Medication Safety Imprest Systems- Clinical Nurse

Level *

Level 1 (Galup)

Name *

First

Last

Date / Time

Date

Time

Imprest

	Meets requirement	Does not meet requirement (less than)	Stock Levels above requirements	Within Date	Expired Stock	Ordered Awaiting delivery	Supply Issue
Aspirin 300 mg (#1)	Meets requirementAspirin 300 mg (#1) Meets requirement	Does not meet requirement (less than)Aspirin 300 mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsAspirin 300 mg (#1) Stock Levels above requirements	Within DateAspirin 300 mg (#1) Within Date	Expired StockAspirin 300 mg (#1) Expired Stock	Ordered Awaiting deliveryAspirin 300 mg (#1) Ordered Awaiting delivery	Supply IssueAspirin 300 mg (#1) Supply Issue
Baclofen 10 mg (#1)	Meets requirementBaclofen 10 mg (#1) Meets requirement	Does not meet requirement (less than)Baclofen 10 mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsBaclofen 10 mg (#1) Stock Levels above requirements	Within DateBaclofen 10 mg (#1) Within Date	Expired StockBaclofen 10 mg (#1) Expired Stock	Ordered Awaiting deliveryBaclofen 10 mg (#1) Ordered Awaiting delivery	Supply IssueBaclofen 10 mg (#1) Supply Issue
Baclofen 25 mg (#1)	Meets requirementBaclofen 25 mg (#1) Meets requirement	Does not meet requirement (less than)Baclofen 25 mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsBaclofen 25 mg (#1) Stock Levels above requirements	Within DateBaclofen 25 mg (#1) Within Date	Expired StockBaclofen 25 mg (#1) Expired Stock	Ordered Awaiting deliveryBaclofen 25 mg (#1) Ordered Awaiting delivery	Supply IssueBaclofen 25 mg (#1) Supply Issue
Buscopan 10 mg (#1)	Meets requirementBuscopan 10 mg (#1) Meets requirement	Does not meet requirement (less than)Buscopan 10 mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsBuscopan 10 mg (#1) Stock Levels above requirements	Within DateBuscopan 10 mg (#1) Within Date	Expired StockBuscopan 10 mg (#1) Expired Stock	Ordered Awaiting deliveryBuscopan 10 mg (#1) Ordered Awaiting delivery	Supply IssueBuscopan 10 mg (#1) Supply Issue
Clonidine 100 mcg (#1)	Meets requirementClonidine 100 mcg (#1) Meets requirement	Does not meet requirement (less than)Clonidine 100 mcg (#1) Does not meet requirement (less than)	Stock Levels above requirementsClonidine 100 mcg (#1) Stock Levels above requirements	Within DateClonidine 100 mcg (#1) Within Date	Expired StockClonidine 100 mcg (#1) Expired Stock	Ordered Awaiting deliveryClonidine 100 mcg (#1) Ordered Awaiting delivery	Supply IssueClonidine 100 mcg (#1) Supply Issue
Coloxyl and Senna (#1)	Meets requirementColoxyl and Senna (#1) Meets requirement	Does not meet requirement (less than)Coloxyl and Senna (#1) Does not meet requirement (less than)	Stock Levels above requirementsColoxyl and Senna (#1) Stock Levels above requirements	Within DateColoxyl and Senna (#1) Within Date	Expired StockColoxyl and Senna (#1) Expired Stock	Ordered Awaiting deliveryColoxyl and Senna (#1) Ordered Awaiting delivery	Supply IssueColoxyl and Senna (#1) Supply Issue
Ibuprofen 200 mg (#3)	Meets requirementIbuprofen 200 mg (#3) Meets requirement	Does not meet requirement (less than)Ibuprofen 200 mg (#3) Does not meet requirement (less than)	Stock Levels above requirementsIbuprofen 200 mg (#3) Stock Levels above requirements	Within DateIbuprofen 200 mg (#3) Within Date	Expired StockIbuprofen 200 mg (#3) Expired Stock	Ordered Awaiting deliveryIbuprofen 200 mg (#3) Ordered Awaiting delivery	Supply IssueIbuprofen 200 mg (#3) Supply Issue
Lactulose	Meets requirementLactulose Meets requirement	Does not meet requirement (less than)Lactulose Does not meet requirement (less than)	Stock Levels above requirementsLactulose Stock Levels above requirements	Within DateLactulose Within Date	Expired StockLactulose Expired Stock	Ordered Awaiting deliveryLactulose Ordered Awaiting delivery	Supply IssueLactulose Supply Issue
Loperamide 2mg (#3)	Meets requirementLoperamide 2mg (#3) Meets requirement	Does not meet requirement (less than)Loperamide 2mg (#3) Does not meet requirement (less than)	Stock Levels above requirementsLoperamide 2mg (#3) Stock Levels above requirements	Within DateLoperamide 2mg (#3) Within Date	Expired StockLoperamide 2mg (#3) Expired Stock	Ordered Awaiting deliveryLoperamide 2mg (#3) Ordered Awaiting delivery	Supply IssueLoperamide 2mg (#3) Supply Issue
Lithium Carbonate 250 mg (#1)	Meets requirementLithium Carbonate 250 mg (#1) Meets requirement	Does not meet requirement (less than)Lithium Carbonate 250 mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsLithium Carbonate 250 mg (#1) Stock Levels above requirements	Within DateLithium Carbonate 250 mg (#1) Within Date	Expired StockLithium Carbonate 250 mg (#1) Expired Stock	Ordered Awaiting deliveryLithium Carbonate 250 mg (#1) Ordered Awaiting delivery	Supply IssueLithium Carbonate 250 mg (#1) Supply Issue
Metoclopromide 10 mg /1 ml (#1)	Meets requirementMetoclopromide 10 mg /1 ml (#1) Meets requirement	Does not meet requirement (less than)Metoclopromide 10 mg /1 ml (#1) Does not meet requirement (less than)	Stock Levels above requirementsMetoclopromide 10 mg /1 ml (#1) Stock Levels above requirements	Within DateMetoclopromide 10 mg /1 ml (#1) Within Date	Expired StockMetoclopromide 10 mg /1 ml (#1) Expired Stock	Ordered Awaiting deliveryMetoclopromide 10 mg /1 ml (#1) Ordered Awaiting delivery	Supply IssueMetoclopromide 10 mg /1 ml (#1) Supply Issue
Metoclopromide 10 mg (#2)	Meets requirementMetoclopromide 10 mg (#2) Meets requirement	Does not meet requirement (less than)Metoclopromide 10 mg (#2) Does not meet requirement (less than)	Stock Levels above requirementsMetoclopromide 10 mg (#2) Stock Levels above requirements	Within DateMetoclopromide 10 mg (#2) Within Date	Expired StockMetoclopromide 10 mg (#2) Expired Stock	Ordered Awaiting deliveryMetoclopromide 10 mg (#2) Ordered Awaiting delivery	Supply IssueMetoclopromide 10 mg (#2) Supply Issue
Movicol (#1)	Meets requirementMovicol (#1) Meets requirement	Does not meet requirement (less than)Movicol (#1) Does not meet requirement (less than)	Stock Levels above requirementsMovicol (#1) Stock Levels above requirements	Within DateMovicol (#1) Within Date	Expired StockMovicol (#1) Expired Stock	Ordered Awaiting deliveryMovicol (#1) Ordered Awaiting delivery	Supply IssueMovicol (#1) Supply Issue
Mylanta (#1)	Meets requirementMylanta (#1) Meets requirement	Does not meet requirement (less than)Mylanta (#1) Does not meet requirement (less than)	Stock Levels above requirementsMylanta (#1) Stock Levels above requirements	Within DateMylanta (#1) Within Date	Expired StockMylanta (#1) Expired Stock	Ordered Awaiting deliveryMylanta (#1) Ordered Awaiting delivery	Supply IssueMylanta (#1) Supply Issue
Olanzepine 5mg (#3)	Meets requirementOlanzepine 5mg (#3) Meets requirement	Does not meet requirement (less than)Olanzepine 5mg (#3) Does not meet requirement (less than)	Stock Levels above requirementsOlanzepine 5mg (#3) Stock Levels above requirements	Within DateOlanzepine 5mg (#3) Within Date	Expired StockOlanzepine 5mg (#3) Expired Stock	Ordered Awaiting deliveryOlanzepine 5mg (#3) Ordered Awaiting delivery	Supply IssueOlanzepine 5mg (#3) Supply Issue
Paracetamol 500 mg (#3)	Meets requirementParacetamol 500 mg (#3) Meets requirement	Does not meet requirement (less than)Paracetamol 500 mg (#3) Does not meet requirement (less than)	Stock Levels above requirementsParacetamol 500 mg (#3) Stock Levels above requirements	Within DateParacetamol 500 mg (#3) Within Date	Expired StockParacetamol 500 mg (#3) Expired Stock	Ordered Awaiting deliveryParacetamol 500 mg (#3) Ordered Awaiting delivery	Supply IssueParacetamol 500 mg (#3) Supply Issue
Quetiapine 25mg (#5)	Meets requirementQuetiapine 25mg (#5) Meets requirement	Does not meet requirement (less than)Quetiapine 25mg (#5) Does not meet requirement (less than)	Stock Levels above requirementsQuetiapine 25mg (#5) Stock Levels above requirements	Within DateQuetiapine 25mg (#5) Within Date	Expired StockQuetiapine 25mg (#5) Expired Stock	Ordered Awaiting deliveryQuetiapine 25mg (#5) Ordered Awaiting delivery	Supply IssueQuetiapine 25mg (#5) Supply Issue
Quetiapine 100mg (#1)	Meets requirementQuetiapine 100mg (#1) Meets requirement	Does not meet requirement (less than)Quetiapine 100mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsQuetiapine 100mg (#1) Stock Levels above requirements	Within DateQuetiapine 100mg (#1) Within Date	Expired StockQuetiapine 100mg (#1) Expired Stock	Ordered Awaiting deliveryQuetiapine 100mg (#1) Ordered Awaiting delivery	Supply IssueQuetiapine 100mg (#1) Supply Issue
Quetiapine XR 50mg (#1)	Meets requirementQuetiapine XR 50mg (#1) Meets requirement	Does not meet requirement (less than)Quetiapine XR 50mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsQuetiapine XR 50mg (#1) Stock Levels above requirements	Within DateQuetiapine XR 50mg (#1) Within Date	Expired StockQuetiapine XR 50mg (#1) Expired Stock	Ordered Awaiting deliveryQuetiapine XR 50mg (#1) Ordered Awaiting delivery	Supply IssueQuetiapine XR 50mg (#1) Supply Issue
Salbutamol Inhaler (#1)	Meets requirementSalbutamol Inhaler (#1) Meets requirement	Does not meet requirement (less than)Salbutamol Inhaler (#1) Does not meet requirement (less than)	Stock Levels above requirementsSalbutamol Inhaler (#1) Stock Levels above requirements	Within DateSalbutamol Inhaler (#1) Within Date	Expired StockSalbutamol Inhaler (#1) Expired Stock	Ordered Awaiting deliverySalbutamol Inhaler (#1) Ordered Awaiting delivery	Supply IssueSalbutamol Inhaler (#1) Supply Issue
Sodium valproate 200 mg (#1)	Meets requirementSodium valproate 200 mg (#1) Meets requirement	Does not meet requirement (less than)Sodium valproate 200 mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsSodium valproate 200 mg (#1) Stock Levels above requirements	Within DateSodium valproate 200 mg (#1) Within Date	Expired StockSodium valproate 200 mg (#1) Expired Stock	Ordered Awaiting deliverySodium valproate 200 mg (#1) Ordered Awaiting delivery	Supply IssueSodium valproate 200 mg (#1) Supply Issue
Sodium valproate 500 mg (#1)	Meets requirementSodium valproate 500 mg (#1) Meets requirement	Does not meet requirement (less than)Sodium valproate 500 mg (#1) Does not meet requirement (less than)	Stock Levels above requirementsSodium valproate 500 mg (#1) Stock Levels above requirements	Within DateSodium valproate 500 mg (#1) Within Date	Expired StockSodium valproate 500 mg (#1) Expired Stock	Ordered Awaiting deliverySodium valproate 500 mg (#1) Ordered Awaiting delivery	Supply IssueSodium valproate 500 mg (#1) Supply Issue
Thiamine 100mg (#3)	Meets requirementThiamine 100mg (#3) Meets requirement	Does not meet requirement (less than)Thiamine 100mg (#3) Does not meet requirement (less than)	Stock Levels above requirementsThiamine 100mg (#3) Stock Levels above requirements	Within DateThiamine 100mg (#3) Within Date	Expired StockThiamine 100mg (#3) Expired Stock	Ordered Awaiting deliveryThiamine 100mg (#3) Ordered Awaiting delivery	Supply IssueThiamine 100mg (#3) Supply Issue
Thiamine 100 mg (IMI Vials #5)	Meets requirementThiamine 100 mg (IMI Vials #5) Meets requirement	Does not meet requirement (less than)Thiamine 100 mg (IMI Vials #5) Does not meet requirement (less than)	Stock Levels above requirementsThiamine 100 mg (IMI Vials #5) Stock Levels above requirements	Within DateThiamine 100 mg (IMI Vials #5) Within Date	Expired StockThiamine 100 mg (IMI Vials #5) Expired Stock	Ordered Awaiting deliveryThiamine 100 mg (IMI Vials #5) Ordered Awaiting delivery	Supply IssueThiamine 100 mg (IMI Vials #5) Supply Issue

Review Summary

	Action required	No action required
Stock requires adjustment	Action requiredStock requires adjustment Action required	No action requiredStock requires adjustment No action required
Expired stock requires replacement	Action requiredExpired stock requires replacement Action required	No action requiredExpired stock requires replacement No action required
Coordinator informed	Action requiredCoordinator informed Action required	No action requiredCoordinator informed No action required
Stock in Imprest that is not listed	Action requiredStock in Imprest that is not listed Action required	No action requiredStock in Imprest that is not listed No action required

Further comments