1. At a Glance: Omitted Doses 1. Before signing the drug chart, ask… Why is the patient unable to take the dose? Is this medicine a time critical medicine? What are the potential consequences if a dose is missed? Ward 7DMarch 2014Produced by: Neha Shah, Karen Buckingham An omission occurs when a medicine is not given to the patient before the next due dose. 2. Always document Select the appropriate code for the omission and document it clearly on the drug administration section of the drug chart. For ALL missed doses, document the reason for the omission in the notes. Documentation – Allergies – Regular Medicines – Time Critical Medicines Remember! Review omitted doses on medicines rounds. Supportive OUH Pharmacy Guidance Available Time Critical Medicines Ward Stock Lists Online BNF (accessible via the intranet) Medicines Policy Procedure 49 – Procedure for Administering Medication Check with a Colleague A senior nurse Pharmacist Prescriber Specialist nurses If a drug omission has occurred that has clinically affected the patient, complete an incident report. 3.Take Action If you do not know whether or not it is safe to omit the dose, contact the prescriber or pharmacist Inform the prescriber if more than ONE dose of a critical medicine is missed. Inform the prescriber if more than TWO doses of any other medicine is missed. Omitted doses will be highlighted in green by the ward pharmacist ALL doses must be accounted and signed for. Blanks on drug charts may lead to errors occurring.

2. Documentation – Allergies – Regular Medicines – Time Critical Medicines An omission occurs when a medicine is not given to the patient before the next due dose. Ward 7DProduced by: Neha Shah, Karen Buckingham March 2014 Drug chart codeFactors to considerActions to take URGENT/CRITICALNON-URGENT 2. Patient could not take the medicine Are alternative administration routes available? How many doses will this potentially affect? Does the patient need a SALT referral? Contact prescriber, contact ward or on-call pharmacist Prompt review by ward pharmacist and prescriber 3. Patient refused medicine Why does the patient not want to take their medication? Does the patient understand why this medicine has been prescribed? Is the patient suffering from adverse drug reactions ? Contact prescriber, contact ward or on-call pharmacist Prompt medication counselling by ward pharmacist 4. Medicine not available 1.Are there any PODs? 2.Is the medicine ward stock? 3.Has it been ordered by a pharmacist already? 4.Is the medicine ready for collection in pharmacy? 5.Is the medicine stored in the fridge? 6.Are there any pharmacy bags waiting to be unpacked? 7.Is it a time critical medicine? Check POD locker/fridge/patients belongings/pharmacy tracker for the medication. Borrowing from other wards is not always safe. Contact ward or on-call pharmacist. Order ward stock from pharmacy stores. Document in pharmacy diary. 5. Nursing decision What is the medication indication? Is the decision to omit the dose clinically justified? Have observation charts/monitoring records been completed? Does the patient need to be reviewed by a specialist team? Clearly document rationale for omission and relevant clinical parameters to support decision. Contact prescriberPrompt review by ward pharmacist and prescriber 6. On instructions of doctor Was the decision to omit the dose communicated clearly? When will the patient be reviewed? Document clearly on the drug chart and in the notes. Ensure a review date is agreed and document in the notes. 8. Not all of dose taken How much of the dose was taken? Why was the full dose not taken? Document the dose that was taken above the drug administration box Contact prescriber, contact ward or on-call pharmacist Prompt medication counselling by ward pharmacist ALWAYS Make an informed decision. If in doubt, CHECK. At a Glance: Omitted Doses

3. Documentation – Allergies – Regular Medicines – Time Critical Medicines An omission occurs when a medicine is not given to the patient before the next due dose. Ward 7DProduced by: Neha Shah, Karen Buckingham March 2014 If a drug omission has occurred that has clinically affected the patient, complete an incident report. Omitted doses will be highlighted in green by the ward pharmacist Supportive OUH Pharmacy Guidance Available Time Critical Medicines Ward Stock Lists Online BNF (accessible via the intranet) Medicines Policy – General Guidelines for Prescribing Check with a Colleague Ward nurses Pharmacist Prescriber Specialist nurses 1. Review the drug chart What codes have been documented? Have all doses been signed for? What is the indication for medicine? How many doses have been missed? 2. Review the notes What is the reason for the omission? If it is unclear, is the nurse and/or pharmacist available to discuss with? Are further doses likely to be affected? 3.Take Action Is an alternative route needed? Is an alternative medicine needed? Has a dose of a time critical medicine been omitted? Is specialist input needed from another team? Is the dose to be intentionally held? If so, has it been clearly indicated on the drug chart and notes? At a Glance: Omitted Doses Remember! Review omitted doses when reviewing the drug chart.