Best Practice Procedures
FOR RESIDENTIAL AGED CARE FACILITIES
17-19 Moore Street, Leichhardt NSW 2040
P: +61 (0)2 9563 4900 I FREE CALL 1800 244 358
F: +61 (0)2 9563 4955 I FREE FAX 1800 626 739
EMAIL: [email protected]
S149
u
©(03/2012) Manrex Pty Ltd t/as Webstercare -2012. Version 3.0
Best Practice Procedures for Webster-pak® Multi Dose
Webster-pak® Multi Dose
Best Practice Procedures
Introduction .................................................................................... …2
How the Webster-pak System works ........................................................ 8
Special Medication Categories ...............................................................10
Medication Round ..............................................................................12
Quality Assurance ..............................................................................14
Communication & Stationery ................................................................17
Communication with the Pharmacy ........................................................18
Quality Processes ..............................................................................20
Appendix ....................................................................................... 22
© Manrex Pty Ltd (ABN: 29 974 510 173) t/as Webstercare. Manrex, Webstercare, Webster-pak, Webstersystem,
Unit Dose 7, Flexi-pak, Pil-Bob, LoTemp and MedsPro are Registered Trade Marks of Manrex Pty Ltd Webstercare
whilst Virtual Pill Count (VPC) and Flexi-shelf are Trade Marks of Manrex Pty Ltd t/as Webstercare.
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare - 2013
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Best Practice Procedures for Webster-pak® Multi Dose
Introduction
Welcome to the Webstercare Best Practice Procedures Manual. This manual seeks to ensure
the maximum benefits from using Webster-pak are realised. Best practice procedures and
additional pharmacy services can optimise the benefits of using Webstercare medication
management systems.
Here is how the manual is organised:
Best Practice Procedures for Webster-pak Multi Dose and Flexi-pak Webster-pak
This section introduces you to:
• The components of the system
• How they system works
• Special medication categories.
• Medication rounds
• Quality assurance
Webstercare Communication and Stationery Components
This section introduces you to:
• Communication – the stationery available to ensure all order information is
communicated between the Pharmacy and RACF
• Stationery – the stationery available for Patient Profiles, Checking Sheets, S8
Delivery Record Book, and more
• Communication with the Pharmacy – How to re-order medication, new
medication and communication of dosage changes or ceased medication
• Storage
Quality Processes – This section introduces you to the various resources and guidelines for
medication management. Areas include: Incident reports, Drug (MAC) Committee, Disposal of
Drugs and STAT Medication.
This manual is also designed to describe in detail the minimum expected standards required
both within the pharmacy and at the RACF or with community based patients.
Webstercare recommends you keep this document handy for easy reference.
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare - 2013
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Best Practice Procedures for Webster-pak® Multi Dose
Best Practice Procedures for Webster-pak Multi Dose and
Flexi-pak Webster-pak
Introduction to Webster-pak Multi Dose
Webster-pak Multi Dose is designed to reduce the possibility of error, and comply with
medication management regulations. In addition, Webster-pak meets duty of care
requirements when non-registered staff are responsible for the supervision or assistance in
administering medication at Residential Aged Care Facilities (RACFs) and other care centres.
Webster-paks can only be dispensed by a pharmacist or under the direct supervision of a
pharmacist and becomes the original dispensed container once packed.
Because of its simplicity and ease of use a Webster-pak can also allow residents to handle
their own medication easily, giving them greater independence as well as, serving as a
‘barometer’ of a person’s ability to self medicate. It is an auditable system of medication
management for use by both Registered Nurses and Non-Registered Carers.
Webster-paks are arranged in four columns across for the doses of the day and seven rows
down representing the seven days of the week. Webster-paks can be placed in a re-useable
plastic folder or disposable options are available.
Webster-pak containing one full week’s medication
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Best Practice Procedures for Webster-pak® Multi Dose
Introduction to Flexi-pak Webster-pak
The Flexi-pak folders are specially designed with opening flaps which allow medication to be
removed for a particular day or dosage time.
The perforated blisters, allow for the tearing off of sealed blister compartments for any
number of days or dosage times. This is ideal for residents who are more ambulant and
attend days out of the RACF as they only take to doses they require away with them.
Flexi-pak containing one full week’s medication
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Best Practice Procedures for Webster-pak® Multi Dose
Components
Folders
The side of the re-usable plastic folder is labelled with the days of the week: Monday at the
top of the pack, following through to Sunday at the bottom.
Colour Coding System
The folders are used in a colour coding system for different types of medication or dosage
schedules.
Blue
Pink
Orange
White
Yellow
Purple
Green
Mustard
Regular Weekly medication: Breakfast, Lunch, Dinner, Bedtime
Before Food medication
Special Drugs or Reducing Dose regimes
PRN ‘When Necessary’ medication
14 or 28 day dosages in one pack
Accountable medication
Antibiotic medication
Warfarin
The same colour coding is used for the Webster-pak Multi Dose and Flexi-pak systems.
Blisters
Webster-pak
• Four sizes available to accommodate different size medications
• Have 28 cavities, accommodating the seven days of the week and four different dosage
times per pack
Flexi-pak
• Three sizes available to accommodate different size medications
• Can be perforated or non-perforated
LoTemp Foil
Webster-pak
• Sealed onto the filled blister to keep the medications in place
• Printed through the Webstercare Medication Management Software with:
Clients’ Details
Drug names
Directions
Brief Description of pills
List of drugs per blister
‘Prescribed as’ information
• Attaches the header card to the blister
• Tamper evident
• Aids in medication stability
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Best Practice Procedures for Webster-pak® Multi Dose
Multi Dose Webster-pak foil
Flexi-pak
•
•
Same attributes as the Webster-pak Multi Dose foil
Each individual blister can be removed (using perforated blisters) if the resident is
going out for the day, making the medication more portable each blister is also printed
with:
Client name
Dosage time
Day
Contents
Header Card
Webster-pak
• Printed through the Webstercare Medication Management Software
• Records:
Resident Name
Resident Photo
Allergies
‘Also on’ medication (non-packed medication)
Flexi-pak
• Same attributes as the Webster-pak Multi Dose header card
• Z-Fold option
Double Ply Label
•
•
•
Pharmacy dispensing label
Used for labelling non-packed items
Top layer is removed for re-ordering non-packed items at the RACF
Moulded Folder Trays
Webster-pak
• Used to store the Webster-paks either in the medication trolley or in a cupboard
Flexi-pak
• Wider than the Webster-pak moulded folder tray to accommodate the wider Flexi-pak
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Best Practice Procedures for Webster-pak® Multi Dose
folders
Resident ID Divider – Multi Dose Webster-pak
•
•
•
•
•
Same product as the ‘Medications For’ Card with a different insert
Laser Resident ID Divider Insert printed from the Webstercare Software
To identify each resident
Used to divide each resident’s medication folders on the moulded folder tray
Records:
Resident Name
Resident Image
Allergies
Notes
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Best Practice Procedures for Webster-pak® Multi Dose
How the Webster-pak System works
Every week, the pharmacy packs the residents’ medication into Webster-pak Multi Dose
according to what the doctor has ordered on the medication chart.
Blister Pack
Medication for each dosage time is packed into blisters and sealed with the LoTemp foil. The
dose in each blister will be all the pills required for that dosage time.
For Webster-pak Flexi-pak, the pharmacy can use either perforated or non-perforated blisters
depending on the RACFs requirements.
Header Cards
Each blister pack has a header card attached when sealing on the foil. The header card is
labelled with the resident name, photo, pharmacy details and other required information.
The dosage time for administration (e.g. breakfast picture – pink square with rising sun) are
pre-printed onto the header card as a visual cue. Blank header cards can be used to print
special times through the Webstercare Medication Management Software.
Folders
The sealed blisters with header cards are placed in the correct coloured folder for each
medication type.
Moulded Folder Trays
Used to transport and store the folders both at the pharmacy and RACF.
Weekly Cycle
The pharmacy provides automatic changeover every week therefore, re-ordering of regular
weekly medication is not necessary.
The new supply is delivered from the pharmacy at least 24 hours before the previous supply
finishes. For this reason, the pharmacy will require two sets of folders, Resident ID Dividers
and Moulded Folder Trays.
Dosage Changes and New or Ceased Medication
Dosage changes and new medication is delivered to the RACF in separate folders, saving time
and reducing error.
For ceased medication the pack is returned to the pharmacy and a new pack sent with the
medication change made.
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Best Practice Procedures for Webster-pak® Multi Dose
PBS Dispensing, Prescriptions and Storage of Medication
The pharmacy will dispense the PBS prescriptions as normal prior to packing the medication in
weekly amounts. At the request of the resident, or the RACF, the pharmacy will retain the
balance of medication for each weekly supply.
Once the dispensing is complete, a record of the dispensed medication for each resident must
be maintained. This can be done through the use of MedsPro® Virtual Pill Count (VPC)™
System. A record of resident’s medications is retained in the software. If at any time a resident
requests their medications, the pharmacy has a record of their balance held on the resident’s
behalf and the pharmacy can supply at short notice.
Alternatively, Integrity bags can be used to store each resident’s medications with the
identification similar to “this medication is the property of………..”
The pharmacy will always know how much medication is left at any time and can advise when
prescriptions are due. Prescriptions can be signed or authorised according to the HIC
requirements.
Quality Assurance
Quality Assurance (QA) audits are carried out on a regular basis and a written report provided
for review and action. A Quality Assurance checklist is provided (at the end of this section) to
verify suggested processes are being followed, and identifying room for improvement. This
checklist has an incident report column where the need for corrective action can be identified.
The Pharmacy Checking Process
The minimum checking process recommended is a double check:
1. The pack is checked before sealing, by checking the contents of each blister against the
foil backing. This is done from the rear of the pack.
2. The sealed and labelled pack is then double-checked by a pharmacist from the front
against the master patient profile.
This back to front and front to back checking process removes the probability of human error.
The original dispensed packs are always available to verify the identity of the medications
packed.
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Best Practice Procedures for Webster-pak® Multi Dose
Special Medication Categories
PRNs (‘When Necessary’) medication, Antibiotics and S8 Medication can be handled in two
ways:
1. The medications are kept in the original dispensed manufacturer’s containers OR
2. The blister packs are placed in the colour coded folders.
This decision has to be made between the RACF and the pharmacy as to how these special
types of medication will be handled.
PRN (‘When Necessary’) Medication
‘When Necessary’ medication can be packed in 28 dose packs
and put into white folders.
‘When Necessary’ medication is administered as required up to
the prescribed limit and registered on the medication chart.
A full pack is prepared (all blister compartments) with one
specific PRN medication. Multiple folders may be required until
all medication is packed. For example: Panamax 500mg 100
tabs, 2 four times a day PRN, there would be 2 packs; one pack
of 28 and one of 22.
For Webster-pak Multi Dose, the foil backing does not need to
be labelled when only one drug is dispensed.
NOTE: For Webster-pak Flexi-pak, the foil backing does not need to be labelled when only one
drug is dispensed, unless, the resident requires the ability to tear off doses for outings.
Antibiotics
The full quantity of the antibiotic or short term medication is
packed into one or more packs with the dosage times set out by
times of the day and days of the week and placed into green
folders.
Long-Term Antibiotic medication is handled differently. Long
Term Antibiotic medication is packed in with regular dosage
times.
For Webster-pak Multi Dose, the foil backing does not need to
be labelled when only one drug is dispensed.
NOTE: For Webster-pak Flexi-pak, the foil backing is not labelled
when only one drug is dispensed, unless the resident requires
the ability to tear off doses for outings.
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Best Practice Procedures for Webster-pak® Multi Dose
Accountable Drugs
These may be dispensed into purple folders, recorded and
stored according to State regulations (if required). In all states
S8’s and S4d’s (NSW) need to be accounted for by the RACF at
the time of administration and securely stored.
Regular, accountable medication should be dispensed in the
full quantity into one or more packs with the dosage times set
out, four columns across for the doses of the day and seven
rows down representing the seven days of the week.
PRN, accountable medication should be dispensed in the full
quantity into one or more packs.
The purple folder is numbered from 28 (top-left) to 1
(bottom-right) therefore the full dispense quantity can be
packed in a standard format, whether requiring one or more folders. For example: for
Oxycontin 10mg 60 tabs, 1 PRN, there would be 3 packs; two of 28 and one of 4.
Dispensing the full quantity of medication and sending the complete set to the RACF makes
accounting for the medication more manageable.
NOTE: For Webster-pak Flexi-pak, the foil backing is not labelled when only one drug is
dispensed, unless the resident requires the ability to tear off doses for outings.
Warfarin Medication
Warfarin Medication can be dispensed into Mustard folders.
Due to the frequent dosage changes with Warfarin and its
narrow therapeutic margin it is easier to monitor the
medication when dispensed separately.
The different coloured folder will also alert to staff that this
medication requires additional attention.
The mustard colour is the same colour as the Warfarin
Medication Chart for consistency.
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Best Practice Procedures for Webster-pak® Multi Dose
14 Day or 28 Day Folders
If a resident is taking medication at only one or two dosage
times a day, these may be packed into 14 or 28 day packs. These
are packed into yellow folders to reduce the possibility of
confusion. They are labelled as 14 or 28 day packs on the front
label.
NB: These 14 and 28 day packs carry a risk of inadvertent error if
care staff does not check the dosage time at the top of the pack
and the label. If there is any risk of confusion they must not be
used.
Medication Round
Preparing for the Medication Round
The Registered Nurse or Carer:
• Selects the Folder Tray for the section
• Places other required items such as medication cups, jam etc in the trolley
• Selects the Medication Charts for administration
• Checks for S8/S4D medication or antibiotics to be administered at this time
• Takes the trolley on the medication round
Administering Medication
The Registered Nurse or Carer:
• Checks the name and photograph on the pack/s, to correctly identify the resident
• Selects the correct blister or blisters for the time of the day and the day of the week
• Pushes the blister through to expel the contents into a medication cup. This cup is then
given to the resident to take
• Checks for multiple folders of medication and administers these as well. Adequate
water is available and the carer stays with the resident until the medication is taken
• Checks the front label of the folder and the actual pack labels and/or medication chart
for any other medication that is required to be taken at this time. This is also
administered and supervised
HINT: To ensure medication has been administered it is good practice to remove the folder
from one tray and place it in another tray after administration or to turn it around or use some
other cue to ensure a resident’s medication is not missed.
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Best Practice Procedures for Webster-pak® Multi Dose
Signing for Administration
Care Worker Administration:
• The content of the blister or blisters is signed for after being administered
• The content is verified from the printed foil
• Any other medication administered is also signed for at this time
Registered Nurse Administration:
• Registered nurses verify each medication individually
• Each medication is signed for individually
• Identification is done using the MIMS description and drug identification listed on the
foil as well as on the medication chart or signing sheet
Resident not Present at Medication Round
The Registered Nurse or Carer:
• Leaves folder in tray or does not turn it around, whichever practice is used to ensure
medication is not missed
• Continues with the medication round until all residents are medicated
• Returns to administer the medication to the resident
If the resident is still not present, the RN or Carer writes the reason code on the medication
chart or signing sheet.
PRN (‘When Necessary’) Medication
The Registered Nurse or Carer:
• Locates the PRN Folders
• Selects the required resident’s PRN medication folder
• Administers the medication by placing the Pil-bob at the back of the pack and pressing
through until the medication has been released
• Then transfers the medication to a medication cup for administration
• Then signs the PRN medication chart with Date, Time, Quantity and Signature
Social Leave using Webster-pak Flexi-pak
The Registered Nurse or Carer:
• Locates the resident’s folder
• Removes from the folder the dose that the resident needs to take with them. For
example: Wednesday, Lunch
• Signs the medication chart with the Reason Code for Social Leave
• Gives the Flexi-pak blister to the resident for self medicating at the right time
NOTE: Medication is not pre-dispensed in advance of a medication round. Medication in the
packs is not tampered with or altered in any way. Any alterations (e.g. providing half tablets)
are only made by the pharmacist or pharmacy technician under the supervision of a
pharmacist, prior to the final sealing of the pack.
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Best Practice Procedures for Webster-pak® Multi Dose
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Best Practice Procedures for Webster-pak® Multi Dose
Quality Assurance for Multi Dose Webster-pak
and Webster-pak Flexi-pak
Pharmacy Procedures
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
YES
Prescriptions are available at the time of dispensing unless they are
urgent requests. These urgent requests are communicated directly by
the doctor in accordance with Pharmaceutical Benefits regulations.
The pharmacist dispenses the prescriptions according to the
Pharmaceutical Benefits Scheme regulations.
Original packs and bottles are labelled and stored on behalf of the
resident and used to supply the Webster-pak / Flexi-pak dispensed
pack.
Non-packed medication carries the normal pharmacy dispensing label.
Webster-pak / Flexi-pak is dispensed by a pharmacist or under the
direct supervision of a pharmacist according to State and
Commonwealth regulations.
Hard Copy Patient Profile forms are used by the pharmacist to record
and maintain information on the medication profile for each resident.
Along with the patient name and date, the pharmacist enters nonpacked medication, to be printed on the Header card.
Colour photographs of the resident are printed on the header card of
each pack.
Photographs can also be attached to the Webster-pak / Flexi-pak by
using the Webster-pak Photo ID sleeve.
A minimum double-checking procedure is used when preparing the
packs. Firstly from the back before sealing checking against the
printed foil and secondly, from the front after sealing, against the hard
copy.
Webster-paks / Flexi-paks are dispensed into colour coded folders as
defined by Webstercare.
The regular packs are packed into BLUE folders
‘When Necessary’ medication is packed in white folders and carries
the normal pharmacy dispensing label
Short term antibiotics are packed into green folders. The foil is not
labelled.
"Before food" medication is packed into pink folders and is labelled
‘before food’.
14 or 28 day packs are packed into yellow folders and are clearly
identified.
When more than one folder is supplied these are joined together by
means of a split ring. These multiple folders are labelled Pack 1 of 2,
Pack 2 of 2 etc.
Medication changes and new medication are sent by the pharmacy to
start at the next dosage time and to finish at the regular finishing time
of the folder or folders in use. In the case of an addition an extra
folder is sent. In the case of a change a new folder is sent and the
existing folder returned to the pharmacy.
Identical or indistinguishable drugs are dispensed in a separate pack.
Webster-pak folders are well maintained and are cleaned regularly.
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare - 2013
NO
Incident Report
(Corrective Action)
Required
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Best Practice Procedures for Webster-pak® Multi Dose
RACF Procedures
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
YES
NO
Incident Report
(Corrective Action)
Required
Residents are identified by name and photograph prior to
administration of medication.
Medication is expelled from the appropriate blister or blisters into a
medication cup and administered direct to the resident. Adequate
water is provided and the resident is supervised whilst taking the
medication.
If required, individual medication can be checked against the foil
backing label and the drug description.
The medication is not handled at any time.
Non-packed medication is checked and administered as appropriate
and supervised and charted on the non-packed signing sheet.
‘When Necessary’ medication is administered no more than the
maximum amount and charted on the ‘When Necessary’ signing card
attached to the `When Necessary’ folder.
Procedures that ensure any resident’s medication is not missed are in
place.
The pharmacist is informed if doses are missed or spilled and advice
followed.
Charts are used for medication and dosage documentation. These
charts are written by the doctors to record each resident’s medication
profile and any changes that may occur.
Green re-order sheets are used to request medication required in
advance.
Medication changes and new orders are communicated direct to the
pharmacist by the doctor or by means of the Medication Chart or
Pharmacy Order Form, or any other written chart/ form or
prescription completed in writing by the doctor.
The medication folders and trolley are kept in a secure, neat and tidy
fashion
Webster-pak / Flexi-pak folders are stored in Webster-pak / Flexi-pak
folder trays in the Webstercare trolley. Other medication not packed
is stored in the trolley. Multiple folders are linked together using a
split ring.
The medication trolley is kept locked when not in use or not attended.
All medication is kept in the locked trolley.
Discontinued medication is returned to the pharmacy to be disposed
of appropriately.
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Best Practice Procedures for Webster-pak® Multi Dose
Webstercare Communication and Stationery
Components
Communication
Green Pharmacy Order Sheet
• RACF staff record non-urgent medication for re-ordering
• Re-ordering is by either:
1. Sticking the top layer of the double-ply label on the Order Sheet for the item
that needs re-ordering (non-packed items) OR
2. Writing the order onto the order sheet
• Pharmacy pick-up when delivering daily order
White Pharmacy Faxed Order Sheet
• RACF staff record urgent medication orders
• Used for faxing urgent orders directly to the pharmacy
Yellow Return Sheet
• RACF staff attach to medication returned to the pharmacy
• Space for label and reason for return is provided
Medication Incident Response Form
• Pharmacy staff record an incident or use to respond to the RACF
• Used for continuous improvement
Stationery
Patient Medication Profile
• To record patient profile records
• Used as the hard copy profile for checking
Pharmacy Admission Notice
• RACF staff use to record resident’s details upon admission to the facility and send to
the pharmacy
S8 Delivery Driver Book
• Used for recording S8 drug deliveries to the RACF
• Signed by both pharmacy delivery driver and RACF staff
• One copy is kept at the RACF and the other copy for the pharmacy
Weekly Order Sheet
• Packing Technicians place the re-order labels on the Weekly Order Sheet
• Pharmacy Technicians dispense the ordered medication in time for next weeks packing
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Best Practice Procedures for Webster-pak® Multi Dose
Medication Administration Documentation
Medication Chart and/or signing sheets
• Used to record the medication that has been administered
• Used for Packed, Non-Packed, PRN, Nurse Initiated and Telephone orders
Communication with the Pharmacy
Re-ordering Medication
Re-ordering is not required for regular packed medication as this is delivered by the pharmacy
on a regular basis (weekly or fortnightly).
For Non-Packed Medication:
• When noticing that the liquid / inhalant / drops are getting low, peel off the double ply
re-order label
• Place onto the green Pharmacy Order Sheet
• Place the green Pharmacy Order Sheet with the other items for the pharmacy to pick
up
For PRN (‘When Necessary’) Medication:
• Write on the green Pharmacy Order Sheet, the resident’s name and medication
required
• Place the green Pharmacy Order Sheet with the other items for the pharmacy to pick
up
New Medication
When a new medication is ordered during the regular weekly cycle, only enough medication is
sent for that weekly cycle. Even if this means there is just a few tablets in the folder. The
new medication will automatically be included with the next full week’s medication.
This may be labelled “additional” medication or similar.
When the new order is written on the medication chart:
• Write the new order onto the white Pharmacy Faxed Order sheet
• Fax to the pharmacy with a copy of the relevant medication chart
• Place the prescription and white Pharmacy Faxed Order Sheet in the Pharmacy pick-up
tray for collection by pharmacy staff
When the new order is a telephone order:
• The RN writes the medication order onto the medication chart in the Telephone Orders
section recording doctor, medication, dosage, date
• Write the new order onto the white Pharmacy Faxed Order sheet
• Fax to the pharmacy with a copy of the relevant medication chart
• Place the Pharmacy Faxed Order Sheet in the Pharmacy pick-up tray for collection by
pharmacy staff
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Best Practice Procedures for Webster-pak® Multi Dose
When the new order is a faxed order:
• Write the new order onto the white Pharmacy Faxed Order sheet
• Fax to the pharmacy with a copy of the faxed medication chart
• Attach the faxed copy to the medication chart for recording administration
Dose Changes
Dose changes should always be forwarded to the pharmacy immediately so that repacking of
the packs can occur and pharmacy records are kept up to date. Failure to do this is likely to
result in medication error and medication wastage.
Communicate dosage changes by:
• Writing the request onto the white Pharmacy Faxed Order sheet
• Faxing this with the relevant medication chart to the pharmacy
The pharmacy will send up either a separate folder with the extra medication, starting at the
next dosage time and finishing at the end of the weekly cycle, or, a new folder, incorporating
the change of regular medication and also starting at the next dosage time.
Dropped or ‘Lost’ Medication
Any medication that is accidentally lost or dropped can be administered from the next day’s
medication dose. Once requested, the pharmacy will send up replacement medication in a
labelled vial or blister pack.
This may be labelled “replacement” medication or similar.
Communicate dropped or lost medications by:
• Phoning the Pharmacy
The pharmacy will always send up new medication supplies at least 24 hours before the
current supply runs out.
Ceased Medication and Dosage Changes
Communicate ceased medications by:
• Writing the information onto the white Pharmacy Faxed Order sheet
• Faxing this with the relevant medication chart to the pharmacy
Storage
In most cases the medication may be stored in a Webstercare trolley for the medication round
along with all the other non-packaged medication such as liquids, patches and eye drops etc.
Only the pharmafiles for the applicable dosage time need to be taken in the trolley for the
medication round, reducing weight. The other Pharmafiles can be stored in a locked
medication cupboard in the medication room, when not in use.
Contact Webstercare for trolley specifications and plans/proposed fit-out of suitable storage
cupboards for pharmafiles when not in use.
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Best Practice Procedures for Webster-pak® Multi Dose
Quality Processes
Quality Assurance
Quality Assurance (QA) audits are carried out on a regular basis and a written report provided
for review and action. In particular QA audits address adherence to State and Commonwealth
regulations, storage and labelling of drugs, medication administration practices, adherence to
these Best Practice guidelines and any other matters specified by the drug committee.
Packaging Material
Packaging material such as blisters and foil are disposable and not recommended for reuse.
Incident Reports
To aid in the continuous improvement process, Incident forms, can be used. This form is ideal
for reporting medication incidents, causes and suggested short and long-term corrective
action. A quality assurance checklist is provided (at the conclusion of each section in this
manual) to verify suggested processes are being followed, identifying room for improvement.
This checklist has an incident report column where the need for corrective action can be
identified.
Drug Committee
A pharmacist is involved in the Medication Advisory Committee (MAC) as described in APAC
Integrated Best Practice and provides the necessary reports, inputs and opinions as required.
The purpose of a drug committee is to determine policies and procedures to ensure optimal
medication usage.
Standards and Guidelines
Pharmacists are required to follow the directives of the relevant state pharmacy boards. Other
useful guidelines are contained in the Pharmaceutical Society of Australia, Pharmaceutical
Practice Guidelines, The Quality Care Pharmacy Practice Standards and the Australian
Pharmaceutical Advisory Council (APAC), Integrated Best Practice Guidelines for education
management in aged care facilities.
Disposal of Drugs
Any unused, discontinued or out of date medication is removed and disposed of in accordance
with State and Commonwealth regulations and in an environmentally safe manner.
Medication discontinued for a resident is kept for a short period of time in case it is
recommenced (say one week) and then disposed of.
Deliveries and After Hours Service
Depending on the contract between the pharmacy and the RACF the pharmacy may provide a
daily service for urgent items, new items, and new residents as well as general stock. The
majority of routine orders are delivered on a weekly basis at a time agreed or at a frequency
decided by both parties. Typically, an emergency number is available for after hour’s
emergencies.
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare - 2013
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Best Practice Procedures for Webster-pak® Multi Dose
Emergency ‘STAT BOX’
As Doctors may initiate treatment when the pharmacist may be
unavailable, a list of emergency items is determined by the prescribing
preferences of the visiting doctors and through the Medication
Advisory Committee (MAC) of the RACF.
A supply of emergency medication is kept, where allowable, in an
emergency STAT BOX or similar. STAT medication is to be kept in
original manufacturer's bottles and packs.
STAT Box for Emergency Medication
Procedures for STAT Medication at the RACF:
1. Identify the medication that you require
2. Remove from STAT box
3. Determine what you need to do with the medication (e.g. liquids)
4. If needing only one or two doses of medication (tabs / caps), remove only the required
amount until the resident’s Webster-pak arrives
5. Return balance of medication to the STAT box
When emergency stock is used the pharmacy is informed so that it can be replaced. The
emergency stock packs carry the re-order label and are labelled 'STAT'.
Education
In-service education is provided to all staff on implementation of the system. The pharmacist
accompanies the RACF staff on the initial medication rounds to ensure all staff begin to
become familiar with the systems and procedures. Regular in-service is provided to staff on
the policies and procedures involved in the smooth operation of the system.
General pharmaceutical education is provided on a regular basis and the Webstersystem
printed Consultant Pharmacy Service is provided monthly to all nursing staff. The
Webstercare website (www.webstercare.com.au) holds a library of continuing education
brochures distributed over the last several years.
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare - 2013
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Best Practice Procedures for Webster-pak® Multi Dose
APPENDIX A
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