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TABLE OF CONTENTS Page Preface 3 Abbreviations 4 (1) Recommendations on Prescription Practices / Procedures Medication Administration Record (MAR) 5 Standard Intravenous (IV) Fluid and Drug Additives Administration Form 5 Standard Insulin Administration MAR Form 5 Legibility 5 Start Date 5 Drug Name 5 Dosage 6 Routes of Administration 6 Times of Administration 6 Valid Period 6 Signature 6 Transcription of Drug Order 6 Alterations & Cancellation of a Prescription 7 Electronic Prescribing (Medication Order Entry -- MOE) 7 Verbal Orders 7 Patient’s Own Medications 7 Drug Samples 7 Clinical Trial Medications 8 Record of All Medications 8 Chinese Medicines (CM) 8 Nurse-initiated Medications 8 Discharge Medications 8 (2) Recommendations on Pharmacy Drug Supply System Pharmacy Drug Supply System 9 Individual Patient Dispensing 9 Preparation of Drugs 9 Accuracy in Dispensing 9 Labelling of Dispensed Medications 9 Re-packaging of Medications from the Manufacturers’ Original Containers 9 Drug Replenishment 9 Ward Stock Supplies 9 Emergency Drug Supplies Outside Pharmacy Service Hours 10 Supply of Antidotes and Detoxifying Agents in HA Hospitals 10 Supply of Medications for Patients during Inter-hospital Transfer 10

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(3) Recommendations on the Delivery / Storage of Drugs Delivery of Drugs 11

Storage of Drugs 11 Storage of Dangerous Goods (DG) 11 Storage of Medical Gas Cylinders/Containers 11 (4) Recommendations on Drug Administration Procedures in the Wards Level of Nursing Personnel Involved in Drug Administration 12 Order and Receipt of Drug Supplies from the Pharmacy 12 The Principle of Three Checks and Five Rights 12 Administration of Intravenous (IV) Medications 13 Record of Administration 14 Recording and Reporting 14 Self-medication Programme 14 The Supply of Ward Stocks 14 Pooling and Relabelling of Drugs 14 Dispensing Outside Pharmacy Service Hours 15 Borrowing of Drugs 15 Method of Drug Return / Disposal 15 (5) Recommendations on Handling Requirements for Specific Drugs Dangerous Drugs 16 Cytotoxic Drugs 16 Hazardous Chemicals 16 High Risk Drugs 16 Medications Used in Resuscitation 16 (6) Quality Assurance Programmes Medication Incident Reporting Programme 17 Adverse Drug Reactions Reporting Programme 17 Quality Complaints on Pharmaceutical Items 17 Drug Recall 17 APPENDIX Appendix 1 Lists of HA-wide Approved / Standard Abbreviations 18

in Prescribing

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PREFACE The full “Report on Drug Administration Procedures and Practices in Public Hospitals, 2005 edition” was prepared by the Working Group which comprises doctors, pharmacists and nurses from the institutions under the HA. The Working Group was appointed to review the existing drug administration systems in public hospitals and a set of Recommended Practices was then drawn up for the improvement of the overall standard and quality of service. The Pocket Version is an abridged version of the fourth Chapter on Recommended Practices of the full Report. Its purpose is to provide an easy-to-use, concise, portable version that can be utilized for quick reference by the front-line staff. It is not intended to replace the complete information found in the full Report. Appendix material such as the list of HA-wide Approved / Standard Abbreviations in prescribing is also available for reference. Prescribers should either prescribe in full text or adhere to these lists of Abbreviations.

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Abbreviations The abbreviations used in this book are listed in the table below for your easy reference. ADR Adverse Drug Reactions HCE Hospital Chief Executive

A&E Accident and Emergency ICP Intra-cranial Pressure

AIRS Advanced Incidents Reporting System

IT Information Technology

CARS Computerized Automatic Refill System

IV Intravenous

CCE Cluster Chief Executive KCl Potassium Chloride

CDDH Corporate Drug Dispensing History

LKSSC Li Ka Shing Specialist Clinic

CE Chief Executive MAR Medication Administration Record

CIVAS Centralized Intravenous Admixture Service

MI Medication Incident

CM Chinese Medicine MIRP Medication Incident Reporting Programme

CMS Clinical Management System MOE Medication Order Entry

COS Chief of Service MOEMET Medication Order Entry Major Enhancement Task

CPO Chief Pharmacist’s Office NCR No Carbon Required Multi-part Carbonless Paper

CSC Clinical Service Coordinator PMH Princess Margaret Hospital

CVP Central Venous Pressure PMS Pharmacy Management System

D Director PMS-OP Pharmacy Management System – Out-patient

DM Department Manager PYNEH Pamela Youde Nethersole Eastern Hospital

DTC Drug and Therapeutics Committee

QMH Queen Mary Hospital

DURC Drug Utilization Review Committee

SOPD Specialist Out-patient Department

EDS Express Dispensing System TKOH Tseung Kwan O

GM(N) General Manager (Nursing) TMH Tuen Mun Hospital

GOPD General Out-patient Department TPN Total Parenteral Nutrition

HA Hospital Authority YOOPD Yan Oi Out-patient Department

HAHO Hospital Authority Head Office

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RECOMMENDED PRACTICES AND REQUIREMENTS

1 RECOMMENDATIONS ON PRESCRIPTION PRACTICES / PROCEDURES

Medication Administration Record (MAR)

1.1 MAR should be the ONLY official document for the entire in-patient drug administration process i.e. on which doctors prescribe, for which the pharmacy staff dispense drugs, and according to which the nurses administer drugs.

1.2 Personal details, diagnosis of the patient and drug allergy are regarded as essential information to be provided in the MAR. Patients without drug allergy must be recorded as “NIL” or “No Known Drug Allergy (NKDA)”. Prior to the prescribing of medications, drug allergy records of the patients must be re-checked by the doctors.

Standard Intravenous (IV) Fluid and Drug Additives Administration Form

1.3 The drug order and administration of intravenous infusion and drug additives are to be recorded in the “IV Fluid and Drug Additives Administration Form”.

1.4 Doctors should review the intravenous drug orders on a daily basis.

Standard Insulin Administration MAR Form

1.5 The order and administration of insulin are to be recorded in the “Insulin Administration / Blood Glucose Monitoring Form” and “Intravenous Insulin Administration Form (DKI or IV insulin pump)” recommended to the hospitals’ DTCs.

Legibility

1.6 Doctors should prescribe in a clear and legible manner.

1.7 Doctors are required to write FIRMLY on the MAR with indelible ink.

Start Date

1.8 This date on which a drug treatment is to commence should be recorded.

Drug Name

1.9 All drugs should be prescribed by their approved name and should preferably be printed in full in BLOCK LETTERS.

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1.10 Doctors should either prescribe in full text or adhere to the list of standard abbreviations (refer to Appendix 1 of the Pocket Version).

Dosage

1.11 The dose of medications should be prescribed using the METRIC system. Dosage should be expressed in terms of the active ingredients except in the case of compound preparations.

1.12 Dosage abbreviations and decimal points should be avoided. Microgram should be written in full instead of mcg or μg. Units should be written in full instead of i.u.

Routes of Administration

1.13 Doctors should either prescribe in full text or adhere to the list of standard abbreviation (refer to Appendix 1 of the Pocket Version).

Times of Administration

1.14 Times of administration schedule should be clearly given. If abbreviations are to be used, doctors should adhere to the list of standard abbreviations (refer to Appendix 1 of the Pocket Version).

1.15 For “ONCE ONLY” medications, the date and time of administration should be specified.

1.16 For “AS REQUIRED” medications, the reasons for treatment, the maximum frequency of administration and/or the times of administration should be stated.

1.17 For “ONCE DAILY" medications, the full text ‘daily’ should be used and the time of administration should be specified.

Valid Period

1.18 When a certain medication is to be given for a defined period, this should be clearly stated e.g. antibiotics.

Signature

1.19 Doctor must put their identification code or full name in block letters together with their authorised signature on all the prescriptions.

Transcription of Drug Order

1.20 A copy of the MAR in the doctor’s original handwriting should be sent to the pharmacy by using the NCR paper or by fax.

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Alterations & Cancellation of a Prescription

1.21 No prescription item should be altered in part. Any changes in a prescription order should involve the complete cancellation of the existing prescription item and the writing of a new one.

1.22 Medications should be cancelled by drawing a diagonal line through the drug name and/or a slanted double-line across the administration section and must be signed and dated.

Electronic Prescribing (Medication Order Entry -- MOE)

1.23 Discharge and home leave prescriptions can be prescribed through the Medication Order Entry (MOE) system.

Verbal Orders

1.24 Only in emergency and approved circumstances may a verbal order be given. The instruction must be recorded immediately in the patient’s MAR and annotated it a ‘verbal order’.

1.25 After the instruction has been written, it must be READ BACK to the doctor.

1.26 The nurse receiving the message must administer the drug and personally give both verbal and written instructions to the nurses taking over from him/her.

1.27 A verbal order must be confirmed in writing by the doctor concerned within 24 hours at the latest.

1.28 Dangerous Drugs should not be ordered through verbal orders.

Patient’s Own Medications

1.29 The patient’s own medications should not normally be administered in hospital unless they have been positively identified, specifically prescribed by the doctor and when supplies are not immediately available from hospital sources.

1.30 If the patient’s own medications are to be administered in hospital, identification, prescribing and administration of the patient’s own medications should follow the protocol / logistics endorsed by the hospitals’ DTC.

Drug Samples

1.31 The hospital DTC or an equivalent committee should establish policies and procedures to approve, control and monitor the use of drug samples in the hospitals and their affiliated clinics.

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1.32 Drug samples approved for use must be dispensed by the pharmacy.

Clinical Trial Medications

1.33 Individual hospitals should draw up their own protocols regarding the supply, storage, preparation and distribution of clinical trial medications.

1.34 Appropriate details regarding such clinical trial medications should be supplied to the pharmacy before the commencement of the clinical trial.

Record of All Medications

1.35 All medications including routine drugs, clinical trial medications, brought-in drugs, drug sample, intravenous fluid, insulin and TPN should be prescribed properly and their administration recorded accordingly.

Chinese Medicines (CM)

1.36 The use of CM in the HA hospitals should follow the guiding principles of the “Hospital Authority Guidelines on Interface Issues between Chinese Medicine and Conventional Western Medicine”.

1.37 The use of CM should be indicated by the doctors on the MARs as “Chinese Medicines”. The MARs should be sent / faxed to the Pharmacy for computer entry and the administration of CM should be properly recorded.

Nurse-initiated Medications

1.38 The protocols approved by the hospital DTC should specify the rank of nurses allowed to initiate medications on the approved list.

1.39 Medications initiated by nurses should be checked and countersigned by a doctor within 48 hours for non-poisons and 24 hours for poisons.

Discharge Medications

1.40 Doctors should prescribe all the medications that the patients are currently taking and not just those required for discharge.

1.41 When the supplies of certain medications are not required, they should be clearly indicated on the prescription or in the MOE.

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2 RECOMMENDATIONS ON PHARMACY DRUG SUPPLY SYSTEM

Pharmacy Drug Supply System

2.1 The Pharmacy drug supply system comprises individual patient dispensing and ward stock supply.

Individual Patient Dispensing

2.2 The majority of inpatient medications should be supplied on an individual patient basis by the pharmacy. It enables the pharmacist to verify the safety and appropriateness of each prescription order.

Preparation of Drugs

2.3 Pharmacists should supply drugs in the most appropriate form or the most ready-to-administer form.

Accuracy in Dispensing

2.4 Proper in-house checking procedures should be built into the pharmacy dispensing system. Every prescription order and all dispensed medications should preferably be checked by a pharmacist.

2.5 Mere checking of the label against the content is not sufficient. Reference should always be made to the ORIGINAL prescription for the correctness of the drugs and possible undesirable drug interactions. The double check system should be practised whenever possible.

Labelling of Dispensed Medications

2.6 Proper labelling should be provided on all dispensed medications in compliance with the requirements for mandatory labelling of medications.

Re-packaging of Medications from the Manufacturers’ Original Containers

2.7 The re-packed drugs should be properly labelled with a retraceable batch reference and proper records should be kept.

Drug Replenishment

2.8 Proper recording and checking mechanisms should be in place to facilitate the replenishment and recall of drugs.

Ward Stock Supplies

2.9 To maintain the continuity of drug supplies outside pharmacy service hours, ward stocks will still be required. The following points are to be considered for maintaining a proper ward stock system :-

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(a) The reasons for keeping ward stocks must be well established.

(b) Those items that have commonly been involved in potential or serious medication errors should not be kept as ward stock in general care areas e.g. concentrated KCl injection.

(c) All ward stock items must be supplied in appropriate labelled containers.

(d) The range of ward stocks and the quantity kept for each item should be minimised.

(e) A list of ward stock items should be maintained and periodically reviewed.

(f) Pharmacy staff should be actively involved and responsible for the whole process of ward stock management e.g. by using a bar-code topping up system.

(g) In the absence of barcode topping up system, the “two bottle system” should be employed.

Emergency Drug Supplies Outside Pharmacy Service Hours

2.10 Access to a limited supply of medications from the Night Cabinet outside Pharmacy service hours should be made available to medical or nursing staff.

2.11 The drug items should be kept in the Night Cabinet which is kept locked when not in use.

2.12 The container for each item should be properly labelled.

2.13 When a medication order must be made at the time of emergency drug supply, such medication order should be verified by the pharmacy staff and the drug item replenished within 24 hours.

Supply of Antidotes and Detoxifying Agents in HA Hospitals

2.14 Certain antidotes and detoxifying agents are stocked in some HA hospitals (refer to Appendix 7 of the full Report).

2.15 Arrangement should be made through the hospital pharmacy if any of these agents are required.

Supply of Medications for Patients during Inter-hospital Transfer

2.16 The medications supplied should be properly labelled. The detailed HAHO guidelines are shown in Appendix 8 of the full Report.

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3 RECOMMENDATIONS ON THE DELIVERY / STORAGE OF DRUGS

Delivery of Drugs

3.1 Drugs should be delivered in locked receptacles.

3.2 Separate receptacles should be used for refrigerated items and cytotoxic drugs.

Storage of Drugs

3.3 Drug trolleys with separate receptacles for keeping the individual patients’ medications should be used on the wards.

3.4 Ward drug cupboards and drug trolleys have to be kept locked when not in use and to be kept out of reach of patients.

3.5 DD should be kept under lock and key in a designated drug cabinet at all times.

3.6 Pharmaceutical refrigerators which are used for the proper storage of drugs in wards and in pharmacy should be used solely for this purpose.

3.7 Medicinal products for external use should be stored in a SAFE place and should be kept separately from the drug items that are for internal use.

Storage of Dangerous Goods (DG)

3.8 Dangerous Goods (DG) should be stored at designated places in the clearly labelled chemical storage cabinets. For details, end-users should refer to (1) Factories and Industrial Undertakings (fire precautions in notifiable workplaces) Regulation, Cap. 59V, Section 9 for storage of inflammable substances and (2) Dangerous Goods General from the Fire Services Department.

Storage of Medical Gas Cylinders/Containers

3.9 The storage of medical gas cylinders must comply with the provisions of the Dangerous Goods (General) Regulations. For details, end-users should refer to the Medical Gas System Operation Manual on cpo.home of HA intranet.

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4 RECOMMENDATIONS ON DRUG ADMINISTRATION PROCEDURES IN THE WARDS

No medications should be administered to a patient if a drug order is unclear or when there is doubt in the appropriateness and safety of the patients.

Level of Nursing Personnel Involved in Drug Administration

4.1 A Registered Nurse is competent to administer medications on his/her own.

4.2 It is advisable to have a second person counter check the drug administration process especially in situations where skill, experience and familiarity with the clinical conditions are required to ensure safe practice.

4.3 Enrolled Nurses can administer medications, when delegated this duty by Registered Nurses.

4.4 Nurse learners who have undergone training in medication administration and are deemed to be competent, may administer medications under the supervision of qualified nurses.

Order and Receipt of Drug Supplies from the Pharmacy

4.5 All drugs orders should be sent to the pharmacies for vetting irrespective of whether the supplies of drugs are required.

4.6 All “discontinued” medications on the MAR should be faxed to the pharmacy as soon as possible.

4.7 All drugs delivered to wards must by checked by the authorized nursing staff as soon as they are received.

The Principle of Three Checks and Five Rights

Check patient’s identity according to the patient identification guidelines.

4.8 In drug administration, the following principle of “three checks and five rights” should always be observed. These include :-

THREE CHECKS

(i) First check: Careful checking BEFORE taking the medication out from the container.

(ii) Second check: Careful checking AFTER removing the medication from the container.

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(iii) Third check: Final checking of the medication against the container before disposal/putting it away.

FIVE RIGHTS

(i) Right patient: Check the identity of the patient. Check the patient’s name and that the name of the drug corresponds with the prescription. Check the patient’s drug allergy.

(ii) Right drug: Nurses should refer to the MAR for the administration of drugs. Read the prescription. Ascertain which drug is due to be given.

(iii) Right dose: Caution should be exercised in the calculation of dose especially the high risk drug items.

(iv) Right route: Check the route of administration & ensure the right mode of administration on the prescription.

(v) Right time: Check the time of administration against the doctor’s prescribed directions on the MAR.

4.9 Should nurses have any doubt during the course of the procedure, they should withhold drug administration until verification by the doctor or another Registered Nurse.

Administration of Intravenous (IV) Medications

4.10 Nurses should always refer to the product inserts or contact the pharmacy department of their hospitals for guidelines on parenteral drugs administration in the case of any uncertainty.

4.11 The drug order of a high risk intravenous medication should be independently checked by 2 nurses to ensure that the order has been correctly interpreted and that the drug, dose calculations, preparations, route & mode of administration are accurate.

4.12 Extreme care should be exercised with those intravenous drugs which can never be given by bolus but only by infusion. The dose calculation should preferably be done by a pharmacist.

4.13 The bolus of IV dangerous drugs should preferably be administered by a doctor.

4.14 Syringes containing drugs should be properly identified in order to prevent any mix-up of medications. In no circumstances should any unidentified drugs be given to patients and they MUST BE discarded immediately when found.

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4.15 The IV line and non-IV tubing should be traced back carefully to the site of insertion before drugs or feeds are administered.

4.16 Double checking should be practised when setting up infusion pumps for infusing high risk drugs.

4.17 A uniform colour-code for stopcocks has been adopted to facilitate venous / arterial line identification. The guidelines on the use of three-way and four-way stopcock are depicted in Appendix 10 of the full Report.

Record of Administration

4.18 The date, time of administration and signature should be entered immediately after the drug has been given and consumed by the patient.

4.19 The date, time of administration and the amount of IV fluid and drug additives to be given and signature should be entered in the IV Fluid and Drug Additives Administration Form.

Recording and Reporting

4.20 Any reasons leading to an omission in drug administration should be recorded on the patient’s MAR. The doctors concerned should always be informed.

4.21 Nurses should record and report the effects and side-effects of the treatment experienced by the patient.

Self-medication Programme

4.22 Individual hospitals should establish protocols for carrying out this programme. Pharmacist should provide patient education and counselling on the use of drugs. Nursing staff should provide appropriate supervision and the assessment of the patient is to be documented.

The Supply of Ward Stocks

4.23 Ward stocks should be stored in an orderly manner. The practice of the rotation of stock should be observed.

Pooling and Relabelling of Drugs

4.24 Pooling, transferring, repackaging and relabelling of ward stocks should be avoided.

4.25 Labels originally provided by the pharmacy should NOT be altered or amended.

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Dispensing Outside Pharmacy Service Hours

4.26 For the dispensing of A&E and other prescriptions outside pharmacy service hours, the local policy of individual hospital should be followed.

4.27 Dispensing of ward stock medications by doctors or nurses for home leave and on discharge is not recommended. When this is unavoidable, the medication dispensed should be clearly labelled.

Borrowing of Drugs

4.28 Borrowing drugs from another patient’s supply or from other wards should be restricted to exceptional circumstances.

Method of Drug Return / Disposal

4.29 Local policies regarding ward drug returns and disposal should be followed and any other required documentation completed.

4.30 Antibiotics, dangerous drugs, poisons, other pharmaceutical products and cytotoxic drugs in bulk or significant residue volume in container (e.g. unused or partially used drugs in ampoules or syringes) should be disposed according to the guidelines set up by Environmental Protection Department for disposal as stipulated in Appendix 13 of the full Report.

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5 RECOMMENDATIONS ON HANDLING REQUIREMENTS FOR SPECIFIC DRUGS

Dangerous Drugs

5.1 Refer to Appendix 14 of the full Report for the guidelines on the handling of DD in HA hospitals.

Cytotoxic Drugs

5.2 Individual hospital should draw up local policies with regard to the handling and disposal of cytotoxic drugs.

Hazardous Chemicals

5.3 Each hospital should establish a Comprehensive Chemical Safety Programme in compliance with the Occupational Safety and Health Ordinance (OSHO) and Subsidiary Regulations.

High Risk Drugs

5.4 Particular caution should be exercised regarding the high risk drugs that have been involved in potential or serious medication errors, e.g. digoxin, concentrated KCl injection.

Medications Used in Resuscitation

5.5 The medications used in resuscitation are stocked in the emergency trolley and emergency-kit (E-kit).

5.6 The medications used must be specific and consistent within the same specialty of the cluster / hospital. The conditions and expiry dates of the medications should be checked periodically and records kept of such check.

5.7 A mechanism should be established for expiry dates monitoring, medication replenishment and replacement/exchange of medications used in resuscitation.

5.8 All medications ordered and administered should be documented in the MAR / resuscitation forms as soon as possible or within 24 hours of the CPR process whichever is the earlier.

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6 QUALITY ASSURANCE PROGRAMMES

Medication Incident Reporting Programme

6.1 Medication incidents including “near-miss” cases in HA hospitals should be reported locally in each hospital using standardised forms (refer to Appendix 15 of the full Report).

6.2 Completed reports are directed to the hospital DTC or its equivalent. The Committee should also report quarterly statistical data as well as the details of cases of severity index 1-6 to the HAHO using the standardised return forms.

6.3 The HAHO will monitor the overall trend of medication incidents and consider appropriate corporate-wide measures.

6.4 Each hospital unit should also establish a quality assurance/risk management mechanism.

Adverse Drug Reactions Reporting Programme

6.5 Doctors, nurses and pharmacists should be alert to the potential for or presence of ADR. A standard procedure to record and report clinically significant ADRs has been established in the HA (refer to Appendix 16 of the full Report).

Quality Complaints on Pharmaceutical Items

6.6 All cases of quality complaints must be reported by using the standard report form. (refer to Appendix 17 of the full Report).

Drug Recall

6.7 Pharmacists must comply immediately with any warning or recall about defective medicines.

6.8 All drugs should preferably be kept in their original containers with their unique lot/batch number.

6.9 When a drug recall is activated, pharmacy must notify all parties concerned immediately.

6.10 All affected stock must be quarantined pending further instructions.

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Appendix 1 Lists of HA-wide Approved / Standard Abbreviations in Prescribing Prescribers should either prescribe in full text or adhere to the following lists of approved Abbreviations: 1) Standard Drug Name Abbreviations DRUG ABBREVIATION Acetomenaphthone Vit. KAdenosine Triphosphate ATPAdrenocorticotrophic Hormone ACTH Adsorbed Diphtheria & Tetanus Vaccine DTAdsorbed Diphtheria, Tetanus & Pertussis Vaccine DTPAlpha Tocopheryl Acetate Vit. EAlpha Tocopheryl Nicotinate Vit. EAscorbic Acid Vit. CBacillus Calmette Guerin Vaccine BCG Vaccine Calcium Carbonate CaCO3 Calcium Chloride CaCl2Carmustine BCNU Cisplatin CDDPCyanocobalamin Vit. B12 Cytarabine Ara-CDesmopressin DDAVP Ergocalciferol, Calciferol Vit. D2 Erythropoietin EPOEtoposide VP-16Ferrous Sulphate FeSO4Filgrastim G-CSF Fluorouracil 5-FUGlyceryl Trinitrate GTN, TNG Hepatitis B Immune Globulin HBIGIsoniazid INAHLomustine CCNU Magnesium Chloride MgCl2Magnesium Sulphate MgSO4 Measles/Mumps/Rubella Vaccine MMR Vaccine Mercaptopurine 6-MPMethotrexate MTXMolgramostim GM-CSF Phenoxymethylpencillin Pencillin V Phytomenadione Vit. KlPotassium Chloride KClPotassium Iodide KIPotassium Permanganate KMnO4 Propylthiouracil PTUProstaglandin E2 PGE2Pyridoxine Hydrochloride Vit. B6Riboflavine Vit. B2Sodium Bicarbonate NaHCO3

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DRUG ABBREVIATION Sodium Chloride NaClTeniposide VM-26 Thiamine Vit. B1Thyrotrophin-releasing hormone TRHThyroxine T4Liothyronine Sodium T3Zinc Oxide ZnO

Reference : 1. Martinadale, The Extra Pharmacopoeia, 34th edition, The Royal Pharmaceutical

Society of Great Britain. 2. American Hospital Formulary Service (AHFS) Drug Information 2002, Authority of

the Board of Directors of the American Society of Health-System Pharmacists 3. Medline Plus® (Medical Dictionary – The US National Library of Medicine and the

National Institutes of Health) HA-wide Approved Local Drug Name Abbreviations DRUG ABBREVIATION Balance Salt Solution BSSDihydrocodeine Tartrate DF118Expectorant Stimulant MESHydrocortisone 1% & Clioquinol 3% H1V3Multivitamin MVVitamin B Complex Vit.B Co

2) Standard Abbreviations for the Route of Administration ABBREVIATION EXPLANATION I.D. Intradermal I.M. Intramuscular I.V. Intravenous

For intravenous injection, whether it is bolus, slow IV or infusion should be specified.

I.P. Intraperitoneal N.G. Nasogastric P.O. Per oral P.R. Per rectum P.V. Per vagina S.C. Subcutaneous S.L. Sublingual

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3) Standard Abbreviation for Drug Administration Frequency INSTRUCTION LATIN ABBREVIATION once daily once daily twice a day bis die b.d. twice a day bis in die b.i.d. three times daily ter die sumendus t.d.s. three times daily ter in die t.i.d.1 four times daily quater in die q.i.d.2 four times daily quater die sumendus q.d.s. at bedtime hora somni h.s. at night nocte noct. every night omni nocte o.n. every morning omni mane o.m. before noon ante meridiem a.m. afternoon post meridiem p.m. when required pro re nata p.r.n. used as directed more dicto utendus m.d.u. immediately statim stat. alternate alternus alt. before food ante cibum a.c. after food post cibum p.c.

_______________________ 1 t.i.d. is preferable to be used in prescription 2 q.i.d. is preferable to be used in prescription because q.d.s. is easily mistaken with q.d. 4) Standard Abbreviations for Dosage Forms DOSAGE FORM LATIN ABBREVIATIONS capsule capsula cap. drops guttae gtt. for the eye oculo ocul. irrigation irrigatio irrig. mixture mistura mist. ointment unguentum ung. pessary pessus pess.. powder pulvis pulv. suppository suppositorium supp. syrup syrupus syr. tablet tabletta tab. tincture tinctura tinct.

Reference : Pharmaceutical Handbook, The Pharmaceutical Press Pharmaceutical Practice, D.M. Collect, M.E. Aulton The Chief Pharmacist’s Office is responsible for coordinating the procedures involved in the addition of drug abbreviation. Any request for addition of drug abbreviation should be made through the hospital pharmacy.

HAHO 2000 (revised in Jan 05)