TSDHCT Point of Care Medicines Safety Checklist Tool

• Document No.

• Conducted on

  Date

• Prepared by

Patient One

• NHS Number

• Name of drug and dose prescribed?

• Who currently administers medication?

  RN

  HCA

  AP

• Could this patient be delegated to an HCA or AP?

  Yes

  No

  N/A

• Were all doses in the last 4 weeks given on time ? ( +/- 30 minutes of prescribed time )

  Yes

  No

  N/A

• If no, how many doses were missed?

• How many doses were delayed by more than 30 minutes?

• Was insulin administered in the last month?

  Yes

  No

  N/A

• What is the reason that the team has taken on administration of insulin for this patient?

• How frequently is insulin prescribed for administration?

  Daily

  Twice Daily

• Does anyone else administer the insulin?

  No

  Family

  Friends

  Neignbours

  Other

• Has a clear communication plan been established?

  Yes

  No

  N/A

• Any further comments you wish to add?