THE FIVE RIGHTS OF MEDICATION ADMINISTRATION The Right The Right 5 Patient Dose 1 The Right The Right The Right Time Drug Route 2 4 3 System checks “Right Time” with AOM schedule; System checks “Right Drug” & “Right Patient” by scanning; SYSTEM CAN'T REPLACE OUR PROFESSIONAL JUDGEMENT “Right DOSAGE” and “Right ROUTE” depends on Nurse
Table of Contents Chapter 1 General Information 1.1 IPMOE Support Phone List 1.2 KH AOM Schedule 1.3 Clinical Dashboard 1.4 Verbal Order List 1.5 Checking Procedure for AOM with IPMOE System 1.6 Summary of Drug Administration by Ward 1.7 Summary of Drug Administration by Patient 1.8 KH Exclusion List (Unit/Procedure/Regimen NOT using IPMOE) 1.9 Default Medication Review Time 1.10 IPMOE Icon 1.11 Clinical Handover Chapter 2 Basic Drug Administration 2.1 Basic Drug Round 2.2 Basic IVF administration 2.3 Amend Schedule (with AOM Schedule) 2.4 Amend Schedule (without AOM Schedule) 2.5 Suspend & Resume Infusion 2.6 Change Infusion Rate 2.7 Defer, Omit, Withhold Administration, On-Hold 2.8 Self-Administration of Medication 2.9 Checking of Corporate IP Prescribing History 2.10 Checking of IP Prescribing History Chapter 3 Handling of Medication 3.1 Workflow for Handling Verbal Order in IPMOE 3.2 Workflow for Obtaining Medication from Nightcabinet 3.3 Workflow for Handling of Non-KH Formulary Items in IPMOE 3.4 Workflow for Handling Self-Financed Item (SFI) 3.5 Workflow for Handling of Brought-in Medication 3.6 Workflow for Handling of Pending Prescription for Clarification in IPMOE 3.7 Workflow for Handling Ultra-Urgent Item
Table of Contents Chapter 4 Transfer of Patient 4.1 Workflow for Patient Transfer (Inter – From Non-IPMOE Hospital) 4.2 Workflow for Patient Transfer (Inter – From IPMOE Hospital) 4.3 Workflow for Patient Transfer (Intra – From Non-IPMOE Ward) 4.4 Workflow for Patient Transfer (Intra – From IPMOE Ward) 4.5a Workflow for Patient Transfer to Procedure Room in Department of Respiratory Medicine 4.5b Workflow for Patient Transfer to Procedure Room in Department of Psychiatry Chapter 5 Offline CMS Backup 5.1 Pairing Ward for Offline CMS Backup 5.2 Workflow of printing Offline MAR 5.3 Downtime Offline MAR printing procedure Chapter 6 Smart Tips 6.1 How to print eMAR? 6.2 Quick Reference for AOM round in IPMOE 6.3a Hardware Features - ToughPad 6.3b Hardware Features - Scanner 6.3c Hardware Features - Printer Appendix KCC Portal and KH IPMOE Website
Chapter 1 - General Information CONTENT 1.1 IPMOE Support Phone List 1.2 KH AOM Schedule 1.3 Clinical Dashboard 1.4 Verbal Order List 1.5 Checking Procedure for AOM with IPMOE System 1.6 Summary of Drug Administration by Ward 1.7 Summary of Drug administration by Patient 1.8 KH Exclusion List 1.9 KH Default Medication Review Time 1.10 IPMOE Icon 1.11 Clinical Handover
1.1 IPMOE Support Phone List General Enquiry & Drug Admin KH IPMOE Office 3129 6855 (Until March 2021) Drug Dispensing Pharmacy 3129 6670 (WW & MB) 3129 7030 (RB) Local IT Ext: 3129 6686 (Office Hour) HA Call Centre: 2515 2653 (24-hour Hotline)
1.2 Administration Of Medication Schedule Due Time Allowance +/-1.5 hours AOM Frequency Default Others Schedule Groups Daily Morning 08:00 06:00 16:00 OM At Noon 08:00 06:00 PM Evening 08:00 06:00 NOCTE At Bedtime 12:00 BD 17:00 15:00 TDS/TID 17:00 20:00 QID 20:00 23:00 5 times per day 20:00 23:00 6 times per day 08:00 17:00 08:00 20:00 09:00 17:00 8 times per day 08:00 12:00 17:00 08:00 12:00 20:00 Before Breakfast Before Lunch 08:00 12:00 17:00 Before Dinner 20:00 With Breakfast With Lunch 00:00 08:00 12:00 With Dinner 16:00 20:00 After Breakfast After Lunch 08:00 11:00 14:00 After Dinner 17:00 20:00 23:00 08:00 10:00 12:00 14:00 16:00 18:00 20:00 22:00 08:00 12:00 17:00 08:00 12:00 17:00 08:00 12:00 17:00
1.2 Administration Of Medication Schedule AOM Frequency Default Others Schedule Groups Q1H 00:00 01:00 02:00 Q2H 03:00 04:00 05:00 Q3H 06:00 07:00 08:00 Q4H 09:00 10:00 11:00 Q6H 12:00 13:00 14:00 Q8H 15:00 16:00 17:00 Q12H 18:00 19:00 20:00 Q24H 21:00 22:00 23:00 Q1H Daytime 00:00 02:00 04:00 Q2H Daytime 06:00 08:00 10:00 12:00 14:00 16:00 18:00 20:00 22:00 00:00 03:00 06:00 02:00 05:00 08:00 09:00 12:00 15:00 11:00 14:00 17:00 18:00 21:00 20:00 23:00 00:00 04:00 08:00 12:00 16:00 20:00 00:00 06:00 12:00 02:00 08:00 14:00 18:00 20:00 00:00 08:00 16:00 08:00 20:00 00:00 12:00 06:00 18:00 12:00 00:00 08:00 16:00 18:00 20:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 08:00 10:00 12:00 14:00 16:00 18:00 20:00
1.3 Clinical Dashboard Clinical Dashboard link can be found in all CMS workstations, COW, Toughpads, and wall mount CMS. Bed numbers of patients who have any MAR changes will be shown in MAR change section. Check all Ward Code Check any MAR changed
1.4 Verbal Order List Analgesics Trade Name Dosage Form Dosage Route/Rate Paracetamol Panadol Tablet 500mg Oral Paracetamol Panadol Rectal Suppository 500mg Rectal Paracetamol Alcohol Free Panadol Suspension 500mg NG tube / PEG tube Antihistamines Trade Name Dosage Form Dosage Route/Rate Chlorpheniramine Maleate Piriton Tablet 4mg Oral / NG tube / PEG tube Chlorpheniramine Maleate Piriton Injection 10mg IV Bolus Bronchodilator Trade Name Dosage Form Dosage Route/Rate Salbutamol Sulphate Ventolin Inhaler 2puffs Inhalation Salbutamol Sulphate Ventolin Inhaler 4puffs Inhalation Cardiovascular Agents Trade Name Dosage Form Dosage Route/Rate Glyceryl Trinitrate TNG Sublingual Tablet 500 Sublingual microgram(s) Glucose Trade Name Dosage Form Dosage Route/Rate Dextrose 50% -- Infusion 20ml IV Bolus Dextrose 50% -- Infusion 40ml IV Bolus Dextrose 50% -- Infusion 20ml Oral / NG tube / PEG tube Dextrose 50% -- Infusion 40ml Oral / NG tube / PEG tube Intravenous Fluids Trade Name Dosage Form Dosage Route/Rate Gelofusine -- Continuous IV 500ml IV-Full Rate Infusion Sodium Chloride 0.9% -- Continuous IV 500ml IV-Full Rate Infusion Dextrose 5% -- Continuous IV 500ml IV-Full Rate Infusion Hartmann’s -- Continuous IV 500ml IV-Full Rate Infusion Steroid Trade Name Dosage Form Dosage Route/Rate Hydrocortisone Solu Cortef Injection 100mg IV Bolus Hypnotics Trade Name Dosage Form Dosage Route/Rate Zopiclone Imovane Tablet 3.75mg Oral / NG tube / PEG tube Zopiclone Imovane Tablet 7.5mg Oral / NG tube / PEG tube Antipsychotics Trade Name Dosage Form Dosage Route/Rate Haloperidol Haldol Intramuscular 2.5mg IM injection Haloperidol Haldol Intramuscular 5mg IM injection Antimuscarinic Drugs used Trade Name Dosage Form Dosage Route/Rate in Parkinsonism Benztropine Mesylate Cogentin Injection 2mg IM
1.5 Checking Procedure for AOM with IPMOE System 1st Check (Prescription) 1. Using “Drug Admin by Ward/ by Patient” for oral or injection round: 2. Select corresponding patient to administer the Due/ Overdue drugs (with “Y”) and PRN drug in the ward round list accordingly 2nd Check (Medication) 5. Select medication to be administered from drug drawer 6. Manual checking on the drug packing against doctor’s prescription to ensure the right patient, right drug, right time, right dose and right route 7. Manual checking the drug before putting the drug package back to drawer 3rd Check (Patient) 11. Click \"Proceed\", then a message box will pop up and indicate patient's particulars. Meanwhile, patient's name, patient's ID and case number will also be displayed on the scanner. Now, go to bedside.
1.5 Checking Procedure for AOM with IPMOE System Preparation: Turn On the IPMOE Hardware (e.g. Toughpad, Scanner and Printer) and Login CMS 3. Check patient’s identification, allergy status, condition before AOM: 4. Identify the Due drug (highlighted in Blue and with ) and prepare the PRN drug if necessary. 8. Then prepare the right dose of drug according to prescription 9. Manual checking the drug before putting the drug package back to drawer 10. Repeat the above procedure for other drugs until complete the drug preparation 12. Verbal checking patient’s name 13. “Patient Match” will be shown on and visual checking patient's scanner if the patient is correct, then information on wristband against press “M1” for confirmation the display of scanner, and then scan patient’s 2D barcode 14. The ward round list will be updated wristband for system check and shown on due/overdue drug
1.6 Summary of Drug Administration by Ward 1. Attention (will show any Type of Ward Round: Current Date duplicated schedule found) 1. Oral & Misc and Time 2. Injection 2. Ward Round 3. Intrathecal 3. Overdue List 4. On Hold 1. Injection (view only) 5. Unschedule 2. Future Start Drug 6. Infusion 7. PD Attention! On-Hold Future Start Drug No. of patient with Due/Overdue Page of patient Due/Overdue drug Drug list on this page Summary Countersign 1. Stat 2. PRN 3. Dangerous Drug 4. Self Admin. 5. Withhold
1.7 Summary of Drug Administration by Patient Right Click / Long Hold the Order Line Function Drug without Drug with AOM Schedule AOM Schedule Urgent Dispensing Request “Urgent dispense” of un-vetted drug Amend Custom Schedule Rule Drug without AOM schedule Amend Schedule Drug AOM schedule Replenish Request “Replenishment” of vetted drug with number of dose Preview Schedule Drug AOM schedule Acknowledge Right Click/ Long Hold the Time Schedule (Turn off reminder in Clinical Dashboard) 1. Change Infusion Rate Verbal Order 2. Suspend Print MAR 3. Resume Withhold Administration 4. Amend (e.g. home leave, fasting, etc.) 5. Self-admin 6. Omit 7. Retrospective
1.8 Exclusion List 1. Medication used during resuscitation 2. CAPD regimen (except IP medication) 3. Medication used at Pulmonary Function Laboratory, Bronchoscopy Room and Electro Convulsive Therapy Room 4. Eye procedure / examination in RMD SOPC 5. TPN (with / without additives) 1.9 KH Default Medication Review Time
1.10 IPMOE ICON Order Line Order Line Vetted Item Fixed Concentration Single Use (For IP Discharge Continue with own stock Medication) Fixed Period (For IP Purchase by Patient Discharge Medication) Dispense in Clinic (For IP Medication Alert Discharge Medication) Purchase by Patient Dangerous Drug with Safety Net Ward Stock Standing Order Formulary Management Indicator Verbal Order Pending for Dr/ Dispensed as Pharm clarification refrigerated drug Drug admin module MAR timeslot MAR timeslot New Drug Due Change infusion rate Modified Overdue Suspend Drug On time / Fluid Urgent Resume replacement Dispensing Omit Self-admin Replenish Withhold Downtime Self-admin Early given record Retrospective Clinical dashboard Late Given MAR change Re-admin
1.11 Clinical Handover Check \"ORAL & MISC\", \"INJECTION\" and \"INTRATHECAL\"
Chapter 2 - Basic Drug Administration CONTENT 2.1 Basic Drug Round 2.2 Basic IVF administration 2.3 Amend Schedule (with AOM Schedule) 2.4 Amend Schedule (without AOM Schedule) 2.5 Suspend & Resume Infusion 2.6 Change Infusion Rate 2.7 Defer, Omit, Withhold Administration, On-Hold 2.8 Self-Administration of Medication 2.9 Checking of Corporate IP Prescribing History 2.10 Checking of IP Prescribing History
2.1 Basic Drug Round Clinical > Drug Admin by Ward 1. choose ‘Oral & Misc’, ‘Injection’ or ‘Intrathecal’ 2. choose patient with “Y” in Due/Overdue list 3. Press ‘admin’ Check patient’s allergy before drug administration
2.1 Basic Drug Round Due drug will highlighted in blue background with yellow timeslot Number of Due/Overdue drug Scan 2D Barcode to confirm ‘Right Drug’
2.1 Basic Drug Round After scan the drug label Scanned drug name fell in A tick appear Prepared Drug List Prepare Right Dose of medication Number of Due/Overdue drug Prepared all the Due/Overdue drugs 3. Press ‘Proceed’ when all 1. Number of Due/ drugs are prepared Overdue drug is ‘0” 2. Scroll down to look for PRN drugs
2.1 Basic Drug Round Confirm right patient information on handheld scanner Confirm right patient 我叫胡小茜 1. Verbal and visual 身份證係… checking patient’s 你叫咩名 ? 身份證號碼 ? name and HKID 2. Scan patient’s wristband 2D barcode. Check if “Patient Match” shown on the scanner.
2.1 Basic Drug Round Give drug to patient 夠鐘食藥喇 知道 2. Scanner shows ‘No new job’ 3. Ensure tablet received the signal by checking red ‘Y’ change to black ‘N’ 1. Press ‘M1/M2’ on scanner to confirm after patient taken medication
2.2 Basic IVF administration In ‘Drug Admin by Ward’ 1. Choose ‘IV Fluid’ tab 2. Total number of patient with active IV fluid prescription 1. Choose Patient 2. Point over the last admin time to get the admin detail 3. Press ‘admin’
2.2 Basic IVF administration Check patient’s alert before drug administration Check patient’s Allergy before drug admin Drug administration Admin If no 2D barcode, long hold and press ‘Admin’
2.2 Basic IVF administration Select the required IV fluid 2. Click proceed 1. Choose the correct IVF then press ‘Proceed’ The IVF selected fall in Prepared Drug list 1. Prepared IVF as shown Printer gererate label showing 2. Click proceed details of current infusion
2.2 Basic IVF administration Confirm right patient information on handheld scanner Check the patient information to confirm if it is match with handheld scanner Confirm right patient 我叫胡小茜 1. Verbal and visual 身份證係… checking patient’s 你叫咩名 ? 身份證號碼 ? name and HKID 2. Scan patient’s wristband 2D barcode. Check if “Patient Match” shown on the scanner.
2.2 Basic IVF administration Give drug to patient 夠鐘食藥喇 知道 2. Scanner shows ‘No new job’ 3. Ensure tablet received the signal by checking the admin record 1. Press ‘M1/M2’ on scanner to confirm after patient taken medication
2.3 Amend Schedule (with AOM schedule) In Drug Admin by Patient Long-hold or Right click the order line at left side Select ‘Amend Schedule’
2.3 Amend Schedule (with AOM schedule) Amend frequency group Select a schedule 1. Choose the other schedule 2. Press ‘Confirm’
2.3 Amend Schedule (with AOM schedule) Preview schedule 1. Check the schedule by press ‘Month’ 2. Press ‘Save’ Check the amended schedule Check the schedule Can preview a month’s schedule
2.4 Amend Schedule (without AOM schedule) In Drug Admin by Ward 1. Click “Unschedule”Tab 2. Choose 3. Choose drug patient 4. Click“Proceed” In Drug Admin by Patient Long-hold or Right click the order line at left side
2.4 Amend Schedule (without AOM schedule) Select ‘Amend Custom Schedule Route’ Amend drug administration schedule rule 2. Press ‘Add’
2.4 Amend Schedule (without AOM schedule) Amend drug administration schedule rule 3. Change 1. Choose the schedule the start day recurrence pattern if applicable 2. Enter the recurrent interval 4. Choose the time and click ‘ ’ 5. Press ‘OK’ Preview schedule 1. Check the schedule by press ‘Month’ 2. Press ‘Save’
2.4 Amend Schedule (without AOM schedule) Check the amended schedule Check the schedule
2.5 Suspend / Resume infusion Suspend In Drug Admin by Patient To Suspend Infusion Long-Hold or Right Click the LAST admin time. Choose “Suspend” and state the Reason Click “Save” Suspend Input suspend time and reason
2.5 Suspend / Resume infusion Suspend In Drug Admin by Patient Suspend Input suspend time and reason To Resume Infusion Long-Hold or Right Click the “ ” time. Choose “Resume”. Click “Save”
2.6 Change infusion rate In Drug Admin by Patient For prescription with infusion rate range Use ”Drug Admin by Long-hold or Right click the last Patient” to change admin time and choose infusion rate of IVF ‘Change Infusion Rate’ Drug with “Infusion Rate Range” allows rate adjustment during infusion Input the required For prescription with infusion rate range infusion rate and remarks
2.6 Change infusion rate Admin record with icon For prescription with infusion rate range In Drug Admin by Patient For prescription with fixed infusion rate 1. Long-hold or Right click the last admin time and choose ‘Amend’ 2. Enter corresponding information
2.6 Change infusion rate For prescription with fixed infusion rate Administer with new order Amend record in new order For prescription with fixed infusion rate 1. Long-hold or Right click the last admin time and choose ‘Amend’ 2. Enter corresponding information
2.7 Defer, Omit, Withhold Admin, On-Hold Defer Defer is designed for managing present drug administration. The drug will be given later, e.g. drip out or drug not available. Patient without Heparin Block, need to Defer Zinacef Only scan the drugs need to be administrated and press ‘Proceed’ Defer Choose ‘Defer’ and press ‘Save’
2.7 Defer, Omit, Withhold Admin, On-Hold Defer After drug administration Red ‘Y’ shown due drug needed to be handled Omit Omit is designed for managing Present drug administration. The drug will not be administered, e.g., Hypotension status omit anti-hypotension agent. Heart rate = 50 bpm Need to Omit Betaloc DO NOT scan the drug want to be omitted
2.7 Defer, Omit, Withhold Admin, On-Hold Omit Choose ‘Omit’ and enter reason 2. Enter the reason HR 50bpm 1. Click ‘Omit’ 3. Press ‘Save’ Omit Omit record shown on MAR Black ‘N’ shown no due drug
2.7 Defer, Omit, Withhold Admin, On-Hold Withhold Withhold Admin is designed for managing future drug Admin administration. The drug will not be administered, e.g. NPO for operation, investigation or procedure, or home leave Choose ‘Withhold Admin’ Withhold Withhold ALL Drug(s) or Withhold individual drug Admin ‘Withhold ALL Drug(s)’ ‘Withhold individual drug’ can for all drugs choose the drugs want to withhold
2.7 Defer, Omit, Withhold Admin, On-Hold Withhold Choose required drug, input duration and reason Admin Withhold Withhold record is shown on MAR Admin Green color indicate withhold function is activated
2.7 Defer, Omit, Withhold Admin, On-Hold Withhold List of active withhold items Admin Click ‘Edit’ to edit withhold period and reason of the withhold order Click ‘End Now’ to delete withhold order
2.7 Defer, Omit, Withhold Admin, On-Hold On-Hold is designed for managing present prepared drug. The drug will not be administered temporarily, e.g., patient away from bed, vomiting or changing condition. Mr. Pang is away from bed after medications prepared and \"Proceed\" button pressed. On-Hold 2. Click “On-Hold” 1. Click “Unlock” after scanning drug 3. State reason 4. Click “OK” 5. Printer generates an unique QR code Label for labeling on-holding
2.7 Defer, Omit, Withhold Admin, On-Hold On-Hold is designed for managing present prepared drug. The drug will not be administered temporarily, e.g., patient away from bed, vomiting or changing condition. Mr. Pang is back to bed after bathing. The On-Hold medications will be administered. 1. Click “On-Hold”Tab in Drug Admin by Ward On-Hold 2 Click “Admin All” 3. Click “Proceed”
2.7 Defer, Omit, Withhold Admin, On-Hold On-Hold 4. Scan the On-Hold Label instead of drug label 5. ”On-Hold” drugs will be shown and click “Proceed” Check the patient information to confirm if it matches with handheld scanner. Scan wristband 2D barcode for System Checking after confirmed patient identity manually. “Patient Match” will be shown on the scanner. Press “M1/M2” on scanner for confirmation. Signal will be send back to CMS
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