��GARIS PANDUAN�PRESKRIPSI UBAT-UBATAN

� Jabatan Farmasi

Hospital Kuala Lumpur

INTRODUCTION: �PRESCRIPTION

• “any written or oral instruction to the seller or supplier to supply any poison, or medicine containing any poison, for the purpose of the medical, dental or animal treatment of any person or animal, given by any person.”

Poison Act 1952 section 24 para 2

INTRODUCTION: �PRESCRIPTION

• A properly written prescription is important.
• Prescriber must ensure correct patient receives correct medicines at correct dosages for correct/optimum duration in order to reach expected health outcome.

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MEDICATION ERROR (ME)

50,000 prescriptions found �not to be so correct!

WHAT IS MEDICATION ERROR?

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.

National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP, US)

Medication Use Process

Prescribing

Dispensing

Administering

Monitoring

• Wrong dose
• Wrong drug
• Wrong route/form
• Allergy
• Interaction

Error can happen in any of the steps

• Wrong dose
• Wrong drug
• Wrong route
• Wrong time
• Wrong patient
• Incorrect labelling

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• Wrong dose
• Wrong drug
• Wrong route
• Wrong time/omitted
• Wrong patient
• Incorrect labelling

• Wrong time/Omission
• Wrong patient

• Data Entry
• Filling
• Labelling
• Counterchecking
• Dispensing

Medication Error Category

Sentinel Event

}

Goals In Malaysian Patient Safety Goals 2.0

JK MEDICATION SAFETY ACTION TEAM (MSAT)�HOSPITAL KUALA LUMPUR

11

HKL TOTAL MEDICATION ERROR 2018-2023�(PRESCRIBING, DISPENSING & ADMINISTRATION )

TOP 5 TYPE OF MEDICATION ERROR 2022

Pitch deck title

7/1/20XX

13

18

Wrong Dose

17

Wrong Drug

9

Wrong Patient

7

Wrong Frequency

18

Omission Error

n=85

TOP 5 CATEGORY OF DRUG ERROR 2022

7

7

7

Cardiovascular

5

Immunological agents

10

Analgesic

Antibiotic

Anticoagulant

n=85

FORMULARI UBAT �KKM (FUKKM)

UBAT-UBATAN DI FASILITI KKM

Terdiri dari :

• Ubat yang disenaraikan di dalam

Formulari Ubat-Ubatan KKM (FUKKM)

• Dipersetujui/diluluskan oleh

J/K Ubat peringkat hosp./kesihatan

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*****Jenis ubat-ubatan yang disimpan berbeza antara fasiliti

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Garis Panduan Formulari Ubat Kementerian Kesihatan Malaysia, Edisi 3 (Ogos 2012)

FUKKM: Transformation

First

Edition

1984

1989

1994

FUKKM: Transformation

2004

2008

2009

FUKKM: Transformation

My Blue Book

• Android Only
• Last updated: 2016

Blue Book Drug Formulary

• Android & IOS
• Can search by brand name

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Website:

https://www.pharmacy.gov.my/v2/en/apps/fukkm

FORMULARI UBAT KKM (FUKKM)

This formulary is :

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1. To provided the policy and administrative approach to control, promote and encourage rational, safe and cost effective drug prescribing and usage in the Ministry of Health.

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2. To control the introduction of new drug until there is a satisfactory amount of experience gained with their efficacy and toxicity and evidence-based document their benefits and added value.

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3. To purchase drugs that are optimally used which lead to a better control in drug expenditure.

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PRESCRIBING GUIDE

• Kategori Pegawai yang diberi kuasa untuk mempreskripsi/memulakan (initiate) ubat dari formulari adalah seperti berikut :

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A* = Pakar Perunding/Klinikal untuk indikasi yang spesifik sahaja

A = Pakar Perunding/Klinikal

A/KK = Pakar Perunding/Klinikal/Pakar Kesihatan Keluarga

B = Pegawai Perubatan

C = Anggota Paramedik

C+ = Anggota Paramedik dalam perbidanan

​

• Pakar Perunding Pergigian / Pakar Pergigian dan Pegawai Pergigian turut dimasukkan di dalam kategori ini tetapi untuk ubat-ubat yang digunakan dalam rawatan pergigian sahaja.
• Ubat-ubatan hendaklah dipreskrib sekiranya diperlukan sahaja, dan semua risiko yang terlibat telah diambil kira.
• Ubat didispens secara generik

FORMULARI UBAT KKM (FUKKM)

Nama Ubat

• nama generik
• nama dagangan sebagai

contoh sahaja

Malaysian Drug Code (MDC)

MDC adalah kod pengenalan untuk setiap ubat

17 format kod alphanumeric

• ATC (7 digit)
• Base/Garam (3 digit)
• Dosage (3 digit)
• Kepekatan (2 digit)
• Brand (2 digit)

NEDL

• Senarai Ubat Penting

Kebangsaan

APPL

• perolehan dari

syarikat konsesi

(Approved Product

Purchase List)

FORMULARI UBAT KEMENTERIAN KESIHATAN

(FUKKM)

Permohonan Penyenaraian Ubat Ke dalam Formulari

PENGAWALAN UBAT-UBATAN YANG DISIMPAN

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• Jawatankuasa Ubat peringkat Hospital/Kesihatan
• Perbincangan dengan Preskriber
• Ubat Terkawal : kuota pesakit, kuantiti penggunaan
• Limitasi Preskriber untuk preskrib
• Drug Utilization Review
• dll

FUKKM

UBAT-UBATAN DI FASILITI KKM

• Ubat yang tidak disenaraikan di dalam FUKKM mestilah mendapat kelulusan Ketua Pengarah Kesihatan(KPK) Malaysia

​

• Contoh:
• Tab. Sildenafil 50mg
• Cap. Glucosamine

​

​

����Good Prescribing Practice

Good Prescribing Practice, JK MSAT HKL

31

OUTPATIENT

PRESCRIPTION

AHMAD B. ALI

123456-78-9001

1879999

TAB

GLICLAZIDE MR

60MG

OD

1/52

Pre Lunch

SW32

55

Atikah

PEGAWAI PERUBATAN UD44

MMC: XXXX

Hospital Kuala Lumpur

Chia

PAKAR PERUBATAN UD54

MMC: XXXXX

Hospital Kuala Lumpur

• Two identifiers required:
• Name of patient (compulsory)
• Registration Number OR IC no.
• Wad/No Katil
• Diagnosis

Weight required in children below 12

86

6am

2pm

10pm

23/9

22/9/2021 9.05pm

Stat dose

Status alahan: Ya/Tidak/Unknown

√

22/9/2021

22/9/2021

POM

Ticked if patients have brought their own medications to ward. Pharmacy will not supply

Arahan Khas

Additional orders e.g infusion rate, specific days.

Serum creatinine

Option for RT/NG feeding

ᵹ ϡ

• Prescriber Chop & Signature
• Date

Aspiration pneumonia

INPATIENT

PRESCRIPTION

ALLERGY STATUS ON PRESCRIPTIONS

To have allergy status on prescription

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For training purpose

For training purpose

34

Importance for prescribers to Tick & Fill Allergy Box on Prescriptions

Awareness Poster on HKL Elevator Door

KNOWN ALLERGY MEDICATION ERROR 2017 - 2022

36

Good Prescribing Practice, JK MSAT HKL

Get Countersign For

All Prescription

Get Countersign For All Prescription

Siti Aishah

860205-12-5214

28015687

NW4

23

SC HEPARIN

5000u BD

TAB ATORVASTATIN

40mg ON

Dr XXX

Peg Perubatan

Hospital Kuala Lumput

MMC 23588991

INPATIENT

PRESCRIPTION

Dr AAA

Pegwai Perubatan Siswazah

Hospital Kuala Lumput

MMC (S) 1234567

Dr XXX

Pakar Perubatan

Hospital Kuala Lumput

MMC 23588991

Dr AAA

Pegwai Perubatan Siswazah

Hospital Kuala Lumput

MMC (S) 1234567

Do not tear out

DO NOT tear out prescriptions from the same page

INPATIENT

PRESCRIPTION

One page per patient�

Filling in patient details only ONCE each page

Siti Aishah

860205-12-5214

28015687

NW4

23

Strike off unused prescription �(before tearing off the carbon copy)

Paracetamol

QID

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

25/5/2022

SC HEPARIN

5000u BD

INPATIENT

PRESCRIPTION

STAT dose column: �Sign & record Date/Time given

SN ϡ 25/5/2022 @ 12.35am

INPATIENT

PRESCRIPTION

Prescribing Do’s and Don’ts

Use

GENERIC NAME

instead

brand name

Use LEADING ZERO before decimal point

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

25/5/2022

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

25/5/2022

DO NOT use TRAILING ZERO after decimal point.

Use mcg or microgram instead of using symbol μg

DO NOT use ABBREVIATION or ACRONYYM except for acceptable standard of abbreviation.

For drugs to be ADMINISTERED ONLY ON SPECIFIC DAYS of the week, please specify the day.

Clearly state DILUTION AND INFUSION RATE of the medications.

To OFF or WITHOLD must be accompanied with DATE &

Doctor’s SIGN and CHOP

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

25/5/2022

Off

TAB PARACETAMOL

1G QID/PRN 1/52

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

25/5/2022

Ensure that prescriptions and SIGNATURES ARE LEGIBLE, and include prescriber’s name printed next to the signature.

TDS

TDS

All modifications/

changes made to a prescription must be done in one sentence/line of regimen and signed with name/chop

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

25/5/2022

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

25/5/2022

DR. AMIR

PEGAWAI PERUBATAN

MMC: XXXX

HOSPITAL KUALA LUMPUR

EXAMPLE OF ERRORS

Good Prescribing Practice, JK MSAT HKL

53

WRONG FREQUENCY

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Example: Doctor wrongly prescribed the frequency of T. Perindopril as BD-dosing instead of OD-dosing.

Good Prescribing Practice, JK MSAT HKL

54

WRONG FREQUENCY

​

Example: Appropriate frequency should be written on the prescription.

Good Prescribing Practice, JK MSAT HKL

55

ILLEGIBILITY

​

Example: The frequency ‘BD’ looks like ‘OD’. Doctor intended to prescribe BD-dosing but SN interpreted it as OD-dosing due to unclear handwriting.

​

Good Prescribing Practice, JK MSAT HKL

56

Good Prescribing Practice, JK MSAT HKL

57

No Drug Name

ILLEGIBILITY

​

Example: The frequency ‘OD’ looks like ‘QID’. Doctor intended to prescribe OD-dosing but SN interpreted it as QID-dosing due to unclear handwriting.

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Good Prescribing Practice, JK MSAT HKL

58

DILUTION INSTRUCTION

Doctor intended to give

IV MgSO₄ diluted in 100cc but no clear dilution instruction was written on the prescription for

IV MgSO₄ so SN administered bolus dose instead.

Example of how a dilution instruction should be written on the prescription.

Good Prescribing Practice, JK MSAT HKL

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Good Prescribing Practice, JK MSAT HKL

60

Unclear handwriting

No frequency of Metformin

No indication

ABBREVIATION

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Example: EES should be written in full, i.e. Erythromycin Ethylsuccinate.

Good Prescribing Practice, JK MSAT HKL

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Good Prescribing Practice, JK MSAT HKL

62

Abbreviation

Incomplete IC No

No MRN

WRONG DOSE

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Example: Doctor prescribed the wrong dose for Levothyroxine. The intended dose was ‘25mcg OD’ instead of 250mcg OD.

Good Prescribing Practice, JK MSAT HKL

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Good Prescribing Practice, JK MSAT HKL

64

Wrong dose 0.5mg= 500mcg

Corrected 0.05mg= 50mcg

HERCULES

Dr Hercules Tan

Hospital Kuala Lumpur

​

​

Good Prescribing Practice, JK MSAT HKL

65

All modifications/

changes made to a prescription must be done in one sentence/line of regimen and signed with name/chop

66

Overlapping Of Carbon Copy

VERBAL ORDERS

• Verbal orders are more prone to errors.

Eg:

• Naloxone one half ampoule iv stat for an elderly patient having respiratory depression from meperidine.
• Nurse took a 10ml, 1mg/ml vial naloxone & administered half the vial, total 5mg
• The Dr meant half of a 1 ml , 0.4 mg/ml vial or 0.2 mg

VERBAL ORDERS

• Limit the number of staff who may receive spoken orders
• The receiver read back the transcription to the informer

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Common Risk Factor

1

Look-Alike Sound-Alike Medication (LASA)

Reference: Guide on Handling Look Alike, Sound Alike Medications (2012)

Pharmaceutical Services Division

2

3

4

5

6

SAFE & CORRECT PRESCRIBING = PATIENT’S SAFETY

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How to Download

HKL Drug List

(Prescriber Version)

from HKL Website?

​

​

Go to www.hkl.gov.my

​

​

​

​

Click on “Internal Apps”

at the homepage

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Click on “HKL Drug List”

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Enter password: KLHosp

to view document

1

2

3

4

https://linktr.ee/hkldoctors_starterpack

Information Accessibility

Access to HKL Doctor’s Starter Pack

https://linktr.ee/hkldoctors_starterpack

Farmasi HKL

HKL Policies , Guidelines, Protocols & References

HKL Newsletters & Updates

76

HKL Newsletters & Updates

Medication Error Video Alert!

Thank You

For Your Kind Attention!

GOOD PRESCRIBING PRACTICE QUIZ

79