Standard Operating Procedure:

Clinical pharmacy screen of medication charts - inpatient units

Objective

Ensure consistent screening, annotation and endorsement of the patient

medication chart during a clinical screen by a pharmacist is undertaken

Roles and
responsibilities

Applies to all pharmacists employed (directly or via contracts)

Scope

Applies to all NELFT community in-patient units where medications are

prescribed via a patient medication chart and checked by a pharmacist.

Overall process
to follow

Introduce yourself to the patient (if present) and explain your role
Locate all of the current medication chart(s), ideally kept with the patients
observation folder
Confirm the medication chart is for that patient

Patient demographics
Ensure all relevant patient details have been completed:
- Patient name, date of birth, sex
- Weight where appropriate
- Date of admission
- NHS number
- Consultant
- Ward
Ensure patient name has been written on the inside, when required and any
medicines reconciliation section of the chart
For charts used at Grays Court and in-patient units at King George hospital,
ensure the medicines reconciliation form has been fully completed with the
patients name, date of birth and NHS number
Allergies/sensitivities
Drug allergies/adverse drug reactions section to state:
- Name of drug
- Severity and type of reaction if known
- Source of information (patient, carer, relative, GP)
- No known Drug Allergies (NKDA) where appropriate
- Non-drug sensitivities/intolerance to be stated if relevant e.g.
peanuts/peanut (arachis) oil; lactose.
- Entry to signed, dated and designation of staff completing entry stated
Medicines reconciliation (see relevant SOP for full details)
Any annotation(s) on the medication chart by the Pharmacist must be in
indelible ink in a dark colour not already used on the chart e.g. green or
purple gel ink pens. The writing must be able to be photocopied and so it is
important that a suitable pen and colour of ink is used (usually green gel ink
pens).
Record medication history in the appropriate section of the medication chart.
If one is not present, annotate along the top edge of the inside of the chart.
CHS SOPs Clinical pharmacy screen of medication charts

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For charts screened at Grays Court and Foxglove ward at King George
Hospital, the medicines reconciliation form must be completed and
medicines reconciliation box on the front of the drug chart must have the
date and signature of the pharmacist doing this
Record the following information along with the medication:
- Source of information (ideally 2 sources should be used)
- Date
- Name and signature of pharmacist
If Patients Own Drugs (PODs) are to be used refer to the SOP for PODs
(including Monitored Dosage Systems). PODs should state:
- Name of the medicine
- Directions for use
- Date
- Quantity
- Origin of supply
Document clearly on the front of the chart that the medication history has
been checked e.g.
- Rio signature, date when electronic record checked
- S1
signature, date when electronic record checked
- GP signature, date when GP surgery fax checked
- PODs signature, date, when PODs checked
- MAR signature, date when MAR chart checked

Highlighting prescription queries

Record medication queries with:
- Q next to drug/dose being queried
- Q signature, date when query resolved
- Q with brief explanation if query not resolved immediately and requires
follow-up
Any change to the prescription should be counter signed by the prescriber
Stock ordering
Pharmacist to annotate each prescribed drug on the medication chart, on the
right section of the DRUG Pharmacy section of the prescribed drug:
- Stock drugs: S; Date; Signature
- Non-stock drugs: TTA (if ordered as fully labelled packs) or IP (if labelled
as in-patient stock); Quantity ordered; Date; Signature
- Controlled Drugs: CD in a triangle; Date; Signature
- Patients Own Drugs: POD; Quantity; Date: Signature
As required (PRN) medication (Refer to CHS procedure for safe and secure
handling of medicine)
Ensure As required medication prescriptions state:
- Indication
- Dose (avoid ranges or give clear directions)
- Frequency
- Interval
- Maximum dosage
CHS SOPs Clinical pharmacy screen of medication charts

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- Route (caution when more than one route is prescribed)

- Period drug is valid for
- Caution if the medication is also on the regular side
Check that all required details are being completed when administered.
If PRN medication is being used frequently consider prescribing as regular

Antibiotics
The pharmacist must ensure that prescribed antibiotics are appropriate for
use
All prescribed antibiotics should clearly state the indication and duration of
use
The use of restricted antibiotics should be discussed with a consultant
microbiologist and if appropriate, the pharmacist should write Micro
approved.
All intravenous prescriptions must be reviewed after three days, unless
advised by the consultant microbiologist or stated in treatment guidelines
All antibiotic prescriptions must be reviewed after five days unless otherwise
indicated by the consultant microbiologist
Annotations
Annotate each medication with the generic or approved name
State brand names for non-bioequivalent drugs e.g.
- Lithium
- Clozapine
- Nifedipine MR/LA
- Theophylline MR
- Tacrolimus
- Ciclosporin
- Phenytoin
- Carbamazepine
- Diltiazem
- Mesalazine
- Transdermal strong opioids
- Duloxetine (different licensing between brands)
- Inhalers i.e. QVAR , Clenil Modulite
- Multi-ingredient products i.e. Oral contraceptives, creams
A more comprehensive list is available from the UKMI (attached below)

Clarify doses if unclear avoid decimal points or abbreviations for

nanograms, micrograms or units
Oral liquids prescriptions should state the strength of preparation dispensed
and volume necessary to meet the dose prescribed
Dosing intervals to be clarified, with crosses where appropriate,
- Methotrexate (weekly)
- Alendronic acid (if weekly)
- 3 or 7 day patches
Annotate any special instructions for use on the Other instructions section
on medication chart where available e.g.

CHS SOPs Clinical pharmacy screen of medication charts

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With food for metformin, dispersible aspirin, gaviscon, ibuprofen, etc

Avoid food for x period for flucloxacillin, thyroxine, sucralfate, etc
Swallow whole for modified release preparations, or otherwise unsafe
medicines e.g. lithium carbonate MR tablets (Priadel); Omeprazole;
Alendronic acid; Pancreatin
Rinse mouth after use for corticosteroid inhalers
Fridge for chloramphenicol eye drops, Risperdal Consta, etc
Lithium: State date and result of last serum lithium level
Digoxin: Reminder to check pulse rate >60bpm

Intravenous medication
- Check NPSA recommendations are met (attached)
- Instructions for reconstitution if unusual or caution is needed
- Check the diluent, flush is prescribed
Variable dose medication
Titration of drugs, including chlordiazepoxide, amiodarone , clozapine, etc
- Variable dose medication to be prescribed within that section of the
medication chart.
- This medicine must also be prescribed in the main section (Regular side)
of the medication chart by the prescriber and state See Variable dose
Warfarin
- Prescribe in the main section (Regular side) of the medication chart
- Must state Dose as per anticoagulation book
- State indication
- State target INR
- Date for next INR testing and results
- Anticoagulant book should be left in either the patients locker or securely
attached to the medical notes and the warfarin section should be
annotated to show where the book is kept

Thromboprophylaxis
- When applicable ensure that the VTE section of the chart has been
completed if not, the doctor on duty should be asked to complete this
as soon as possible
- Where a low molecular weight heparin has been prescribed, check that
the dose is appropriate in terms of the patients VTE risk and U&E results
- Clinically check to see if thromboprophylaxis is appropriate when the
patient is also being prescribed warfarin and/or other anti-coagulants and
antiplatelets

Stat or One off doses

Check the Stat section of the drug chart during each visit.
Intravenous fluids
Check volumes being administered
Check concentrations of additives prescribed
Sliding scale insulin charts
CHS SOPs Clinical pharmacy screen of medication charts

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Monitor units and blood glucose levels

Re-written medication charts

Ensure all patient details have been transcribed (including allergy status)
Check all transcribed drugs against the previous medication chart to ensure
there are no transcription errors
Any changes must be confirmed
Confirm stock quantities:
- State quantity remaining, sign and date entry, or,
- State date and quantity supplied, sign entry
Annotate each drug entry as described above
Annotate the front of the medication chart with Rewritten and indicate that
the medication history has been completed as above.
Complete the Medicines reconciliation section of the chart:
- Write patients name
- Write name of ward
- Tick, date and sign the statement MR completed on previous chart
Clinical pharmacy screen
To indicate that the prescription has been clinically screened by a pharmacist for
appropriateness and safety, the pharmacist should sign and date the Other
section for each medicine.
Other useful
information

Trust Medicine Policy

CHS Safe and Secure Handling of Medicines
Q_A_247__medicine NRLS-0434F-Promoti NRLS-0434B-Injecta NRLS-0434-Injectabl
s_not_suitable_for_generic_prescribing_in_primary_care[1].doc
ng-safe~SOP-template-2007-v1[1].pdf
ble-med~competence-1-2007-v1[1].pdf
e-medicines-PSA-2007-v1[1].pdf

Written by

Name
Emma Gardner

Job Title
Clinical pharmacy lead
community health services

Signature

Approved and amended by

Date
Date for revision
Revision Record
Revision
Date

March 2013
March 2015 or sooner if deemed necessary

Responsible Person

CHS SOPs Clinical pharmacy screen of medication charts

Description of change

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