IPC Topic Quiz #2
The absence of disease, disability, and symptoms of pain and discomfort. The individual with this _________ perspective on health will often focus entirely on symptoms, and the underlying causes of the problem can get lost in the search for specific treatment of generalized symptoms.
negative
You cannot refill CII drugs
no matter what the doctor says/prescribes (BUT they can write 3 separate, sequential prescriptions to be dispensed on certain days)
•Patients who feel that their concerns are not being attended to by the practitioner often do not take medications as intended. oConcerns related to medications are a major cause of ___________.
nonadherence
A care plan should:
optimize therapy/address any med-related problems set goals of therapy that have achievable outcomes for patient's health engage in patient by education and empowerment support care continuity (follow up and transitions of care)
•If this method is used, a prescription for a schedule III, IV or V drug must be made readily retrievable by use of a red "C" stamp not less than one inch high. If a pharmacy has an electronic recordkeeping system for prescriptions which permits identification by prescription number and retrieval of original documents by prescriber's name, patient's name, drug dispensed, and date filled, the requirement to mark the hard copy with a red "C" is waived.
option 2 of patient prescription records
_______ is dispensed for immediate administration to the ultimate user (for example, an order to dispense a drug to an inpatient for immediate administration in a hospital is not a prescription).
order
progress towards the achievement of therapy goals
outcomes of care
Opening line of CC usually includes:
patient age, sex, reason for visit (symptom, condition, previous diagnosis, follow up, referral)
•Common ________ include: -risks of taking a certain medication -side effects experienced -confusion over how to take a medication or why it is being taken
patient concerns
If we don't understand a patients concept of illness this leads to systemic inattention of illness which can be responsible for
patient non adherence dissatisfaction with care inadequate clinical care
Pharmacy success used to be measured on number of Rx but is now measured by
patient outcomes
Pharmacy business was once passive via prescriptions -now practice grows via
patient recruitment (word of mouth)
Pharmacy visits were once determined by refill/supply -now determined by
patient risk/benefit
We are changing the relationship between providers and patient from the traditional model to one that is:
patient-centered
The pharmaceutical care practitioner must understand the patient's _______ of their medication and the _______ these medications are having on their life.
perception; impact
The patient's medication experience is the patient's __________ to the use of medicines—why he believes or feels a certain way about drug therapy.
personal approach
A, B, F, G
physician (someone who can prescribe all on their own)
Individualized in collaboration with other health care professionals and the patient/caregiver that is evidence-based and cost-effective
plan
should include treatment course of actions with therapies listed in order of importance
plan
patient's attitude about health tend to be either:
positive or negative
•We call the patient's perspective on medications, his "medication experience," whereas we call the pharmacist's perspective on medications, ____________
"pharmacotherapeutics."
Over time and with experience, patients develop attitudes toward and beliefs about drug therapy generally and the medications they are taking specifically.
#1Patient's General Attitude Toward Taking Medications
•The patient may present with a thorough and comprehensive understanding of all their drug therapies, or may understand very little about the medications
#2 Patient's Understanding of Drug Therapy
•Establishing what your patient wants is the most productive place to begin an assessment. •To provide a service that a patient feels is valuable, it must be perceived as doing what they want it to do.
#3 Patient's Wants and Expectations
•Patients frequently express what they want in terms of concerns they have about the medication itself or how it must be taken.
#4Patient Concerns
•Understand the social context of each patient, where lies the religious beliefs, traditions, and social expectations that can impact a patient's: •attitudes and beliefs about the efficacy of the medication, •its appropriateness, and •the proper way to administer it
#5 Cultural, Ethical, and Religious Issues
•Describes the decisions a patient makes and acts upon related to the use of drug products and dosage regimens.
#6 Patient's Medication Taking Behavior
Do the patients fear that the symptoms they present may be the precursor of a more serious problem such as cancer? Sense of relief from responsibilities? Does the patient feel angry or guilty about being ill?
Patient feelings about illness
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "A" stand for?
Alleviating and Aggravating factors: What makes it better? What makes it worse?
When we ask about medications a patient has previously used in attempt to alleviate the CC, what medications are we implying?
Any medication used to alleviate symptoms (prescription, herbal, OTC, dietary supplements)
What meaning do they attach to the illness experience? Is the illness seen as a form of punishment or, perhaps, as an opportunity for dependency?
Patient ideas about illness
Defined as the sum of all the events a patient has in their lifetime that involve drug therapy --> the patient's personal experience with medications that shapes their attitudes, beliefs, and preferences about drug therapy.
Patient medication Experience **exam Q**
a patient-provider relationship that considers treatment options based on a patients unique concerns, values, preferences -the desired outcomes based on experience, background, lifestyle
Patient-centered care
Defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life
Pharmaceutical Care
5 elements of a consistent process that uses the principles of evidence-based practice (pharmacists practicing patient-centered care should perform this process)
Pharmacist's Patient Care Process (PPCP) (CAPIF wheel)
Steps taken to treat the patient or specific recommendations to address a problem
Plan
identify and prioritize problems and achieve optimal care
Assess
The use of critical thinking for the synthesis of "subjective" and "objective" information --> generates the diagnosis & can be used to identify drug related problems
Assessment
Vital signs include
BP, HR, RR, O2, Temp
Look at the efficacy of the care plan and make modifications as needed in collaboration with other HCP's and the patient/caregiver
Follow-up: Monitor and Evaluate
format that is broken down by disease states in order of priority
Problem Based format
2 main formats care providers use for assessment and Plan
Problem based system based
•The two letters are followed by 7 numbers. The numbers follow a formula that can be used to verify the number: •Add digits 1, 3, and 5 •Add digits 2, 4, and 6, and multiply the sum by two. •Add the results of the above and the last number of the summation should equal last number in the DEA number
Verifying DEA Numbers
Objective data should include
Vital signs, physical exam info, Laboratory data, Imaging results, Diagnostic data, Documentation of other clinicians
Patients are more likely to do what You say if they think you are taking their ________ into account.
Wants
first letter of DEA tells you
What kind of practitioner they are
information on current medication list and medication history for prescription and nonprescription medications, herbal products, and dietary supplements
collectible information
The patient's ________ is usually very different from what the HCP thinks
concept of illness
practitioners must Emphasize that the patient is always the final decision maker --> they must give ________ to the practitioner's influence on whether and how to take a drug product.
consent
the patients lived experience associated with illness can have many positive or negative ____________
consequences
A prescription for a __________ must be written in ink or indelible pencil or typewritten and must be manually signed by the practitioner on the date when issued. An individual (secretary or nurse) may be designated by the practitioner to prepare prescriptions for the practitioner's signature. The practitioner is responsible for ensuring that the prescription conforms to all requirements
controlled substance
Purpose of getting a patient's __________ is to obtain subjective patient information --> what the patient says about their own health, medications, etc.
medication history
for this Collection component of the Pharmacist's Patient Care Process, what information is collected by "Recall by the patient/caregiver or list provided by them"
medications
M
midlevel practitioner (do not prescribe on their own)
Records of controlled substances dispensed (i.e., prescriptions, schedule V logbook) •Reports of Theft or Significant Loss (DEA Form 106), if applicable •Inventory of Drugs Surrendered for Disposal (DEA Form 41), if applicable •Records of transfers of controlled substances between pharmacies •DEA registration certificate •Self-certification certificate and logbook (or electronic equivalent) as required under the Combat Methamphetamine Epidemic Act of 2005
more records required by DEA
•Also known as "opioids," the term "narcotic" comes from the Greek word for "stupor" (narkosis- benumbing) and originally referred to substances that dulled the senses and relieved pain.
narcotic
•A __________ is an order for medication which is dispensed to or for an ultimate user. --not an order for medication which is dispensed for immediate administration to the ultimate user (for example, an order to dispense a drug to an inpatient for immediate administration in a hospital is not a prescription).
prescription
When recording a patient's allergies under the subjective section of a SOAP note, you should:
record both the allergy and the reaction
Legend
regular Rx -not controlled
The assessment portion of the soap note should include
restatement of CC Diagnosis of CC (& reasoning) course Action Therapy goal medication regimen (keep, change, or implement new) what the patient instructions will be
controlled substance with No currently accepted medical use in the U.S., a lack of accepted safety for use under medical supervision, and a high potential for abuse.
schedule 1
drugs have a low potential for abuse relative to substances in schedule III.
schedule 4 •CIV
Rx are only valid if written within the correct _____________
scope of practice
Physical exam findings could include
skin, HEENT, Pulmonary, CV, MS/Ext, Mental status
broken down by body systems
system based format
Where do you sign the soap note?
the bottom, place credentials after your name
what is the check digit
the digit of the sums (that you compare to the 7th digit)
Does the presentation of a sore throat carry with it an expectation of penicillin? Does the patient want the provider to do something or just listen?
the patient's expectations of the provider
When listing surgical history you should state:
the year and the surgeon
What is the main goal of pharmaceutical care?
to optimize the patient's health-related quality of life and to achieve positive clinical outcomes, with realistic economic expenditures
True or false you can receive CII Rx electronically
true
•Your patient's level of _________ will determine the extent to which you will need to educate and explain effectiveness and safety instructions.
understanding
1.What is the patient's general attitude toward taking medication? 2.To what extent does the patient understand their medications? 3.What does the patient want/expect from their drug therapy? 4.What concerns does the patient have about their drug therapy? 5.Are there cultural, religious, or ethical issues that influence the patient's willingness to take medications? 6.What is the patient's medication taking behavior? (all components of __________________)
understanding the patient's medication experiences
•Schedule II controlled substances require a __________ which must be signed by the practitioner. There is no federal time limit within which a Schedule II prescription must be filled after being signed by the practitioner. While some states and many insurance carriers limit the quantity of controlled substance dispensed to a 30-day supply, there are no specific federal limits to quantities of drugs dispensed via a prescription. -can be electronic
written prescription
General information, listed under objective data, includes information such as
"Obese male, in NAD"
•Today _________ refers to opium, opium derivatives, and their semi-synthetic substitutes.
"narcotic"
Doctors cannot write Rx for schedule ______ drugs
1
•Refilling a CII is prohibited. •A practitioner may issue multiple prescriptions for up to a 90-day supply of a CII if:
1. Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice. 2. The practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription. 3. The practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse. 4. The issuance of multiple prescriptions is permissible under applicable state laws. 5. The practitioner complies fully with all other applicable requirements under the Controlled Substances Act and Code of Federal Regulations, as well as any additional requirements under state law
What are the two varying formats of presentation order in a SOAP note?
1. Keep assessment and plan as separate sections 2. combined assessment and plan
Medical History should contain what 4 types of histories?
1. Medical (past or current conditions) 2. Surgical 3. Family (first degree relatives) 4. Social (HEADSS)
•Pharmacies have two options for filing prescription records under the C.F.R. All prescription records must be readily retrievable for DEA inspection. Controlled substance prescriptions must be filed in one of the following ways:
1. Paper Prescriptions Records Option 1 (Three separate files): •A file for schedule II controlled substances dispensed. •A file for schedules III, IV and V controlled substances dispensed. •A file for all noncontrolled drugs dispensed. 2. Paper Prescriptions Records Option 2 (Two separate files): •A file for all schedule II controlled substances dispensed. •A file for all other drugs dispensed (noncontrolled and those in schedules III, IV and V).
the specific structure and order you should think in when providing Pharmaceutical patient centered care (thinking/making decisions/acting)
1. Patient 2. Medical condition (diagnosis) 3. Medications
Rx Label is required to contain:
1. Pharmacy name and address 2. Assigned serial number (prescription #) 3. Date of initial dispensing 4. Name of patient 5. Name of prescriber 6. Directions for use 7. Federal controlled substances warning label or "transfer label" for a Schedule II, III, and IV controlled substance to read: •CAUTION: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.
To truly practice in a patient-centered manner, we must understand (3 things)
1. What our patient wants 2. What their concept of illness is 3. What the patient's medication experience is
What are the 5 practice principles of Pharmaceutical care?
1. data collection 2. information evaluation 3. Formulation of Plan 4. Implementation of Plan 5. Monitoring and modifying plan to assure positive outcomes
4 foundational components of pharmacist's patient care process
1. est a patient-pharmacist relationship 2. open, communication with patient, family, and caregivers 3. collaborate, document, and communicate with other care providers 4. utilization of information technology systems
List the 5 major drug related problems
1. needs a new drug 2. Not receiving the optimal drug 3. dose is not optimal 4. adverse drug reaction 5. drug interaction
4 reasons for the creation of: Pharmacist's Patient Care Process
1. promote consistency within the profession 2. provide a framework 3. design an approach to patient care that facilitates collaboration 4. Applicable to all pharmacy patient care settings
•an Rx for a controlled substance Must Include:
1. the patient's full name and **address** 2. the practitioner's full name, address, and 3. Practitioner's DEA registration number. 4. drug name 5. strength 6. dosage form 7. quantity prescribed 8. directions for use 9. number of refills (if any) authorized
3 Components of patient medication experience
1.Patient description of their wants, needs, concerns, understanding, or beliefs about health in general, specifically drug therapies 2.Patient medication history 3.Patient current medication record
What is in an Rx -required by law?
1.Prescriber's Name, Address, and phone # (and DEA# if CS) 2.Patient's name (and Address if CS) 3.Date issued by prescriber 4.Name of drug or device 5.Drug strength 6.Quantity to dispense 7.Directions for use 8.Prescriber's signature 9.Refill instructions (if none then do not refill)
when collecting medication history and records, providers have not traditionally sought and utilized information from the patient about:
1.how the patient feels about taking her medications, 2.how a patient makes her decisions about whether to take a medication or not, and, how she will actually take it.
•Electronic records must be maintained electronically for _____ years from the date of their creation or receipt. However, this record retention requirement shall not pre-empt any longer period of retention which may be required now or in the future, by any other Federal or State law or regulation, applicable to pharmacists or pharmacies.
2
The only thing that is legally required by the DEA is just the patient's full name -dr graham says to always get
2 forms of identification
DEA No. AB3878432 can be verified as follows:
3 + 7 + 4 = 14; 8 + 8 + 3 = 19; 19 × 2 = 38; 14 + 38 = 52; The seventh digit of the DEA number should be "2" (i.e., AB3878432). If it is not, the number is incorrect, and fraud may be suspected. (answer is 52 so its correct)
The acronym, HEADSS is used to remember the components of a patient's Social History. What does the A stand for?
Activities
In pharmacology, any unexpected or dangerous reaction to a drug. An unwanted effect caused by the administration of a drug.
Adverse reaction
Subjective information of the SOAP note should include:
CC HPI history (PMH, FH, SH, SH) -surgical and social ROS Current meds Allergies
cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams
CV
drugs have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.
CV
Some patients may have difficulty describing what they want in terms that the practitioner can fully understand, whereas others may be hesitant to share their goals with someone with whom they have not yet established a strong therapeutic relationship • _______ -Sometimes what a patient wants is not necessarily what they need.
Caveat
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "C" stand for?
Characterization: How does the patient describe the CC? (sharp, dull, aching, cramping)
reason the patient is seeing a HCP or presenting for treatment
Chief Complaint CC
(PPCP) The pharmacist assures the collection of necessary subjective and objective information about the patient in order to understand the relevant medical/medication history and clinical status of the patient
Collect
____________ a drug or other substance, or immediate precursor, included in schedule I, II, III, IV, or V of the CSA.
Controlled substance
When your pharmacist buys CII they have to fill out a form called
DEA form 222
There is a lot that federal laws do not address -each state is different (fed law does not require a patient's ____________ -surprising
DOB
The acronym, HEADSS is used to remember the components of a patient's Social History. What does the D stand for?
Drugs
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "D" stand for?
Duration: how long has the CC been going on for?
The acronym, HEADSS is used to remember the components of a patient's Social History. What does the E stand for?
Education, Employment, Eating
What are the systems we should mention in the ROS?
General, Neuro, HEENT, Cardiac, Respiratory, GI, GU, MSK, Endocrine, Heme
Current/past medical conditions, surgical history, family history, and social history should all be listed in the patient's HISTORY. What is the acronym we can use for remembering the components of SOCIAL HISTORY?
HEADSS
The acronym, HEADSS is used to remember the components of a patient's Social History. What does the H stand for?
Home and environment
Illness experience is related to patient behavior which is why we should consider the patient's:
Ideas about their illness feelings expectations of provider effects of the illness to patient function
X-ray, CT, MRI, Ultrasound
Imaging Results
collaborative effort between the pharmacist, other care professionals, and the patient/caregiver
Implement
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "L" stand for?
Location: Where is the CC located?
Soma is a schedule 4 everywhere except for
Louisianna
•Note that the previous discussion is for Federal Law only. •Each state may have different schedules for some drugs •____ - pseudoephedrine is a CIII •____ - carisoprodol (Soma®) is a CII
MS LA
Your plan should include
Medication (drug dose, route, frequency, duration) Efficacy (monitor to determine if therapy works) Toxicity (parameters to monitor to determine if therapy is causing problems) Counseling points (administration, side effects, precautions, storage) Follow-up (when, where, with who?) Treatment alternatives
Pharmacists should continuously monitor:
Medication appropriateness (safety, effectiveness, adherence) Clinical endpoints (contributing to patient's overall health) Outcomes of care (progress towards goal achievement)
List components the would go under objective data
Meds from chart, allergies, Physical exam findings, vitals, general information, HEENT, Extremities, Neuro, Microfilament test, Labs
•____________ include: •whether a patient chooses to obtain and take the medication •how the patient takes the medication •whether the patient chooses to refill a prescription •whether the patient chooses to adhere to the regimen •These behaviors frequently need to be __________ to obtain the desired results from therapy.
Patient Behaviors positively reinforced
Documentation from other clinicians could include
Notes, diagnoses, medications, allergies
•Controlled Substance Theft or Significant Loss •Should a theft or significant loss of any controlled substance occur at a pharmacy, the following 2 procedures must be implemented within one business day of the discovery of the theft or loss.
Notify DEA and local police Complete DEA Form 106.
What is the Acronym we use when figuring which components of patient information would go under "History of Present Illness"?
OLDCARTS
Data directly observed by healthcare professionals
Objective
Fact-based, measurable and observable (labs, data)
Objective
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "O" stand for?
Onset: when did the CC begin?
What can you do with a patient's medication experience?
Optimize therapeutic outcomes
What is required by state and federal law for pharmacists to be reimbursed for the provision of clinical services?
Proper Documentation
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "R" stand for?
Radiation: Does the CC move or does it stay in one location?
Records regarding controlled substances must be _____________ from all other records. Electronic records must be easily readable or easily rendered into a format that a person can read.
Readily retrievable
The records which must be maintained by a pharmacy are:
Required Records
is usually used in critical care units so that they are covering every possibly problem/symptom association
Review of Systems
Designed to identify symptoms not mentioned by the patient
Review of Systems (ROS)
What acronym makes a great community pharmacist tool?
SCHOLARMAC
Most HCP use this format for documentation because it helps standardize medical records, and makes information easier to find:
SOAP format
•Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.
Schedule 2 (CII)
•Potential for abuse less than substances in schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.
Schedule III
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "S" stand for?
Severity: Using a measurable scale, how does the patient raise the CC?
The acronym, HEADSS is used to remember the components of a patient's Social History. What does the S stand for?
Sexuality
Patient or caregiver reported information: experiences, feelings (not directly observed or measured
Subjective
based on personal opinion, interpretation, view, emotions, and judgement (things the patient verbally expresses)
Subjective
The acronym, HEADSS is used to remember the components of a patient's Social History. What does the second S stand for?
Suicide/Depression
what does the acronym, SCHOLARMAC stand for?
Symptoms Characteristics of symptoms History of Symptoms Onset Location Aggravating factors Remitting factors Medications Allergies Conditions
The acronym "OLDCARTS" is used for the components of HPI. What does the letter "T" stand for?
Temporal factor: Is the CC worse/better at a certain time of day (ex: acid reflux is worse when you lay down after you eat -this could be night time)
is the source for all natural opioids, whereas synthetic opioids are made entirely in a lab and include meperidine, fentanyl, and methadone. Semi-synthetic opioids are synthesized from naturally occurring opium products, such as morphine and codeine, and include heroin, oxycodone, hydrocodone, and hydromorphone.
The Poppy Papaver Somniferum
A dispensing pharmacy used to be a space to display and sell but is now viewed as
a space organized to meet patient-needs
**Notice: health history INCLUDES _____________
medication history
•The practitioner must _________ religious practices, traditional beliefs, and cultural norms that may be very different from her own.
accommodate
When implementing the care plan a pharmacist's responsibilities include:
address med or health related problems and engage in preventative care strategies initiate, modify, discontinue, or administer med therapy provide education and self-management training to patient Contribute to care coordination (referral or transition to another HCP) schedule follow-ups to achieve therapy goals
Mediation appropriateness (effectiveness, safety, adherence) can be monitored through:
available health data, diametric test results and patient's feedback
what you do for each patient should have a clearly defined:
beginning, middle, and end
you can asses the things you ___________
collect
(PPCP) _____________ •A current medication list and medication use history for prescription and nonprescription medications, herbal products, and other dietary supplements. •Relevant health data that may include medical history, health and wellness information, biometric test results, and physical assessment findings. •Patient lifestyle habits, preferences and beliefs, health and functional goals, and socioeconomic factors that affect access to medications and other aspects of care.
collect (subjective, objective)
What are the components of the patient centered care wheel?
collect, assess, plan, implement, follow-up: monitor and evaluate
Subjective and Objective -. current and past medication lists, Health data, lifestyle habits, socioeconomic factors
collectible information
to the HCP, the collection of symptoms or lab values results in a ___________ which reflects a disease, ailment or syndrome
diagnosis
For the continuity of care, professional liability, regulatory policy, and to receive payment for our work, we must
document everything
Pharmacy/medical records used to by kept for legal purposes but are now for
documentation to provide quality care
A reaction between two (or more) drugs or between a drug and a food, beverage, or supplement.
drug interaction
things you can asses:
each medication health and functional status (aspects of care) Immunization status (the need for preventive care/services)
Does it limit patients' daily activities? Does it impart their family relationships? Does it require a change in lifestyle?
effects of the illness on function of patient
•If a prescription is created, signed, transmitted, and received electronically, all records related to that prescription must be retained _____________
electronically.
•For Schedule II controlled substances, an oral order is only permitted in an ___________ situation.
emergency
•Prescriptions for Schedules III-V controlled substances may be transmitted by fax from the practitioner or agent to the dispensing pharmacy. The fax is considered to be equivalent to an original prescription.
fax is equivalent to written rx by all but CII
A patient's family history should include
first degree relatives
•Schedule III and IV controlled substances may be refilled only up to ___________ after date issued. After --whichever occurs first, a new prescription is required.
five refills or after six months
•to promote health •to prevent disease •to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective. (theses are all________)
goals of Pharmaceutical care
you can fill a CII Rx by fax but cannot dispense it until the patient gives you the ________ for the Rx
hard copy
A patient's IDEAL state of __________ is complete physical, mental, and social well-being and not merely the absence of disease and infirmity. --this is a __________ attitude
health positive
medication history is included in
health history
Subjective information such as ___________ Usually is combined with objective physical examination and laboratory data to evaluate the patient's current health status
health history and medication history
HEENT
heart, eyes, ears, nose, throat
Why do we have document things as pharmacists?
if it isn't documented, it didn't happen
To a patient the collection of symptoms, labs, test results are experienced as _______________ --> the patient's lived experience with associated consequences
illness
To check DEA number add 1, 3, 5 number and then add 2, 3, 6, (multiply by 2) sum the sums
last number should be the DEA number
How can we achieve the goal of pharmaceutical care?
maintain a professional relationship with patients collect patient specific medical information evaluate patient specific info and plan a drug therapy with patient make sure patient has all supplies/knowledge to achieve therapy goal Monitor and modify plan with the patient and HC team
•3 exceptions to the fax requirements for CII's. The Fax may serve as the original prescription as follows:
•1. A CII narcotic to be compounded for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion. The pharmacy will consider the fax prescription a "written prescription" and no further prescription verification is required. All normal requirements of a legal prescription must be followed. •2. CII for residents of Long Term Care Facilities (LTCF) •3. CII Rx for a patient enrolled in a hospiceprogram certified and/or paid for by Medicare or licensed by the state. The practitioner or agent will note on the prescription that it is for a hospice patient.
combination products containing less than 15 milligrams of hydrocodone per dosage unit. products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with codeine®),
•CIII narcotics
Registration Requirements of pharmacist
•Every pharmacy that dispenses a controlled substance must be registered with the DEA. •To register as a new pharmacy, a state license must be obtained and DEA Form 224 must be completed. •Hospital registrations are issued to the entire hospital as an "institutional practitioner." •A pharmacy registration must be renewed every three years utilizing DEA Form 224a.
The required records which must be maintained by a pharmacy are:
•Executed and unexecuted official order forms (DEA Form 222) or the electronic equivalent •Power of Attorney authorization to sign order forms •Receipts and/or invoices for schedules III, IV, and V controlled substances •All inventory records of controlled substances, including the initial and biennial inventories, dated as of beginning or close of business •Records of controlled substances distributed (i.e., sales to other registrants, returns to vendors, distributions to reverse distributors)
____________ a concise summary of the patient's current and past medical problems, ___________, family history, social history, and review of systems.
•Health history - medication history
attitudes and beliefs (about taking medications) that patients may develop include: •"Drugs don't work, they only cause more problems." •"I don't take medications."
•Negative
•Mid-level practitioners" include the following:
•Nurse practitioners •Physician assistants •Optometrists (only fit glasses) not the same as actual eye doc •Pharmacists •Chiropractors
•The FDA/DEA has 3 levels of regulation of drugs:
•Over the counter •Prescription (legend drugs) •Controlled substances •CI •CII •CIII - V
attitudes (about taking medications) include: •"There must be a drug I can take to solve this problem."
•Overly positive
factors that will influence whether patients take a medication or not, how they will use the medication, whether they believe it will be effective, and whether they believe the medication will be harmful.
•Personal experience •Medications that were effective vs those that failed •Current drug therapy prescribed •Whether/how patient is taking their medication(s) •Traditions •Religion •Culture •What they have heard and learned from others
is a patient-centered, outcomes-oriented pharmacy practice that requires the pharmacist to work in accordance with the patient and the patient's other healthcare providers:
•Pharmaceutical care
______________ places all substances which were (1970) in some manner regulated under existing federal law into one of five schedules. This placement is based upon the substance's medical use, potential for abuse, and safety or dependence liability.
•The Controlled Substances Act (CSA)
•"significant loss" depends, in large part, on the business of the pharmacy and the likelihood of a rational explanation for the occurrence. significant loss for a pharmacy may be comparatively insignificant for a hospital The following factors influence significance:
•The schedule of the missing items. •The abuse potential of the missing items. •The abuse potential in your area of the missing substance. •The quantity missing (one tablet vs. one bottle or container). •Is this the first time this loss has occurred? •Has a similar loss occurred before? •Was this loss reported to local law enforcement authorities? •If there is a question as to whether a loss is significant, a registrant should err on the side of caution and report it to DEA
•Achieving the patient's goals of therapy depends on the patient having a clear understanding of:
•why each medication is being taken •the name of each medication (in a way the patient understands) •the dosage and dosing schedule for each medication •the clinical and laboratory measures that will be used to determine a successful outcome •the clinical and laboratory measures that can be used to detect if any safety/risk issues occur
