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Items: only items marked in Q5a are displayed Q6) Did you drive a car yourself in the past 6 months? Items: only items marked in Q5a are displayed Road safety in general Q9) How concerned are you about each of the following issues? Binary variable: concerned (1-2) - not concerned (3-4) Items: rate of crime – pollution - road accidents - standard of health care - traffic congestion – unemployment Acceptability of unsafe traffic behaviour Q10) Where you live purchase propranolol with visa, how acceptable would most other people say it is for a driver to… order 40mg propranolol amex.? Binary variable: acceptable (4-5) – unacceptable (1-3) Items (random) drive 20 km per hour over the speed limit on a freeway / motorway drive 20 km per hour over the speed limit on a residential street drive 20 km per hour over the speed limit in an urban area drive 20 km per hour over the speed limit in a school zone talk on a hand-held mobile phone while driving type text messages or e-mails while driving check or update social media (example: Facebook propranolol 40mg amex, twitter, etc. You can indicate your answer on a scale from 1 to 5, where 1 is “unacceptable” and 5 is “acceptable”. Binary variable: acceptable (4-5) – unacceptable (1-3) Items (random): idem Q10 Support for road safety policy measures Q12) Do you support each of the following measures? Answering options: yes – no – don’t know/no response Items (fixed order): each time for: speeding – alcohol – drugs – seat belt The traffic rules should be more strict The traffic rules are not being checked sufficiently The penalties are too severe Self-declared behaviour Q14) In the past 12 months, as a road user, how often did you…? You can indicate your answer on a scale from 1 to 5, where 1 is “never” and 5 is “(almost) always”. You can indicate your answer on a scale from 1 to 5, where 1 is “disagree” and 5 is “agree”. Binary variable: agree (4-5) – disagree (1-3) Items (random) Driving under the influence of alcohol seriously increases the risk of an accident Most of my acquaintances / friends think driving under the influence of alcohol is unacceptable If you drive under the influence of alcohol, it is difficult to react appropriately in a dangerous situation Driving under the influence of drugs seriously increases the risk of an accident Most of my acquaintances / friends think driving under the influence of drugs is unacceptable I know how many drugs I can take and still be safe to drive Driving fast is risking your own life, and the lives of others I have to drive fast, otherwise I have the impression of losing time Driving faster than the speed limit makes it harder to react appropriately in a dangerous situation Most of my acquaintances / friends feel one should respect the speed limits Speed limits are usually set at acceptable levels By increasing speed by 10 km/h, you have a higher risk of being involved in an accident It is not necessary to wear a seat belt in the back seat of the car I always ask my passengers to wear their seat belt The instructions for using the child restraints are unclear It is dangerous if children travelling with you do not wear a seat belt or use appropriate restraint For short trips, it is not really necessary to use the appropriate child restraint My attention to the traffic decreases when talking on a hands free mobile phone while driving My attention to the traffic decreases when talking on a hand-held mobile phone while driving Almost all car drivers occasionally talk on a hand-held mobile phone while driving People talking on a hand-held mobile phone while driving have a higher risk of getting involved in an accident When I feel sleepy, I should not drive a car Even if I feel sleepy while driving a car, I will continue to drive If I feel sleepy while driving, then the risk of being in an accident increases Subjective safety and risk perception Q17) How (un)safe do you feel when using the following transport modes in [country]? You can indicate your answer on a scale from 0 to 10, where 0 is “very unsafe” and 10 is “very safe”. Items (random): only items marked in Q5a are displayed Q18) In your opinion, how many road traffic accidents are caused by each of the following factors? In other words, how many accidents out of 100 were caused by the following factors. Always answer using a figure between 0 and 100 (+ option: don’t know) The total sum of all the factors can be more than 100. Items (random): aggressive drivers distracted drivers (drivers who are busy with something else, e. Answering options: increased – no change – decreased Items (random): idem Q19 Involvement in road crashes Q21a) In the past three months have you been involved in a road traffic accident as a … (if no accident: answering option: ‘none of these’) Items (multiple responses possible; only items indicated in Q5a are displayed): Extra sub-items for motorcycling: motorcyclist (50-125 cc) – motorcyclist (>125 cc) public transport: on the train – on the subway – on a tram – on the bus Q21b) Please indicate the severity of the accident: Answering options (multiple responses possible per transport mode (i. Items (multiple responses possible): violating the speed limits – driving under the influence of alcohol – driving under the influence of drugs (other than medication) – not wearing a seat belt – transporting children in the car without securing them correctly (child’s car seat, seat belt, etc. Items (multiple responses possible): idem Q23b Q24) In the past 12 months, how many times were you checked by the police for alcohol while driving a car (i. Binary variable: at least once - never Q25) In the past 12 months, how many times have you been checked by the police for the use of drugs/medication while driving? Binary variable: at least once - never Socio-demographic information (2) Q26) What is the highest qualification or educational certificate you obtained? Items: None – Primary education – Secondary education – Bachelor’s degree or similar – Master’s degree or higher – No answer 6 Q27) What is the postal code of the municipality in which you live? They also address the training and registered in the profession in relation to a matter of roles of dispensary assistants. These guidelines are developed to provide guidance to registered pharmacists or those seeking to become Guidelines registered pharmacists. They apply to all pharmacists In dispensing a prescription, a pharmacist has to exercise registered in the following categories: an independent judgment to ensure the medicine is safe • general and appropriate for the patient, as well as that it conforms to the prescriber’s requirements. In addition to complying with these guidelines, pharmacists are encouraged to maintain an awareness of 2 Dispensing multiple repeat the standards published by the profession, and relevant prescriptions at one time to their area of practice and category of registration. In considering notifcations (complaints) against pharmacists, The simultaneous supply of multiple quantities of a the Board will have regard to relevant professional practice particular medicine (i. It does not promote Australian Governments to provide for the National best pharmacy practice in relation to regular review of Law, ownership of pharmacies, regulation of premises, therapy and efective provision of medicine information, inspections and related matters do not form part of the which assists in minimising medication misadventure. The National Law, and each jurisdiction will have separate supply of multiple repeats at the one time is permitted legislation and guidelines for these purposes. Dispensing of the practice of pharmacy in the jurisdiction where the multiple quantities of any prescriptions should only occur dispensing occurs. Guidelines A pharmacist, who has taken reasonable steps to satisfy themselves that the prescription is bona fde and in accordance with relevant State or Territory legislation, may dispense a prescription transmitted by facsimile or scanned copy in advance of receiving the original prescription. An original prescription must still be obtained and retained in accordance with poisons legislation. The Board recognises, however, that there are circumstances where these forms of communication are necessary in, or 6 Incident records appropriate to, the patient’s circumstances (e. Dispensing errors, signifcant other errors, omissions, incidents, or other noncompliances, including complaints Guidelines of a noncommercial nature arising both within and external A pharmacist supplying medicines indirectly to a patient to the pharmacy, may be the subject of investigation. Australia’s Guidelines for Dispensing of Medicines, and Guidelines established practice and quality assurance standards. The record is to show when the incident was recorded, 5 Extemporaneous dispensing when it occurred, who was involved (both actual and (compounding) alleged), the nature of the incident or complaint, what actions were taken and any conclusions. If contact was Pharmacists should refer to the Board’s new Guidelines on made with third parties, such as government departments, compounding of medicines published in March 2015 and prescribers, lawyers or professional indemnity insurance in efect from 28 April 2015. Regardless of how serious the incident may appear, comprehensive detailed records need to be kept. The record should be kept for three years because of the delayed nature of some forms of litigation. The routine use of other ancillary immediate container (including each component of labels in the Australian Pharmaceutical Formulary and multiple-therapy packs) unless the immediate container Handbook is recommended having regard to each patient’s is so small or is so constructed that the label would circumstances. In such instances, 8 Counselling patients about the label should be attached to the primary pack or prescribed medicines alternatively, purpose-designed labelling tags or ‘winged’ Patients have the right to expect that the pharmacist labels may be used. The unambiguous and understandable English; other pharmacist should make every efort to counsel, or to ofer languages that are accurate translations of the English may to counsel, the patient whenever a medicine is supplied. Patient counselling is the fnal checking process to ensure the correct medicine is supplied to the correct patient. The special needs of patients with disabilities, such those with poor eyesight, should be accommodated and the Lack of counselling can be a signifcant contributor in patient adequately informed. Examples The label is to include the following: include: • the brand and generic names of the medicine, the • the taking of medicines that can sedate strength, the dose form and the quantity supplied; for extemporaneously prepared medicines and medicines • the taking of medicines that have a narrow therapeutic not dispensed by count, the name and strength of index each active ingredient, and the name and strength of • unusual dose forms (e. State or Territory privacy authorities Face-to-face counselling is the best way of communicating should be contacted in cases of uncertainty. Examples of persons to whom information may be inadvertently disclosed could 9 Privacy and confdentiality include a person paying a family account or to third party Commonwealth, State and Territory privacy laws set out organisations (including service companies) that process the privacy principles applicable to health providers. Pharmacists should ensure that all pharmacy services The inadvertent disclosure of the identities of patients’ are provided in a manner that respects the patient’s medicines (and therefore the patients’ medical conditions) privacy requirements, and is in accordance with relevant to third parties is to be avoided. Guidelines 10 Dispensing errors and near misses Information about a person that a pharmacist obtains in All reasonable steps need to be taken to minimise the the course of professional practice is confdential and may occurrence of errors. They are an aid to, but not a substitute • advanced dispensing technologies for, minimising selection errors. Counselling of the patient or carer about their medicines provides an additional • other dispensing-related responsibilities (e. Pharmacists dispensing medicines need required to dispense above this rate in unforeseen to ensure that the operation of the pharmacy dispensary circumstances, such as staf shortage due to sudden is such that the risk of errors is minimised to their illness or unpredicted demand. Pharmacists should ensure that the individual workloads Note: This guideline is subject to review following further under which they operate are at reasonable and consideration.
Drowsiness cheap 80 mg propranolol amex, drooling purchase propranolol 40 mg with visa, tachycardia cheap propranolol 40 mg amex, dizziness, constipation, low blood pressure, headache Quetiapine 25, 50, 100, 12. The prescribed dosage by your doctor and your effective dose may vary from dosages listed. For more information on medical causes of disrupted sleep, including obstructive sleep apnea and congestive heart failure, please check with your physician or healthcare provider. An Epworth Sleepiness Scale (see Appendix D) can help identify the circumstances that cause daytime sleepiness and provide 33 Parkinson’s Disease: Medications clues to disruption of sleep at night. This questionnaire (given in the office or completed at home) concerns a person’s tendencies to fall asleep during the day in various real life situations such as driving or watching television. The evaluation typically will include observations during sleep of heart rate, breathing activity, snoring, involuntary movements and quality of sleep. Voluntary movement of the legs, particularly walking, relieves the uncomfortable urge at least temporarily. Like many of the in-sleep disorders, the bed partner is more aware of the involuntary movements than the person with the symptom. Diagnostic evaluation can be fairly simple when the symptoms are obvious, but your physician or provider may prescribe an overnight sleep study to help determine a clear diagnosis. Your healthcare provider may also want to consider benzodiazepines (clonazepam), gabapentin or low-dose opiates. Discuss with your healthcare provider whether to reduce, rearrange or even eliminate daytime dopamine agonists. Examples of these behaviors may include obsession with shopping, sexual activity, eating and gambling, all of which can interfere with sleep. If you experience any of these behaviors, be sure to speak with your healthcare provider. Every attempt should be made to normalize the sleep-wake cycle and to improve sleep hygiene. This means: • Establishing regular bedtimes and rising times • Reducing caffeine and alcohol intake • Limiting naps • Avoiding food and drink within several hours of bedtime Also, you should not use the bed as a site for non-sleeping tasks, such as reading, doing work or watching television, as these activities can condition the body for wakefulness. Sleep hygiene can be further improved by the prudent use of physician-supervised sleeping medications such as quetiapine, clonazepam and others. Some antidepressant drugs, such as trazodone (Desyrel®) or mirtazapine (Remeron®), can also promote sleep due to their sedative properties. Most over-the-counter preparations are not suggested for use unless recommended by a physician, although the antihistamine diphenhydramine (Benadryl®) may double as a sleeping pill and an antitremor drug because of its anticholinergic properties. If motor symptoms such as stiffness and tremor interrupt sleep because of the long gap between the last dose of antiparkinson medication in the evening and the first dose the following day, an extra dose of carbidopa/levodopa may be taken late in the evening or during the night on awakening. Stimulants such as methylphenidate (Ritalin®) and mixed amphetamine salts (Adderall®) can be tried. They should be given in low doses and taken in the morning initially, preferably before 8 a. Side effects include palpitations, high blood pressure, confusion, psychosis and insomnia (if the dose is too high or taken too late in the day). The non-stimulant modafinil (Provigil®), approved only for treatment of narcolepsy, also is potentially useful. Its mode of action in the brain is unknown, but it has a good track record of reducing daytime sleepiness with fewer side effects because it is not a stimulant like methylphenidate and the amphetamines. In addition, the drugs commonly used to treat high blood pressure can make orthostasis worse. Any person who experiences orthostatic symptoms should inform all healthcare providers involved with their care. A good example of a frequent and straightforward parallel problem (or comorbidity) is back, neck and limb pain due almost always to degenerative arthritis of the spine. Orthostatic hypotension is usually the primary reason for the symptom, but general medical causes, especially involving the heart or lungs, must be explored. In addition, other medications prescribed by other physicians and healthcare providers, particularly medications for high blood pressure, should be thoroughly considered. Communication between all treating physicians and members of the healthcare team is mandatory in these matters. The following non-pharmacologic techniques are important: • Change positions slowly, particularly when rising from a seated to a standing position. If the foregoing measures are not effective, then ask your physician or healthcare provider if medications to raise blood pressure would be appropriate in your case. Fludrocortisone (Florinef®) will increase blood pressure by increasing retention of salt and blood volume. Leg edema (swelling) and high blood pressure when lying flat are potential adverse effects. Midodrine (Proamatine®) increases blood pressure by stimulating the autonomic nervous system directly and is dosed three times per day. The development of high blood pressure when lying flat is greater with midodrine than fludrocortisone and should be carefully monitored. Pyridostigmine (Mestinon®) can be used either as monotherapy or as an adjunctive drug to augment the blood pressure raising effect of flodrocortisone and midodrine. Ordinarily used to treat the neuromuscular disease myasthenia gravis, Mestinon® has been evaluated in two single dose clinical trials (one open-label and one placebo-controlled), both of which showed a small but statistically significant elevating effect on diastolic blood pressure. Only one study, an open-label survey, has examined the long-term effect of using Mestinon® for orthostatic hypotension. Therefore, the continued effectiveness of Northera should be assessed periodically by your doctor. Similar to midodrine and fludrocortisone, there is potential for the development of high blood pressure when lying flat (supine hypertension) that should be monitored carefully. Northera is only available through specialty pharmacies; your doctor has to complete a treatment form and fax it to the Northera Support Center to prescribe it. Slowed gastric emptying translates into gas and bloating, nausea, loss of appetite and pain. All of these symptoms vary in their responses to treatment with antiparkinson drugs, but usually improve with the use of drugs that specifically speed gastrointestinal movement. Dopaminergic medications can worsen nausea, but the addition of extra carbidopa (Lodosyn®) to the prefixed mixture of carbidopa/levodopa in Sinemet® usually helps to prevent or lessen this side effect. It should not be combined with apomorphine as it can cause lowering of blood pressure. Fortunately, good dietary management and the prudent use of stool softeners, laxatives and other bowel modulators are usually helpful. There are several steps to good dietary management and preventive maintenance: • Drink plenty of water and fluids.
Avoid drinking alcohol while taking metronidazole and for at least one full day after fnishing the medicine buy 40mg propranolol otc. Avoid drinking alcohol while taking tinidazole and for three days after fnishing the medicine order propranolol with american express. Psychiatric Disorders Depression buy propranolol on line amex, bipolar disorder, general anxiety disorder, social phobia, panic disorder, and schizophrenia are a few examples of common psychiatric (mental) disorders. Use the amount of medicine that your doctor tells you to use, even if you are feeling better. Don’t do activities like operating machinery or driving a car, until you know how your medicine affects you. Antidepressants Antidepressants treat depression, general anxiety disorder, social phobia, obsessive-compulsive disorder, some eating disorders, and panic attacks. The medicines below work by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. Examples citalopram escitalopram fluoxetine paroxetine sertraline Interactions Food: You can take these medicines on a full or empty stomach. They work by increasing the amounts of certain natural substances that are needed for mental balance. Antipsychotics Antipsychotics treat the symptoms of schizophrenia and acute manic or mixed episodes from bipolar disorder. People with schizophrenia may believe things that are not real (delusions) or see, hear, feel, or smell things that are not real (hallucinations). They can also have disturbed or unusual thinking and strong or inappropriate emotions. These medicines work by changing the activity of certain natural substances in the brain. Examples aripiprazole clozapine olanzapine quetiapine risperidone ziprasidone Interactions Food: Take ziprasidone capsules with food. Caffeine: Avoid caffeine when using clozapine because caffeine can increase the amount of medicine in your blood and cause side effects. Alcohol can add to the side effects caused by these medicines, such as drowsiness. Sedatives and Hypnotics (Sleep Medicines) Sedative and hypnotic medicines treat people who have problems falling asleep or staying asleep. Some of these medicines you can buy over-the-counter and some you can only buy with a prescription. Tell your doctor if you have ever abused or have been dependent on alcohol, prescription medicines, or street drugs before starting any sleep medicine. Examples eszopiclone zolpidem Interactions Food: To get to sleep faster, don’t take these medicines with a meal or right after a meal. Bipolar Disorder Medicines People with bipolar disorder experience mania (abnormally excited mood, racing thoughts, more talkative than usual, and decreased need for sleep) 29 and depression at different times during their lives. Bipolar disorder medicines help people who have mood swings by helping to balance their moods. Examples carbamazepine divalproex sodium lamotrigine lithium Interactions Food: Take divalproex with food if it upsets your stomach. Lithium can cause you to lose sodium, so maintain a normal diet, including salt; drink plenty of fuids (eight to 12 glasses a day) while on the medicine. Osteoporosis Bisphosphonates (bone calcium phosphorus metabolism) Bisphosphonates prevent and treat osteoporosis, a condition in which the bones become thin and weak and break easily. Take the medicine frst thing in the morning with a full glass (six to eight ounces) of plain water while you are sitting or standing up. Don’t take antacids or any other medicine, food, drink, calcium, or any vitamins or other dietary supplements for at least 30 minutes after taking alendronate or risedronate, and for at least 60 minutes after taking ibandronate. Don’t lie down for at least 30 minutes after taking alendronate or risedronate and for at least 60 minutes after taking ibandronate. Over-the-counter Medicines Over-the-counter medicine has a label called Drug Facts on the medicine container or packaging. The label is there to help you choose the right medicine for you and your problem and use the medicine safely. Some over- the-counter medicines also come with a consumer information leafet which gives more information. Prescription Medicines Medication Guide (also called Med Guide): This is one kind of information written for consumers about prescription medicines. The pharmacist must give you a Medication Guide each time you fll your prescription when there is one written for your medicine. If you keep a written record, it can make it easy to share this information with all your healthcare professionals—at offce, clinic and hospital visits, and in emergencies. Resources and references are hyperlinked to the Internet for convenience and referenced to encourage exploration of information related to individual areas of practice and/or interests. Respiratory Therapists must not prescribe, sell or compound a drug, or supervise the part of a pharmacy where such drugs are kept. Please Note… Other regulated health care professionals who are authorized to perform this controlled act in its entirety, or parts of it, have additional regulations and standards guiding these practices. Page | 5 Administering & Dispensing Medications Professional Practice Guideline The 9 “Rights” of Competent Medication Administration 1. After a drug is labeled and Most facilities now use some form of medication management system, which dispensed to a usually includes an automated medication dispensing unit. The purpose of patient/client via implementing this type of delivery system is to avoid preventable medication an automated errors and improve patient safety. The pharmacy receives the medication order medication electronically from the physician and dispenses the medication into the unit. The dispensing unit, medication can then be accessed by staff to be administered when needed. The prescription and medication container must be checked, along with the patient/client’s identity and any potential allergies/drug sensitivities, as with any other medication. Oral medications in a tablet form should be given to the patient in a disposable container, and liquid preparations should be measured using syringes specifically designed for that purpose. The technical component includes tasks such as receiving and reading the prescription, selecting the drug to dispense, checking the expiry date, labeling the product, and record keeping. The cognitive component of dispensing involves assessing the therapeutic appropriateness of the prescription, applying approved substitution policies, being able to make recommendations to the prescriber and advising the patient/client. For example, a physician can write the order for the medication and a pharmacist can delegate dispensing of that medication. Page | 9 Administering & Dispensing Medications Professional Practice Guideline Table 1: Who can order medication and who can order dispensing medication. Ability to Order Ability to Order the healthcare Professional Medication Dispensing of Medication Physician P P Nurse Practitioner P P Midwife P P Dentist P P Pharmacist O P Reg. Practical O O Nurse Orders for Dispensing An order to dispense must include the following: • order date, • client name, • medication name, • dose in units, • route, • frequency, • purpose, quantity to dispense; and • prescriber’s name, signature, and designation. Do you reasonably believe that the person who delegated are not obligated to dispensing to you has the authority and the competence to do so?
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A randomized, premature rupture of membranes: is there an optimal gesta- controlled trial of oral and intramuscular dexamethasone in tional age for delivery? Effect of corticosteroids for fetal maturation on perinatal glucose screening test reliable after a short-term administra- outcomes. To decrease lactic acidosis risk, avoid in: Liver disease, alcohol abuse/bingeing If creatinine ≥1. On September 22, 2017 Provincial Council approved a policy direction for the administration of cannabis for medical purposes that required a change to content on page 30. The purpose of this document is to provide guidelines to address various components of safe and effective medication management in the practice setting. It requires nursing knowledge, skill and 1 Words or phrases in bold italics are listed in the Glossary. Safe and effective medication practices are a result of the efforts of many individuals and reliable systems (Institute for Safe Medication Practices, 2007b). Safe medication management includes the knowledge of medication safety, human factors that may impact medication safety, limitations of medication systems and best practices to reduce medication errors. Safe medication management requires: assessing the appropriateness of a medication for the client based on their health status or condition upholding the client’s rights in the medication process information on allergies and sensitivities performing medication reconciliation at client transitions of care knowledge of the actions, interactions, usual dose, route, side effects and adverse effects of the medication knowledge of correct drug dose calculations (drug dose calculators and drug libraries) and preparing the medication correctly appropriate documentation educating clients on the management of their own health including fully informing them about their medication, anticipated effects, side effects, contraindications, self-administration, treatment plan and follow-up monitoring the client before, during and following medication administration managing side effects or adverse effects of the drug evaluating the effect of the medication on the client’s health status The Seven Rights of Medication Administration Safe and competent medication practice requires using the seven rights of medication administration. Medication Reconciliation Communicating effectively about medication is a critical component of safe medication delivery (Accreditation Canada, the Canadian Institute of Health Information, the Canadian Patient Safety Institute, & the Institute for Safe Medication Practices Canada, 2012). Medication reconciliation is part of the High 5s Project launched by the World Health Organization to address major concerns about client safety around the world. Medication reconciliation is a formal process in which health-care providers work together with clients and families to ensure accurate and comprehensive medication information is communicated consistently across transitions of care. It enables authorized prescribers to make the most appropriate prescribing decisions for the client. Guideline 2: Nurses perform medication reconciliation in collaboration with the client/family and the health-care team. Further information on medication reconciliation can be found at the following websites: www. Ordering a Schedule 1 medication in Alberta is a restricted activity under the Government Organization Act (2000) and can only be performed by authorized prescribers. Many practice settings require an order or prescription for medication on any of the Schedules. A Schedule 1 medication is a medication that requires a prescription or order from an authorized prescriber. For information on medication schedules please see the Scheduled Drugs Regulation under the Pharmacy and Drug Act (2000) at http://www. Information on a prescriber’s authority is available from the prescriber’s regulatory college. Registered nurses, graduate nurses and certified graduate nurses are not authorized to prescribe Schedule 1 medications. They are unregulated workers who work under the supervision of a physician, and provide direct client care. Any medication order from a physician assistant must be authorized by the supervising physician before it is implemented by nurses. It is the responsibility of the physician assistant to ensure that the medication order is signed by the supervising physician in a timely manner. Guideline 4: Nurses only implement medication orders from a physician assistant that have been authorized by the supervising physician. Components of a Medication Order Medications should be prescribed as direct orders; that is, the medication is ordered for a specific client. A complete medication order includes: full name of the client the date name of the medication drug strength, if applicable dosage, if applicable route of administration frequency, and in some cases the length of time the drug is to be administered prescriber’s name, signature and designation reason/purpose (e. Verbal and Telephone Orders Verbal and telephone orders are more prone to error because of miscommunication when compared to orders that are written or communicated in a secure electronic health record system. The expectation is that authorized prescribers will provide a handwritten order or enter medication orders into a point of care electronic health record whenever possible. Situations where verbal or telephone orders would be considered acceptable include: emergent or urgent situations where delay in treatment would place a client at risk of serious harm; or when a prescriber is not present and direction is urgently required to provide appropriate client care In practice settings where authorized prescribers are not present (e. Guideline 5: Nurses only accept verbal and telephone orders in emergent or urgent situations where the authorized prescriber is unable or not present to document their medication orders directly. The authorized prescriber is accountable for authorizing or signing all of their verbal or telephone orders unless in an emergent or urgent situation where there is a designated recorder. The practice setting should have a policy that outlines the process for the use of verbal or telephone orders. Nurses are not responsible for ensuring that medication orders are signed off by the authorized prescriber. Telephone orders or prescriptions to the pharmacy should be by direct communication between the authorized prescriber and the pharmacist. Direct communication between an authorized prescriber and the pharmacist lowers the risk of medication errors. Communicating a prescription on behalf of an authorized prescriber: blurs accountability increases the risk of miscommunication reduces the effectiveness of the prescription confirmation process increases the legal risk for the intermediary and authorized prescriber as current legislation does not support or is silent on the use of intermediaries in the communication of medication prescriptions There are unique challenges related to providing safe, timely and effective client care in community and ambulatory settings. The document in Appendix 1, Ensuring Safe and Efficient Communication of Medication Prescriptions in Community and Ambulatory Settings (Alberta College of Pharmacists, College and Association of Registered Nurses of Alberta, & College of Physicians and Surgeons of Alberta, 2007), provides guidance and direction to nurses about their responsibility and the potential legal and professional implications. Standing Orders Historically, standing orders were used in some practice settings to prescribe or order treatment(s) or medication(s) that applied to a group or population. Standing orders were not client-specific and did not specifically identify conditions and circumstances that must be present to administer the medication(s) or implement the treatment(s). Order Sets Pre-printed or electronic order sets are used in many practice settings. They provide an authorized prescriber with a choice of medication or treatment orders that apply to a specific population. The authorized prescriber identifies only those particular orders that apply to a specific client (College of Registered Nurses of Nova Scotia, 2011). Guideline 7: Nurses implement pre-printed order sets that are client specific and have been authorized by the prescriber. Protocols A protocol is a formal document that guides decisions and includes interventions for specific health-care problems to guide clinical decision making.
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