Hospital Pharmacy Exam 2
PATIENT-CENTERED-INTERGRATED model
- All pharmacists in the department accept responsibility for all elements of the medication use process; perform distributive and clinical functions - Generally requires greater use of automation and delegation using Pharmacy techs *Can be implemented in a wide range of hospitals to varying extent depending on service implementation*
What are the main technologies in use in pharmacy today?
- Computerized Provider Order Entry (CPOE) - Electronic Medication Administration Record (Emar); Electronic Health Record (EHR) - Bar-Code Medication Administration (BCMA) - Automated Dispensing Cabinets (ADCs) - Carousel Dispensing Technology (CDT) - Robotics - Smart Pumps (Infusion Devices)
What is the CDC guidline for prescribing opiods for chronic pain?
- When to Initiate or Continue Opioids for Chronic Pain - Selection, Dosage, Duration, Follow-up, and Discontinuation - Assessing Risk and Addressing Harms of Opioid Use - Intended to Apply to Chronic Pain > 3 months; not Cancer -Milligram-Morphine-Equivalents (MMEs) for Opioids (Tools) -> On-Line Calculator link -> Washington State Agency Calculator link
What does "Clinical" NOT necessarily imply?
An activity implemented in a hospital setting
Controlled Substances (CS)
Classified according to their potential for abuse, accepted medical use, and potential for physical or psychological dependence. i.e. Schedules I-V
Within the system of health care, who are experts in the therapeutic use of medications?
Clinical Pharmacists - They routinely provide medication therapy evaluations and recommendations to patients and health care professionals - Are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications
Patient Safety
Freedom from accidental injury due to medical care or medical errors
Medication Safety
Freedom from accidental injury due to medical care or medical errors during the medication use process
How can hospital pharmacies implement clinical services?
Implementation of Clinical Services: - Renal Dosing of Medications - Antibiotic Dosing / Rounding - Anticoagulation/Warfarin Management - Admission (ER) Medication Reconciliation - Discharge Counseling with or without Bedside Delivery - Antimicrobial Stewardship - Opioid Stewardship Whatever you have the initiative to take on!
Potential Adverse Drug Events or "Near-Misses"
Medication Errors that do NOT cause any harm—either because they are intercepted before reaching the patient or because of luck
Medication Reconciliation
The process of resolving discrepancies between what a patient has been taking in the past and what the patient should be taking now
According to the IOM Report U.S. Findings (2000) how many preventable hospital deaths/year occurred? How much $ in avoidable costs? How does this happen?
- 44,000-98,000 deaths (more than motor-vehicles, breast cancer and AIDS) - $17-37 billion (add'l care, lost income & household productivity, disability) - Errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them
Clinical Pharmacy
- A health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention - The area of pharmacy concerned with the science and practice of rational medication use - Includes all the services performed by pharmacists practicing in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used - The focus of attention moves from the drug to the single patient or population receiving drugs
Adverse Drug Reaction (ADR)
- A response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function - An appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product; adverse effects (ADRs) usually predict hazard from future administration and warrant prevention, or specific treatment, or alteration of the dosage regimen, or withdrawal of the product - Any unexpected, unintended, undesired, or excessive response to a drug that requires a medical response
What are the USP 797 Requirements (buffer area)?
- Air exchanges in buffer area (≥30/hr) - Temperature 20⁰ Celsius (68⁰ Fahrenheit) - HEPA-filtered air at ceiling, low-wall air return vents - Smooth walls, ceilings, fixtures, floors, no cracks, etc. - Positive pressure, buffer room to anteroom - Positive pressure, anteroom to pharmacy - Hazardous CSPs require negative pressure or isolator - Media-fill testing to ensure microbial-free CSP (every 6-12 mos) - Garb (gown, glove, head covering, shoe covering)
Clean Room
- An enclosed space in which airborne particulates, contaminants, and pollutants are kept within strict limits. Clean rooms are used when it is necessary to ensure an environment free of bacteria, viruses, or other pathogens - Clean room specifications for particulate matter (such as dust) are defined according to the maximum allowable particle diameter, and also according to the maximum allowable number of particles per unit volume (usually cubic meters)
Adverse Drug Event (ADEs)
- An injury (large or small) resulting from medical intervention related to a drug. This includes medication errors, adverse drug reactions (ADRs), allergic reactions, and overdoses - Involves a broader knowledge of patient-specific, drug-specific, and clinician-specific risk factors *Emphasis is on PREVENTION*
What areas in the hospital where CS can especially be a problem?
- Anesthesiology Dept - Surgical Suite/Operating Room - Procedural Areas (outpatient) *Areas that may be inaccessible to Pharmacy (Possible Solution: Satellite Pharmacy; ADC)*
Ante Area (Anteroom)
- Area in close proximity to the cleanroom where techs perform PREPARATORY tasks - The anteroom is usually equipped with a sink, cabinets, bench, etc. - The anteroom is engineered as an ISO 8 or better environment depending on the risk level of the sterile products being prepared in the critical area - There is usually a line of demarcation between clean and dirty areas of the anteroom - Anteroom supports the Buffer Area
What is the impact of technology on pharmacy manpower?
- Automation frees Pharmacists from routine and repetitive tasks, including some DISTRIBUTIVE duties, to perform more CLINICAL Activities - Pharmacists must demonstrate Improved Quality and Patient Outcomes as part of the health care team; Lower Cost/Higher Productivity? - Pharmacist Reimbursement for Cognitive Svcs - Expanded Technician Utilization/Responsibilities
What are the elements of In-House Packaging and Labeling; Comounding?
- Bulk Tablet/Capsule Packaging into Unit-Dose (U/D) - Liquids Packaging into Unit-Dose link link - U/D Injectables Involve Sterile Compounding (USP 797) (Example: Frozen IV Cefazolin 1gm "piggybacks") - Expense and/or Patient Safety Issue (ROI for Purchase of Repackaging Equipment, some Products Not Available in U/D or RTU form, Highly Favorable for Pediatric Facilities/Patients)
What are some other controlled substance (CS) issues and practices in the hospital pharmacy?
- C-II Usually have AUTO-STOP (e.g. 3-days); must renew - MD Order is Original Copy in the Medical Record - Mid-Level Practitioners (PA, NP) Prescribe per Med Exec Cmte - LTC and Hospice facilities Do Not Require Original C-II Rx - CS Written in Federal Facility Does Not Require DEA # - Compounding Using CS (e.g. PCA) Maintain CS Schedule - Exact Count (CII) vs. Estimation (CIII-V)
Clinical Pharmacists
- Care for patients in all health care settings - Possess in-depth knowledge of medications that is integrated with a foundational understanding of the biomedical, pharmaceutical, sociobehavioral, and clinical sciences - To achieve desired therapeutic goals, the clinical pharmacist applies evidence-based therapeutic guidelines, evolving sciences, emerging technologies, and relevant legal, ethical, social, cultural, economic and professional principles - Assume responsibility and accountability for managing medication therapy in direct patient care settings, whether practicing independently or in consultation/collaboration with other health care professionals
What are the elements of Drug Procurement, Receipt, and Storage?
- Daily Wholesaler Deliveries Directly to Pharmacy - May Receive Bulk Deliveries (e.g. IV Fluids) - Drugs Purchased in Unit-Dose (U/D) and RTU forms (Commercially Available vs. In-House Packaging) - Some Drugs may be on Allocation (e.g. blood products) - Products with Special Storage Requirements - Generally No Weekend Deliveries; Emergency Provisions - Borrowing Policy Generally in Place
What are causes and effects of adverse drug reactions? *Think of what's happening with the patient*
- Discontinuing the drug (therapeutic or diagnostic) - Changing the drug therapy - Major dose modification - Admission to a hospital - Prolonged stay/tx in a healthcare facility - Supportive treatment - Significantly complicates diagnosis - Negatively affects prognosis or - Results in temporary or permanent harm, disability, or death ASHP definition also includes: - Allergic reactions - Idiosyncratic reactions
How can hospital pharmacies improve medication safety processes?
- Dispense Meds in Ready-to-Use (RTU) form including: IV Antibiotics, Pre-filled Syringes, Unit-Dose Packaging - Prepare and double-check Hi-Risk Sterile Preps (e.g. Chemo) - Formulary and Protocol Implementation & Adherence - Implement Standards-Based Policies and Procedures - Participate in Hospital Committees (e.g. Med Error, Nutrition) - Provide Staff Education and In-Service on New Drugs - Implementation of Technology (in addition to CPOE): Infusion pumps, ADC's, Bar-Code Administration
CLINICAL-PHARMACIST-centered model
- Distributive Pharmacists 1º or exclusively involved in drug distribution, reviewing orders, verifying accuracy of medications, approving technician work - Clinical Pharmacists 1º working with medical teams on nursing units; may have no responsibility for med-use or med-delivery systems in the distributive process *Little or NO collaboration between Distributive and Clinical Pharmacists in the extreme of this model*
Medication Errors
- Errors or Mistakes in the medication-use process (prescribing, transcribing, dispensing & preparation, administering & monitoring of drugs) that might result in negative outcomes - Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer No Harm -> Harm -> Death
Drug Side Effects
- Expected, well-known (drug) reactions resulting in little or no change in pt. management" that occur with "predictable frequency; intensity and occurrence are related to the size of the dose *If severe enough to require extensive medication management are NOT side effects - they are ADEs*
What are some monitoring errors?
- Failure to Review a Prescribed Regimen for Appropriateness or not using lab or clinical data to assess patient response - Example: hold insulin for blood glucose <60; hold pain med for excessive sedation *Circumstances/Conditions that modify a therapy*
What did we do before the unit dose system?
- Floor Stock System - Bulk containers of meds supplied by pharmacy & stored on unit (drug rm); Nurse prepares meds from doctors' orders and gives to patients; Pharmacy replenishes floor stock; minimal pharmacist involvement; non-secured - Patient Prescription System - MD orders transcribed, sent to pharmacy; Pharmacy sends 2-5 day supply to floor and refilled on nursing request. Nurse prepares meds and gives to patients on the unit; Upon DC, meds returned to Pharmacy (credited?); limited pharmacist involvement; non-secured
What factors vary when defining a practice model?
- Hospital type (community vs. academic) - Size of Institution (large vs. small); staffing - Patient Population (chronic vs. critical) - Philosophy of how Pharmacy Services Should be Delivered; includes culture - Intra-hospital relationships (Nursing, MDs) - Academic Affiliations; Residency Training Site
Buffer Area (buffer room)
- ISO 7 or cleaner area where the primary engineering control (i.e. the laminar flow hood) is physically located; separated from the anteroom by a wall (if Hi-Risk CSPs) and pass-thru - Activities that occur in this area include the preparation and staging of components and supplies used when compounding CSPs - The anteroom and buffer are collectively called the secondary engineering control
What are terms most commonly used in Compounded Sterile Preps (CSPs)?
- IV Admixture - Aseptic Technique - Clean Room - Laminar Flow Hood/Cabinet - USP 797 and 800 - Risk-Level Compounding - ISO Ratings - HEPA Filtration - Single/Multi-Use Vials - IV RTU Medications - Beyond-Use-Dating - IV Compatibility - Trissel's Handbook on Injectable Drugs - Total Parenteral Nutrition (TPN) - Chemotherapy Preps
What are some transcribing and interpretation errors?
- Illegible (handwritten) Orders - Misinterpretation (abbreviations, verbal) - Omission *Less likely with CPOE (Computerized Provider Order Entry System)*
What are the main Injectable Routes of Administration?
- Intravenous (IV) - General reference to administration into a vein, usually peripherally (vs. intra-arterial or centrally) - IV Bolus or IV Push: Usually (rapid) injection of a med or some amount of IV fluid into the circulatory system - IV Infusion (IV Drip): Intravenous fluid or med given at a controlled rate (e.g. 125mL/hr) - Intrathecal: Direct injection around the spinal cord (PF) *Note: Intramuscular & Subcutaneous are also Injectable RAs*
Sterile Compounding (IV Admixtures) & Products
- Manufacturer Ready-to-Use (RTU) - Outsourced (e.g. PCA narcotics) - Pharmacy-Compounded Sterile (beyond-use-dating) -> Bulk Preps (e.g. Cefazolin 1gm IVPB) -> Total Parenteral Nutrition (TPN) - Standardized preps -> Chemotherapy Preps -> Infusions for Outpatient Clinic Administration Should include Bar Codes May be used with Smart Pump Technology
Unit dose medication distribution may differ in form, depending on the specific needs of the organization - but what distinctive elements are basic to all unit dose systems?
- Medications are contained in single unit packages & dispensed in as ready-to-administer (RTU) form as possible - For most meds, not more than a 24-hr supply of doses is delivered to or available at the patient-care area - RPh reviews every order & checks against med profile
What are examples of hospital pharmacy information systems (PIS)?
- Meditech - Epic - Cerner - HCS *EHR and HIT Interoperability?!* *PIS may be part of an integrated Hospital EMR System*
What problems and limitations of technology and automation?
- Over-Reliance on Technology (False Sense of Security and Carelessness; CULTURE) - Failure to Assure Accuracy & Optimization (i.e. Resources to Manage, Monitor & Train) - Not Engaging ALL Involved Professionals in Implementation (i.e. MD, Nursing, Pharmacy) - Ignoring Workflow Impact (Work-arounds?!) - Cost! (Initial and On-Going)
Federal Comprehensive Drug Abuse Prevention and Control Act = Controlled Substances Act - CSA (1970)
- Part of the "War on Drugs" (Nixon) and Concerns about Drug Abuse - Federal Drug Enforcement; Replacement of 50 State Laws - Created the (federal) BNDD & DEA (recordkeeping) - Department of Justice — DEA and FBI Investigative Powers
What are the elements of Pharmacy Information System?
- Patient Medication Profiles (Dx, Allergies, Location, DOB, Wt, Sex) - May be Standalone System, interface to Registration System (Demographics, ADT, and Financial purposes) - Better if Integrated with Hospital-wide CPOE/EMR system - Interfaces with Automation (ADC, Carousel, Robot) - Functionality Specifically for Pharmacy (not an all-inclusive list) - Pharmacist Reviews Profile When Entering/Verifying Order - The PIS prints labels as needed for doses and deliveries - Special Alerts and Administration Messages can be Programmed in or Added to Drug Entries - Drug Entries in the PIS Determine what the NURSE Sees on the Medication Administration Record (MAR) - Standardized Medication Administration Times are Built-in - PIS Links to ADC and May Generate the MAR
What are the main types of IV access?
- Peripheral IV (18-22 gauge) - Usually inserted in the hand or limb; used to give replacement fluid/electrolytes, meds, blood products - Central Line or Triple Lumen Access (16-18 gauge) - Inserted into a large vein (subclavian or Internal Jugular) to insure patency & dilution (e.g. meds and TPN) - PICC Line - Peripherally-inserted Central Line, inserted into vein in the arm and threaded into a larger vein extending to near the heart, intended for long-term access. Similar to a Hickman Catheter (runs along chest wall); similar indications as PICC line - Port-A-Cath - Implanted catheter device placed/sewn under the skin (chest) threaded into large vein; the port has a rubber cap allowing access; most commonly used for chemo regimens
Elements of Controlled Substances (CS) in the Hospital Pharmacy vs. Community Pharmacy
- Perpetual Inventory and Chain of Custody is required - CS are stocked (techs) on the nursing unit (dispersal; secure) - CS includes RTU syringes (carpuject) & unit-dose packaging - CS are ordered but not dispensed directly to patients - In electronic system, access is tied to RPh order verification - Wastage must be witnessed and documented (policy) - Nursing Performs Inventory Verification Regularly (per shift) - Pharmacy Monitors Inventory and Audits Discrepancies - May have a dedicated staff member (technician) to manage - Ordering Federal Form 222 (paper or electronic CSOS) - Losses Documented on Federal DEA Form 106 link - Losses Documented on State BNDD Form MO 580-2766 link - Expired or Unused CS Require Use of Reverse Distributor - DIVERSION is a Problem in the Hospital (policy & procedures) - Prescribers Must Have DEA (may use Hospital DEA if teaching facility) This Process of CS Ordering, Disposal, and Loss Reporting is the same as in Community Pharmacy
DRUG-DISTRIBUTION-centered model
- Pharmacists 1º process med orders/distribute drugs - Role is reactive, responding to MD/RN requests - Rarely initiates major changes in therapy (extreme) - Little involvement with the health care team *Smaller and/or less-well resourced non-teaching hospital may tend to employ this model to a greater extent*
What are some of the typcial clinical pharmacy services in a hospital stetting?
- Pharmacokinetic Consultations (Renal, Vanc, AG's) - Therapeutic Drug Monitoring (Warfarin) - TPN Team Participation - CPR (Code) Team Participation - Drug Information Services and Education - Drug-Use Evaluations - Medication Reconciliation (TJC)
Compatability (i.e. Incompatability)
- Physical Incompatibility -> Haze, Precipitation, Color Change, Gas Development (e.g.Ca2+PO4) - Chemical Incompatibility -> 10% Decomposition of 1 or more components in 24 hrs or less under specific conditions =Change in Potency; not NOT a visible reaction (e.g. light sensitivity with Na+ Nitroprusside) - Therapeutic Incompatibility -> Causes a change of activity of 1 or more drugs -> Antagonistic or Synergistic Reaction (e.g. tetracycline & penicillin)
What are some aspects of quality improvement in a pharmacy setting?
- Preventing Medication Errors - Culture of Safety - Models of Quality Improvement - PDSA (Plan-Do-Study-Act) Cycle of Safety Improvement
What are the elements of Bar-Code Medication Administration (BCMA)?
- Process that incorporates the use of bar code scanning functionality into the medication administration phase of the medication-use-process. It utilizes a number of hardware and software components to display, receive, & chart real-time patient & medication info, provide caregivers with the information needed to accurately administer and document med administration. Also called POINT-OF-CARE Technology -> 3-Way Check: Nurse-Medication-Patient (at bedside) -> Verifies drug against MAR
What do the 5 KEY clincal pharmacy services aim to do?
- Reducing patient mortality - Decrease drug and total cost of care - Reductions in LOS (lost or stolen) and medication errors
What steps are required for medication reconciliation?
- Requires obtaining and verifying the medication list - Medications & dosages are checked for appropriateness - Clinical decisions are made or recommended - Should occur at each transition of care - Reconciliation at hospital discharge must include communication to the next care-giver or care setting
What are the elements of Centralized Med Distribution Using Automation?
- Robot-Rx (McKesson? Omnicell?) -> Integrates with Pharmacy Information System -> No More Cart-Fill for Pharmacy Techs -> Prioritizes Dispensing of Meds -> Requires Barcode Packaging of Meds or Overwrap -> High-Volume Drug Distribution -> RPh Must Still Check? (State Board of Rx Rules?)
What are the elements of medication cart-fill system?
- Rolling Med Cart Based on Patient location (Rm-Bed) - Unique Bin or Drawer with Meds for Each Patient - Pharmacy (tech) fills 24-hr cassettes; checked by RPh - Cassettes Exchanged daily at Specified Time - Initial and Updated Meds Delivered by Pharmacy - Med Cart Usually Contains Secure CS Supply - Med Cart may Include Computer-Access to EHR
What are the key elements of a Pharmacy-Centric System (also called Pharmacy Management System)?
- Safely Managing the Medication-Use-Process - Pharmacist Workflow - Reporting Functions
What are the elements of Unit-Dose (U/D) Drug Distribution?
- Safer for the patient - More efficient and economical for the organization - More effective method of utilizing professional resources
What are potential hazards of IV administration?
- Sepsis - Thrombi - Air Emboli - Hypersensitivity Reaction - Drug or Fluid Overdose - Particulate Contamination
What does it mean to have a "decentralized" pharmacy service model?
- Some years ago "Decentralized" meant medication distribution from a Satellite Pharmacy that had it's own separate inventory and staff - Today, a "Decentralized" Pharmacy Service Model may involve physically locating the Pharmacist closer to the patient care area (e.g. an office or workstation) but more commonly refers to the use of Automated Dispensing Cabinets (ADCs) located in patient care areas, with the pharmacist working from a Central Pharmacy location or remotely (including from home or another hospital)
What are ways for diversion prevention and protection in a hospital pharmacy?
- Surveillance (cameras, ADC'S, random audits) - Prescription Pads Security (locked, serial #) - Automated Dispensing Cabinets - Electric Prescribing (Required in MO and other states) - Tamper-Resistant Paper and/or Measures - CS LOSS REPORTING (Federal and State)
What factors define a practice model?
- Type of Drug Distribution System Used - Layout and Design of the Department - Technology and Automation in Use - How Pharmacists Spend Their Time (practice functions and practice priorities) *How pharmacists, technicians, and automation inter-relate to provide pharmacy services*
Why do we give things by the intravenous (IV) route?
- Unavailability in Oral form - Pharmacokinetics/Bioavailability (ADME profile) -> Drug may be subject to inactivation -> Concentrated-related variables - Emergent Reasons for Rapid Administration/Onset -> Life-threatening infection -> Emergency (e.g. CVA) -> Rapid correction of metabolic abnormalities
What are some dispensing and preperation errors?
- Wrong Drug or Dose - Error in Preparation or Calculation - Drug for Wrong Patient (labeling, delivery) - Wrong Form (tablet for npo (nothing by mouth) patient) *Pharmacist is required to check prior to dispensing*
What are some types of prescribing errors?
- Wrong Drug, Dose or Dosage Form - Wrong Instructions - Wrong Quantity, Concentration or rate - Wrong Route of Administration - Illegible prescriptions or orders
What are some administration errors?
- Wrong Drug, Dose, Route, Administration Time, infusion rate - Incorrect Handling or Storage - Missed, Late, or Extra Dose *Generally a nursing function*
What are the 3 main hospital pharmacy practice models?
1. DRUG-DISTRIBUTION-centered model 2. CLINICAL-PHARMACIST-centered model 3. PATIENT-CENTERED-INTERGRATED model
What are the 5 KEY clinical pharmacy services?
1. Drug Information 2. Adverse Drug Reaction Management 3. Drug Protocol Management 4. Participating in Medical Rounds 5. Admission Drug Histories
What are the 3 key issues in the hospital pharamcy in terms of pharmacy law and regulations (CS)?
1. Physical Security and Storage 2. Distribution, Control, and Documentation 3. Diversion Prevention and Detection
Another way to classify medication errors is by where they occur in the medication-use-process - what are those steps in the medication-use-process?
1. Prescribing Errors 2. Transcribing and/or Interpreting Errors 3. Dispensing Errors 4. Administration Errors 5. Monitoring Errors
What are advantages and disadvantages of Bar-Code Medication Administration (BCMA)?
Advantages: - Automated, accurate, complete documentation of med admin - Improved patient safety and accuracy (wrong = no scan; missed dose alerts) - Increased charge accuracy - Better control of CS and prevention of diversion Disadvantages: - Requires workflow adjustments for nurses - Large equipment expense! - Requires good network and radio-frequency connections - Less effective if organization does not have EMR, CPOE - Requires Pharmacy to have a process to Bar Code ALL meds
What are advantages and disadvantages of the medication cart-fill system?
Advantages: - Meds dispensed in U/D form - Meds/supplies close to patient - Efficient for nursing staffing - No "traffic jam" at the ADC - Newer equipment can be interfaced with other software (e.g. Bedside Bar-Code Admin, access, EMR, MAR) Disadvantages: - Must wait for Rx to deliver 1st doses of medications - Cannot store refrigerated meds or IV fluids in cart - Missing meds are a frequent problem and irritant (24hr supply) - Nurse must transfer meds when pts. are transferred - Failure to lock med cart when not in use (must double-lock CS)
What are the advantages and disadvantages of Automated Dispensing Cabinets (ADCs)?
Advantages: - Secure storage and controlled access to medications - Meds readily available on pt. care unit after RPh verification (faster turnaround time) - Combines patient medication profile, drug info, administration alerts & documentation - Saves time for Nursing - Remote Rx Management & Audit - Unit-Specific Drug Inventory Disadvantages: - Duplicate Inventory - Line forms at the ADC - Still must have a place to store multi-dose meds (e.g. inhalers) - Expensive! (capital lease?) - Stock Outs - Diversion is still possible - Technology does fail
Automation
Any technology, machine, or device linked to or controlled by a computer and used to do work
Technology
Anything that is used to replace routine or repetitive tasks previously performed by people, OR which extends the capability of people
Opioid Stewardship Progams
Coordinated programs that promote appropriate use of opioid medications, improve patient outcomes, and reduce misuse of opioids - Identify Patients at High-Risk of Opioid-Related Adverse Events (ORAEs) - Implementing Pain Management Service - Implement Palliative Care Service - Medication Use Evaluation (MUE) Process
Schedule I Control Drugs
Drugs with NO currently accepted medical use and a HIGH potential for abuse Examples: heroin, marijuana
Schedule II Control Drugs
Drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous - do have accepted medical use Examples: Hydrocodone, Oxycodone, Fentanyl, Adderall
Schedule IV Control Drugs
Drugs with a lower potential for abuse and lower risk of dependence Examples: Xanax, Soma, Valium, Ativan, Ambien, Tramadol
Schedule III Control Drugs
Drugs with a moderate to low potential for abuse and for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV Examples: 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone
Schedule V Control Drugs
Drugs with fairly low potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes Examples: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Lyrica *These products previously could be obtained by signature in limited quantities on an "exempt log"* Missouri has placed Schedule V drugs in Schedule IV so a prescription is required; more stringent rules apply
According to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), how many ADEs (adverse drug events) are preventable?
Estimated ~ 50% of ADEs are preventable
Clinical Pharmacist Researcher
Generate, disseminate, and apply new knowledge that contributes to improved health and quality of life
What are the elements of Automated Dispensing Cabinets (ADCs)?
May be Used in a Variety of Configurations: -> Location-Based (e.g. Anesthesia Pyxis) -> Controlled Substances Security and Documentation -> First-Doses only with Medication Cart Use -> All-dose Dispensing (e.g. no med carts) - Several Major Suppliers (BD, Omnicell)
What does the practice of clinical pharmacy embrace the philosophy of ?
Pharmaceutical Care - It blends a caring orientation with specialized therapeutic knowledge, experience, and judgment for the purpose of ensuring optimal patient outcomes
What is the the role of the hospital pharmacist (directly or indirectly) in the medication use process?
Pharmacists have important direct or indirect roles in: - Presribing - Transcribing - Dispensing - Administration - Monitoring
How are technologies employed?
Prescribing: CPOE including Clinical Decision Support Dispensing: Carousel, Robotics Dispensing & Delivery, ADCs (CS dispensing & inventory tracking), IV and TPN compounding devices & software, pneumatic tube delivery, U/D packaging equipment Administration: BCMA, Smart Pumps Monitoring: Clinical documentation, Compliance & Disease management tracking systems
Pharmacy-Centric System (also called Pharmacy Management System)
Supports the distribution and management of drugs in the hospital or facility Includes several core functions, including in- and outpatient order entry, dispensing, inventory and purchasing management, and financial functions
National DEA Drug Take Back Day
The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications
Aseptic Technique and key concepts
The methods used to manipulate manufacturer-supplied sterile products so they remain sterile as compounded sterile preparations; preventing contamination - It is the foundation of Compounded Sterile Products Prep - Poor technique defeats the best clean room facilities - HUMANS are the dirtiest element in the process - PATIENT SAFETY is why aseptic technique is important!
What is the main goal of patient and medication safety?
To avoid harm by creating a process where it is EASY to do the right thing and HARD to do the wrong thing
Is the following statement True or False? STLCOP teaches and prepares students (as Pharmacists) to care for patients in ANY SETTING.
True
Harrison Narcotic Act (1914)
U.S. federal law that regulated and taxed the production, importation, and distribution of opiates and coca products
