Management of

Medications (MOM) - NABH

Nayan Roychowdhury
M.Sc(Microbiology), MBA, PGDCC(Quality & Accreditation)
Intent
Safe and organized medication process.
Policies procedures for :
Availability
Safe storage
Prescription
Dispensing
Administration

Pharmacy should guide and audit medication process.

Correct Storage
Emergency Medications
High Risk Medicines

Monitoring of Patients after administration of drugs

Education of patients and family members about safe medication and food-drug interactions.
Medications also include blood, implants and devices.
MOM 1 Pharmacy Services and Usage of Medication

Documented policy for pharmacy services and medication usage.

Pharmacy Manual
Procurement
Storage
Formulary
Prescription
Dispensing
Administration
Monitoring and use of medications

Drug Formulary
Laws and regulations
Drugs and Cosmetic Acts
Pharmacy Act
Narcotic and Psychotropic Substances Act
Drugs and Magical Remedies ( Objectionable Advertisement) Act
Multidisciplinary committee Drug & Therapeutic Committee
Procedure to obtain medication when pharmacy is closed.
MOM 2 Hospital Formulary
A list of medicines as per scope of the organizations clinical services.
Developed by the multidisciplinary committee DTC Committee
Reviewed and updated annually.
Made available to clinicians.
Monitor the frequency of prescriptions being rejected because it contained non formulary
drugs
Process for accusations of the same.
Vendor selection
Vendor evaluation
Re-order levels
Indenting process
Generation of purchase order
Receipt of goods
The process also addresses managing stock outs due to various reasons
Process to obtain medicines not in the formulary.
Evaluation
Authorization
ratification
MOM 3 Storage of medicines
Documented policies and procedures exist for storage of medication.
Temperature
Light
Ventilation
Pest control
Stored in clean, safe and secure environment, incorporating manufacturers
recommendations.
Sound inventory control practices.
ABC
VED
FSN
FIFO
LASA drugs stored separately apart.
Emergency medicine
Defined & stored in uniform manner.
No other drugs kept with emergency medicine

Made available all the time.

Replenished in a timely manner when used.
Inventory check - daily
MOM 4 Safe and Rational
Prescription of medications
Polices and procedures of medications
Good practices/ guidelines for rational prescription of medications.
(WHO definition Rational use of medications requires that the patients receive medications
appropriate to their clinical needs, in doses that meet their own individual requirements, for an
adequate period of time, and at the lowest cost to them and their company.)
Minimum requirements of medications
Name of the patient
CR No
Name of the drug
Route and Frequency
Name, Signature and registrations no of the prescribing doctor.
All hand written entries MUST be in Capital Letters
Known drug allergies to be ascertained.
Define who can write a prescription.
Orders are written in uniform location along with patient name and CR no.
MOM 4 Safe and Rational
Prescription of medications ..contd..
Medical orders clear, legible, dated, timed, named and signed.
Dangerous abbreviations shall not be used.
Refer ISMP guidelines.
Order name of medicine, route, dosage, frequency
Verbal Order Policy
Discouraged
Only doctors are allowed to take verbal orders in case of emergency.
Document the same. The consultant to counter sign within 24 hrs.
Define high risk medications.
Heightened risk for adverse outcomes and catastrophic harm whenever there
is an error.
Includes Low therapeutic window, controlled substances, psychotherapeutic
medications, LASA drugs, concentrated electrolytes.
MOM 4 Safe and Rational
Prescription of medications ..contd..
Audit of medication orders/ prescription is carried out to check for safe
and rational prescription of medicines.
At least once a month
Reconciliation of medications occur at transition points of patient care.
To ensure that the list of medication that a patient is to receive is complete
and up to date in relation to past clinical condition and present care plan.
Prescribed medications be checked for accuracy at the transition points, i.e.
The time of admission, transfer of the patient from one ward to another, at
the time of discharge.
Effective communication during hand over during re - concillation of
medications.
MOM 5 Safe dispensing of
medications
Procedure to address medicine recall.
Medicine recall form.
Recall reasons
Visible Contamination
Letters from regulatory bodies.

Expiry dates checked before dispensing.

Procedure for near expiry medicines.
Near expiry medicines 3 months from the date of expiry

Labelling requirements are documented and implemented.

Drug Name
Strength
Frequency of administration
Expiry Dates

High risk medication orders are verified before dispensing.

MOM 6 Policies and procedures for
medication administration
Prescription Audit
Sl no
1 Name,CR No,Age,Sex

2 The medication orders are clear,legible,dated, timed,named and signed.

3 The strength of medication clearly mentioned

4 Number of dosage units per unit dose mentioned clearly

5 The route of administration clearly written

6 The duration and frequency of dosage written clearly

7 Prescription is dated.

8 Generic name of the medicine is written.

9 Therapeutic duplication.

10 Measures taken to avoid ADR/food drug interaction.

11 Orders are written in uniform location in the medical record.

12 Use of abbreviations

13 Name,signature and registration number of the prescribing doctor.