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Ecart Replacement Form

The document is an E-Cart Inventory and Replacement Form used for tracking high alert and other medicines within a healthcare setting. It includes details such as the generic name, dosage form, approved quantity, actual quantity, expiry dates, and reasons for opening the E-cart. The form requires signatures from a pharmacist and a nurse on duty for verification.

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NDH PHARMACY
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124 views1 page

Ecart Replacement Form

The document is an E-Cart Inventory and Replacement Form used for tracking high alert and other medicines within a healthcare setting. It includes details such as the generic name, dosage form, approved quantity, actual quantity, expiry dates, and reasons for opening the E-cart. The form requires signatures from a pharmacist and a nurse on duty for verification.

Uploaded by

NDH PHARMACY
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

E- CART INVENTORY AND REPLACEMENT FORM

DATE: WARD:

Generic name/ Dosage form/ Approved Actual Date Replaced/


Expiry date
Dosage Strength Qty Qty New Expiry Date
DRAWER 1- HIGH ALERT MEDICINES
Amiodarone 150 mg ampule
Atropine Sulfate 1 mg/ml Ampule
Calcium Gluconate 10% 10 ml Ampule
Diazepam 10mg/2ml Ampule
Epinephrine 1mg/ml Ampule
Magnesium Sulfate 1g/2ml Ampule
Magnesium Sulfate 25% 250mg/ml Amp.
Midazolam 5mg/ml Ampule
Morphine Sulfate 10mh/ml Ampule
Nalbuphine 1mg/ml Ampule
Naloxone 400mcg/ ml Ampule
Norepinephrine 1mg/ml; 4ml Ampule
Phenobarbital 30mg Tablet
Potassium Chloride 40 mEq/ 20ml Vial
Sodium Bicarbonate 50ml Vial
Dextrose 50% in Water 50ml Polyamp.
DRAWER 2- OTHER MEDICINES
Adenosine 6mg/ 2ml Ampule
Aspirin 80mg Tablet
Clopidogrel 75mh Tablet
Digoxin 250mcg/ml; 2ml Ampule
Dobutamine 250mg/5ml Ampule
Dopamine 200mg/5ml Ampule
Diphenhydramine 50mg/ml Ampule
Furosemide 20mg/2ml
Haloperidol 50mg/ml Ampule
Hydrocortisone 250mg vial
Isosorbide Dinitrate 5mg SL Tablets
Levetiracetam 500mg/5ml Vial
Lidocaine 10% in 50ml Spray
Lidocaine 2% solution 5ml Vial
Methylprednisolone 125mg vial
Methylprednisolone 4mg Tablet
Metoclopramide 10mg/2ml Ampule
Nicardipine 1mg/ml; 10ml Ampule
Paracetamol 300mg/2ml Ampule
Phenytoin 100mg/2ml Ampule
Ranitidine 25mg/ml Ampule
Salbutamol 2m/ml Nebule
Tranexamic Acid 100mg/ml; 5ml Ampule
Vitamin K 10mg/ml Ampule
DRAWER 5- FLUIDS and OTHER SUPPLIES
Hydroxyl Ethyl Starch 500ml Bag
Mannitol 20% sol’n 500ml
PLR 1L
PNSS 1L
D5 Water 500ml
Reason/s for opening E-cart:

Checked by (RPh): Verified by (NOD):

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