) Regulation, Chapter
354C, the following pharmaceuticals are classified as chemical wastes
requiring special disposal action:

• Part A – Antibiotics, Dangerous Drugs, Poisons (Part 1)

• Part B – Other pharmaceutical products & medicine

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 Chemical Waster Producer
• A person or a body corporate who is authorized in that behalf, who produces
chemical waste or causes it to be produced.

• Required to register with Environmental Protection Department (EPD) to obtain a

Waste Disposal License

• Examples:
• Account No. (PWH) WPN: 9331‐756‐P2281‐01
• Account No. (ST) WPN: 9332‐759‐P2281‐04
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 Chemical Waster Producer
Are required to:
• Inform EPD on any changes in the registration particulars (e.g. locations,
amount of chemical waste).
• Arrange the chemical waste to be properly handled and disposed of in all
circumstances.
• Handover the waste to a licensed waster collector for the proper disposal of
the waste.
• Produce such records for inspection upon request by the Director of EPD

Do NOT dispose of drugs by the RCHE itself! 23

 Disposal & Collection of Pharmaceutical
Chemical Wastes
• Waste containers will only be collected
from licensed chemical waste collector.

• Wastes should be filled to occupy

maximum 70% of the volume of the
container (i.e. maximum 14 liters/ pail桶).

• Liquid content in each container should

not exceed 500ml in total.
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 Chemical Waste Record
• At time of collection, a designated form would be collected together with
the waste container by the licensed chemical waste collector.
• A designated form should be retained by the waste producer as a record of
consignment for at least 12 months.
• Collection of pharmaceutical waste should be scheduled at time of collection
of other chemical waste from RCH.
• Chemical Waste Record should be kept by RCHE for inspection by SWD.
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