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June 04 生活近況目前生活過的蠻舒服的, 蠻像職業家庭主婦, 工作之餘, 打掃家裡環境及做料理
其實下班後, 我是很累的, 身體及雙手勞累不堪, 但不知一回到家, 規律地做家事及大部份做好吃料理
在這裡我過以前我沒過的生活, 必竟資源不一樣, 生活及工作壓力較沒以前那麼大, 當然環境不一樣
目前下班後我可以做我想做的事, 看一些美國影集, 做好吃料理, 學調理精油
前幾天我生日, 低調過生日, 好久好久沒吃海鮮, 因為很難買到新鮮, 去中國城海鮮店買些魚及螃蟹
生日當天做一道南洋味椰奶蛋汁咖哩螃蟹飯及滷一鍋蘿蔔/海帶/香菇/雞肉/豆干/豆皮, 與我房東一起享受
當我房東得知我生日, 隔天他竟然送我禮物(現金)及卡片, 我蠻感動的, 一位修女也送我禮物
其實, 我也沒在過生日, 一句生日快樂我就很高興了...................
March 21 The administration of drugs  1. The three documents are:
■ the Poisons and Therapeutic Goods Act 1966 (the Poisons Act); ■ the Poisons List (which is updated regularly); ■ the Poisons and Therapeutic Goods Regulation 2002 (the Poisons Regulation) which commenced on 4 September 2002. 2. The Poisons Act regulates, controls and prohibits the supply and use of poisons, restricted
substances, drugs of addiction and certain dangerous substances. It does not specifically identify these substances, but divides them into broad headings, under schedules, which describe them by type. The Act also dictates penalties for breach of the Act and Regulation and declares some activities to be criminal offences. 3. The Poisons List is important to nurses because it is a specific list of drugs and substances and
informs as to which schedule of the Poisons Act they belong. Nurses need to be familiar with it because they deal with drugs and other listed substances as part of their daily work. 4. The purpose of the Poisons Regulation is to detail requirements to be observed when certain
authorised persons are dealing with various substances.These include aspects such as authority for possession, supply, prescription, control, storage and administration of drugs used by nurses in their daily work. 5. The eight schedules set out under the New South Wales Poisons Act are: Schedule One (dangerous poisons)
Substances which are of extreme danger to life as to warrant their being supplied only by medical practitioners, nurse practitioners authorised under section 17A of the Act, pharmacists, dentists, veterinary surgeons or persons licensed under Part 3. Schedule Two (medicinal poisons)
Substances whish are dangerous to life if misused or carelessly handled but which should be available to the public for therapeutic use or other purposes without undue restriction. Schedule Three (potent substances)
Substances which are for therapeutic use and: (i) about which personal advice may be required by the user in respect of their dosage, frequency of
administration and general toxicity; (ii) with which excessive unsupervised medication is unlikely; or
(iii) which may be required for use urgently so that their supply only on the prescription of a medical
practitioner or veterinary surgeon would be likely to cause hardship. Schedule Four (restricted substances)
Substances which in the public interest should be supplied only upon the written prescription of a medical practitioner, nurse practitioner under section 17A, dentist or veterinary surgeon. Schedule Five (domestic poisons)
Poisonous substances of a dangerous nature commonly used for domestic purposes which should be readily available to the public but which require caution in their handling, use and storage. Schedule Six (industrial and agricultural poisons)
Substances which should be readily available to the public for agricultural, pastoral, horticultural, veterinary, photographic or industrial purposes or for the destruction of pests. Schedule Seven (special poisons)
Substances of exceptional danger which require special precautions in their manufacture or use. Schedule Eight (drugs of addiction)
Substances which are addiction producing or potentially addiction producing. Copyright Elsevier Australia, 2003 1 6. Schedule four and Schedule eight are most relevant to nurses because they refer to substances or
drugs which nurses administer on a daily basis which require special knowledge relating to their use and storage. 7. Appendix D of the Poisons Regulation sets out specific drugs, such as barbiturates and
benzodiazepams, which may be abused and are liable to cause dependence. These are restricted drugs and have special storage and handling requirements over and above those required for other Schedule four substances. They are referred to as ‘Prescribed Restricted Substances’. 8. Regulation 29 refers to the requirements for the storage of Schedule four, Appendix D substances;
Regulation 31 states who may prescribe restricted substances; Regulation 34 states how such prescriptions must be written; Regulation 66 states what steps should be taken in the case of loss or theft of prescribed restricted substances; Regulation 74 refers to the requirements for storage of drugs of addiction in hospital wards; Regulation 76 states who may prescribe drugs of addiction; Regulation 122 states what steps should be taken in the case of loss or theft of drugs of addiction. 9. The most common problems which occur in the administration of drugs are giving:
■ the wrong drug; ■ the right drug at the wrong time; ■ the right drug by the wrong route; ■ the wrong dosage; ■ a drug which the patient is allergic to or a drug which is contraindicated is given in combination with other drugs. Activities 1. You should check that the hospital has written firm and clear policies and procedures which cover the following areas: ■ ensuring that the relevant provisions of the Poisons Act and Regulations and the Department of Health guidelines and circulars are implemented and carried out; ■ advise all staff concerned with drug administration of any relevant changes which may be made to the above documents; ■ ensuring that staff are informed and instructed in the use, requirements for handling, storage and any contraindications of new drugs; ■ contentious issues, such as checking procedures for drugs of addiction or legibility of medical officer’s drug orders are included in policy documents that are readily available to the staff; ■ any extended role as it relates to the handling of drugs. If you find any deficiencies in any of these areas you should consult with your administrative colleagues and/or the hospital drug committee to ensure that the situation is rectified. 2. In New South Wales Pethidine is listed in the Poisons List as a Schedule eight substance. Under
Regulation 115 of the Poisons Regulation, the nurse in charge of the ward is required to maintain a register of the administration of all Schedule eight substances. In the activity set out there are two legal issues involved. The first is the failure of both nurses to meet their obligations to maintain the register by recording particulars of the drug administration. The second is the failure to check the administration of the drug.The two nurses should have gone together to the bedside while the drug was given, then signed the register together. However, whether this omission would be judged to be a crime probably depends on whether or not the omission could be considered ‘wilful’. Both nurses should learn from the experience that the register should be completed at the proper time to avoid such problems. 3. Mogadon (Nitrazepam) is a substance whish is listed in Appendix D, Schedule four of the Poisons
List. This means that, unless an emergency exists, a doctor must give a written authorisation for its use. Nurse Golding would be in breach of the Poisons Regulation if she administered the drug without written authorisation. Clearly, the doctor’s hurry to be on his way does not constitute an emergency. In any event, the manner of the doctor’s order is such that the nurse is not given any opportunity to make a reasonable check that she understood the correct name of the patient, the dosage, or any other relevant details. There is certainly no witness who could attest to the order CHAPTER 6 The administration of drugs 2 Copyright Elsevier Australia, 2003 being given. Nurse Golding could be held to have committed an offence under the Poisons Act and Regulation if she gave the drug in these circumstances. She really has no choice but to ask the doctor to write out his order before he leaves the hospital. If he resists, she can only point out that as the situation does not constitute an emergency, she will not be able to administer the medication. 4. Nurse Burns has just made a common medication error; she has given the wrong dose of the right
drug. This type of medication error is not covered by the poisons legislation, so the nurse has not committed any crime under that framework. However, she has probably breached her duty of care to Mrs King by not checking both the type and dose of medication required. If Mrs King suffers any damage as a result of having been given the incorrect dose, Nurse Burns may incur a civil liability and the patient may sue for negligence. It is important that Nurse Burns takes action immediately to minimise the risk of damage. She should contact Mrs King’s doctor, tell the doctor what has happened and carry out whatever instructions the doctor gives to contain the situation. Nurse Burns must also notify nursing administration of her error and complete an incident report form.This notification is important because, if a civil action is brought against her, she has shown that she was not attempting to conceal her mistake and that she has taken all appropriate steps to minimise any damage to her patient. 5. Your memorandum will emphasise the need for careful handling of medication, for staff to acquaint themselves with the relevant poisons legislation and to bear in mind the following points in their day-to-day administering of medications. a. Read medications sheets carefully. b. Check the labelling of any drug. If it is an ampule, check the labelling on the ampoule, not the container. c. Leave medication in the same package in which it is sent from the pharmacy. d. Avoid transcribing patient medication orders. e. If, in an emergency, you have to take a drug order by telephone, observe the following steps: ■ obtain the patient’s notes if possible; ■ have the doctor repeat the order until it is clear; ■ repeat the order back to the medical practitioner; ■ if possible have a second nurse look at the order; ■ immediately enter on the patient’s notes the date, time, drug, amount, number of dosages etc., and sign the entry (have the second nurse countersign); ■ ensure that the doctor confirms his or her verbal order in writing as soon as possible afterwards. f. Question any order where you have doubts or where the order is not clear. g. Do not administer drugs until you have been properly instructed and assessed to do so. h. Always check a drug and drug order with a second person where possible. i. Follow the rule — if in doubt, question and clarify any drug order with the relevant medical officer. |
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