During my dispensary rotation I have had the opportunity to not only enter orders into the patient’s medical record (see previous procedure logs), but to also dispense the medications.
At BCCH, the product, label and original scanned prescription are all checked and cross-referenced to ensure no errors occurred both at entry and during dispensing.
1) SR is a 4 month old 5.6 kg, NKDA, with a new order for spironolactone 6mg PO daily.
- I calculated their daily dose of spironolactone to be: 1.07 mg/kg/day (within normal ranges), and confirmed they had taken this medication before (as per the order entry pharmacist’s notation) – they were previously on BID (same dose) regimen.
- I checked the patient’s name, MRN, the dose, the expiry (10/16) and the actual product
- At BCCH spironolactone is compounded by the technicians and then drawn up in a syringe (i.e. an extemporaneous dose). I checked the syringe to ensure that the concentration and the dose intended results in the appropriate volume, and that the syringe had that amount in it. I then signed off on it, and put in the area for the technicians to send it by tube to the appropriate ward.
2) JA is a 9 yo, 25.8 kg with an allergy to allopurinol with a new order for tacrolimus 1.5 mg PO BID.
- I calculated their daily dose based on weight, and it was appropriate. They had increased their dose from 1mg PO BID.
- At BCCH tacrolimus 1mg is available as a unit dose (pre-packaged dose made by the technicians to streamline filling process). However the tacrolimus 0.5mg cap is not available as a unit dose. Thus the order was filled as one unit dose of 1mg cap and one extemp dose of 0.5mg cap. I checked both and they were the right product, and the expiry was appopriate.
- I then signed off on it, and had it sent up by tube to ensure the patient received it in a timely manner.
3) CW is a 11 yo, 38.5kg NKDA with an order for pass meds
- Pass meds are a method for us providing patients with their medication when they leave the ward/facility for more than 24 hours. Typically (unless ordered otherwise) it is only for their reg meds, not any PRNs/narcs/multi-dose products/pt’s own meds. The labels are written like community pharmacy labels, ensuring that the language is patient friendly and descriptive.
- CW had pegalax 17g daily PO or NG daily provided with an appropriate number of packets for the days on pass, and an appropriate expiry.
- CW also had a new label for their antibiotic eye ointment, so that it would be written in patient friendly English (as opposed to pharmacy/med language).
- This was a great check for me as it is not something I had encountered before and was a good blend of my experience in community and my new exposure to hospital pharmacy.