Circular No. 23/2011/TT-BYT guides the use of medicines in healthcare facilities with hospital beds.

CIRCULAR

Guidelines for the use of medicines in healthcare facilities with beds

On the basis of The Medicine Law number 34/2005/QH11 dated June 14, 2005;
Decree No. Decree 188/2007/NĐ-CP dated December 27, 2007 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;
The Ministry of Health provides guidelines for the use of medicines in healthcare facilities with beds as follows:

PART I
GENERAL PROVISIONS

Article 1. Scope of Regulation

These Circulars provide guidelines for the use of medicines in healthcare facilities with beds.

Article 2. Responsibilities in prescribing and guiding the use of medicines

1. The person responsible for prescribing medicines to patients (referred to collectively as Medical Practitioners) includes:

a) Physicians;

b) Midwives at commune health stations, urban district hospitals, and rural district hospitals (collectively referred to as commune health stations and district hospitals) where there is no physician responsible for prescribing medicines to patients;

c) Traditional medicine practitioners and midwives at commune health stations and district hospitals who are responsible for prescribing traditional medicines and herbal medicines to patients;

d) Midwives at commune health stations when there is no physician or midwife available to prescribe emergency medications during childbirth.

2. Guidance on the use of medicines

a) Pharmacists in the Pharmacy Department are responsible for updating information about medicines and providing guidance on their use to Medical Practitioners, pharmacists, nursing staff, and patients.

b) Medical Practitioners must guide patients (or their family members) on how to take their medicines.

c) Nursing staff and midwives are responsible for ensuring that patients take their medicines correctly or guiding patients on how to take their medicines to ensure they are taken properly, at the right time, and in the correct dosage according to medical orders.

d) Patients must comply with treatment, not arbitrarily stop taking prescribed medicines or use medicines not prescribed by Medical Practitioners. Patients or their family members are responsible for any adverse events resulting from the improper use of medicines not prescribed by Medical Practitioners.

Chapter II
GUIDELINES FOR THE USE OF MEDICINES

Article 3. Medical Practitioners' prescription of medicines

1. When examining patients, Medical Practitioners must collect medication history, allergy history, list all medicines the patient has used prior to hospitalization within 24 hours, and record the clinical course of the patient in the medical record (paper or electronic as specified by the Ministry of Health) to prescribe or discontinue the use of medicines.

2. Medicines prescribed for patients must meet the following requirements:

a) Consistent with the diagnosis and progression of the disease;

b) Consistent with the patient's pathological condition and constitution;

c) Consistent with age and weight;

d) Consistent with treatment guidelines (if applicable);

đ) Medication should not be overused.

3. Prescription writing

a) Prescriptions must be fully and clearly recorded on the prescription form and medical record, without abbreviating drug names or using symbols. Any corrections must be signed next to the corrected content.

b) Prescription content must include: drug name, concentration (dosage), single dose, number of doses in 24 hours, interval between doses, timing of administration, route of administration, and special instructions for use.

c) Prescription should be recorded in the following sequence: injection, oral, insertion, external application, and other routes of administration.

4. Rules for numbering days of use for certain groups of medicines requiring careful use

a) Medicines that require numbering days of use include:

- Radioactive drugs;

- Addictive drugs;

- Psychotropic drugs;

- Antibiotics;

- Tuberculosis treatment drugs;

- Corticosteroids.

b) For chronic diseases requiring addictive drugs, psychotropic drugs, tuberculosis treatment drugs, corticosteroids, and long-term cancer treatment drugs, the days of use should be numbered according to each treatment cycle, with the start and end dates of each cycle clearly recorded.

5. Prescription duration for medicines

a) In cases of emergency, Medical Practitioners prescribe medicines based on the progression of the disease.

b) In cases where observation is needed to select appropriate medicines or dosages, Medical Practitioners prescribe daily medicines.

c) In cases where appropriate medicines and dosages have been selected, the maximum prescription duration shall not exceed two working days and three non-working days.

6. Selection of the route of administration for patients

a) Based on the patient's condition, severity of illness, and route of administration of the medicine, issue an order for the appropriate route of administration.

b) Intravenous administration should only be used when the patient cannot take oral medication or when oral administration does not meet the treatment requirements or when the medicine can only be administered intravenously.

7. Medical Practitioners must inform nursing staff and patients (or their families) about the potential side effects of medicines. Monitor the patient's response to the medicines and promptly address any adverse reactions. Report adverse drug reactions to the Pharmacy Department immediately (using Form Appendix 5).

Article 4. Medication consolidation at clinical departments

1. Nursing staff shall consolidate medications and chemicals from medical records into daily medication consolidation logs (according to Model Appendix 10), then consolidate the department's medication usage onto Medication Withdrawal Forms (according to Model Appendix 1). Chemical withdrawal forms and consumable medical supplies withdrawal forms (according to Model Appendices 2 and 3) shall be consolidated weekly.

2. Narcotic drugs, psychotropic drugs, and radioactive drugs must have separate medication withdrawal forms as prescribed by current regulations.

3. Medication withdrawal forms must be approved in writing by the Head of Department or a physician authorized in writing by the Head of Department. For withdrawal forms during holidays and for urgent medication requests, on-duty physicians and medical assistants are permitted to sign the withdrawal forms.

4. The consolidation logs and medication withdrawal forms must be recorded clearly, fully, accurately, without abbreviations, and any corrections must be confirmed with a signature beside them.

Article 5. The Pharmacy Department organizes the distribution and guidance on the use of medications

1. Review medication orders and withdrawal forms daily before distribution.

2. Organize daily medication distribution and supplementary medications according to medical orders. Distribute medications promptly to ensure patients take their medications at the correct time.

3. Individual medications that are not in original packaging must be repackaged in sealed containers with labels indicating the drug name, concentration (dosage), and expiration date. Repackaging must be done in a clean environment and with hygienic procedures.

4. Depending on hospital conditions and specialty, the Pharmacy Department will prepare medications according to medical orders and distribute them in pre-prepared form for use.

5. The Pharmacy Department will refuse to distribute medications in cases where withdrawal forms or prescriptions contain errors. Replacement withdrawal forms or prescriptions after consultation with a pharmacy staff member must be signed by the person who originally signed the withdrawal form (or prescription).

6. Provide information about medications: drug name, components, pharmacological effects, side effects, dosage, application in treatment, price, and stock levels.

7. The Pharmacy Department serves as the point of contact to report adverse drug reactions to hospital leadership (according to Model Appendix 5) and immediately send reports to the National Center for Drug Information and Adverse Reaction Monitoring after handling.

Article 6. Responsibilities of clinical departments in administering medications to patients

1. Before patients use medications

a) Publicly announce daily medications for each patient by informing the patient before administration, and require the patient or family member to sign the Medication Disclosure Form (according to Model Appendix 7). The Medication Disclosure Form should be kept at the top or bottom of the patient's bed.

b) Guide and explain to patients how to follow the treatment regimen.

c) Check the medications (drug name, concentration, dosage, number of doses in 24 hours, interval between doses, timing, and route of administration) against the medical orders, and check the expiration date and visual quality of the medications. When abnormalities are detected in the medical orders, such as prescribing excessive dosages, inappropriate routes of administration, or multiple medications causing interactions, nursing staff must report to the treating physician or on-duty physician.

d) Prepare equipment and medications:

- Ensure sufficient equipment for patients to take medications: medicine trays, clean drinking water for oral medications, individual medicine bottles for hourly dosing;

- Transport equipment must be clean, neatly arranged, and easily visible;

- Prepare emergency drug boxes and shock treatment protocols for injectable medications;

- Prepare injection solutions for patients according to the manufacturer's specifications, ensuring the correct solvent, volume, and requirements.

2. During medication administration

a) Ensure hygiene to prevent infections.

b) Ensure the five rights:

- Right patient;

- Right drug;

- Right dose;

- Right route;

- Right time.

c) Directly witness patients taking their medications and monitor to promptly detect any abnormalities during medication use.

3. After patients use medications

a) Monitor patients:

- Continuously monitor to promptly address any abnormalities in patients. Record all clinical developments of the patient in the medical record.

- The treating physician is responsible for monitoring the effects of the medication and promptly addressing any adverse reactions caused by the medication, recording them in the adverse reaction log (according to Model Appendix 5).

b) Specifically record the number of medications administered to each patient, marking each completed medication.

c) Store remaining medications (if any) according to the manufacturer's requirements.

d) Dispose of and store equipment related to medication use for patients according to regulations.

Article 7. Management and storage of drugs in clinical departments

1. Drugs in emergency medicine cabinets must comply with the approved list and quantity, and be stored according to the regulations and requirements of the manufacturer.

2. Narcotic drugs, psychotropic drugs, precursor substances, and radioactive drugs must be managed and stored in accordance with current regulations.

3. Nurses assigned to check and verify the name of the drug, concentration/dose, quantity, quality, and form of preparation on the drug requisition form when receiving drugs from the Pharmacy Department and when handing over drugs to nurses providing care.

4. When nurses discover incorrect drug usage, missing drugs, or damaged drugs, they must immediately report to their direct superior manager for timely measures and request clarification of the cause and responsibility.

5. Excess drugs resulting from changes in medical orders, patient transfers between departments, discharge, transfer to another hospital, or death (hereinafter referred to as discharge) shall be compiled (according to Form Appendix 4), confirmed by the head of the clinical department or a person authorized in writing by the head of the clinical department, and returned to the Pharmacy Department within 24 hours. For excess narcotic drugs, psychotropic drugs, and radioactive drugs, a record must be made and the drugs returned according to current regulations.

6. Compile the consumption of drugs, chemicals, and medical supplies for each patient before discharge and transfer to the Finance and Accounting Department for settlement of hospital fees.

7. Hand over the actual quantity of drugs and equipment to the next shift and record in the Continuous Drug Handover Logbook and Continuous Equipment Handover Logbook (according to Forms Appendix 8 and 9).

8. Strictly prohibit individuals from borrowing, lending, or exchanging drugs.

Article 8. Reporting

1. In case of special incidents (adverse events, errors) related to drug use, hospitals must handle them immediately and report to the direct superior management authority.

2. Report adverse drug reactions (according to Form Appendix 5) to the direct superior management authority and the National Center for Drug Information and Adverse Reaction Monitoring.

3. Report the use of narcotic drugs, psychotropic drugs, and radioactive drugs in accordance with the current regulations of the Ministry of Health.

Chapter III
IMPLEMENTING PROVISIONS

Article 9. Effective Date

This Circular takes effect from July 25, 2011. This Circular replaces the "Regulation on Drug Usage" in the Hospital Regulation issued together with Decision No. 1895/1997/BYT-QĐ dated September 19, 1997, of the Minister of Health.

Article 10. Responsibility for Implementation

The officials: Director of the Ministry's Office, Director of the Department of Medical Examination and Treatment, Inspector General of the Ministry, General Director, Directors of all Departments and Bureaus under the Ministry of Health, Directors of hospitals and institutes with beds under the Ministry of Health, Directors of Health Services of provinces and centrally-administered cities, and Heads of health services of other sectors are responsible for organizing the implementation, monitoring, and evaluating the implementation of this Circular.

During the implementation process, if there are difficulties or obstacles, units and localities need to promptly reflect these issues to the Ministry of Health (Department of Medical Examination and Treatment) for guidance, consideration, and resolution./.