Gop Didactic Training

GOP DIDACTIC TRAINING
DAY 1 LECTURE In times of need, you can count on us

Cause we are here to serve you
1. AM LECTURE We are here to take care of you
I. GOP Introduction Davao Doctors Hospital
a. VMG; DDH Jingle We care for life
b. DDH I-CARE We care for life
c. Nursing Organizational Chart We care for life
d. DDH Nursing Modalities & Function
e. Job Description II. Vision, Mision, and Core Values
f. Ward Routine A. DDH
g. Qualities of a Nurse 1. Vision - “Unparalleled health institution
h. DDH Look & Image Branding beyond borders.”
2. Mission
2. PM LECTURE a) To ensure excellent clinical
II. Emergency Room Admission outcomes
a. Admission Guidelines b) To nurture a culture of learning
b. Admission Process Flow and develop highly effective
c. Emergency Turn Around Time (TAT) healthcare professionals
d. … c) To provide clients with delightful
III. Admission of Patient in the Unit experiences
a. Preparing Admission Verifying Room d) To collaborate seamlessly with
Readiness Zoning Protocol stakeholders
b. Receiving Patient from ER e) To adhere to the highest
c. … standards of safety, quality, and
d. Nursing Phraseology excellence in service
B. Nursing Service
GOP Introduction 1. Vision - “The incomparable leader of
Lecturer: Wilven Jordan T. Romarate, RN, MAN, PhD exemplary nursing care.”
2. Mission
I. DDH JINGLE a) To consistently implement gold
Davao Doctors Hospital… standard in nursing
We give you care beyond compare b) To provide continuing
We’re helping you throughout these years professional development
We’re family. We’re like a home programs
You’ll never feel alone c) To deliver prompt, holistic and
Serving all the people compassionate care exceeding
With love and comfort client’s expectation
Our gentle hands, our special care d) To foster teamwork and
Echoes everywhere maintain harmonic relationship
Davao Doctors Hospital with the healthcare team
We care for you, we care for life e) To conform to the highest level
Davao Doctors Hospital of safety and error free nursing
In times of need, you can count on us practice
Cause we are here to serve you
We are here to take care of you C. Core Values (I 6P’s)
Davao Doctors Hospital 1. Integrity
We care for life 2. Client-centered
Davao Doctors Hospital 3. Culture of excellence
We give you care beyond compare 4. Climate of respect and professionalism
We’re helping you throughout these years 5. Creativity and innovation
We’re family. We’re like a home 6. Commitment to safety
You’ll never feel alone 7. Consistent synergy
From illness to wellness
To care for you is what we do best D. Golden Rules
Davao Doctors Hospital 1. Love your patient as you love yourself.
Because we care for life 2. Attend to your patients’ needs with
Davao Doctors Hospital genuine concern.
We care for you, we care for life 3. Be on time always.
Davao Doctors Hospital 4. Ask when in doubt.
Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

5. Listen to the wisdom of your ● 1st Floor/Ground Floor
colleagues. ○ Rowell V. Arandilla, RN - ED Dept.
6. Embrace the company’s policies and ○ Ma. Linda T. Solis, RN - Healing Well
procedures. Dept.
7. Have a “can-do” attitude. ● 2nd Floor
8. Perform your role with passion and ○ Krishna Grace A. Jordan, RN
sense of urgency. - 2A Department
9. Own and value your work. ○ Michaela Lyn B. Sumalinog, RN
10. Smile. It heals. - 2C Department
○ Marlo V. Palma Gil, RN
III. DDH I-CARE - ICU2/CCU Department
A. Core Values ○ Cherry C. Marimon, RN
I - am the client’s experience. This also - ICU1 Department
stands for the & core values of DDH ○ Jed Garret I. Calida, RN
(Integrity, Client-centered, Culture of - PICU Department
excellence, Climate of respect and ● 3rd Floor
professionalism, Creativity and innovation, ○ Sophia Camille N. Alminaza, RN
Commitment to safety, Consistent synergy) I - 3A Department
am the client’s experience. ○ Chez Madelleine Y. Canilao, RN
C - Client-centricity - 3C/3D Department
A - Assurance ○ Dan Timothy M. Abrantes, RN
R - Responsiveness - OR/PACU Department
E - Empathy ○ Maecelle D. Malupa, RN
- NICU Department
B. 3 Sufferings ○ Carolina A. America, RN
1. Due to diagnosis/symptoms - DR Department
2. Due to treatment ● 4th Floor and 5th Floor
3. Due to avoidable sufferings ○ Genie V. Antero, RN
- 4A/4B Department
IV. Nursing Organizational Chart ○ Ma. Christine S. Manzano, RN
- 4C Department
Nursing Management Team ○ Al-ain A. Telen, RN - 5A Department
● Director of Nursing Service: Maria Karina M. ● Oncology Area
Santos, RN, MAN, MBA ○ Novelita P. Dael, RN, MAN
● Asst. Director of Nursing Services: Jarilyn M. - ITU Department
Bastasa, RN, MAN
V. DDH Nursing Modalities & Function
Nursing Supervisors A. Skill Mix
Rotating Supervisors 1. Combination of different healthcare
● Rebella P. Claro, RN (Nursing Quality & Audit) staff with specific skills to deliver
● Dexter H. Hallarsis, RN (Nursing Engagement) effective patient care.
● Rhea Marie C. Tan, RN (5A Section Manager) 2. Having the right person with the right
● Resyl Mae A. Yamyamin, RN (Crash Cart & skills at the right time.
Policies and Protocol Auditor) 3. Advantages:
a) Address overworking of staff.
Room and Board Supervisor b) Higher staff job satisfaction.
● Maria Aurora Dolores S. Naraindas, RN, MAN c) Lower staff turnover.
(Section Manager for ICU1, ICU2, PICU, NICU, d) Delivery of safe, effective, and
4C, DR) quality care.
● Evelyn L. Garcia, RN - Section Manager, 2A, 2C, e) Nurses spend time on patient
3A, 3C, 3D, 4A education.
f) Increased staff time at the
Special Units and Training Nursing Supervision
bedside.
● Maria Karen M. Gannaban, RN, MAN
g) Improved patient outcome.
- OR-PACU/ Cath-Lab
h) Lower staff total cost.
● Maria Minerva J. Miguel, RN, MAN
- OPD-ED, Healing Well
4. Shifting Schedule:
● Wilven Jordan T. Romarate, RN, MAN, PhD
a) 7am - 3pm (AM)
- Nrg Training, Research, D&A
b) 3pm - 11pm (PM)
Head Nurse/Unit Managers c) 11pm - 7am (NOC)

E. Bedside Nursing Care
VI. Job Description 1. CBG, I&O, tube feeding, drains, ADL,
A. Unit Manager catheter care, suctioning procedure, pt
1. Monitors overall activities in the positioning, BT protocols, needle stick
department. injury
2. Department scheduling.
3. Coaching and monitoring staff VIII. Qualities of a Nurse
4. Annual personnel evaluation. A. Integrity
B. Bedside Nurse 1. Act responsibly and with honesty.
1. Receives endorsement using E-SBAR 2. Be consistent in words/actions.
format. 3. Honor commitments and promises.
2. Conducts rounds. 4. Seek and live truth.
3. Perform bedside nursing procedures. 5. Protect and respect the confidentiality
4. Medication administration. of information.
5. Documentation 6. Exercise accountability and accept the
C. Nursing Assistants consequences of an action.
1. Provides general help (VS, ADLs, B. Client-Centered
errands). 1. We selflessly set our client’s delightful
2. Sending specimens to the lab. experiences.
3. CBG monitoring. C. Culture of Excellence
D. Clinical Coder (CC) 1. Go extra mile to surpass our client’s
1. Provides clerical services. expectations in the quality and delivery
2. Carries out admission/ discharge of care.
orders. D. Climate of Respect and Professionalism
E. Clinical Pharmacist (CP) 1. Exercise trust and respect and
1. Review of Prescriptions (ROP). embrace the diversity of all individuals.
2. Scan/encode medications. 2. Full accountability.
3. Countercheck drug-to-drug E. Creativity and Innovation
interactions. 1. Explore and develop new and
4. Check complete and incomplete advanced ways that challenge the
prescriptions status quo to enhance quality of life.
5. Monitors prescribing errors F. Commitment to Safety
6. Antimicrobial Stewardship Program 1. Adhere to safety precautions.
(ASP) G. Consistent Synergy
1. Foster collaboration.
VII. Ward Routine
A. Endorsement IX. DDH Look and Image Branding
1. E-SBAR A. Uniform - all white
2. Update cardex before the outgoing B. Hair - neat bun, clean cut
endorsement. C. Jewelries - not allowed
3. Chart-to-chart D. Makeup - encouraged
4. Pay attention to: Food allergies, E. Attire - no wash day huhuhuhu
Hemodialysis access, Risk for fall,
AND/NHM Status
B. Quick Rounds Emergency Room Admission
1. Done immediately after endorsement. Lecturer: Maria Minerva J. Miguel, RN, MAN
2. Introduce
3. Initial assessment and Kamustahan I. Admission Guidelines
4. Initial IVF and inspection of IV site A. Requirements:
5. Documentation 1. CXR
C. IVF Rounds a) All pt for admission
1. Check IVF q2hrs (w/o incorporation), b) Initial is required
check IVF qhrly (w/ incorporation). c) Validity of CXR result is
2. Check the actual level. 7 days
3. Check from proximal to distal. 2. RAT
D. VS/NVS Taking a) Emergency surgery
1. BP - PR - RR - temp - pain - o2 b) Emergency deliveries
2. Frequency as ordered. c) intra-hospital
3. Relay unusualities. 3. RT-PCR
4. Perform independent nursing functions. a) Pt w/ fever, cough, sore

throat, dyspnea b. Covid (+)
b) Nause, anorexia, 2. STAT Dialysis
diarrhea a. STAT dialysis – in-patient
c) General weakness, b. STAT dialysis – ICU
fatigue, headache, 3. Critical Care Unit
myalgia a. PICU
d) Crackles upon b. ICU 1, ICU 2, CCU
auscultation, CXR 4. ITU
pneumonia, RAT a. Direct to room (surgery)
positive (+) b. Direct to DR
II. Admission Process Flow 5. STAT OR Surg/OB/Gyne
A. Triage - Respective Department, a. Routine OR Surg.OB/Gyne
Stabilization, Carrying Out of Orders - 6. Orthopedic
Exit to ER, Transport to Room a. Orphan (ENT, OPTHA, PLASTIC)
B. Triage
1. CTAS Level
a) CTAS 1&2 - E-Med
b) CTAS 3 - ROD Admission of Patients in the Unit
c) CTAS 4&5 - Junior Lecturer: Ma. Christin S. Manzano, RN
Consultant (OPD)
2. Assessment 1. Preparing for Admission; Verifying Room
a) Initial Impression Readiness; Zoning Protocol (Clean or
(1) A-irway Non-infectious and Unclean or Infectious)
(2) B-reathing
(3) C-irculation I. Receiving New Patient Admission from ED
3. Vital Signs Nurse.
a) Assess BP, PR, RR, ● Admitting associates will call the Nurse
O2, pain scale, temp Station for room assignment and Room
4. Canadian Triage and Acuity Attendant (RA) for incoming admission.
Scale (CTAS) ● Initial data and case - for proper patient
a) Level 1 - Resuscitation zoning
(shall be attended ○ Complete Name
immediately) ○ Age
b) Level 2 - Emergent ○ Attending Physician
(shall be attended ○ Initial Dx
within 15 mins) ○ Allergies
c) Level 3 - Urgent (shall
be attended within 30 II. Preparing Admission Set
mins) ● Prepared charts to receive admission
d) Level 4 - Less Urgent ○ Medication Administration
(can be attended within Sheet
60 mins) ○ VS sheet
e) Level 5 - Non Urgent ○ TPR sheet
(can be attended within ○ I & O monitoring sheet
120 mins) ○ IV Flow Sheet
C. Proceed to Respective Department ○ Doctor’s Order sheet
D. Carrying Out of Doctors Order ○ Nurses Bedside Notes
E. Handover of Patient to Floor/Room ● Door tags and patient directory tags
shall also be prepared. Name tag with
III. Emergency Room Turn Around Time (TAT) designated color coding:
A. Door to Triage ○ Green: Surgery, Neurosurgery &
B. Triage to Registration Orthopedics
C. Registration to Doctor’s Order done ○ Blue: OBGYN
D. Doctor’s Order done to Carry out ○ Pink: Pediatrics
E. Ready for Transfer ○ White: Internal Medicine
F. Transfer to Room ○ Red: EENT, Ophthalmology and
Otorhinolaryngology
Types of DDH Admission ○ Yellow: Service Care
1. RTI III. Counterchecking Room Readiness
a. Non-RTI ● Ensure materials

○ Infusion pumps
○ Feeding pumps I. Ensuring Comfortability of patient in the
○ O2 gauge Room
○ Defibrillators ● Check patient’s comfort
○ Machine pump ● Ask for other needs before leaving
○ Mechanical Vent ● Ensure side rails up
○ Pulse Oximeter ● Once everything is all secured, the BN
is now ready to receive the
IV. Zoning Protocols endorsement from the ED nurse
3. Receiving Admission Endorsement

2A IM clean, Trans out ICU pts., Semi-critical
● BN will receive endorsement from ED
dpt.
nurse
● Charge nurse may receive if BN is
2C IM clean and pneumonia cases, Trans out
unavailable
ICU pts., Semi-critical dpt.
I. Planning and Carrying Out Doctor’s Order
3A IM clean; OB; NB; Surgery
● BN formulate NCP according to their
illness/complaint
3C Surgery; OB; NB
● Nurses should also carry out the
medical orders
3D Surgery; OB; NB
4A Surgery; OB; NB; IM II. Implementing the Plan and Dr’s Orders
● The BN shall initiate implementation of
4B Surgery; OB; NB; IM med. Management by facilitating the
requirement for examination, treatment,
4C Pediatric; Trans out PICU; medication and referrals
● Charge nurse’s/Clinical coder’s
5A Non-covid; Non-critical surgery pts; OB; responsibilities:
NB; IM ○ Encoding the procedures…
○ For any STAT procedure the
5B Confirmed + COVID pts; F1 (Exposed to charge nurse/clinical coder shall
COVID patients) inform the concerned dept. by
phone of the STAT procedure
and shall take not of the
Onco ITU; Brachytherapy; Radiotherapy; expected time that the
Chemotherapy procedure may be performed
○ For the procedure requiring
ICU 1 CCU pts; Dirty/Unclean (UTI, pneumonia) special preparation (imaging w/
contrast, endoscopy, surg.)
ICU 2 CCU pts; Clean (Post-op, Kidney ○ The charge nurse/clinical coder
transplant) is responsible for confirming
with the involved dept for
NICU Critical NB; materials.
○ The charge nurse shall fill out
PICU Critical Pediatric pts. KARDEX form, containing the
pt’s date and pertinent
PACU Post Operative pts. Under monitoring post procedures.
anesthesia ○ The charge nurse shall endorse
all pending procedures to the
BN
2. Receiving New Patient Admission
● Upon arrival, greet and introduce to the patient III. Requesting of Medications
and watcher ● From 7AM-11PM, all initial doses shall
● BN accompany patient to room be charged/encoded by the clinical
● Acquire VS and asses pt’s condition once in the pharmacist
room ● NOC 11PM-7AM shift, care of nurse
● Orientation to ward admission and safety ● Medication orders shall then be
measures; including, how to use the call button transcribed in the MAR
to ask for help.

IV. Doctor’s Referral of Admission
● The resident physician shall be informed
of:
○ Pt’s name
○ Attending physician
○ Room No.
○ Chief complaint
○ Pertinent initial assessment
○ …
V. Diet Encoding
● Diet shall be encoded in HIS
● The Clinical Nutrition Dietary Services
(CNDS) shall be notified that the pt is in
the room
VI. Documentation on Admission

● The charge nurse shall:
○ Document the departmental pt’s
logbook
○ Fill-up the daily floor census
and the daily monitoring of the
patient’s admission time w/
pertinent details
○ Prepare a name tag in duplicate
containing the pt and
quadruplicate
■ Green: Surgery,
Neurosurgery &
Orthopedics
■ Blue: OBGYN
■ Pink: Pediatrics
■ White: Internal Medicine
■ Red: EENT,
Ophthalmology and
Otorhinolaryngology
■ Yellow: Service Care
VII. Attached to the FF:

● Patient’s chart
● …
VIII. BN Responsibilities
● BN Orientation
○ Pt’s rights and responsibilities
○ No. of allowable watchers
○ Use of watcher’s ID
○ Visiting hrs
○ Use of side rails
○ Use of crib
○ Exclusive purchase of supplies
and medication
○ Damaged linen and hospital
equipment property
V. Nursing Phraseology for Admission/

Orientation

DAY 2 LECTURE d. Informed Consent for IV Therapy
i. Usually done at ER, except for direct to
1. AM LECTURE room patients
I. Documentation
ii. No need for new consent if dislodged
2. PM LECTURE iii. Also can be used for CT Scan with
II. Carrying Out Doctor’s Orders contrast dye.
a. Basic Information
b. Complete Doctors Order e. Referral and Consultant Report
c. Transcribing Protocol i. Used by previous MD for the Consulting
d. Medication Protocol
Physician to be used
ii. CONSULTANT – written as “rounds
DOCUMENTATION with…”
Lecturer: Michaela Lyn B. Sumalinog, RN iii. DO NOT carry out orders written in this
form
I. HOSPITAL STANDARD FORMS
a. Emergency Room Nurses’ Bedside Notes f. No Heroic Measures (NHM) / Do Not
i. Allergies must be written in RED ballpen Resuscitate (DNR) Form
if present i. Signed by consenting person
ii. All procedures in ER are STAT ii. Should Not be left blanked; No erasures
iii. Big Four:
b. Adult Venous Thromboembolism (AVT) Risk 1. NO CPR
Assessment Tool 2. NO Intubation
i. Low Risk
1. Prophylaxis not required 3. NO Assisted Ventilation
2. Early mobilization 4. NO Defibrillation
3. Patient education iv. Renewed every 3 days (considered full
ii. Moderate Risk
code if not renewed)
1. Pharmacological option
v. No NHM at ICU!!!
2. OR Mechanical device
iii. High Risk g. Release from Responsibilities for Extubation
1. Pharmacological option i. Signed by consenting person to confirm
2. AND Mechanical device needed removal of intubation and life support
systems
Some forms must be renewed accordingly. h. Medication Administration Record

Example:
i. Records of all the medications of the pt.
● AVT - q5 days if WARD; q3 days if CRITICAL
ii. Do NOT write food allergies
iii. Not known allergies should still be
c. Consent for Referral written as NO KNOWN ALLERGIES
i. Used to refer patient to another iv. Recopied forms are placed on top
physician
ii. Physicians are not always accredited to i. IV Flow Sheet
HMO. i. If IV fluid did not finish when received at
iii. Make sure that referral is stated in DO WARD, write the time finished in ER
1. Consultation - 1 day service form then #2 on IV sheet
2. Co-management - same ii. If Blood Transfusion, use or write the
duration as main MD serial number.
3. Transfer of service - Referred
j. I&O Monitoring Stret
MD will start when Previous MD
transfers duty k. Morse Fall Risk Assessment Tool

i. Done every shift, admission, and ii. Food & Drug Allergies (RED Ink)
sensory changes (maybe associated iii. Date & Time
with fall). iv. Accurate Data & Assessment Records
v. Real-time Monitoring
l. Braden Scale vi. Problem Identified
i. If with pressure ulcer, different sheet will vii. Referral Notations
be used viii. Complete Name & Signature
ii. Done by AM shift only
III. Ballpens to be Used
m. VAP and Non-VAP Prevention Bundle a. Blue or Black - AM and or PM shift
i. Done every shift
b. Red - NOC
i. No Red Ballpen at carrying out orders!
n. Vital signs Sheet
ii. No using of pencil at Doctor’s Order
i. Done as needed / q4, q15, qh, etc.
IV. Bedside Nurse Problem Identification

o. TPR Graphing Sheet
a. Actual
b. Procedures
p. Neuro Vital Sign Sheet
c. Treatment
d. Outcomes/Remarks
q. CBG Monitoring Sheet
e. Time
i. Done 2 hours before and after meals
f. Problem
g. Interventions
r. Humpty Dumpty Scale
h. Evaluation
i. Fall risk scale for children
V. Significant Notation
s. Pressure Ulcer Scale for Healing (PUSH)
a. Blood Transfusion
i. if with a pressure ulcer.
i. Time BT Started
ii. Type of Blood
t. Release from Responsibility for Discharge
iii. Serial Number
i. for Home Against Medical Advice
iv. Transfusion Rate
(HAMA)
v. Due Time
vi. Level of Blood Components Received
u. Pre-op Checklist
b. Refusal
i. Can serve as guide for the contents of
i. Name of Drug
informed consent to medical and
ii. Dosage
surgical procedure
iii. Time
ii. BN will only fill out the “Floor Nurse”
iv. Reason of Patient
side
v. Let the patient/watcher write at the
doctor’s order to show legibility with
v. Informed Consent to Medical and Surgical
three signatures.
procedure
c. Bedside Care
i. Valid for only 24 hours
i. Transfer and Discharge Instructions
d. IV Reinsertion
w. Request For Transfer of Patient
V. Special Considerations
x. Request to Transfer to other Department
a. No advanced charting!
b. Use of rubber stamp
y. Nurses Bedside Notes
c. Use the word “ERROR” at the top of the barred
mistaked word or shall be written separately as
II. COMPLETENESS AND FILLING UP
an addendum (Ex. Mistake Error/Initials).
a. Standard Forms
d. No superimposition
i. Complete Headings
e. Should have accurate measurements.

f. Standard terminologies only.
D. Types of medication order
1. Single Dose - only once
2. STAT/NOW - immediate, w/in 30 mins.
3. PRN - as needed
CARRYING OUT DOCTOR’S ORDER
Lecturer: Wilven Jordan T. Romarate, RN, MAN, PhD
4. Standing - Routine, and up until the
ordering physician discontinues the
I. Basic Information medication
Forms:
● Kardex Medication Ticket
● Medication Administration Sheet ● White - Oral and PRN Oral Medication
● Doctor’s Order Sheet ● Blue - Parenteral, Intravenous,
Infusions/Injections, including PRN
II. Carrying Out Doctor’s Orders ● Pink - Treatment & PRN treatment, Nursing
1. Date and Time Ordered Procedures
2. Name, signature, and license of prescribing ○ Should be endorsed to the incoming
physician nurse unless otherwise the procedure is
3. Name of procedure: to include date, time & terminated or discontinued
other preparations needed ● Red - STAT & Single-dose ordered medicines
4. Complete headings ○ The ticket can be discarded after
5. Complete medication order carrying out.
a. Generic name ○ Ex. Diphenhydramine 50mg/amp, 1 amp
b. Brand name IVTT now; Tetanus toxoid injection/vial,
c. Dosage IM as a single dose
d. Route
e. Frequency E. Standard Entry for MAR
f. Parameters ● Indicate the actual time.
g. Dosage strength ● Actual number of meds (received from
pharmacy).
● Actual number of meds (received from
outgoing nurse).
F. Encoding
III. Transcribing Protocol ● Initial dose
A. Who can order? a) 1 day dose + 1 dose
● Attending physician ● Last Touch Policy
● Resident physician b) If the meds received is only 1, it
● Postgraduate intern (PGI) is the outgoing nurse’s
responsibility to refill.
B. 5 steps in carrying out doctor’s order
1. Check the order for completeness. G. Discontinued Medicines
2. Scan the doctor’s order sheet. ● Indicate the date and the time the
3. Encode in HIS. medicine was discontinued.
4. Transcribe in the MAR and/or ● Put two diagonal bars covering the
CARDEX. spaces use by medication.
5. Sign, countersign, and endorse to the H. Revision of Medicines
bedside nurse. ● (...)
C. Points to remember: I. Single VS. STAT
● Carry out orders within 30 minutes after ● Single - once only
the physician signs. ● STAT - now
● Verify from the ordering physician if in
doubt. J. Parameters
● Use trodat to indicate name and license ● Specific Duration
number. ○ Complete 5 days of
● Carried-out orders must be Azithromycin (Zenth) 500mg/tab
counterchecked and countersigned. 1 tablet PO once daily
● Always indicate the actual time and date ● Specific Number of Doses
the order was carried out. ○ Kalium durule 10meq/durule 2
● If in doubt, always ask. durules PO BID for 3 doses

● Shifting/Discontinue for the medicine to be requested.
○ Give last dose of IV
Azithromycin then shift to B. Out of Stock
500mg/tab PO OD ● The charge staff will inform the ordering
○ Dynastat 40mg/vial, 1 vial IVTT, physician of the unavailability and
IVTT Q12 x 3 doses then inform him/her of the proposed
discontinue alternative
● Conditional ● If amenable: the physician shall then
○ For persistent increase in order to use alternative brand name
BP>160/100, Start Nicardipine before the request is processed by the
Drip In-patient Pharmacy
○ For restlessness, may start ● If not amenable: The preferred drug
Precedex Drip shall be acquired by following the local
purchase process.
K. Comprehensive Dangerous Drug Act ● If part of the DDH formulary: The local
● Yellow prescription (DBB Form No. purchase may proceed without the
1-72) according to RA 9165 known as approval of the Medical Director
Comprehensive Dangerous Act of 2002,
as amended.
● Local Purchase Request Form and
In-patient Prescription -(Provide a
DDH STANDARD TIMING
triplicate copy of the in-patient Rx)
● Very Restricted Antimicrobial (VRA)
DAILY 8 AM
Form
- this form must be accomplished by the
BID 8 AM - 6 PM
resident-in-charge and signed the IDS
consultant
TID 8 AM - 2 PM - 8 PM
-After it is completed, scan this form and
forward to clinical pharmacy
QID 8 AM - 12 NN - 4 PM - 8 PM
● Beyond Seven Days (BSD) Form
EVERY (Q4, Q6, Q8, Q12, Q24, etc.) - this form must be accomplished by the
will depend on the start of initial resident-in-charge and signed the IDS
medication consultant
-After it is completed, scan this form and
PRN No specific timing forward to clinical pharmacy
shall be given as the need arises
STAT Shall be given within 30 minutes

from the time of order
PRE-MEALS Daily: 5 AM
BID: 2 AM - 5 PM
TID: 5 AM - 11 AM - 5 PM
POST MEALS Shall be given after the patient has

taken meals
HS At hours of sleep
9 PM
IV. Medication Concerns

A. If doubtful, incomplete, non-legible,
incorrect:
● Inform - the prescribing/ordering
physician of the concern
● Re-order- the prescribing/ordering
physician will be the one to re-order it
● Re-scan- The new validated order
should be re-scanned and sent to CP

ABBREVIATIONS VRA Very Restricted Antimicrobial Form
ADLs Activities of Daily Living BSD Beyond Seven Days Form
AND Allow Natural Death DEU Designated Educational Unit
ASP Antimicrobial Stewardship Program HIS Hospital Information System
BN Bedside Nurse HIMS Hospital Information Management

System
CTAS Canadian Triage and Acuity Scale
IDC Independent Double Checking
CBG Capillary Blood Glucose
CM Credit Memo
CXR Chest X-Ray
VTE Venous Thromboembolism
CNDS Clinical Nutrition Dietary Services
SUNS Surgical Update Notification System
CP Clinical Pharmacist
CDC Cardiac Diagnostic Center
E-SBAR Electronic Situation Background
Assessment Recommendation IPP In-Patient Pharmacy
HIS Hospital Information System CSS Central Sterile Supply
HGT Hemoglucotest AHCP After Hospital Care Plan
ITU In-patient Therapeutic Unit EMS Emergency Medical Service
NHM No Heroic Measures CPAP Continuous Positive Airway Pressure
NA Nursing Assistant BIPAP Bilevel Positive Airway Pressure
OPD Outpatient Department PEEP Positive End-Expiratory Pressure
PTG Patient Transfer Group IOL Intraocular Lens
RAT Rapid Antigen Testing OCT Optical coherence tomography
ROD Resident on Duty RRS Renal Replacement Center
RT-PCR Reverse Transcription Polymerase CPT Chest Physiotherapy

Chain Reaction Test
CCM Cold Chain Management
ROP Review of Prescriptions
UDDS Unit Dose Dispensing System
TAT Turn Around Time
IDC Independent Double Checking
UN Unit Manager
ACI Accredited Canada International
VAP Ventilator Associated Pneumonia
HAM High Alert Medication
VIP Visual Infusion Phlebitis
PGI Post Graduate Interns


DAY 3 LECTURE 10. Assess the degree of the
patient’s understanding of the
1. AM LECTURE discharge plan.
I. Discharge Process 11. Expedite transmission of the
a. Discharge Process Flow discharge summary to clinicians
b. Credit Memo accepting care of the patient.
c. Discharge Checklist 12. Provide telephone
d. Turn Around Time For Discharging reinforcement of the discharge
Patients plan.
e. After Hospital Care Plan (AHCP)
f. Home Against Medical Advice (HAMA) C. Who decides if a patient is
g. Transfer To Other Facility discharged?
h. Use of Ambulance ● Attending Physician
2. PM LECTURE D. No Conditional Doctor’s Order

II. Handover Process 1. Discharge after AP’s rounds
a. Standard Form 2. Discharge if the result of the
b. Handover Using Cardex pending procedure is normal
c. Handover using E-SBAR 3. Discharge tomorrow
II. CREDIT MEMO

DISCHARGE PROCESS
Lecturer: Sophia Camille N. Alminaza, RN ● All unused medications and
discontinued medications and supplies
I. DISCHARGE PROCESS FLOW shall be returned properly and
A. Hospital Discharge immediately to In-Patient Pharmacy
● The point at which the patient (IPP) and Central Sterile Supply (CSS)
leaves the hospital and either to preserve their integrity and make it
returns home or is transferred to ready for another patient’s use.
another facility.
● Involves medical instruction A. When To:
● A service that considers the a. May Go Home, HAMA, Transfer
patient’s needs after the to Another Facility
hospital stay. b. Discontinued Order
c. Change in Doctor’s Order
B. 12 Components (Increase/Decrease in dosage)
1. Ascertain the need for and d. Expired Patient
obtain language assistance.
2. Make appointments for follow B. In-Patient Pharmacy
up care. (e.g., medical a. Schedule: 5am-12am
appointments and post b. Except for the following:
discharge tests/lab) i. Expired patient
3. Plan for the follow-up of results ii. Transfer to another
from tests or labs that are facility
pending at discharge.
4. Organize post discharge C. CSS CM
outpatient services and medical a. Schedule: 24 hours
equipment.
5. Identify the correct medicines D. Guidelines
and a plan for the patient to a. All non formulary medicines and
obtain them. loose tablets should not be
6. Reconcile the discharge plan returned.
with the national guidelines. b. Medicines that use cold chain
7. Create a written discharge plan management should be placed
the patient can understand. inside a cool box.
8. Educate the patient about c. The medicines, when verified
his/her diagnosis and against the HIS, should bear the
medicines. same brand, dosage, and
9. Review with the patient what to strength.
do if a problem arises. d. The number of items encoded
Transcribed by: (Angga, C., Armas, A., Babao, L. & Bantique, B.)
for return should be equal to the ● CM accepted by the pharmacist
actual number of items on hand. ● CM accepted by CSS
e. All items should be returned in ● Unused medicine has to be
good condition, intact, with no returned
tears or lacerations in the ● Cancel procedures that have
packaging. not been performed
● Take home medicines
III. DISCHARGE CHECKLIST completed
● Headings shall be filled up by ● Encode PF of doctors
the bedside nurse. ● Final Diagnosis
● Ensure all data entries shall be ● Procedures with PHIC
completely filled in with actual Coverage
time stamps and the signature ● Complete Philhealth CF4
of the discharging nurse. ● Take home medicines with
● Tick the box appropriate for the contact person
discharge disposition. ● Post charges finalized
● Finish by completing the date ● VTE compliance
and time of the MGH order and ● Lab products returned
the actual discharge form.
● Document also the number of STEP 2: BILLING COMPUTATION
compiled charting based on the ● After sending the final bill from
Nurse’s Bedside Notes. the nursing portal to billing
section
A. Documenting Discharge Patients ● Billing computation shall ensure
a. After discharging the patient in ○ Finalization of the
the unit, document in the hospital charges
following: ○ Philhealth deduction
i. Discharge Logbook ○ HMO coverage
ii. 24 hours Daily Floor ● After finalization of the patient’s
Census Report bill, the SOA will be sent back to
the nurse
Note: You have to completely ● Printed Statement of Account
fill in the required data needed shall be given as soon as
for documentation. possible to the patients watcher
● TAT for the discharge for processing their bill
process payment.
● Time of actual
discharge STEP 3: BILL SETTLEMENT
● Discharge diagnosis ● A printed SOA shall be given by
the bedside nurse to the
IV. TURN AROUND TIME FOR DISCHARGING watcher.
PATIENTS ● The watcher shall proceed to
the cashier to process their bill
A. Turn Around Time For The Discharge settlement.
Process ● The watcher shall secure a
a. Final MGH Order discharge clearance and shall
b. Carrying Out Doctor’s Order- 30 hand it back to the bedside
minutes nurse to facilitate actual
c. Billing Computation- 60 minutes discharge.
d. Bill Settlement- 60 minutes
e. Acute Discharge- 30 minutes STEP 4: ACTUAL PATIENT
f. Discharged DISCHARGE
● Once the clearance is secured,
Total Discharge Time: 3 HOURS contact the Housekeeping
Quality Supervisor to initiate
STEP 1: CARRYING OUT DOCTOR’S room checking.
ORDER ● Once cleared, the bedside
Completing nursing tasks in the HIS nurse will contact a member of
(Procedures shall be prepared ahead of the Patient Transport Group to
time) assist the patient and watcher
to discharge. possible outcomes of HAMA.
● Signed discharge clearance ● Obtains a written informed consent after
shall be signed by the QS. explanation and orders for HAMA request.
Discharge clearance from the ● Clinical coder or charge nurse shall follow the
QS is sent back to the bedside discharge process after HAMA is made.
nurse with actual time. ● The patient should sign 3 signatures in the
● QS signals discharge in HIS. Doctors Order.
TRANSFER TO OTHER FACILITY

AFTER HOSPITAL CARE PLAN (AHCP) ● When the patient decides to be transferred to
● Discharge plan of the cause of treatment to be other facility.
given to the patient and used by the patient after ● A written order should be given by the attending
leaving the hospital. physician or resident in charge for the transfer of
● It should be easily understood. the patient.
● The supervisor on duty must also be informed!
Process ● Follow the same steps with discharge process
1. After receipt of the discharge clearance is And note that the patient wants to be transferred
secured, the IRC shall facilitate giving the to other facility.
discharge instructions.
2. The RIC & bedside nurse discuss the AHCP Documents to Prepare
contents with the patient and watcher. ● Transfer to other facility data sheet
3. After giving teh discharge instructions, RIC ● Waiver of patient transfer to other hospital
should have printed documents signed by the ● Data of patient transfer to other hodpital
patient and watcher. ● Photocopy of laboratory
4. The bedside nurse countersigns and verifies the ● Clinical summary - additional
correctness of entries on the AHCP.
5. One copy of the printed document will be given ➔ Headings
to the patient/watcher and the other copy to the ➔ ROD fills up pertinent data
bedside nurse. ➔ Should be a duplicate copy
➔ The original copy is for the receiving facility
AHCP Contents ➔ The duplicated copy is for the patient chart.
1. CLINICAL IMPRESSION
2. DISCHARGE MEDICATIONS Transfer Within Davao
3. HEALTH TEACHING & OUT-PATIENT FOLLOW ● The patient will be escorted by the resident
UP physician if DDH ambulance will be used.
● There will be no escort if third party [car] is used
Discharge Medications for transfer.
1. Generic and Brand Names
2. Strength/Preparation Outside Davao
3. Dosage ● The DDH will not provide a healthcare provider
4. Frequency to escort the patient.
5. Route ● The resident physician will only make telephone
6. Duration endorsement to the facility.
7. Quantity - total number of medications needed ● The family will be the one to make necessary
to complete the treatment. reservations.
AHCP Health Teaching USE OF AMBULANCE

1. SPECIAL INSTRUCTIONS ● The transportation of patient from DDH outside
2. ACTIVITIES destination.
3. DIETARY INSTRUCTIONS ○ HAMA = No ambulance!
○ Diagnostic Treatment Procedures
HOME AGAINST MEDICAL ADVICE (HAMA) (Ambulance)
● When the patient decides to leave the hospital ■ Comprehensive Oncloogy
against the decision of the Attending Physician. Center
● Intention to go home AMA, the nurse or CC ■ Renal Replacement Center
informs the Resident Physician. ■ Infusion Unit
● Nurse or CC furnishes a copy of RELEASE ● Does not cater to other hospitals inter-facility
FROM RESPONSIBILITY FOR DISCHARGE transfer.
FORM to the Resident Physician. ● Does not cater to emergency cases due to lack
● Resident P. explains the medical risks and of EMS.
C. Handover Responsibilities
IN-PATIENT USE OF AMBULANCE Bedside Nurse to Bedside Nurse
● The patient will be accompanied by the resident
physician. Outgoing Nurse:
● Patient with mechanical ventilator shall be Before Endorsement
accompanied by a pulmonary technician. 1. Shall ensure to close all charts prior to
endorsement
How to avail? 2. Shall ensure and countercheck all
● Inform Ambulance personnel documentation was duly signed
● Nurse gets a trip ticket 3. Make sure that all the orders within the shift
● Give the trip ticket to the watcher and pay at were carried out, transcribed, encoded, and
billing. performed
○ PHP 100 minimum ambulance service 4. Shall perform a final chart review of the handled
rate (outpatient) patient’s chart for any pending tasks and
documentation
HANDOVER PROCESS During Endorsement

Lecturer: Al- Ain A.Telen, RN 1. Shall endorse all pertinent data to the incoming
nurse.
I. Standard Form 2. Shall back read doctor’s order within 48 hours
as part of the endorsement.
A. Handover Objectives 3. Shall perform comparative endorsement.
● Provide patient-quality care Ensuring all pertinent data was transcribed
● Improved better communication correctly to the different nursing standard forms.
● Improve implementation of nursing care 4. Shall follow the standard flow of endorsement of
● Ensure doctor’s queries and patients the contents of the patient chart.
needs are addressed properly and
promptly After Endorsement
According to Flinders University, a Handover 1. Quick Rounds
requires a nurse to: 2. Bid goodbye to the patient.
● Communicate objectively, appropriately, 3. Update all information boards and Directory
and concisely with other health
professionals; D. Basic Flow
● Understand and use medical or nursing 1. Cardex
terminology 2. Doctor’s Order Sheet
● Interpret charts and other documents 3. Medication Administration Record Sheet
● (Write up?) patient observations, and 4. Vital Signs Sheet
understand clinical procedures. 5. TPR Graphing Sheet
6. I & O Monitoring Sheet
B. Endorsement Flow 7. IV Flow Sheet
1. Start 8. Nurse’s Bedside Notes
2. Prayer
3. Census E. Handover Reminders
4. Patient-patient Endorsement All Patients must be assigned to all Bedside Nurse
5. Quick rounds ● Using a chart is requisite during the
6. End of endorsement entire endorsement process
● While the first nurse on duty (NOD)
● Before the handover, the nurse must receives his/her endorsement, the other
ensure that the tabulation of the NODs may review their assigned
departmental census report has been patient’s charts, do the medicine stock
done inventory, and prepare the earlier due
● The nurse shall read the entries from dose
the end-of-shift report of the ● Back reading of the doctor's order must
departmental census to the incoming begin 48 hours prior to the latest order.
nurse ● Comparative endorsement must be
● This census report logs all the activities done for newly ordered medicine to
in the department in terms of patient ensure complete transcription to
movement from admission to discharge medication administration record.
in the unit. Nursing Assistant
Shall endorse and performs the following:
●VS, CBG, I & O monitoring ● Blood typing
●Patients who need extra care like ● Compatibility
changing diapers, ambulation, or enteral ● No. of blood transfused
feedings
● Inventory of IME, Departmental assets, Procedures
crash carts ● Accounting clearance
● For completion of unfinished errands ● Consent
like NF medicine, CM, borrowed ● In-charge informed/aware
supplies, and post charges. ● Preparation (NPO, bowel prep)
Reminder!
In absence of the clinical coders and nursing O2 Support
assistants, the bedside nurse shall perform their ● Room air
role. ● Liter per minute
● Set up
II. Handover Using Cardex ● Weaning
● For ABG
a. Attending Physician
● Consent Others
● RIC informed/aware ● Room reservation
● Encoded to system ● Out of order machines
● HMO accredited ● Send-out specimen
● House/Private case ● For local purchase
b. Laboratories Procedure
● Encoded/to encode Important Qualities During Endorsement
● To be performed 1. Communication
● Pending result 2. Punctuality
● Result released (referred) 3. Conscientiousness
c. Monitoring 4. Comprehensiveness
● VS, NVS, CBG Frequency
● Abnormal - Referred to III. Handover Using E-SBAR
● Weight, abd. Girth, pain scale Situation
d. Patient Safety ● Diagnosis
● Fall Tool Assessment ● Current issues
● History of Fall Background
● Signages ● Medical history
● Previous Labs and Treatment
e. IV Fluids ● Psychosocial Issues
● On-going IVF ● Allergies
● IVF rate, level, number ● Code Status
● Side drip, cycle number ● Physical Assessment
● IVF to follow ● VS
● IV site and due ● Line Set
● IV Drips
f. Diet ● Assessment Ventilator Settings
● Allergies (labeled) Assessment
● Progression (To inform) ● Drains
● Religion ● Tubes
● Restriction ● Diet
● ADL’s
g. Contrapments ● Restrictions
● Drains (FC, colostomy, IJ, cystoclysis) ● Wound Assessment and Care
● Laboratories
h. Machines ● Response to Treatment & Care
● Cardiac monitor ● Family Updates
● Pulse ox Recommendations
● Telemetry ● Plan of Care
● Needs to be Attended
Blood Products ● Pending Orders
● Type of blood ● Discharge Planning
● # of available units or to secure ● Issues
● Barriers review the contents carefully during the
endorsement
A. Charge Nurse/Coder 5. If found erroneous, it must be corrected
● The charge nurse/ clinical coder sheet log in to immediately. The correct order must be
the HMS application and shall do patient followed and transcribed accordingly.
assignments for the incoming nurse 6. The findings shall be reported to the
● The distribution of patient assignments shall be charge nurse, unit manager, or to the
based on the patient acuity score supervisor on duty for documentation
● The charge nurse/ clinical coder shall ensure and filling in the OFIRS
that the patient is equally distributed to the
incoming nurse D. From the doctor’s order sheet where to compare:
● Once the patient is equally distributed, the ● Medication Order- MAR sheet
electronic SBAR shall be printed ● Vital Sign Order- Vital sign sheet/ TPR graphing
● The printed SBAR shall be handed over to the Sheet
incoming Bedside Nurse based on the ● I & O monitoring- Cardex/ I & O monitoring
distribution and patient assignment sheet
● The E-SBAR tool shall be used during handover. ● CBG monitoring- CBG monitoring sheet/ cardex
● Referral and co-management- Cardex
B. Bedside Nurse ● Special Endorsement- Cardex
● Bedside nurse shall use the printed E-SBAR
upon receiving the handover from the outgoing E. Special Endorsement
nurse ● Special endorsements are important and
● Even if the contents of the E-SBAR were pertinent data that need to be communicated to
electronically provided, it is the responsibility all healthcare teams
also of the BN to update through writing the ● This is special information to take note from the
important information that was not included in original data entries inputted in the Cardex
the print-outs during the handover. ● This information is part of the special
● During endorsement, important notations on the considerations and precautions in managing the
E-SBAR shall be documented and shall be care of the patient
taken into account for continuity of patient care. ● Some special endorsement include those
● The Bedside Nurse shall maximize the utilization ordered by the resident physician or attending
of the E-SBAR tool throughout his/her shift. physician that needs to be carried out before
● All new orders and bedside tasks shall be patient discharge
written in this tool to have a visual reminder for
completion. 1. The nurse shall transcribe all special
● The bedside nurse can also use colored pens or endorsements at the back portion of the Cardex
highlighters to put emphasis on the important 2. ALL significant information shall be endorsed to
task that needs to be accomplished and marked the incoming nurse
with high emphasis. 3. There should be an emphasis on special
● As much as possible, it is recommended that the endorsement during handover. Such as but not
E-SBAR shall be the only tool used for the limited to:
documentation of handover to avoid confusion “No BP taking at left/right arm”
and lost of data information. “Save left/right arm for AVF creation”
● At the end of the shift, the used E-SBAR shall “No blood extraction at left/right arm”
be compiled in the departmental folder for future “Suicide precaution”
reference. “Seizure precaution”
● The E-SBAR shall not be discarded and thrown, “Elevate left/right leg”
it should be filed accordingly. “Provide a complete photocopy of all laboratory
results prior to discharge”
C. Comparative Endorsement
1. The nurse shall compare the written E. Quick Rounds
orders if it is correctly transcribed in the 1. After the chart-to-chart endorsement in the
nursing standard forms nurse station the outgoing nurse together with
2. After reading the doctor’s order, the the incoming nurse shall perform quick rounds
nurse must have to look into the to all the patients endorsed
transcribed order and check for its 2. The outgoing nurse shall bring with them a
correctness whiteboard marker and an eraser to be used for
3. The nurse must see to it that the orders updating the patient information board
are carried out accordingly. 3. This also allows the outgoing nurse to finalize
4. The outgoing and incoming nurse shall his/her tasks of the shift to formally bid goodbye
to his/her patients and to formally introduce the II. Food allergy
incoming nurse who will be in charge of these III. Other Special Reminders
patients
H. Door Tags Color Coding
F. What to do during quick rounds ● Blue- OB-GYNE
1. Introduction ● White- IM
● Inform the patient that your shift has ● Green- Surgery/ Ortho
ended and you will be handling over the ● Pink- Pedia
care to the incoming nurse ● Red- EENT
● Introduce the name of the incoming ● Yellow- Service Case
nurse
2. Assessment ➢ Door tags shall be coordinated with the posted
● Quickly assess the status of the patient APs name in the patient directory found in the
and simple “kamustahan” with the nurse’s station.
patient. Ask the patient about his/her ➢ This shall also be updated following the same
current state color coding whenever there are changes in the
● Perform an environmental assessment members of the patient’s care team.
including safety measures
3. Orientation
● Inform the patient of the plan of care of I. Door Signage (DRUG AND FOOD ALLERGY)
the day. Update the Patient Information ❖ Drug allergy
Board ❖ Food allergy
● Orient the patient on the pending ❖ Food & Drug Allergy
laboratories and diagnostic procedures
that are to be done within the day II. Door Signage (FALL PREVENTION)
(including the preparations needed) and ❖ Low Risk
other significant information ❖ Moderate Risk
4. IV rounds ❖ High Risk
● Initially assess the IV status of the
patient (IV level, rate and etc.) III. Door Signage (ISOLATION PRECAUTION)
● Check for the IV site of the patient ❖ Droplet Precaution (red)
following the standards of VIP scoring ❖ Standard Precaution (yellow)
● Ensure that the IV site is examined from ❖ Airborne Precaution (green)
proximal to distal ends. ❖ Protective Precaution (black)
5. Outroduction ❖ Contact Precaution (blue)
● The outgoing nurse shall bid goodbye to
the patient IV. Door Signage (OTHER IMPORTANT
● The incoming nurse shall inform the REMINDERS)
patient that he/she shall be back after ❖ Visitors allowed
the quick round to administer the due ❖ Complete Bed Rest
medicines and bedside care. ❖ No BLood Taking at Left/Right Arm
❖ No Blood Extraction at Right/Left Arm
G. After receiving endorsement and during quick
rounds, the nurse shall: VIII. Use of patient information Board
1. Countercheck if the door signages and door ● The Patient Information Board shall be updated
tags were hung outside the patient’s room during quick rounds.
2. Make sure also, to presentably hang the door ● This will serve as a visual reminder for the
signage outside the patient’s door patient and the watcher of the transitions of the
3. Door Tags shall also be checked and updated care team and their activities for the day.
from time to time. ● White Board Markers shall be used in updating
I. No patient’s name shall be posted on the information boards.
the doors of the patient only the ● No permanent markers shall be used
attending Physician’s name shall be ● The name of the nurse shall be changed during
posted for identification. quick rounds as the outgoing nurse will
II. Names of APs shall be updated every introduce the name of the incoming nurse.
time there are additional members or ● Procedures shall be deleted once it is done and
changes in the care team shall only leave the procedure that is still to be
4. The hung Door Signages shall coincide with the done.
received endorsement: ● Make sure that the information of the patient will
I. Fall prevention be erased once the patient is discharged or
transferred to another department
● Leave no marks or information on the patient
information boards in preparation for receiving
new patients for admission
DAY 4 LECTURE has already been
requested ℅ nurse
1. AM LECTURE ii. NOD to print CP
I. Hospital Information System findings
a. Encoding
iii. If with CP findings and
b. Scheduling
c. Entering data ordering doctor insists
d. Reference to administer the
medications, NDO to let
2. PM LECTURE physician order and
II. Carrying Out Doctor’s Orders acknowledge the CP
a. Basic Information
findings form
b. Complete Doctors Order
c. Transcribing Protocol b. Clinical Pharmacy
d. Medication Protocol i. Checks the medication
profile
ii. Checks and sends the
HOSPITAL INFORMATION SYSTEM CP findings
Lecturer: Genie V. Antero, RN 5. In-Patient Pharmacy
a. Pharmacy will process encoded
I. ENCODING
meds and will pack items
a. EXAMPLES
requested as unit dosing
i. Medications, Supplies
6. Nurse Station
ii. Procedures, post-charges, packages
a. NOD performs independent
iii. Credit Memo
double checking (IDC),
iv. Record Usage
administers medication with
v. Height and Weight
patient verification and
utilization of the handheld
b. MEDICATIONS
device
i. Unit Dose Dispensing System (UDDS)
7. END
ii. From when the order was given until
meds are given to patient
iii. Three DDH Pharmacy
1. Clinical Pharmacy
2. In-patient Pharmacy
3. Compounding Pharmacy
iv. Flow (scanning, requesting, unit dosing,
barcoding)
1. NOD, CN, CC
2. Doctor’s Order
3. Weekdays/Weekends (7AM -11PM)
a. Clinical Pharmacy
i. Checks medication
profile
ii. Request first dose
medications
iii. Sends and checks CP
findings
iv. Relays to ordering
c. ACTIONS TAKEN ON NON-CONFORMING OF
physician for every
UDDS
finding
i. Overriding of quantity encoded
4. Weekdays/Weekends (11PM -7AM)
ii. Monthly IRs
a. Nurse Station
i. NOD to encode meds
ordered, noting ordered
Transcribed by: Dayap, D.F.; Curambao, N.K.

URGENCY GUIDELINES (Encoding of Medicine ● Ultrasound
Protocol): ● MRI
● MEDICATIONS [...]
○ First dose – 1 day dose + 1 ● POST-CHARGES
○ New admission – 1 day dose + 1 ○ Access the nursing HIS then click the
○ Routine – 1 day dose patient access. Select “Charges” then
○ STAT - immediate dose “Post Charges”
■ encode only the needed dose ○ Select a procedures
for the STAT order ○ Make sure to tas as “tag as done” and
“finalize”
● ROUTINE MEDICATIONS
○ Access the nursing HIS then click the ● PACKAGES
patient access. Select “Medication” then ○ OB – set of cost/inclusions of maternity
“Request medicine from pharmacy” or birthing suites
○ Add the new medications and adjust the ○ Service Care – Surgery, IM, Pediatrics
quantity. Select the type of urgency and ○ Gen. Surgery
finalize the request. ○ HMO Surgical Package
■ 1334 – Lap Chole Priv
● SUPPLIES ■ 1333 – Lap Chole Shared
○ Access the nursing HIS then click the ■ 1330 – HMO modified radical
patient access. Select “Supplies” then mastectomy (IRM) Priv
[…] ■ 1329 – HMO modified radical
○ Add the needed supplies and adjust the mastectomy (IRM) Shared
quantity. Select the type of urgency and ■ 1328 – Thyroidectomy Priv
finalize the request. ■ 1327 – Thyroidectomy Shared
○ Press “click”
● PROCEDURES ○ Print 2 copies by clicking “Print CS”
○ Access the nursing HIS then click the
patient access. Select “Procedures” ● CREDIT MEMO
then “Order Procedure” ○ When:
○ Click “department” then add the ■ MGH
procedure. Select the type of urgency ■ Expired
and finalize the request. ■ Transferred to another facility
○ LIST OF LAB DEPARTMENTS WITH ■ Shifted
PROCEDURES ■ Discontinued
■ Cancer Center ■ Hold
■ Cardiac Diagnostics Center ■ Others
■ Center for Women ○ Not allowed:
■ EEG ■ Loose items
■ Endoscopy Unit and Liver ■ Mask
Center ■ Working gloves
■ Eye Center ■ Bed pan
■ Laboratory In-Patient and Send ■ Urinal
Out ■ Thermometer
■ Medical ■ Liquid
■ Nuclear Medication ■ Not sealed/Broken seal
■ Nursing ○ Check item’s integrity before doing a
■ Ortho-Rehab credit memo
■ Pulmonary
■ Radiology ● RECORD USAGE
● XRay
● CT Scan

○ adjust and update the used medications iii. Set date, shift, assign patient and set
and supplies vs stock on hand of the the desired acuity
meds or supplies.
○ encoded to patient’s account c. VTE
i. Formation of blood clots in the vein
● HEIGHT & WEIGHT
○ Done in ER IV. REFERENCE
○ If not, handled by the BN a. SUNS
i. Surgical Update Notification System
II. SCHEDULING ii. a notification system that will
a. EXAMPLES periodically update a patient’s family
i. OR Online Scheduling through SMS
ii. RRC (Renal Replacement Center)
Online Scheduling b. E-NURSING MANUAL
iii. Registration (Discharge Laboratories i. Reference for diagnostic, medical, and
and Procedures) bedside procedures
b. OR Online Scheduling
i. Doctor’s Order of the operation
ii. Encode to nursing HIS and b approved
by the billing CLINICAL AND PHARMACOLOGICAL
iii. Inform OR personnel POLICIES
iv. Schedule at “OR Scheduling” Lecturer: Roland Arana, RRT (Senior manager of L&D)
c. RRC (Renal Replacement Center) Online
I. DEPARTMENTS IN LABORATORY AND
Scheduling DIAGNOSTICS
i. Hemodialysis prescription order from a. LABORATORY
the doctors b. IMAGING
ii. Encode to nursing HIS and be approved i. Radiology
by the billing ii. Radiation Oncology
iii. Inform RRC personnel iii. Nuclear Med
iv. OB ultrasound
iv. Encode at RRC Scheduling portal
c. AMBULATORY SERVICES
(under nursing portal) i. Cardiac diagnostic center
d. Registration (Discharge laboratories and ii. Liver unit and endoscopy center
procedures) iii. Pulmonary Unit
i. Doctor’s Order iv. Eye center
ii. Nursing HIS (Encode under registration) v. Orthopedic EEG Spine and
iii. Print (handover to patient with AHCP) Rehabilitation Center
II. PULMONARY UNIT

III. ENTERING DATA a. SERVICES
a. E-SBAR i. ABG
i. Access HIMS (Hospital Information ii. Pulmonary Function Test
Management System) iii. Pulmonary Rehabilitation
ii. Click “E-SBAR” then choose the next iv. Chest Physiotherapy
v. Nebulization
shift. Te outgoing nurse must choose
vi. Incentive spirometry
the patients they handled vii. Lung Flute
viii. Mechanical ventilator
b. PATIENT ACUITY SCALE (Low, Moderate, ix. Transport ventilator
High) x. CPAP
Optimize patient care by providing equal distribution of xi. BIPAP
patient assignment among the department xii. High Flow therapy
b. CARDIAC DIAGNOSTIC CENTER
i. Go to the HIMS
i. EEG
ii. Click “Nursing” then “Patient Acuity ii. 2D echocardiogram
Tool” iii. Vascular

iv. Cardiac Rehabilitation injury are common complications
v. Tilt Table associated with mechanical ventilation,
vi. Stress test echo especially when ventilation gets
vii. Holter monitoring prolonged. Nurses play an important
c. ENDOSCOPY AND LIVER CENTER role in avoiding such complications.
i. Colonoscopy They are responsible to practice
ii. Endoscopy infection control techniques including
iii. Fibroscan oral care, proper positioning and
iv. Bronchoscopy encourage CPT (chest physiotherapy).
d. EYE CENTER v. Nurses communication and
i. Mini OR for injections therapeutic collaboration - mechanical involves a
ii. IOL master biometry multidisciplinary approach where nurses
iii. Laser are at the forefront to collaborate with
iv. Perimetry physicians and RTs to accurately judge
v. OCT (Optical coherence tomography) the progress of patients and adjust the
vi. Fluorescence Angiography settings of the ventilator accordingly.
e. ORTHO EEG SPINE vi. Weaning and extubation - the decision
i. Consultation of weaning a patient off ventilation
ii. Basic procedures: ortho facility is totally dependent on the
1. Dressing observation and recommendation of the
2. Removal of sutures nurses. Skilled nursing assistance
3. Removal of cast during extubation also reduces
iii. PHIC Coverable Procedures expected complications.
1. Steroid injection/Arthrocentesis
2. Removal of implant b. BASIC PARAMETERS OF MECHANICAL
3. Closed reduction VENTILATOR
4. Casting i. Mode (AC, SIMV, SPONT)
5. Tendon sheath incision ii. Tidal Volume
6. Incision and draining iii. Respiratory Rate
7. Excision biopsy iv. I:E Ratio (i: inhalation e: exhalation)
v. Fio2 (21% normal inhalation)
III. MECHANICAL VENTILATOR vi. PEEP
a. WHAT ARE THE MECHANICAL VENTILATOR vii. Alarm (low alarm) - disconnected
NURSING RESPONSIBILITIES viii. Alarm (high alarm) - obstruction
i. Monitor ventilator settings and
patient responses - one of the basic NOTE: by checking the alarm, always assess first
responsibilities of the nursing staff the patient - tubings - machine.
taking care of the ventilated patients is
to regularly monitor the settings of the IV. PULMONARY UNIT: O2 Therapy and Aerosol
machine and the responses of the Therapy (Nebulization)
patients. This involves deeply observing
different parameters like BP, HR, and OXYGEN THERAPY
most importantly O2 sat. a. Definition
ii. Assessment of airways and ● Is the administration of oxygen
breathing - nurses are assumed to concentration greater than that in the
examine sounds coming out of the lungs room air to treat or prevent hypoxemia
of patients, expansion of airways and b. Purpose
breathing patterns as a whole. They ● Is to increase O2 sat in tissues where
must be eligible to identify any signal of the saturation levels are too low due to
respiratory discomfort. illness or injury.
iii. Suctioning and airway management - c. Indication
airway management is crucial to provide i. Documented hypoxemia
proper ventilation and avoid aspiration. ii. Severe trauma
Nurses are responsible to clear one iii. Acute MI
secretion from the airway of the iv. Short term therapy (eg. post anesthesia)
ventilated patients and prevent v. Increased metabolic demands (eg.
accumulation of unnecessary mucus severe infections)
that hinder breathing. d. 3 Clinical Goals
iv. Managing ventilator associated i. Treat hypoxemia
complications - pneumonia and lung ii. Decrease work of breathing

iii. Decrease myocardial work
Green 60% 15 lpm
e. O2 Delivery System
i. Low Flow
1. Nasal Cannula 2. Tracheostomy Collar/Mask
a. Flow rate: 1-6Lpm 3. T-PC
b. FiO2: 24-44%
c. 1 - 24%
d. 2 - 28%
e. 3 - 32%
f. 4 - 36%
g. 5 - 40%
h. 6 - 44%
● Advantages:
○ Inexpensive
○ Well tolerated
○ Easy to eat, drink
● Disadvantages:
○ Pressure sores
○ Drying of mucosa f. Pediatric Oxygen Delivery System
○ Epistaxis i. Hazards and Complications of O2
2. Simple Face Mask therapy
a. Flow rate: 5-10 Lpm 1. Oxygen toxicity
b. FiO2: 35-60% 2. Oxygen-induced hypoventilation
● Advantages: 3. Absorption atelectasis
○ Lightweight 4. Retinopathy
○ Easy to apply 5. Drying of mucous membrane
○ Inexpensive
● Disadvantages: AEROSOL THERAPY (NEBULIZATION)
○ Uncomfortable a. Definition
○ Must be removed for ● A suspension of very fine liquid or solid
eating, drinking particles in a gas
3. Partial Rebreather Mask ● Key to aerosol therapy is the aerosol
a. Flow rate: 6-10 Lpm particles
b. FiO2: 35-70% ○ Respirable ranges: 1-5 micron
● Advantages ○ 80% drugs deposited in
○ Deliver higher FiO2 oropharynx
○ Exhaled oxygen is ○ 10% in walls of inhaler
conserved ○ 10% in the lungs
● Disadvantages b. Aim
○ Insufficient flow rate ● To deliver a therapeutic dose of the
may lead to rebreathing selected agents to the desired site of
of CO2 action
4. Non-rebreathing Mask
a. Flow rate: 6-10 Lpm c. Delivery System
b. FiO2: 35-80% i. MDI - metered dose inhaler
ii. High Flow ii. DPI - dry powder inhaler
1. Venturi Mask ● Requires patient’s own
inspiratory effort
COLOR FiO2 O2 Flow ● Powder is delivered when
patient inhales
Blue 24% 2 lpm ● Advantages:
○ Lightweight
White 28% 4 lpm ○ No hand breath
coordination
Orange 31% 6 lpm ○ Quick to delivery of
drugs
Yellow 35% 8 lpm ● Disadvantages
○ Requires high
Red 40% 10 lpm inspiratory flow >
28L/min
iii. Nebulizer

● Advantages:
○ Useful in children,
handicapped and
seriously ill pts.
○ Ventilated patients
○ High dose and
combination drugs can
be used.
○ Enhancement of
secretions
○ Sputum induction
○ Humidification
● Disadvantages
○ Delivery of
contaminated aerosol
○ Tubing condensation
● Drugs for Nebulization
○ Normal saline
○ Mucolytics:
N-Acetylcysteine
○ Beta 2 agonist:
Salbutamol
○ Anticholinergic:
Ipratropium
○ Corticosteroid:
Budesonide
Radiation Oncology
Services
1. Consultation and Evaluation
2. Treatment and Planning
3. External Beam Radiotherapy (Tomotherapy)

DAY 5 LECTURE
c. Patient Verification
1. AM LECTURE ● A name band shall be applied for all in-patients
I. Client Verification ● Patients for admission in the ED must be
II. Do Not Use Abbreviations provided a name band after proper/correct
III. Telephone and Verbal Orders patient identification, as written in the patient’s
IV. Referral Process System datasheet, asking the patient to state their
V. Telephone Etiquette complete name and date of birth and verifying
VI. Effective Communication identity against a valid identification card
VII. Nursing Phraseology ● For Delivery Room (DR) admission for newborn
VIII. 8 Moments of Patient Rounding babies, the name band shall be initially placed by
2. PM LECTURE the DR nurse immediately after delivery.
IX. Topic ● Each baby must have his/her own 2 sets of
name bands:
○ The newborn baby’s name shall be
COMMUNICATION/PATIENT SAFETY applied to the baby’s ankle and to the
Lecturer: Maria Aurora Dolores S. Naraindas, RN, MAN wrist
○ The other for the mother..
I. CLIENT VERIFICATION ● The patient shall be educated on the importance
- The process that organizations use to of placing a name band on his/her name. He
validate an individual’s information and /she shall:
identity………. - Report to the nurse on duty if in case the
- Shall be done in all………. name band is accidentally removed or
has fallen off
a. Purpose of Client Verification - Be reissued a name band
● To establish an explicit protocol on the - Be asked for the two patient identifiers
primary responsibility of the healthcare consistently for every procedure that will
team for checking and verifying the be done to him/her
patient’s identity
● To ensure that the right patient receives ● There shall only be one name band that will be
the right care worn by the patient
● If the patient is both at risk for falls and has drug
and food allergies as well, the patient shall only
b. Patient Verifiers wear the RED colored name band to signify the
● Name of the Patient (full name: Last risk
name, first, and middle name) ● The health care team shall have to consult the
● Age patient’s chart to establish the type of name band
● Birth Date being indicated
● Room numbered for ● The hospital staff shall ask the patient or
● Hospital Number patient’s responsible party for the correct
● Attending Physician identification of the patient using the two–patient
identifiers before medication administration or
➔ When to use patient verification any procedure
● Doing bedside care
● Medication administration - If the patient is incoherent or
● Performing procedures unconscious, the healthcare provider
shall ask for the patient’s identification
➔ Need in the following circumstances through the patient’s responsible party
● Upon admission - However, for patients in the care units,
● Transfer to another hospital patient identification is through the
● Inter-departmental transfer patient’s name band and shall be
● Handover/endorsement compared with the patient’s chart
● Drug administration
● Blood component administration ● Patient who refuses to wear a name despite of
clear explanation of the risks of not doing so
➔ OTHERS ● This refusal shall be documented in the nurses’
Patient identity must be verified when notes. The nurse shall have the patient affix
scheduling, checking in, registering, admitting a his/her signature on the doctors’ order sheet of
patient for service, and when responding to the said refusal
patient ● The patient shall write in the doctor’s order sheet
in his/her own dialect of synch refusal and 11. If the physician is not able to sign the
reason. This shall be included in the order within 24 hours, the order shall be
handover/endorsement procedure considered true and correct
II. DO NOT USE ABBREVIATION b. Verbal/telephone orders will not be

accepted for the following categories of
● Davao Doctors hospital (DDH) ensures patient physician orders:
safety by ensuring that unsafe abbreviations,
symbols, and dose designations are not being 1. Physical Restraints
used in the organization 2. Starting Patient Controlled Analgesia
● All forms of the patient-specific communications (PCA)
including printed, electronic, or handwritten 3. Starting Narcotic or Scheduled
materials shall refer to the ‘Do Not Use list’ in Medications
order to reduce and avoid medication errors 4. Initiating Total Parenteral Nutrition (TPN)
pertaining to abbreviation and shorthand therapy
notations such as acronyms and symbols 5. Category of Care - allow Natural Death
(AND) Code Status
III. TELEPHONE AND VERBAL ORDERS 6. Withdrawal of Life Support
7. Chemotherapy treatment
a. Guidelines for safe practices involving verbal 8. Heparin weight-based orders
and telephone communication 9. Opioid orders
1. Only Attending Physicians of the patients 10. Post-operative order
may give verbal/telephone orders.
2. Resident physicians, Postgraduate b. Verbal Orders at the Emergency
interns, and clerks are not allowed to Department
give verbal/telephone order 1. Only the resident physician assigned in
3. Only the charge nurse or registered the Emergency department (ED) may
nurse directly involved in the care of the give verbal orders. Postgraduate Interns
patient is allowed to receive and senior Clerks are not allowed to do
verbal/telephone orders so.
4. The nurse shall write the complete 2. Verbal communication for medication
verbal/telephone orders on the Doctor's orders shall be restricted to emergency
order sheet. Writing the verbal/telephone situations in which direct written or
orders on a small sheet of paper is electronic communications is less likely
STRICTLY PROHIBITED! 3. The Resident Physician shall enunciate
5. The Receiving nurse must “READ verbal orders clearly
BACK” the order in its entirety and 4. The Charge Nurse shall write down the
“VERIFY” the order given by the complete order in the Nurse's Notes,
ordering physician encode into a computer, read it back,
6. The ordering physician must CONFIRM and receive confirmation form the
the correctness of the order that was resident’s Physician who gave the order.
read back
7. The verbal/telephone order must be IV. REFERRAL PROCESS SYSTEM
dated, and timed, and shall include the
name of the ordering physician and the ● When to refer
name and signature of the person taking ● How to refer
the order ● What to refer
8. Verbal/telephone orders relating to ● Urgency in referral
medications shall include the drug name,
dosage, route, frequency, and, if a. Referral Process Flow
applicable, indication for PRN use and
duration 1. NOD has a referral to make.
9. The letters TO for telephone orders or 2. NOD to contact resident (all calls within 5
VO for verbal orders must be written mins)
prior to the name of the ordering a. 1st call
physician to indicate the manner of b. 2nd call
ordering c. 3rd call
10. The Ordering Physician shall sign the 3. NOD to call the supervisor on duty.
telephone order within 24 hours or 4. Nursing supervisor to give feedback to
before leaving the area if verbal order the department. (feedback can be: to call
the AP or was able contact the resident.) ● Communication Advantages
Note: NOD must have all the details when referring to ● Increases productivity
the doctor, such as, lab result, observations on pt., etc., ● Reduces stress
● Provides an avenue for better
THERE IS NO LIMIT IN REFERRAL, AS LONG AS understanding of what the other is trying
YOU ASSESS THE NEED FOR SPECIFIC to say
INFORMATION TO BE REFERRED. THEN REFER IT ● Gets your message across
ACCORDINGLY!!!! ● Enhances relationships
● Saves time and money
V. TELEPHONE ETIQUETTE ● Information is communicated between
health-care team members for purposes
a. Standard Procedure in answering telephone of:
calls either incoming or outgoing call either - Making Clinical decisions
incoming or outgoing call - Planning treatments
➢ Phone etiquette is the way you present - Performing interventions
yourself and your business to customers
and coworkers through telephone Note: The patient and family are the most important
communication. This includes the way members of the health-care team!!!
you greet a customer, your body
language, tone of voice, word choice,
and how you close a call OVERVIEW
➢ Etiquette also involves how you listen to ● Miscommunication is the leading root cause of
others when discussing professional sentinel events
topics. You might use this form of ● Poor communication between patients, nurses,
etiquette when interacting with customer and the interdisciplinary team greatly affects the
coworking with others within your healthcare process
organization ● Communication failures have been linked to the
majority of both malpractice claims and major
b. Standard Procedure in answering telephone patient safety violations, including errors
calls either incoming or outgoing call: resulting in patient death
1. Greetings ● Effective communication enhances patient
2. State your name satisfaction, health outcomes, and adhere to
3. Department treatment
4. Spiel
2 Types of Communication
VI. EFFECTIVE COMMUNICATION - Verbal Communication
- Non-verbal Communication
- COMMUNICATION is the exchange and flow of
information and ideas from one person to ● Verbal Communication
another - Oral Communication
- It involves a sender transmitting an idea to a - Spoken Words
receiver - F2f Conversation
- Keep it short and simple (KISS)
● What is Communication?
- To express oneself in such a way that Verbal communication is divided into:
one is readily and clearly understood ● Oral Communication - spoken words are used
- The effective sharing or transmission of - Includes face-to-face conversations,
facts, opinions or emotions by two or speech, telephone conversation, vide,
more people radio, television or voice over the internet
- Communication is influenced by pitch,
● Magnitude of the Problem volume, speed, and clarity of speaking
● 1 person dies every 5-10 minutes due to
harmful events in hospital Advantages:
● 70% of these events are the result of a - It brings quick feedback
breakdown in communication - In a face-to-face conversation, by reading facial
● Here breakdowns occur: expression and body language one can guess
- Between patients and healthcare whether he/she should trust what’s being said or
providers not
- Between healthcare providers
Disadvantage:
- In a face to face discussion, the user is unable to - Filtering
deeply think about what he/she is delivering, so - Information Overload
this can be counted as a fault - Poor listening and retention
● Written communication- written signs or How to Overcome:

symbols are used to communicate - Send a crystal clear message
- Messages can be transmitted via email, - Focus on the receiver
letter, report, memo, etc. - Use multiple channels to communication instead
- Is the most common form of of relying one channel
communication being used in business - Ensure appropriate feedback…
Advantages:
- Message can be edited and revised 6 Reasons to Communicate more Effectively:
- Provide record and backup 1. Better understanding
- A written message enables the receiver to fully 2. Faster Solution
understand it and send appropriate feedback 3. Conflict management
4. Clear focus
Disadvantage: 5. More Job Satisfaction
- Doesn’t bring instant feedback. It takes more 6. Better results
time to compose a written message as compared
to word-of-mouth and a number of people
struggle for writing ability. VII. NURSING PHRASEOLOGY
- Universal language used when communicating
● Non-verbal Communication- defined as the with your patients, family, or the watchers
sending or receiving of wordless messages, such - Make sure to be courteous when responding to
as, but not limited to gesture, body language, queries
posture, tone of voice, or facial expressions - Establish a good channel of communication
- Ensure that you are able to provide information
3 Elements: to your patient’s/watcher’s inquiry
- Appearance (Clothing, hairstyle, - Do not answer sarcastically
neatness, room size, lighting, - Make sure to offer assistance or direct the
decorations, furnishing) concern that will give the patient or the watcher
- Body Language (Facial expression, the appropriate information
gestures, posture) - Do not ignore concerns. Allow time to provide
- Sounds (Voice tone, volume, speech necessary information that could be of help to
rate) your patient and watcher
- Learn how to communicate nicely. As much as
Levels of Communication possible assist concerns and lead them properly
- Intrapersonal Communication - Know the basics of effective communication.
- Interpersonal Communication Establish rapport and connection
- Small Group Communication
- One-to-group Communication VIII. 8 MOMENTS OF PATIENT ROUNDING
- Mass Communication 1. Using of opening keyword to reduce anxiety
2. Performing scheduled task appropriately
Barriers of Effective Communication 3. Addressing patient’s 3 Ps ( Pain, Position, Potty)
- Language- the choice of word or language in 4. Addressing additional comfort needs
which a sender encodes a message will 5. Conducting environmental assessment
influence the quality of communication. 6. Asking questions for concerns prior to leaving
- Misreading of body language, tone, and other 7. Informing the patient when you will be back
non-verbal forms of communication 8. Documenting the rounds on the patient’s chart
- Noisy transmission- leading to unreliable relay of
messages and inconsistency
- Receiver distortion
- Interpersonal Relationship- how we perceive
communication is affected by past
experiences…..
CLINICAL PHARMACY DEPARTMENT
- Hurriedness Lecturer: Zela Gen M. Biboso, RPh
- Inappropriate eye contact
- Emotions
- Technology
- Noise
● Generic Name
● Brand Name
● Dosage Strength
● Dosage Form
● Dose
● Route of Administration
● Frequency
JOB SUMMARY ● PRN Indication
● Responsible in providing the correct information
to physicians, nurses, and other allied healthcare
professionals including but not limited to drug 1. Nurse scans all the Medication Order
information, review of medication orders, 2. CP shall request for 1st dose, single dose,
monitoring of patient medications, review of compounding med, and change in dose, brand,
prescriptions, and monitoring of Antimicrobial and route.
Stewardship Program (AFP). Nurse shall request STAT orders (1st dose only),
IV fluids, IV Chemotherapeutic medicines, enteral
DDH Review of Prescription Process nutrition, materials for dressing and supplies, and
radiocontrast agents.
1. DOCTOR 3. All request for medicines will be sent to IPP
● Prescribed new medication for the
patient Note:
2. NURSE 7am-11pm: CP shall request for first dose and
● Scanned the Doctor’s Order and sent to medications above mentioned
the Clinical Pharmacy 11pm-7am: Encoding and requesting of first doses of
3. CLINICAL PHARMACIST medicines shall be done by Nurse In Charge or NOD.
● Review and encode med orders
according to the standard and protocols. The following are items that will not be requested by
● Adhere to Safe Medication Practice the CP:
4. DISPENSING PHARMACIST
● Follows Unit Dose Dispensing System 1. IV Chemotherapeutic Medicines
2. IV Fluids
Review of Prescription (ROP) 3. Materials for dressing
The Clinical Pharmacist reviews all prescriptions or 4. Supplies
medication orders for accuracy and appropriateness: 5. STAT request
● Completeness 6. Radiocontrast agents
● Drug Interaction 7. Enteral nutrition
● Drug Duplication
● Contraindication (Allergies) The nurse shall screen prescriptions and/or med orders
● Recalculation of Doses (Pediatric Patients) for validity and completeness prior to scanning for CP
review and medicine request.
✓ Evaluates the Doctor

CHECKS FOR COMPLETENESS AND CORRECTNESS ✓ Verifies the order if uneven, illegible, or ambiguous
OF MEDICATION ORDERS ✓ Double check for completeness
● Ensure medication orders adhere to the ✓ Confirm the Patient Case Record for the patient name,
standards birthday, and history of allergies
✓ Checks for the name and signature of the prescribing
COMPLETE MEDICATION ORDER doctor
● Generic Name ✓ If there is no discrepancy in the order, carries out the
● Brand Name (Optional) order
● Dosage Strength
● Dosage Form If the doctor’s order/medication order is
● Dose INCOMPLETE or INCORRECT
● Route 1. Clinical Pharmacy will inform Nurse/Coder and
● Frequency ask to reorder
● PRN Indications (For PRN Meds) 2. Nurse/Coder will inform the ROD
3. ROD will reorder or complete discrepancy
Doctor’s Order Sheet should have: 4. Nurse/Coder will scan the complete order
● Headings
● Doctor’s Sign
WARD-BASED CP purchased outside the IPP.
● Review patient’s charts and check for any
inconsistencies ● ClinPharm will inform the NOD/Coder if the
ordered medication is NF. Prepare the necessary
● Check for any missed dose-MAR
documents to facilitate local purchase.
● Suggested timings by the CPs- Drug Interactions ● Documents to prepare:
● Review the accuracy of the dose with relation to ○ NF Form
the patient’s lab results (weight, renal and liver ○ Pink prescription
function)
● Answer queries from physician, nurses, allied ANTIMICROBIAL STEWARDSHIP
healthcare professionals, and patients
● Review of newly ordered/prescribed medicines Very Restricted Restricted Antimicrobial
prior to scanning for ROP Antimicrobial (VRA)
● Prepares due meds per shift
● Ceftazidime + ● 4th Generation
● Requests refill or routine medications
Avibactam Cephalosporin
● 5th Generation ○ Cefepime
COMPOUNDING PHARMACY Cephalosporin ● Carbapenem
● All Carbapenem ○ Ertapenem
DRUG CATEGORY MEDICINES (except Etrapenem) ● Piperacillin+Tazobac
● Colistin/Polymyxin tam
Anti-infectives Azithromycin B ● Aztreonam
Amphothericin ● Teicoplanin ● All fluoroquinolones
● Tigecycline ● All aminoglycosides
Concentrated Calcium Gluconate ● Linezolid (IV & PO)
Electrolytes Magnesium Sulfate ● Vancomycin Note: Not required to be
Potassium Chloride ● All IV antifungal referred to IDS
(except
TPN Combiflex fluconazole)
Nutriflex ○ Amphotericin-B
Kabiven ○ Itraconazole
Smofkabiven ○ Voriconazole
○ Micafungin
Vasoactive/Inotropes Adrenaline ○ Anidulafungin
and Post-OP Pain Dopamine
Drugs Dobutamine
Nicardipine
Preauthorization of VRA
Tramadol
Antimicrobial restriction and pre-authorization mainly
requires clinician to obtain approval from an infectious
NON FORMULARY MEDICATIONS disease specialist (IDS) For use of selected
antimicrobials (VRA) for use of selected antimicrobials
Hospital Formulary before prescribing.
● Formulary is a continually updated list of
medications and related information, representing Nurse ensure VRA is referred to IDS → Referral
the clinical judgment of pharmacists, physicians, documented properly c/o ROD DO sheet written → once
and other experts in the diagnosis, and/or referral is done scan med order and triplicate copy of
treatment of disease and promotion of health. VRA form signed by IDC or RIC → Attach VRA form in
the pt profile and call CP to verify the said form → CP will
AUTOMATIC ALTERNATIVE BRAND SUBSTITUTION acknowledge —-
● Substitution of an unavailable medicine ordered
by the AP with the alternative brand medication 7th Day Automatic Stop Order
which has the same generic component, -Attachment of 6th day slip
preparation and dosage strength.
VRA extends beyond 7 days → Ensure approval from
CRITERIA FOR AAS IDS → BSD form must be filled up and signed by IDS
● All non formulary brands with generic alternatives with specified duration of treatment → Attach the form in
● Out of stock or phased out medicines the pt. profile and inform cp for verification form → After 7
days, vra will automatically stopped by the system. If BSD
All NF medicines with no generic alternatives will be is not attached request of VRA will be restricted.
○ STAT med = <15mins
Drug-related problem findings ○ 1st dose/New admission = 30mins
-The CP is responsible in creating findings (System ○ Routine requests = 2hrs
generated) If a potential drug-related problem is found Patient stocks
● Standard dos/ max dose deviation - DDH allows patient to bring their med stocks
● Inappropriate duplication of therapy as for a given that is should fall to the following
certain medication categories
● Recommend correct timing of med ○ Insulin preparations
● Do not crush meds ○ inhalers
○ antibiotic suspensions that were started
Reporting of adverse drug events at home
● ADR (Extravasation, chemical burn, IV infiltration)
● Report filed through OFIRS the concerned Hospital formulary and non-formulary medicines
department ● Requirements for non-formulary and out of stock
● Forwarded to ClinPharm Dept for investigation formulary meds
○ Patient info
Provision of medication related information ○ Generic Name of medicine
● Answer drug-related queries from physician, ○ Brand Name
nurses, and other allied healthcare professionals ○ Signature
○ Stability of Reconstituted med ○ Quantity (number 2 in words) Quantity
○ Compatible diluents to be used/ good for one day dose
appropriate administration time ○ Prescribing position with signature
● Making of medication info service as required by Note: Only one medicine per Rx
physicians ● Requirements of non formulary meds
○ NF form
In-patient pharmacy services (Kimberly Oren, RPh) ○ approval and signature from billing
(IPP pept) ■ For local purchase above 5,000
Unit dose dispensing system (UDDS) Cold chain management

-Drug distribution system = Single unit, unit dose, unit of - DDH IPP department ensures patient safety
issue, packaging (selection of distribution of drugs to be through cold chain management of vaccines and
pharmacy based and controlled) all refrigerated medicines the staff is aware of
● Basic elements their responsibilities including refrigerator
○ Medications are contained in single unit maintenance, contingency plan, collaboration
packages List:
○ Dispensed in as ready-to-administer form as ● Insulin
possible ● erythropoietin
○ Dispense good for 24 hours + 1 dose supply ● vaccines (rabies. hepa b)
(1st dose) ● Oxytocins
● Three urgencies ● IV immunoglobulins
○ Stat/now - 1 dose Auxiliary label for registrated items
○ First dose/New admission - 1 day dose + 1 ● Pink paper
dose (meds packed individually)
○ Routine - 1 day dose Credit Memo
Guidelines
● Example of barcode sticker 1. NF LPM can’t be returned
○ Patient name 2. Loose tablets
○ generic name 3. meds need cold chain (cool box) upon return
○ brand name 4. Nurse na bring them to the pharmacy along with
○ dosage the two (2) copies of the printed CM form
○ frequency 5. Receiving of meds for cm 5:00 a.m. to 12:00
○ quantity midnight. CM transactions from 12 midnight until
○ remarks 5:00 a.m. not catered except if but not of the
● Medicines sent through the pneumatic tube following reasons
○ Tablets a. Expired patient
○ syrups and oral suspensions b. transfer to other facility
○ Inhalers All meds; Good condition, intact, no lacerations in the
○ topical creams packaging, ampules/vials are not broken and no written
● Turn around time of dispensing medicines based on labels on the box package
urgency requirements
Three Brand Policy ● Remifontanile
● Plan for a comprehensive medicine management ● Fentyl citrate
system
Hospital Formulary Meds

● Each generic name of med has at least three
maintaining formulary brands innovator brand
and two other brands as approved by the
pharmacy and therapeutics committee
● if wala sa three local purchase
Automatic Alternative Substitution

● Substitution of an unavailable medicine that
provide the alternative brand medicine has the
same generic component, preparation and
dosage strength
Compounding Pharmacy
● PD ensures prep of IV admixtures, any extreme
compound
○ Paper tabs
○ IV Admixture
○ Mixing of TPNs
Handling of narcotics, high alert meds(HAM)

● Handling of HAM (narrow therapeutic index)
○ Ensuring safe med practices of HAM
throughout the hospital
Auxiliary Labels Med Class Use
High alert meds All high alert Should be a

meds fixed on
containers of
high alert
Handling and storage of narcotic drugs

● Stored separately from regular meds
● Kept in double locked cabinet
● Only licensed personnel are allowed (handling,
dispensing, and administering of narcotic drugs
List of regulated and dangerous drugs

Regulated drugs (tablets, capsules)
● Alprazolam
● Clonazepam
● Diazepam
● Zolpidem
● Midazolam
● Phenobarbitals
Dangerous Drugs (IVTT, Ampules, Vials, Patch)

● Diazepam
● Perhidine
● Midazolam
● Ephedrine
● Morphine
● Nalbuphine
● Oxycodone
DAY 6 LECTURE
1. AM LECTURE
I. Basic Nursing Skills ● Routes for measuring the body
2. PM LECTURE temperature:
II. Medication Administration o Oral – best site for
measuring in clinical
settings. Axilla-oral
difference is 0.3C
BASIC NURSING SKILLS o Axillary – more likely to
Lecturer: be affected by the
environmental
VITAL SIGNS, I&O, CBG MONITORING temperature, used in
children/adults.
o Rectal – fast
I. VITAL SIGNS MONITORING – reflects the: thermometer, used in
infants/confused
a. Temperature – patients/receiving O2
● Regulated by the therapy.
hypothalamus. o Vaginal – used in
● Heat production is caused by gynecology.
cell metabolism. o Tympanic membrane
● Factors that can affect your o Temporal artery
body temperature include: ● Blue oral probe (used in oral
o Being in a hot or cold and axillary) – slide disposable
environment. cover over and hold
o Exercise thermometer in sublingual or
o Eating hot or cold foods axilla until it chimes.
and beverages.
o Strong emotions. Temperature Adults Children
● Medical conditions that Lower than ≤ 35.9C ≤ 36.4C
can cause your body average
temperature to change Normal 36.0-37.0C 36.5-37.5C
include: Higher than 37.1-38.0C 37.5-38.4
o Stress average
o Infection Fever 38.1-42.2C 38.5-42.2C
o Hypothyroidism
o Dehydration
o Sunburn b. Respiratory Rate -
o Rheumatoid arthritis ● Health conditions that can affect
o Hormonal changes your respiratory rate include,
but aren’t limited to the
Body Temperature Symptoms
following:
Hypothermia Skin paleness ○ o Asthma
↓ 36C Tiredness ○ o Anxiety
Normal Lowest: 5-6am ○ o Pneumonia
36-36.9C Highest:4-6am ○ o Heart disease
Pyrexia / slight fever Perspiration ○ o Lung disease
37.0-37.9C Skin redness ○ o Substance use
Headache disorder
Fever General weakness ● Normal respirations:
○ o Effortless
↑ 38C Tachycardia/hyperpnea
○ o Regular
Skin paleness/redness
○ o Smooth
Presence of infection → Shivers ● Average respirations:
body defense Perspiration ○ o Infant to 2 years –
Transcribed by: (Insert Last Names Here)

24-34/min
○ o To puberty –
20-26/min
○ o Adults – 12-18/min
● Respiratory Rate:
○ o Normal – 12-20/min
○ o Bradypnea - ↓
10/min
○ o Tachypnea - ↑
25/min
○ o Apnea
● Respiratory Rhytm:
○ o Normal
○ o Dyspnea c. Blood Pressure –
(exertion/rest) ● The pressure of blood pushing
○ o Cheynes-stoke against the walls of your
respirations (irregular arteries. Arteries carry b blood
deep/slow/shallow) from your heart to other parts of
○ o Kussmaul’s your body.
breathing (deep) ● If hypotensive –
● Respiration – ○ o Position the patient
inspiration/expiration: to Trendelenburg
○ o Respiratory centers position, and if
– control breathing. amenable.
○ o Chemoreceptors – ○ o Do not give oral
detect changes in O2 antihypertensives or
and CO2 beta blockers.
concentrations ○ o Refer to ROD.
○ o Measure client’s ○ o Assess patient for
respiration – respiratory any other pertinent
rate, rhythm, depth, findings; level of
quiet or noisy, easy or consciousness, profuse
difficult. bleeding, fluid
● Normal respiration rate: imbalances, etc.
● Factors affecting BP:
Age Rate ○ o Blood volume
Newborn 30-40 ○ o Strength of
Infants 30-60 contraction (measured
Toddler 26-32 as ejection fraction in
Child 20-30 2D echo).
○ o Elasticity of artery
Adolescent 16-20
wall
Adults 16-22
● Assessment:
○ o Normal –
● Breathing patterns: 110-130/60-80 mmHg
○ o Hypertension -
↑150/90 mmHg
○ o Hypotension - ↓100
mmHg
● BP reading –
○ o Systolic pressure
(ventricle contraction)
○ o Diastolic pressure
(ventricle at rest)
● BP readings record: BP 120/80
● Equipment:

○ o Sphygmomanometer slow your pulse.
○ o Stethoscope ● Expansion of an artery with
● Places for measuring – each heartbeat.
○ o Upper arm (brachial ● Measuring techniques/places of
artery) assessing:
○ o Calf/thigh (popliteal ○ o Palpation – carotid,
artery) brachial, radial, femoral,
● Measuring techniques – popliteal, etc.
○ o Auscultation ○ o Auscultation –
○ o Palpation stethoscope.
○ o Invasive methods ● Pulse rate:
(CVP) ○ o Normal – 60-90/min
● Blood pressure categories: ○ o Bradycardia - ↓
50/min
○ o Tachycardia - ↑
100/min
○ o Asystole
● Pulse rhythm:
○ o Regular
○ o Irregular – arrythmia
● Pulse quality:
○ o Strong (fever)
○ o Weak (shock/heart
failure).
● Normal ranges of pulse and
● Nurse – heart rate:
○ o Measure blood
pressure – force Age Pulse/heart rate
○ o blood exerts on walls
Newborn 100-170 bpm
of arteries.
○ o Systolic BP – force 1 year 80-170 bpm
during systole (heart 3 years 80-130 bpm
contracts). 6 years 70-115 bpm
○ o Diastolic BP – 10 years 70-110 bpm
pressure during diastole 14 years 60-110 bpm
(heart relaxes). 18 years 60-100 bpm
d. Pulse Rate –
● Factors that can affect your
● Pulse
pulse include:
○ o Throbbing sensation
○ o Exercise
with each heartbeat.
○ o Stress
● Rate
○ o Strong emotions
○ o Number of
○ o Caffeine
pulses/min.
● Health conditions that can affect
● Rhythm
your pulse may include, but
○ o Regular or irregular
aren’t limited to the following:
● Amplitude
○ o An infection
○ o Reflects strength or
○ o Dehydration
fullness of pulse.
○ o Stress
● Radial or carotid artery
○ o Anxiety
● Apical pulse
○ o Thyroid conditions
○ o Site not available.
○ o Anemia
○ o Infant
○ o Shock
○ o Heart condition
○ o Arrhythmia
○ o Takes medications.
● Some medications, especially
● Pulse deficit = apical pulse –
beta-blockers and digoxin, can
radial pulse.

e. Pain –
● The 5th vital signs.
● An unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage, or
described in terms of such
damage.
● It is subjective, thorough
assessment is required.
● Signs and symptoms: III. CBG MONITORING:
○ o Moaning
○ o Guarding the area
○ o Restlessness
○ o Irritability
● Note: only the patient knows
whether the pain is present and
how the experience feels.
● Pain categories:
○ o Acute – sudden
onset, resolves within 3
months.
○ o Chronic – gradual a. Blood Glucose Testing –
onset, lasts > 6 months. ● Measure blood glucose level
○ o Nociceptive – using a glucometer.
somatic, visceral. ● Requires a drop of capillary
○ o Neuropathic – blood.
damage or dysfunction ● Detects DM Type 1, 2, and
of somatosensory GDM.
nervous system. ● Evaluates effects of
○ o Ischemic – medications, diet, and exercise.
insufficient oxygen.
○ o Referred – pain felt IV. I&O MONITORING –
in different location. a. Make sure to accurately measure all intake and
● Assessment of pain: output (by MLs).
○ o O – onset b. Relay any fluid imbalances and unusuality (like
○ o L – location oliguria, polyuria, anuria) to your ROD.
○ o D – duration c. Ensure that I&O for your shift is properly
○ o C – characteristic documented.
○ o A – alleviating and d. If NOC shift, please make sure to total the day’s
aggravating factors I&O.
○ o R – radiating or
relieving factors. V. HEIGHT AND WEIGHT MONITORING
○ o T – timing a. Points to remember:
○ o S – severity. ● Be mindful of your patient’s height, especially
weight, which is important for drug calculations.
II. NEURO VITAL SIGNS MONITORING: b. Important indicators of client’s overall health and
nutritional status.
a. Glasgow coma scale (GCS) c. Accurate weight measurements.
● Same time of day.
● Empty bladder before.
● Same clothes each time.
d. Different types of scales:
● Upright scale
● Chair scale or wheelchair scale
● bed scale

● sling scale who are unable to do so effectively for
themselves.
VI. ANTHROPOMETRIC MEASUREMENTS: ● This could be due to the presence of an
artificial airway, such as endotracheal or
a. Abdominal Girth – tracheostomy tube, or in patients who
● Measures the distance around the abdomen at a have a poor cough due to an array of
specific point. reasons such as excessive sedation or
● Made at the level of the belly button (navel). neurological involvement.
Used to diagnose and monitor the following: I. Oropharyngeal Suctioning –
o Build up of fluid in the a. Procedure to remove secretions from the oral
abdomen, most often cavity and pharynx.
caused by liver failure, b. Yankauer catheter
HF, or any cancer that c. Check with your scope of practice and facility
has spread widely policy before assisting in procedure.
throughout the II. Tracheostomy Suctioning –
abdomen. a. Used to remove secretions from the trachea in
o Obesity individuals with tracheostomy tubes.
o Build up of intestinal III. Types of ET Suctioning –
gas, most often a. Closed – allows suction catheter to be inserted
caused by blockage or into the ET tube through a one-way valve. No
obstruction in the need to disconnect the patient from the
intestines. ventilator.
b. Head Circumference – b. Open – the patient is disconnected from the
● Screening tool for hydrocephalus. ventilator and a single-use suction catheter is
● Large or small head circumference – inserted into the ET tube.
o Microcephaly – head is IV. Suctioning Technique:
smaller than average. a. Dos –
o Macrocephaly – head is ● Insert and withdraw catheter gently.
larger than average. ● Use low suction pressure <120 mmHg.
c. Leg Circumference – ● Use multi hole suction catheter.
● Important measurements for donning of ● Use vacuum breaker.
anti-embolic stockings to prevent DVT. ● Involve physiotherapists.
● Post-surgery. b. Don’ts
● Assessment of patients with DVT. ● Do not perform suction routinely – only
when necessary.
● Do not instill saline prior to suctioning.
PROBLEMS WITH EATING OR DRINKINg ● Do not apply suction when inserting
I. NGT FEEDING: catheter.
a. Dos and Don’ts of NGT Feeding –
● Do not hurry or force feed (may cause
abdominal bloating and discomfort).
● Clean not sterile technique. MEDICATION ADMINISTRATION
● Formula at room temperature: Lecturer: Wilven Jordan T. Romarate, RN, MAN, PhD
o Warm – may cause I. MEDICATION PREPARATION AND

bacterial growth. ADMINISTRATION
o Cold – may cause STEPS
gastric cramping and 1. COUNTERCHECK
2. PREPARATION
discomfort.
3. IDC
SUCTIONING: ADMINISTER—-----------
4. PATIENT IDENTIFIER
● The mechanical aspiration of pulmonary 5. CLIENT EDUCATION
secretions from a patient with an 6. DRUG ALLERGIES
artificial airway in place. 7. ADMINISTER
● Used to clear retained or excessive 8. DOCUMENTS
lower respiratory secretions in patients

STEP #1 ● Understanding the 10 Rights of Drug
● Countercheck due medications for patients Administration can help prevent many
Compare with patient’s chart, MAR sheet, and medication errors.
information received during the endorsement ● Nurses are responsible for ensuring safe and
STEP #2 quality patient care at all times. As many nursing
● Prepare all due medications in the medication tasks involve a degree of risk, medication
tray atleast 30 minutes before the time of administration arguably carries the greater risk.
administration ● Research on Medication Administration Errors
Check medication three (3) times: (MAES) showed that there is a 60% error rate
● Before removing from the cabinet mainly in the form of wrong time, rate, or dose.
● Before preparing or pouring into the ● Some medication errors cause permanent
container disability and for others the errors are fatal.
● Before returning to the cabinet Follow these 10 rights of drug administration to
- Observe the five (5) rights: ensure safe patient care.
Right patient
Right medication 10 RIGHTS FOR SAFE MEDICATION
Right dose ADMINISTRATION
Right route
Right time 1. Right Drug
STEP #3 2. Right Patient
● For initial and STAT doses, perform independent 3. Right Dose
double-checking (IDC) 4. Right Route
STEP #4 5. Right Time
● Verify patient’s identification 6. Right to Refuse
Let the patient state his/her complete name and 7. Right Knowledge and Understanding
date of birth 8. Right Questions or Challenges
Compare against the name band and E-SBAR 9. Right Response or Outcomes
STEP #5 10. Right Advice
● Once verified, provide patient/client education
about the medicine to be given 1. Right Drug
Name of the drug (generic name, brand name, Confirm and verify the order, the drug name, and its
and dosage) form. Verify the expiry date, beware of sound-alike
Indication medications.
Provide health teachings 2. Right Patient
- When is the best time to take the drug? Use two identifiers to verify the client, ask their name
- What to expect after taking the drug? (even if you know it) and check the ID band before
STEP #6 giving the medication.
● Ask the patient for any DRUG ALLERGIES 3. Right Dose
STEP #7 Check the dosage against the doctor’s prescription and
● Administer the medicine according to the route the medication sheet. Question whether this is the usual
ordered by the physician dose for the drug (especially among pediatric patients).
For oral preparations, ensure that the patient 4. Right Route
has swallowed the medication Check on the order whether the route prescribed is oral,
Never leave medicines at bedside, except for by injection, intravenous, or any other route.
topical preparations (ointment and creams) 5. Right Time
STEP #8 Check on the order when and how frequently the
● Indicate the actual time of administration and medication should be given and also on the
sign the administered medications in the MAR documentation when the drug last given.
The second independent checker will also affix 6. Right to Refuse
their signature to the MAR Patients have the right to refuse medications. Provide
STEP #9 information about the drug so they can make an
● Incase of refusal or any adverse drug reaction or informed decision. Additionally, the nurse has the right to
event, inform the ordering physician or the refuse to administer a drug, based on their clinical
resident on duty and document in the MAR judgement, if it’s not in the best interests of the patient.
7. Right Knowledge and Understanding
II. 10 RIGHTS OF MEDICATION ADMINISTRATION Everyone who prescribes, dispenses and administers
medication needs knowledge and understanding of each
BORROWING OF MEDICINES IS STRICTLY drug.
PROHIBITED 8. Right Questions or Challenges
Clinical judgment requires you to ask questions. Raise

any doubts or questions about the medications before ● Includes drug and reason for taking it, dose,
administering it. route, time, possible side effects
9. Right Response or Outcomes ● Monitoring required
… ● Esures full consent
10. Right Advice 10. Right of Patient to Refuse
…. ● Patients are allowed to refuse to take
medications
1. Right Drug ● Determine the reason for refusal
● Verify prescriber’s order sheet (MAR) ● Take reasonable measures to facilitate the
● telephone/verbal orders have to be documented patient's taking of the medication (explain risks
and have to have the prescriber’s signature with refusal/reinforcing the reason)
within 24 hours to protect from liability.. ● Follow-up as required
2. Right Dose
● Give dose as prescribed III. INDEPENDENT DOUBLE CHECKING
● Check to see if the prescription… - Procedure wherein two licensed professionals
3. Right Time separately check each component of the work
● Administer the routine times/interval to ensure process.
drug level is maintained.
● …. Who can perform IDC?
4. Right Route - Nurses in the unit
● Necessary for adequate absorption - Nurse of the nearest nursing unit
● 3 different kinds (enteral, parenteral, topical) - Hospital Supervisor
● Never assume the route of administration
(always clarify!) Independent Double-Checking
● Pick the least invasive route possible ● Initial medications
● Assess the patient’s ability to swallow before ● Initial and succeeding medications of HAM and
giving PO drugs LASA
● DON’T crush/mix meds without consultation ● IV antibiotics
from the pharmacy ● TPN
● Use aseptic/sterile technique with the ● IVFs with electrolyte incorporation
administration of all parenteral drugs ● STAT medications, for non-emergent situations
● Administer at appropriate sites and rotate sites
when needed STEP #1
● Use gloves when handling oral meds ● Order for new medications - INITIAL AND STAT
● Stay with patient when they’re taking their meds DOSES ONLY!!!
5. Right Patient - If complete, proceed to STEP 2
● Verify patient’s name and their DOB on their ID - If incomplete, DO NOT CARRY OUT!!!
bracelet EVERY TIME they receive meds - Call the ordering physician to complete
● Use some type of warning system if two the orders
patient’s names are the same/similar Check the following:
● Note allergy band/bracelet (noted in red most ● Generic name
times) ● Brand name
6. Right Knowledge and Understanding ● Dosage
● Is the reason for giving the drug clear? ● Route
● …. ● Frequency
7. Right Documentation STEP #2
● Actual time and date of administration on MAR ● The charge nurse will carry out the orders
● Document response ● Transcribe in the MAR
● Document if a prescribed drug was withheld and ● Encode in the HIS
the reason for this STEP #3
● Document any adverse/unusual reactions and ● The charge nurse will hand the medication order
notify the prescriber and patient’s chart to the bedside nurse.
● Document improvements/positive changes ● (MAR, Doctor’s order, actual medication)
8. Right Evaluation STEP #4
● Any labs/blood work/special assessments ● After receipt of the encoded medicine, the
before administration bedside nurse will perform the first independent
● Monitor and do a necessary follow-up as checking.
needed before administration ● Do client verification (chart only)
● DO YOUR OWN ASSESSMENTS - Patient’s complete name
9. Right Patient Education - Date of birth

● Compare the actual medicine against the - Requesting
following: - Unit Dosing
- Doctor’s order - Barcoding
- Medication card/ticket
- MAR V. MEDICATION ADMINISTRATION
- Check for DRUG ALLERGIES
STEP #5 VI. IV FLOW SHEET TRANSCRIPTION
● The bedside nurse hands the actual medicine
on hand, the patient’s chart, and the medication Other Considerations in Filling out the IV Flow Sheet
card/ticket to another nurse (charge ● Document also in the IV Flow Sheet…
nurse/clinical coder) for second independent
checking. VII. REPORTING/REFERRAL
STEP #6
● If an error (or any discrepancy) is detected, go Reporting Adverse Drug Reaction (ADR) and Adverse
back to STEP 2 and review the doctor’S order, Drug Events (ADE)
medication card/ticket, and MAR ● Document the patient’s reaction to drug
STEP #7 administration
● If no error is detected, bedside nurse will ● Notify Clinical Pharmacy for the incident
proceed with MEDICATION ADMINISTRATION ● Refer to Resident-Physician for assessment
(another process) ● Prepare the ADR/ADE Form from the Clinical
STEP #8 Pharmacy
● After administration both nurses (1st and 2nd ● Let the ROD complete the form
independent checker) will sign in the MAR ● Submit to Clinical Pharmacy for documentation
and reporting
IDC SUMMARY
1. Check the medication order Drug Administration Assessment
(complete/initial/STAT) ● After medication administration, stay at the
2. Carry out the order/s (MAR/HIS) bedside for 5-10 minutes and observe for any
3. Endorse to bedside nurse reaction.
4. Nurse 1 - First IDC ● Inform the patient to report immediately signs
5. Nurse 2 - Second IDC and symptoms experienced with administration
6. Check for any discrepancy. If (+), go back to ● Evaluate the effectiveness of the administered
STEP 2 and review the order drug.
7. Administer medication - Example: if you are giving
8. Document, sign in the MAR (nurse 1 and nurse anti-hypertensive medication - Recheck
2) Blood Pressure of the patient after 30
minutes
IV. SINGLE-PROCESS CHECKING ● Monitor for expected drug effects and document
● STAT medications, for emergent situations appropriately.
(code): ● Take note also of the duration of the medicine
- Epinephrine ● Refer to the ROD, especially if the drug needs to
- Atropine be discontinued or extended based on the initial
order and actual assessment taken from the
Turnaround Time for Administering Medicine patient.
● STAT medications:
- Shall be given within 30 minutes from VIII. USE OF RED AND PINK TICKET
the time ordered
● Initial medications: Pink Ticket
- Shall be given within 60 minutes from ● Pink Ticket shall be used for the transcription of
the time ordered nursing procedures.
● Routine medications: ● This shall be handed to the bedside nurse to
- Shall be administered 30 minutes before take note of the timing of the procedure.
and after the actual timing ● The ticket shall be endorsed to the incoming
- Example: 8 am due medication can be nurse all throughout ad…
given as early as 7:30 am and 8:30 am
the latest Red Ticket
● Red Ticket shall be used for transcription of
UDDS STAT and single-dose ordered medicines.
- Identifying ● Example:
- Scanning - Diphenhydramine 50 mg/amp, 1 amp

IVTT Now
- …
● This shall…

DAY 7 LECTURE
1. AM LECTURE
I. Topic
2. PM LECTURE
II. Topic


DAY 8 LECTURE
1. AM LECTURE
I. Topic
2. PM LECTURE
II. Topic


DAY 9 LECTURE
1. AM LECTURE
I. Topic
2. PM LECTURE
II. Topic


DAY 10 LECTURE
1. AM LECTURE
I. Topic
2. PM LECTURE
II. Topic



Gop Didactic Training

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GOP DIDACTIC TRAINING

DAY 1 LECTURE In times of need, you can count on us

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

3. Receiving Admission Endorsement

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

VI. Documentation on Admission

VII. Attached to the FF:

V. Nursing Phraseology for Admission/

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

Some forms must be renewed accordingly. h. Medication Administration Record

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

IV. Bedside Nurse Problem Identification

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

STAT Shall be given within 30 minutes

POST MEALS Shall be given after the patient has

IV. Medication Concerns

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

ADLs Activities of Daily Living BSD Beyond Seven Days Form

AND Allow Natural Death DEU Designated Educational Unit

ASP Antimicrobial Stewardship Program HIS Hospital Information System

BN Bedside Nurse HIMS Hospital Information Management

HIS Hospital Information System CSS Central Sterile Supply

HGT Hemoglucotest AHCP After Hospital Care Plan

ITU In-patient Therapeutic Unit EMS Emergency Medical Service

NHM No Heroic Measures CPAP Continuous Positive Airway Pressure

NA Nursing Assistant BIPAP Bilevel Positive Airway Pressure

OPD Outpatient Department PEEP Positive End-Expiratory Pressure

PTG Patient Transfer Group IOL Intraocular Lens

RAT Rapid Antigen Testing OCT Optical coherence tomography

ROD Resident on Duty RRS Renal Replacement Center

RT-PCR Reverse Transcription Polymerase CPT Chest Physiotherapy

PGI Post Graduate Interns

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

Transcribed by: Calisang, Calungsod, Cabro, Desabelle, & Doloritos

2. PM LECTURE D. No Conditional Doctor’s Order

II. CREDIT MEMO

TRANSFER TO OTHER FACILITY

AHCP Health Teaching USE OF AMBULANCE

HANDOVER PROCESS During Endorsement

Transcribed by: Dayap, D.F.; Curambao, N.K.

Transcribed by: Dayap, D.F.; Curambao, N.K.

II. PULMONARY UNIT

Transcribed by: Dayap, D.F.; Curambao, N.K.

Transcribed by: Dayap, D.F.; Curambao, N.K.

Transcribed by: Dayap, D.F.; Curambao, N.K.

Transcribed by: Dayap, D.F.; Curambao, N.K.

II. DO NOT USE ABBREVIATION b. Verbal/telephone orders will not be

● Written communication- written signs or How to Overcome:

✓ Evaluates the Doctor

Unit dose dispensing system (UDDS) Cold chain management

Hospital Formulary Meds

Automatic Alternative Substitution

Handling of narcotics, high alert meds(HAM)

Auxiliary Labels Med Class Use

High alert meds All high alert Should be a

Handling and storage of narcotic drugs

List of regulated and dangerous drugs

Dangerous Drugs (IVTT, Ampules, Vials, Patch)

Transcribed by: (Insert Last Names Here)

Transcribed by: (Insert Last Names Here)