Best Practice Procedures FOR RESIDENTIAL AGED CARE FACILITIES 17-19 Moore Street, Leichhardt NSW 2040 P: +61 (0)2 9563 4900 I FREE CALL 1800 244 358 F: +61 (0)2 9563 4955 I FREE FAX 1800 626 739 EMAIL: info@webstercare.com.au S149 (01/2015) Manrex Pty Ltd t/as Webstercare -2015. Version 4.0
Webster-pak Multi Dose Best Practice Procedures Introduction... 2 How the Webster-pak System works... 8 Special Medication Categories...10 Medication Round... 12 Quality Assurance... 14 Communication & Stationery...17 Communication with the Pharmacy...18 Quality Processes...20 Appendix... 22 Manrex Pty Ltd (ABN: 29 974 510 173) t/as Webstercare. Manrex, Webstercare, Webster-pak, Webstersystem, Unit Dose 7, Flexi-pak, Pil-Bob, LoTemp and MedsPro are Registered Trade Marks of Manrex Pty Ltd Webstercare whilst Virtual Pill Count (VPC) and Flexi-shelf are Trade Marks of Manrex Pty Ltd t/as Webstercare. 1
Introduction Welcome to the Webstercare Best Practice Procedures Manual. This manual seeks to ensure the maximum benefits from using Webster-pak are realised. Best practice procedures and additional pharmacy services can optimise the benefits of using Webstercare medication management systems. Here is how the manual is organised: Best Practice Procedures for Webster-pak Multi Dose and Flexi-pak Webster-pak This section introduces you to: The components of the system How they system works Special medication categories. Medication rounds Quality assurance Webstercare Communication and Stationery Components This section introduces you to: Communication the stationery available to ensure all order information is communicated between the Pharmacy and RACF Stationery the stationery available for Patient Profiles, Checking Sheets, S8 Delivery Record Book, and more Communication with the Pharmacy How to re-order medication, new medication and communication of dosage changes or ceased medication Storage Quality Processes This section introduces you to the various resources and guidelines for medication management. Areas include: Incident reports, Drug (MAC) Committee, Disposal of Drugs and STAT Medication. This manual is also designed to describe in detail the minimum expected standards required both within the pharmacy and at the RACF or with community based patients. Webstercare recommends you keep this document handy for easy reference. 2
Best Practice Procedures for Webster-pak Multi Dose and Flexi-pak Webster-pak Introduction to Webster-pak Multi Dose Webster-pak Multi Dose is designed to reduce the possibility of error, and comply with medication management regulations. In addition, Webster-pak meets duty of care requirements when non-registered staff are responsible for the supervision or assistance in administering medication at Residential Aged Care Facilities (RACFs) and other care centres. Webster-paks can only be dispensed by a pharmacist or under the direct supervision of a pharmacist and becomes the original dispensed container once packed. Because of its simplicity and ease of use a Webster-pak can also allow residents to handle their own medication easily, giving them greater independence as well as, serving as a barometer of a person s ability to self medicate. It is an auditable system of medication management for use by both Registered Nurses and Non-Registered Carers. Webster-paks are arranged in four columns across for the doses of the day and seven rows down representing the seven days of the week. Webster-paks can be placed in a re-useable plastic folder or disposable options are available. Webster-pak containing one full week s medication 3
Introduction to Flexi-pak Cold Seal Webster-pak The Flexi-pak Cold Seal Webster-pak is specially designed with perforated blisters which allow medication to be removed for a particular day or dosage time. The perforated blisters, allow for the tearing off of sealed blister compartments for any number of days or dosage times. This is ideal for residents who are more ambulant and attend days out of the RACF as they only take to doses they require away with them. Flexi-pak Cold Seal containing one full week s medication 4
Components Folders The side of the re-usable plastic folder is labelled with the days of the week: Monday at the top of the pack, following through to Sunday at the bottom. Colour Coding System The folders are used in a colour coding system for different types of medication or dosage schedules. Blue White Purple Green Mustard Burgundy Regular 7 day medication: Breakfast, Lunch, Dinner, Bedtime When necessary medication (PRN) Special Alert e.g. Accountable drugs, Cytotoxic and Special precautions Antibiotic and short term medication Warfarin medication Special dose times and before meals medication The same colour coding is used for the Webster-pak Multi Dose and Flexi-pak systems. Blisters Webster-pak Four sizes available to accommodate different size medications Have 28 cavities, accommodating the seven days of the week and four different dosage times per pack Flexi-pak Three sizes available to accommodate different size medications Can be perforated or non-perforated LoTemp Foil Webster-pak Sealed onto the filled blister to keep the medications in place Printed through the Webstercare Medication Management Software with: Clients Details Drug names Directions Brief Description of pills List of drugs per blister Prescribed as information Attaches the header card to the blister Tamper evident Aids in medication stability 5
Multi Dose Webster-pak foil Flexi-pak Same attributes as the Webster-pak Multi Dose foil Each individual blister can be removed (using perforated blisters) if the resident is going out for the day, making the medication more portable each blister is also printed with: Client name Dosage time Day Contents Header Card Webster-pak Printed through the Webstercare Medication Management Software Records: Resident Name Resident Photo Allergies Also on medication (non-packed medication) Flexi-pak Same attributes as the Webster-pak Multi Dose header card Z-Fold option Double Ply Label Pharmacy dispensing label Used for labelling non-packed items Top layer is removed for re-ordering non-packed items at the RACF Moulded Folder Trays Webster-pak Used to store the Webster-paks either in the medication trolley or in a cupboard Flexi-pak Wider than the Webster-pak moulded folder tray to accommodate the wider Flexi-pak 6
folders Resident ID Divider Multi Dose Webster-pak Same product as the Medications For Card with a different insert Laser Resident ID Divider Insert printed from the Webstercare Software To identify each resident Used to divide each resident s medication folders on the moulded folder tray Records: Resident Name Resident Image Allergies Notes 7
How the Webster-pak System works Every week, the pharmacy packs the residents medication into Webster-pak Multi Dose according to what the doctor has ordered on the medication chart. Blister Pack Medication for each dosage time is packed into blisters and sealed with the LoTemp foil. The dose in each blister will be all the pills required for that dosage time. For Webster-pak Flexi-pak, the pharmacy can use either perforated or non-perforated blisters depending on the RACFs requirements. Header Cards Each blister pack has a header card attached when sealing on the foil. The header card is labelled with the resident name, photo, pharmacy details and other required information. The dosage time for administration (e.g. breakfast picture pink square with rising sun) are pre-printed onto the header card as a visual cue. Blank header cards can be used to print special times through the Webstercare Medication Management Software. Folders The sealed blisters with header cards are placed in the correct coloured folder for each medication type. Moulded Folder Trays Used to transport and store the folders both at the pharmacy and RACF. Weekly Cycle The pharmacy provides automatic changeover every week therefore, re-ordering of regular weekly medication is not necessary. The new supply is delivered from the pharmacy at least 24 hours before the previous supply finishes. For this reason, the pharmacy will require two sets of folders, Resident ID Dividers and Moulded Folder Trays. Dosage Changes and New or Ceased Medication Dosage changes and new medication is delivered to the RACF in separate folders, saving time and reducing error. For ceased medication the pack is returned to the pharmacy and a new pack sent with the medication change made. 8
PBS Dispensing, Prescriptions and Storage of Medication The pharmacy will dispense the PBS prescriptions as normal prior to packing the medication in weekly amounts. At the request of the resident, or the RACF, the pharmacy will retain the balance of medication for each weekly supply. Once the dispensing is complete, a record of the dispensed medication for each resident must be maintained. This can be done through the use of MedsPro Virtual Pill Count (VPC) System. A record of resident s medications is retained in the software. If at any time a resident requests their medications, the pharmacy has a record of their balance held on the resident s behalf and the pharmacy can supply at short notice. Alternatively, Integrity bags can be used to store each resident s medications with the identification similar to this medication is the property of.. The pharmacy will always know how much medication is left at any time and can advise when prescriptions are due. Prescriptions can be signed or authorised according to the HIC requirements. Quality Assurance Quality Assurance (QA) audits are carried out on a regular basis and a written report provided for review and action. A Quality Assurance checklist is provided (at the end of this section) to verify suggested processes are being followed, and identifying room for improvement. This checklist has an incident report column where the need for corrective action can be identified. The Pharmacy Checking Process The minimum checking process recommended is a double check: 1. The pack is checked before sealing, by checking the contents of each blister against the foil backing. This is done from the rear of the pack. 2. The sealed and labelled pack is then double-checked by a pharmacist from the front against the master patient profile. This back to front and front to back checking process removes the probability of human error. The original dispensed packs are always available to verify the identity of the medications packed. 9
Special Medication Categories When necessary medication (PRN), antibiotic, short term medication, special alert such as accountable drugs, cytotoxic or special precaution medications can be handled in two ways: 1. The medications are kept in the original dispensed manufacturer s containers OR 2. The blister packs are placed in the colour coded folders. This decision has to be made between the RACF and the pharmacy as to how these special types of medication will be handled. When Necessary Medication (PRN) When Necessary medication can be packed in 28 dose packs and put into white folders. When Necessary medication is administered as required up to the prescribed limit and registered on the medication chart. A full pack is prepared (all blister compartments) with one specific PRN medication. Multiple folders may be required until all medication is packed. For example: Panamax 500mg 100 tabs, 2 four times a day PRN, there would be 2 packs; one pack of 28 and one of 22. For Webster-pak Multi Dose, the foil backing does not need to be labelled when only one drug is dispensed. NOTE: For Webster-pak Flexi-pak, the foil backing does not need to be labelled when only one drug is dispensed, unless, the resident requires the ability to tear off doses for outings. Antibiotics or Short Term Medication The full quantity of the antibiotic or short term medication is packed into one or more packs with the dosage times set out by times of the day and days of the week and placed into green folders. Long-Term Antibiotic medication is handled differently. Long Term Antibiotic medication is packed in with regular dosage times. For Webster-pak Multi Dose, the foil backing does not need to be labelled when only one drug is dispensed. NOTE: For Webster-pak Flexi-pak, the foil backing is not labelled when only one drug is dispensed, unless the resident requires the ability to tear off doses for outings. 10
Special Alert Medication These may be dispensed into purple folders, recorded and stored according to State regulations (if required). In all states S8 s and S4d s (NSW) need to be accounted for by the RACF at the time of administration and securely stored. Regular, accountable medication should be dispensed in the full quantity into one or more packs with the dosage times set out, four columns across for the doses of the day and seven rows down representing the seven days of the week. PRN, accountable medication should be dispensed in the full quantity into one or more packs. The purple folder is numbered from 28 (top-left) to 1 (bottomright) therefore the full dispense quantity can be packed in a standard format, whether requiring one or more folders. For example: for Oxycontin 10mg 60 tabs, 1 PRN, there would be 3 packs; two of 28 and one of 4. Dispensing the full quantity of medication and sending the complete set to the RACF makes accounting for the medication more manageable. NOTE: For Webster-pak Flexi-pak, the foil backing is not labelled when only one drug is dispensed, unless the resident requires the ability to tear off doses for outings. Warfarin Medication Warfarin Medication can be dispensed into Mustard folders. Due to the frequent dosage changes with Warfarin and its narrow therapeutic margin it is easier to monitor the medication when dispensed separately. The different coloured folder will also alert to staff that this medication requires additional attention. The mustard colour is the same colour as the Warfarin Medication Chart for consistency. 11
Special Dose Times and Before Meals Medication If a resident is taking medication outside regular medication round times e.g. before food medication. These may be packed into a burgundy coloured folder to alert the nursing staff to the special administration time. Special time medications may include anti-parkinson s medicines, paracetamol sustained release 665mg tablets taken every 8 hours, medications best taken 30 minutes before food e.g. antiemetics, some antibiotics, thyroxine and bisphosphonates. Medication Round Preparing for the Medication Round The Registered Nurse or Carer: Selects the Folder Tray for the section Places other required items such as medication cups, jam etc in the trolley Selects the Medication Charts for administration Checks for S8/S4D medication or antibiotics to be administered at this time Takes the trolley on the medication round Administering Medication The Registered Nurse or Carer: Checks the name and photograph on the pack/s, to correctly identify the resident Selects the correct blister or blisters for the time of the day and the day of the week Pushes the blister through to expel the contents into a medication cup. This cup is then given to the resident to take Checks for multiple folders of medication and administers these as well. Adequate water is available and the carer stays with the resident until the medication is taken Checks the front label of the folder and the actual pack labels and/or medication chart for any other medication that is required to be taken at this time. This is also administered and supervised HINT: To ensure medication has been administered it is good practice to remove the folder from one tray and place it in another tray after administration or to turn it around or use some other cue to ensure a resident s medication is not missed. 12
Signing for Administration Care Worker Administration: The content of the blister or blisters is signed for after being administered The content is verified from the printed foil Any other medication administered is also signed for at this time Registered Nurse Administration: Registered nurses verify each medication individually Each medication is signed for individually Identification is done using the MIMS description and drug identification listed on the foil as well as on the medication chart or signing sheet Resident not Present at Medication Round The Registered Nurse or Carer: Leaves folder in tray or does not turn it around, whichever practice is used to ensure medication is not missed Continues with the medication round until all residents are medicated Returns to administer the medication to the resident If the resident is still not present, the RN or Carer writes the reason code on the medication chart or signing sheet. When Necessary Medication (PRN) The Registered Nurse or Carer: Locates the PRN Folders Selects the required resident s PRN medication folder Administers the medication by placing the Pil-bob at the back of the pack and pressing through until the medication has been released Then transfers the medication to a medication cup for administration Then signs the PRN medication chart with Date, Time, Quantity and Signature Social Leave using Webster-pak Flexi-pak The Registered Nurse or Carer: Locates the resident s folder Removes from the folder the dose that the resident needs to take with them. For example: Wednesday, Lunch Signs the medication chart with the Reason Code for Social Leave Gives the Flexi-pak blister to the resident for self medicating at the right time NOTE: Medication is not pre-dispensed in advance of a medication round. Medication in the packs is not tampered with or altered in any way. Any alterations (e.g. providing half tablets) are only made by the pharmacist or pharmacy technician under the supervision of a pharmacist, prior to the final sealing of the pack. 13
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Quality Assurance for Multi Dose Webster-pak and Webster-pak Flexi-pak Pharmacy Procedures Prescriptions are available at the time of dispensing unless they are 1 urgent requests. These urgent requests are communicated directly by the doctor in accordance with Pharmaceutical Benefits regulations. The pharmacist dispenses the prescriptions according to the 2 Pharmaceutical Benefits Scheme regulations. Original packs and bottles are labelled and stored on behalf of the 3 resident and used to supply the Webster-pak / Flexi-pak dispensed pack. 4 Non-packed medication carries the normal pharmacy dispensing label. Webster-pak / Flexi-pak is dispensed by a pharmacist or under the 5 direct supervision of a pharmacist according to State and Commonwealth regulations. Hard Copy Patient Profile forms are used by the pharmacist to record 6 and maintain information on the medication profile for each resident. Along with the patient name and date, the pharmacist enters nonpacked medication, to be printed on the Header card. 7 Colour photographs of the resident are printed on the header card of each pack. 8 Photographs can also be attached to the Webster-pak / Flexi-pak by using the Webster-pak Photo ID sleeve. A minimum double-checking procedure is used when preparing the packs. Firstly from the back before sealing checking against the 9 printed foil and secondly, from the front after sealing, against the hard copy. Webster-paks / Flexi-paks are dispensed into colour coded folders as 10 defined by Webstercare. 11 The regular packs are packed into BLUE folders When Necessary medication is packed in white folders and carries 12 the normal pharmacy dispensing label Short term antibiotics are packed into green folders. The foil is not 13 labelled. "Before food" medication is packed into pink folders and is labelled 14 before food. 14 or 28 day packs are packed into yellow folders and are clearly 15 identified. When more than one folder is supplied these are joined together by 16 means of a split ring. These multiple folders are labelled Pack 1 of 2, Pack 2 of 2 etc. 17 Medication changes and new medication are sent by the pharmacy to start at the next dosage time and to finish at the regular finishing time of the folder or folders in use. In the case of an addition an extra folder is sent. In the case of a change a new folder is sent and the existing folder returned to the pharmacy. 18 Identical or indistinguishable drugs are dispensed in a separate pack. 19 Webster-pak folders are well maintained and are cleaned regularly. YES NO Incident Report (Corrective Action) Required 15
RACF Procedures YES NO Incident Report (Corrective Action) Required Residents are identified by name and photograph prior to 1 administration of medication. Medication is expelled from the appropriate blister or blisters into a medication cup and administered direct to the resident. Adequate 2 water is provided and the resident is supervised whilst taking the medication. If required, individual medication can be checked against the foil 3 backing label and the drug description. 4 The medication is not handled at any time. Non-packed medication is checked and administered as appropriate 5 and supervised and charted on the non-packed signing sheet. When Necessary medication is administered no more than the 6 maximum amount and charted on the When Necessary signing card attached to the `When Necessary folder. Procedures that ensure any resident s medication is not missed are in 7 place. The pharmacist is informed if doses are missed or spilled and advice 8 followed. Charts are used for medication and dosage documentation. These 9 charts are written by the doctors to record each resident s medication profile and any changes that may occur. Green re-order sheets are used to request medication required in 10 advance. Medication changes and new orders are communicated direct to the pharmacist by the doctor or by means of the Medication Chart or 11 Pharmacy Order Form, or any other written chart/ form or prescription completed in writing by the doctor. The medication folders and trolley are kept in a secure, neat and tidy 12 fashion Webster-pak / Flexi-pak folders are stored in Webster-pak / Flexi-pak folder trays in the Webstercare trolley. Other medication not packed 13 is stored in the trolley. Multiple folders are linked together using a split ring. The medication trolley is kept locked when not in use or not attended. 14 All medication is kept in the locked trolley. Discontinued medication is returned to the pharmacy to be disposed 15 of appropriately. 16
Webstercare Communication and Stationery Components Communication Green Pharmacy Order Sheet RACF staff record non-urgent medication for re-ordering Re-ordering is by either: 1. Sticking the top layer of the double-ply label on the Order Sheet for the item that needs re-ordering (non-packed items) OR 2. Writing the order onto the order sheet Pharmacy pick-up when delivering daily order White Pharmacy Faxed Order Sheet RACF staff record urgent medication orders Used for faxing urgent orders directly to the pharmacy Yellow Return Sheet RACF staff attach to medication returned to the pharmacy Space for label and reason for return is provided Medication Incident Response Form Pharmacy staff record an incident or use to respond to the RACF Used for continuous improvement Stationery Patient Medication Profile To record patient profile records Used as the hard copy profile for checking Pharmacy Admission Notice RACF staff use to record resident s details upon admission to the facility and send to the pharmacy S8 Delivery Driver Book Used for recording S8 drug deliveries to the RACF Signed by both pharmacy delivery driver and RACF staff One copy is kept at the RACF and the other copy for the pharmacy Weekly Order Sheet Packing Technicians place the re-order labels on the Weekly Order Sheet Pharmacy Technicians dispense the ordered medication in time for next weeks packing 17
Medication Administration Documentation Medication Chart and/or signing sheets Used to record the medication that has been administered Used for Packed, Non-Packed, PRN, Nurse Initiated and Telephone orders Communication with the Pharmacy Re-ordering Medication Re-ordering is not required for regular packed medication as this is delivered by the pharmacy on a regular basis (weekly or fortnightly). For Non-Packed Medication: When noticing that the liquid / inhalant / drops are getting low, peel off the double ply re-order label Place onto the green Pharmacy Order Sheet Place the green Pharmacy Order Sheet with the other items for the pharmacy to pick up For PRN ( When Necessary ) Medication: Write on the green Pharmacy Order Sheet, the resident s name and medication required Place the green Pharmacy Order Sheet with the other items for the pharmacy to pick up New Medication When a new medication is ordered during the regular weekly cycle, only enough medication is sent for that weekly cycle. Even if this means there is just a few tablets in the folder. The new medication will automatically be included with the next full week s medication. This may be labelled additional medication or similar. When the new order is written on the medication chart: Write the new order onto the white Pharmacy Faxed Order sheet Fax to the pharmacy with a copy of the relevant medication chart Place the prescription and white Pharmacy Faxed Order Sheet in the Pharmacy pick-up tray for collection by pharmacy staff When the new order is a telephone order: The RN writes the medication order onto the medication chart in the Telephone Orders section recording doctor, medication, dosage, date Write the new order onto the white Pharmacy Faxed Order sheet Fax to the pharmacy with a copy of the relevant medication chart Place the Pharmacy Faxed Order Sheet in the Pharmacy pick-up tray for collection by pharmacy staff 18
When the new order is a faxed order: Write the new order onto the white Pharmacy Faxed Order sheet Fax to the pharmacy with a copy of the faxed medication chart Attach the faxed copy to the medication chart for recording administration Dose Changes Dose changes should always be forwarded to the pharmacy immediately so that repacking of the packs can occur and pharmacy records are kept up to date. Failure to do this is likely to result in medication error and medication wastage. Communicate dosage changes by: Writing the request onto the white Pharmacy Faxed Order sheet Faxing this with the relevant medication chart to the pharmacy The pharmacy will send up either a separate folder with the extra medication, starting at the next dosage time and finishing at the end of the weekly cycle, or, a new folder, incorporating the change of regular medication and also starting at the next dosage time. Dropped or Lost Medication Any medication that is accidentally lost or dropped can be administered from the next day s medication dose. Once requested, the pharmacy will send up replacement medication in a labelled vial or blister pack. This may be labelled replacement medication or similar. Communicate dropped or lost medications by: Phoning the Pharmacy The pharmacy will always send up new medication supplies at least 24 hours before the current supply runs out. Ceased Medication and Dosage Changes Communicate ceased medications by: Writing the information onto the white Pharmacy Faxed Order sheet Faxing this with the relevant medication chart to the pharmacy Storage In most cases the medication may be stored in a Webstercare trolley for the medication round along with all the other non-packaged medication such as liquids, patches and eye drops etc. Only the pharmafiles for the applicable dosage time need to be taken in the trolley for the medication round, reducing weight. The other Pharmafiles can be stored in a locked medication cupboard in the medication room, when not in use. Contact Webstercare for trolley specifications and plans/proposed fit-out of suitable storage cupboards for pharmafiles when not in use. 19
Quality Assurance Quality Processes Quality Assurance (QA) audits are carried out on a regular basis and a written report provided for review and action. In particular QA audits address adherence to State and Commonwealth regulations, storage and labelling of drugs, medication administration practices, adherence to these Best Practice guidelines and any other matters specified by the drug committee. Packaging Material Packaging material such as blisters and foil are disposable and not recommended for reuse. Incident Reports To aid in the continuous improvement process, Incident forms, can be used. This form is ideal for reporting medication incidents, causes and suggested short and long-term corrective action. A quality assurance checklist is provided (at the conclusion of each section in this manual) to verify suggested processes are being followed, identifying room for improvement. This checklist has an incident report column where the need for corrective action can be identified. Drug Committee A pharmacist is involved in the Medication Advisory Committee (MAC) as described in APAC Integrated Best Practice and provides the necessary reports, inputs and opinions as required. The purpose of a drug committee is to determine policies and procedures to ensure optimal medication usage. Standards and Guidelines Pharmacists are required to follow the directives of the relevant state pharmacy boards. Other useful guidelines are contained in the Pharmaceutical Society of Australia, Pharmaceutical Practice Guidelines, The Quality Care Pharmacy Practice Standards and the Australian Pharmaceutical Advisory Council (APAC), Integrated Best Practice Guidelines for education management in aged care facilities. Disposal of Drugs Any unused, discontinued or out of date medication is removed and disposed of in accordance with State and Commonwealth regulations and in an environmentally safe manner. Medication discontinued for a resident is kept for a short period of time in case it is recommenced (say one week) and then disposed of. Deliveries and After Hours Service Depending on the contract between the pharmacy and the RACF the pharmacy may provide a daily service for urgent items, new items, and new residents as well as general stock. The majority of routine orders are delivered on a weekly basis at a time agreed or at a frequency decided by both parties. Typically, an emergency number is available for after hour s emergencies. 20
Emergency STAT BOX As Doctors may initiate treatment when the pharmacist may be unavailable, a list of emergency items is determined by the prescribing preferences of the visiting doctors and through the Medication Advisory Committee (MAC) of the RACF. A supply of emergency medication is kept, where allowable, in an emergency STAT BOX or similar. STAT medication is to be kept in original manufacturer's bottles and packs. STAT Box for Emergency Medication Procedures for STAT Medication at the RACF: 1. Identify the medication that you require 2. Remove from STAT box 3. Determine what you need to do with the medication (e.g. liquids) 4. If needing only one or two doses of medication (tabs / caps), remove only the required amount until the resident s Webster-pak arrives 5. Return balance of medication to the STAT box When emergency stock is used the pharmacy is informed so that it can be replaced. The emergency stock packs carry the re-order label and are labelled 'STAT'. Education In-service education is provided to all staff on implementation of the system. The pharmacist accompanies the RACF staff on the initial medication rounds to ensure all staff begin to become familiar with the systems and procedures. Regular in-service is provided to staff on the policies and procedures involved in the smooth operation of the system. General pharmaceutical education is provided on a regular basis and the Webstersystem printed Consultant Pharmacy Service is provided monthly to all nursing staff. The Webstercare website (www.webstercare.com.au) holds a library of continuing education brochures distributed over the last several years. 21
APPENDIX A 22