Patient Safety and Quality Assurance PTCB 3.1- 3.6 26.5 percent of testPTCB test prep

high alert drugs

- heparin and insulin - must be checked by another person

high alert drugs

-anticoagulants -insulin -opioids and narcotics -potassium -sodium chloride (above 0.9%)

Bulk packaging

1. A method of containing loose or granular materials for shipping or storage 2. A method of assembling many items into a container for shipment or storage

Table 1. Common Drug Inventory Terminology Inventory turnover

1. Common Drug Inventory TerminologyInventory turnoverThe number of times that inventory is used up during a year [Formula: cost of goods sold ÷ average inventory]

10 Strategies for Preventing Medication Errors

10 Strategies for Preventing Medication Errors Ensure the five rights of medication administration. ... Follow proper medication reconciliation procedures. ... Double check—or even triple check—procedures. ... Have the physician (or another nurse) read it back. ... Consider using a name alert. ... Place a zero in front of the decimal point. ... Document everything.

High risk medications are drugs that have a heightened risk of causing significant patient harm when they are used in error. High risk medicines include medicines: with a low therapeutic index that present a high risk when administered by the wrong route or when other system errors occur National Safety and Quality Health Service Standard version 2, Medication Safety, High Risk Medications 4.15 (external site) requires health services to identify high risk medicines used within the organisation and take appropriate action to ensure that they are stored, prescribed, dispensed and administered safely. High risk medicines may vary between hospitals and health care settings depending on the types of medicines used and patients treated. However, evidence suggests a group of medicines which can universally be considered high risk. At a minimum, the following high risk medication classes, as recommended by the Australian Commission for Safety and Quality in Healthcare, should be considered for inclusion in the high risk medication register.

A - Antimicrobials P - Potassium and other electrolytes, psychotropic medications I - Insulin N - Narcotics, opioids and sedatives C - Chemotherapeutic agents H - Heparin and other anticoagulants S - Safer systems (e.g. safe administration of liquid medications using oral syringes) Methods to reduce error include strategies such as:

basic stock list

A list used for those staple items that should always be in stock.

Learning objectives

After completing this continuing education program, the pharmacy technician should be able to: Discuss the technology available to help pharmacies manage inventory, including computer systems, perpetual inventory systems, and automatic dispensing systems. Describe the automatic dispensing machines available to help pharmacies manage their inventory, including how errors can occur with these machines. Recognize the concepts of availability, expiration dates, and turnover rates, and their application in managing inventory. Discuss the process of ordering medication for a pharmacy, including terminology associated with ordering, where medications may be obtained from, automatic and manual ordering procedures, and special ordering considerations. Summarize the process of receiving medication orders, including receiving regular orders, medications with special storage conditions, controlled substances, and new products as well as paying invoices and what to do if an order is incorrect or damaged upon receipt. Describe the procedures for returning medications that are outdated, damaged, recalled, or overstocked, including controlled substances, and when it is appropriate to destroy medications that cannot be used. List five reasons for repackaging medications from bulk bottles into unit dose packages and the labeling requirements for repackaged medications. Recall the temperatures required for medication storage at room temperature as well as refrigeration and freezing.

just in time

An inventory-management approach in which supplies arrive just when needed for production or resale

Annual inventory counts

Annual inventory counts Annual inventory counts are conducted once a year to verify the quantity and dollar value of products on the pharmacy's shelves. This event is generally done at a time when the pharmacy is closed or usually not busy to ensure all medications are counted at the same time for an accurate reflection of the inventory. It allows the pharmacy to see its total profitability for the previous year, as well as showing the pharmacy how well its inventory is being managed. Pharmacies with a poorly managed inventory may have more loss through medications expiring, inaccurate accounting, and improperly recorded returns than a pharmacy that has a well-managed inventory. Annual inventories may also uncover any issues with employee theft or missing inventory. Tech alert! Organizing medications on the shelves before an annual inventory count will help ensure everything is counted correctly! The Controlled Substance Act requires biennial inventory counts for controlled substances. Many pharmacies complete this count annually to ensure there are no issues with compliance to this law. A pharmacist must physically count all controlled substances in this inventory, and records must be kept for at least two years or longer, depending on state law.

Safety stock

Buffer for lack of flexibility in supply chain

Bulk packaging

Bulk packaging T he majority of medications in outpatient pharmacies are received in bulk stock bottles. These bottles include labeling that is required by the FDA: brand and generic drug names, dosage form, quantity, national drug code (NDC) number, lot number, expiration date, name of the manufacturer, and storage requirements

Can I take ibuprofen with metoprolol?

Can I take ibuprofen with metoprolol? ibuprofen metoprololCombining these medications may reduce the effects of metoprolol in lowering your blood pressure, especially if you use ibuprofen frequently or regularly (for example, to treat arthritis or chronic pain).

Can you eat bananas with beta blockers?

Can you eat bananas with beta blockers? If you are taking a beta-blocker, your health care provider may recommend that you limit your consumption of bananas and other high potassium foods including papaya, tomato, avocado and kale.

Chemotherapy and hazardous materials

Chemotherapy and hazardous materials Chemotherapy medications are considered hazardous substances. The Occupational Safety and Health Act mandates that all employees who could potentially come in contact with these products be aware of the hazards to which they could be exposed. All facilities that are involved in the handling of these products must maintain a written hazard communication program to inform employees of these risks. Facilities must also receive and maintain MSDS forms for each hazardous material it handles. Policies and procedures of the facility should be followed carefully when handling these products to prevent accidental exposure to these potentially dangerous medications. Special precautions for hazardous substances can be found on the material safety data sheets (MSDS) that the pharmacy must maintain.

Inventory management computer systems

Computer systems are used in both hospital and retail pharmacies to assist with the maintenance of inventory as well as processing prescription orders and maintaining patient files. Wholesalers often have computer programs that they allow pharmacies to use to access information in the wholesaler's computer system. This function can allow the pharmacy staff to order medications directly through the wholesaler's website and check stock at the wholesaler's facility as well as look up specific information on the products the wholesaler carries. Users of pharmacy computer systems are generally limited to pharmacy staff members, who are given usernames and passwords to use to access the system. This allows the employer to prevent unauthorized access to protected health information and keep a record of who performed each task in case an error occurs. Pharmacy staff should protect their usernames and passwords and avoid giving them out to unauthorized individuals. Backup and maintenance of pharmacy computer systems are essential to the continued function of the system. Ensuring the computers are clean and free of dust or moisture is a task the pharmacy technician should complete regularly to ensure continued operation of vital systems. Checking reports for errors after information is entered into the computer system is an important step in making sure information is recorded correctly. A simple data entry error, such as missing a zero or a decimal point, could result in severely incorrect information

Counting medications in the pharmacy inventory

Counting medications in the pharmacy inventory Managing a pharmacy's inventory often involves counting medications in stock to verify or update their quantities in the computer system. Medication counts can be off because of many different reasons, including miscounting a patient's prescription, theft, or improperly inputting an invoice for an order received. Knowing how much medication is on the shelves and ensuring that the quantity on hand in the computer system is an accurate reflection of what is actually on hand are essential to managing a pharmacy's inventory properly. There are two commonly used means of counting items in the inventory, annual inventory counts and cycle counts.

Cycle counts

Cycle counts Cycle counts are a method of auditing a particular product in a pharmacy's inventory at any given time. They are performed regularly to ensure the quantity of medication on the pharmacy's shelf matches up with the quantity of drug the pharmacy should have on the shelf. Cycle counts can be done on random medications, medications preselected by the pharmacist or management because of the high cost or risk of theft, or generated by the computer system for medications whose quantities are suspected to be incorrect. When a shortage or overage of a particular medication is suspected, they are often performed by pulling the drug in question off the shelf and physically counting the quantity on hand. The quantity is then updated in the computer system and analyzed by the pharmacist or pharmacy manager if needed. Cycle counts allow the pharmacy to continually monitor the inventory level without interrupting the operation of the pharmacy. When completed correctly, they allow the pharmacy to maintain an accurate inventory and ensure the automatic replenishment system can work appropriately. However, there is also a risk of error when completing cycle counts. When products are counted incorrectly or quantities are updated in the computer system incorrectly, errors can be introduced. Errors can also occur if products are counted at one time and not updated in the computer system right away. Pharmacy technicians should ensure that cycle counts are done regularly, in a timely fashion, and with as little interruption as possible to minimize error potential.

Damaged products

Damaged products Occasionally, a product sent from the wholesaler may arrive at the pharmacy in a damaged condition. If it is noticed before dispensing to the patient, the pharmacy should contact the wholesaler to seek replacement of any damaged products. The wholesaler generally must send an approval code or return form before they will accept return of a damaged product. Once an approval code or return form has been issued, the pharmacy may send the product back to the wholesaler for credit or replacement, as determined by the wholesaler. If a patient receives a product and discovers that it is damaged after its attempted use, the patient may generally bring it back to the pharmacy for replacement. The pharmacy can give the patient a replacement item from its stock, then contact the drug manufacturer to seek replacement of the damaged product. After completing the necessary paperwork, the manufacturer will send a replacement item to the pharmacy to replace the item the pharmacy gave out to the patient. The manufacturer may or may not request the pharmacy to ship back the damaged item.

Purpose and goals of inventory management

Ensuring there is adequate stock of medications is only one of the many reasons to carefully manage a pharmacy's inventory. Other reasons include: ● Minimizing the occurrence of unexpected out-of-stocks to decrease the impact on patient care. ● Decreasing the carrying cost of maintaining an inventory. ● Lowering costs of ordering medications from wholesalers. ● Ensuring minimal time is spent ordering medications and purchasing tasks. ● Preventing costs associated with damage and expiration of inventory. ● Decreasing total costs to the pharmacy and overall health care organiza There are two main goals to keep in mind when managing an inventory for a pharmacy. The first is to ensure medications are available when patients need them. The products that are regularly kept in stock are based on the needs of the pharmacy and its customers. While some rarely used, extremely expensive or cumbersome products may be ordered in as needed, efforts should be made to keep the medications used regularly in stock and available for use - not outdated or damaged. The second goal of inventory management is to keep medication costs at a minimum. Many pharmacies have preferred wholesalers to order from or contract pricing with specific drug companies to decrease the cost of purchasing medications. The pharmacy technician should make an effort to use preferred delivery systems to try to keep acquisition costs as low as reasonably possible. Preventing profit loss is also a contributing factor to controlling medication costs. Properly managing stock by using medications before they expire and processing returns regularly can help keep medication costs down.

Safety Stock

Extra inventory that a company holds to protect itself against uncertainties in either demand or replenishment time.

Formulary A formulary

Formulary A formulary is a list of medications that have been approved for prescription within a hospital, health care system, or by an insurance company. There are three different types of formularies: ● Open formulary: Any medication may be purchased by the hospital or covered by the insurance company. ● Closed formulary: Medications prescribed may not be purchased or covered unless they are on a restricted list of medications selected by a committee. In general, only certain drugs in a drug class may be covered. This is to ensure cost savings by including less expensive generic medications on formulary instead of higher cost brand-name medications in the same drug class. ● Restricted formulary: A type of formulary that includes aspects of both an open and closed formulary. Formularies at both hospitals and insurance companies are developed by a group of doctors, pharmacists, nurses, accountants, and drug buyers, known as the pharmacy and therapeutics (P&T) committee. The committee reviews the formulary annually and attempts to choose effective, reasonably priced medications for the institution to use. Closed and restricted formularies are common, and many of these formularies prefer the patient use a particular medication over others in the same drug class. This method of creating cost savings often results in a less expensive charge to patients if they use the preferred medication, and a higher charge if they choose to use a non-preferred medication. Using the drug class of proton pump inhibitors as an example, an insurance company may cover omeprazole, a generic product, for a lower co-pay than Aciphex, a brand-name product. Because many patients end up using the medication that results in a less expensive charge, if this particular insurance is commonly used at the pharmacy, it can result in more prescriptions for the cheaper product and fewer prescriptions for the more expensive product. Therefore, the pharmacy technician would need to ensure there is always enough omeprazole to fill prescriptions until the next delivery day, and that Aciphex is not overstocked. Pharmacy technicians in both the hospital and community setting should be aware of the restrictions of common insurance companies or formularies at their pharmacy to ensure they maintain stock of

Freezing

Freezing Because frozen medications are particularly vulnerable to damage, care must be used when handling these products. Frozen medications should be stored below 5 degrees F. There are very few medications that require storage in the freezer; those that do include the chickenpox and shingles vaccines as well as some premixed IV medications in the hospital setting that may be thawed out prior to use. If the pharmacy stores frozen medication, a stand-alone freezer should be used. The temperatures in a stand-alone freezer are more stable than temperatures in a freezer located on top of a refrigerator. If possible, freezers should be plugged into an outlet that is set up to receive power from an emergency generator in case of a power outage. Freezers should never be unplugged, and plugs should be marked to ensure there is no confusion. Thermometers should be placed in the freezer to maintain adequate temperatures, and freezer temperatures should be checked twice daily and recorded on a temperature log

General drug storage

General drug storage The manufacturer's recommendations should be followed when storing prescription medications. Many medications are able to be stored at room temperature, between 59-86 degrees F. Drugs should not be stored above or below this temperature range unless authorized by the manufacturer. The storage area should be clean and free of clutter, moisture, and dust, and be properly ventilated to allow for adequate airflow around the products. Some medications are sensitive to UV light and can decompensate under these conditions. It is recommended to store medications in the manufacturer's original container or an amber-colored vial to decrease the transmission of UV light through the bottle.

How can prescribers reduce LASA errors?

How can prescribers reduce LASA errors? associated with LASA medications by: c. Developing strategies to avoid confusion or misinterpretation caused by illegible prescribing or medication orders, including those that: Require the printing of drug names and dosages. Emphasize drug name differences using methods such as "tall man" lettering

How do you prevent sound alike look alike drugs?

How do you prevent sound alike look alike drugs? Configure all computer screens to prevent look-alike drug name pairs from appearing consecutively. Store products with look-alike names in different locations. Use shelf stickers to help locate products that have been moved. Alert patients to the potential for mix-ups with known, problematic drug names

Introduction

In the pharmacy environment, inventory refers to all of the medications and medical supplies used in daily operation of a pharmacy. The management of inventory comprises a large portion of the pharmacy technician's responsibilities. It is essential to ensure there is an adequate stock of medications and supplies to serve the needs of the patients a pharmacy serves, and careful inventory management can also increase the profitability of a pharmacy. The level of pharmacy technician involvement in inventory management varies based on the facility, and can range from basic ordering and restocking in a retail pharmacy to purchasing and maintaining the inventory of all medications for a hospital. Despite the variety in responsibility level and location-specific considerations, the general principles of pharmacy inventory management remain the same. This course will review basic inventory management terminology and procedures for the pharmacy technician.

Investigational drugs

Investigational drugs Hospital pharmacies are often involved in the distribution of investigational drugs for clinical studies. The pharmacy is often responsible for obtaining, storing, packaging, labeling, distributing, and disposing of investigational drugs. They may also be involved in providing patient education and monitoring and reporting adverse reactions to investigational drugs. These medications often have documentation that needs to be completed and sent to the manufacturer each time they are dispensed. Maintaining the inventory of investigational medications depends on the needs of the clinical study and drug manufacturer, so institution policies and procedures should be followed for managing the inventory of these products.

s EPINEPHrine a high alert medication?

Is EPINEPHrine a high alert medication? Although it is used with relative frequency, it continues to be a potential source of harm in many emergency departments. As noted with all high-alert medications, EPINEPHrine bears a "heightened risk of causing significant patient harm when used in error.Jan 31, 2013

Is dextrose a high alert medication?

Is dextrose a high alert medication? Hypertonic dextrose injection, 20% and above, is a high alert medication because of its acciden- tal substitution for lower Dextrose solutions and the potential harm associated with rapid infusion including fluid overload, altered electrolytes, con- gested states and pulmonary edema.

Is digoxin a high alert medication?

Is digoxin a high alert medication? High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

Is insulin a high alert medication?

Is insulin a high alert medication? Insulin is consistently recognized as a high-alert medication, meaning that it has the potential to cause detrimental patient harm when used in error.Dec

Is lisinopriol risk medication?

Is l risk medication? Lisinopril oral tablet is used for long-term treatment. This drugisinopril a high comes with serious risks if you don't take it as prescribed. If you don't take it at all: If you don't take it at all, your blood pressure will stay high. This will raise your risk for a heart attack and stroke.

Is metoprolol a high alert medication?

Is metoprolol a high alert medication? High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

Is oxytocin a high alert medication?

Is oxytocin a high alert medication? Some medications that have a heightened risk of causing significant patient harm when they are used in error are called "high-alert medications."In 2007, the Institute for Safe Medication Practices added intravenous (IV) oxytocin to their list of high-alert medications.

Is phenytoin high alert medication?

Is phenytoin high alert medication? The high-alert medications were: amiodarone, digoxin, dopamine, epinephrine, fentanyl, gentamycin, heparine, insulin, morphine, norepinephrine, phenytoin, potassium, propofol and tacrolimus

Is vecuronium a high alert medication

Is vecuronium a high alert medication? Neuromuscular blocking agents (e.g., succinylcholine, vecuronium, rocuronium, etc.) Hospitals are taking steps to prevent errors in the use of so-called high-alert medications -- those that, when given in the wrong dose or used incorrectly, have the highest risk of seriously harming or even killing a patient.

Just-in-time

Just-in-time inventoryAn inventory system that attempts to accurately match demand with supply

inventory

Managing drug inventory in a pharmacy is a common task for pharmacy technicians. Data suggest that pharmacy technicians spend nearly one-quarter of their workday maintaining medication and inventory control systems.1 Drugs are typically purchased from a wholesaler, each of which may have a unique system for ordering and in some situations may have the ability to establish a perpetual inventory that automatically maintains set quantities of commonly used medication. It is important in the delivery of high quality patient care to ensure that medication is available when it is needed by patients. Pharmacy technicians must balance keeping adequate inventory that can fulfill patient needs with minimizing unnecessary stock. Most drug wholesalers have a return process that can be used when excess amounts of drugs or unneeded drugs are on the pharmacy shelf. In 2012, prescription stock stayed on hand in community pharmacies for an average of 33 days. 2 Medications that remain on hand for long periods of time can be costly to the pharmacy and have a negative financial impact. To further complicate management, drug inventory can be affected by a number of factors such as new or first-in-class medications, patent expirations, and inventory spoilage (ie, time or storage conditions that cause medicines to weaken), and drug recalls.3 In order to maintain an adequate, cost-effective supply of medications, both technicians and pharmacists must ensure that effective inventory procedures are established and maintained. The following continuing education course will review common factors that impact drug inventory and offer recommendations on how to manage these situations effectively and efficiently.

Medical supplies

Medical supplies Disposable medical supplies may also be stored in the pharmacy, and are often in a separate section from the rest of the stock for simplified organization. Some pharmacies maintain a stock of durable medical equipment as well, such as wheelchairs, crutches, walkers, and assistive devices for activities of daily living, such as shower stools or bedpans. Because many of these products are large and consume a significant amount of space in the pharmacy, they may be stored in a separate storage area or ordered in from the wholesaler as requested

high alert medications

Medications that are known to cause significant harm if an error is made

Basic stock

Merchandise for which consumer demand does not change much, such as men's undershirts and socks.

Pharmacy Inventory Regulations

Most business owners keep inventories of products, supplies and merchandise so they can ensure they have enough materials to complete their projects and monitor against theft and other forms of loss. In the pharmacy industry, however, inventories are closely regulated by the Drug Enforcement Administration, which monitors inventories to ensure pharmacies keep track of controlled substances. Sources of Regulations The Controlled Substances Act, Title 21 of the United States Code and the Drug Enforcement Administration have all issued regulations that affect pharmacies. All regulations have been synthesized in the Pharmacist's Manual, which is available on the Drug Enforcement Administration website. Some pharmacy owners also design inventory regulations that go above and beyond the government's regulations to ensure their pharmacies are always in compliance. Basic Inventory Requirements According to the DEA, a pharmacy's inventory must be "complete and accurate." Pharmacies must physically count all schedule II controlled substances in their possession and estimate the number of schedule III, IV, and V controlled substances they keep. The administration also requires that pharmacies physically count the number of pills in a container that holds 1,000 pills or more. Pharmacies must keep their inventories at their physical locations for two years and must separate inventories of schedule II substances from other inventories. Inventory Record Requirements Pharmacy inventories must include specific information in order to be compliant with government rules and regulations. Pharmacy employees must record the date and time (beginning or end of business day) when the inventory was taken. They must also note the name of the substances inventoried and the forms of those substances, such as 100 milligram capsules. Finally, pharmacy employees must note the number of containers for each controlled substance, such as 30 50-tablet vials, and an actual or estimated count of the contents of each container. Inventory Record Recommendations In addition to the required information, the DEA recommends that each inventory record feature the name, address and DEA number for the pharmacy taking the inventory. The agency also suggests that the person who completed the inventory sign the report. While pharmacies do not need to include this information to remain legally compliant, many pharmacy owners require it. Including the information reduces mistakes and makes correcting errors easier. Frequency According to the DEA, pharmacies must conduct an initial inventory of their controlled substances when they open and every two years after. The pharmacy does not have to conduct inventory at a specific date or time as long as the pharmacy meets two-year deadline. However, if a pharmacy begins supplying a new controlled substance, the pharmacy must inventory that substance as soon as it is offered.

Perpetual inventory systems

Most pharmacies use a computerized perpetual inventory system to maintain the stock of medications in the pharmacy. A perpetual inventory system is a method of recording the quantity of a particular medication continuously as prescriptions are filled. After each prescription is filled and dispensed to the patient, the amount of medication used for the prescription is removed from the inventory to ensure the quantity on hand in the computer is always current. Deliveries and returns are also recorded, often automatically, as they occur. Federal law requires the use of this inventory system for Schedule II controlled substances, but using this system for all medications ensures an accurate reflection of the current stock in the computer system. There are several tools used in the management of a perpetual inventory system. The inventory is generally managed through a computerized inventory management system (although Schedule II controlled substances are required to be managed on paper as well). The computer system is designed to automatically update on-hand quantities as prescriptions are filled and generate automated and manual reports to allow pharmacy staff to analyze and monitor the inventory. In general, the computer system can often track turnover rates, predict future drug needs, notify pharmacy staff when possible errors are detected, and even order more medication based on set reorder points. In a perpetual inventory system, many pharmacies use reorder points, or periodic automatic replacement (PAR) levels, to automatically order more medication when levels are low. These points can be set in the computer system for each medication, which allows the user to set a maximum amount of medication that the pharmacy would like to have at any point in time and a minimum level that should be maintained at all times. When a medication stock level in the perpetual inventory system is reduced to the pre-set minimum level, the computer system can automatically order enough medication to reach the maximum level again. This allows for a simplified ordering system and decreased workload for the pharmacy technician. Handheld devices for order entry also may be used to help maintain a perpetual inventory in a pharmacy. These portable devices allow the user to walk around the pharmacy and scan the barcode or enter the ID number for a medication that needs to be ordered. These devices can also be used for updating on-hand quantities as well as performing other functions, such as recalls or outdates.

Order cycle

Order cycle timeThe amount of time that elapses between the placement and receipt of an order

Outdated medications

Outdated medications Each pharmacy has its own policies and procedures for processing outdated products. In general, outdates should be pulled off of the shelves at regular intervals to minimize the possibility of expired medications getting to a patient. The pharmacy technician is often responsible for checking outdates on all products in the pharmacy once a month. Marking products that will expire in the next year with their expiration date on a sticker can help technicians spot soon-toexpire medications to help use up stock before it expires. Because prescription labels are required to have the actual expiration date of a product if it expires in less than a year, this process helps maintain compliance with Board of Pharmacy regulations as well. Medications should be pulled off the shelf two to three months or more before their expiration date, depending on the policies of the Page 59 PharmacyTech.EliteCME.com specific pharmacy. All medication the patient receives must be used up before the expiration date occurs, and because many patients get 90-day supplies of their medications, the expiration date must be at least three months away for these patients. The pharmacy technician should ensure this task is done regularly to maintain the safety and effectiveness of products in the pharmacy's inventory. Wholesalers and warehouses generally only accept outdated products for credit if they are returned within a specific window of time, generally two to three months before and after the manufacturer's expiration date. The pharmacy technician is responsible for completing this task once monthly to prevent profit loss. Items that have expired should be separated from the rest of the pharmacy stock until the technician is ready to prepare and package these items for return to avoid dispensing expired products to patients. After outdated products have been pulled off of the pharmacy's shelves, the technician must take several steps to prepare them to be sent back to the wholesaler. A list of all expired products, including the name, strength, and dosage form of the medication as well as the quantity, must be compiled. The list is then transmitted to the wholesaler to seek approval for the return. Once approval has been given, the outdated products may be packaged and prepared for shipment to the wholesaler. The specific procedures for processing outdated medications depend on the policies and procedures of the pharmacy, and must be followed carefully to ensure credit is received for outdated products. Pharmacy technicians are generally responsible for the important inventory management task of checking for outdates at least monthly and sending them back to the wholesaler or drug manufacturer. If medications are outdated and are ineligible for return to the wholesaler, they may be eligible to be sent to a reverse distributor for credit. Reverse distributors are companies that focus on the processing of expired, recalled, or damaged medications. They take these products back from pharmacies and complete the necessary paperwork required by each manufacturer to receive credit for returned items. Then they package and ship the unusable medication to the manufacturer and track the medication until credit is received. These companies also accept expired, damaged, or unusable Schedule II-V controlled substances for return to the manufacturers. There is a fee to use the service of a reverse distributor, which is generally a percentage of the refund that is automatically deducted from the final refund amount. Some outdated products are not eligible for return to a wholesaler, reverse distributor, or manufacturer. Compounded or reconstituted drug products are generally not eligible for return, and some companies will not accept bottles of medication that have been partially used. These medications must be either disposed of by the pharmacy or sent to an outside company for destruction. If the pharmacy is destroying the medications, care must be used to ensure the medications are not endangering the environment or anyone who may come in contact with the product in the garbage. Many medications may be discarded with the pharmacy garbage; they should not be poured down the sink or flushed in the toilet to avoid contamination of the water supply. However, there are some exceptions. Medications that are cytotoxic, such as chemotherapy agents, must be discarded in a hazardous waste container. Any medications that have needles in their packaging should be thrown away in a sharps container. If the drug product that cannot be returned is a controlled substance, the DEA must be notified before the product may be destroyed by the pharmacy. DEA form 41 should be used to request permission to destroy controlled substances, and must be completed at least two weeks before the destruction of controlled substances. Once permission is granted, the pharmacy may destroy the drug products for which permission has been given. Destruction of medications must also comply with local, state, and federal environmental regulations, so care must be exercised when throwing away medications. The completed DEA form 41 must be maintained at the pharmacy for at least two years or longer, depending on state recordkeeping laws, and copies must be submitted to the DEA as w

Overstock returns

Overstock returns Pharmacies can often return stock to the wholesaler that has been ordered in excess or is moving slowly off of the shelves. Pharmacy technicians should monitor the pharmacy's shelves for products that are not being used or were previously special ordered for a patient who discontinued treatment with the specific product. In general, if a package has not been opened or damaged and does not expire for at least 12 months, a wholesaler can accept the product for return. Wholesalers should be contacted to request a return approval before sending the medication back. Once approval has been granted, the technician should package the medication and send it to the wholesaler using the method outlined on the approval notice. Specific policies and procedures will depend on the wholesaler's return policy. Tech alert! Check for overstock of seasonal products and return them for credit after the end of the season to prevent profit loss from outdates!

spedific meds high alert

PINEPHrine, subcutaneous epoprostenol (e.g., Flolan), IV insulin U-500 (special emphasis*) magnesium sulfate injection methotrexate, oral, nononcologic use nitroprusside sodium for injection opium tincture oxytocin, IV potassium chloride for injection concentrate potassium phosphates injection promethazine injection vasopressin, IV and intraosseou

Bulk packaging

Packaging, other than a maritime vessel or barge, including transport vehicle or freight container, in which hazardous materials are loaded with no intermediate form of containment and which has (a) maximum capacity greater than 119 gallons as a receptacle for a liquid, (b) maximum net mass greater than 882 pounds or a maximum capacity greater than 119 gallons as a recepacle for a solid, or (c) water capacity greater than 1,000 pounds as a receptacle for a gas.

tall man lettering

Practice of writing part of a drugs name in upper case letters to help distinguish drugs that sound and look alike - to avoid errors - only for portion of drug name that are similar -

Recalls Recalls are issued to ensure

Recalls Recalls are issued to ensure the public is protected from adverse events from the use of a product that has been manufactured inappropriately. Manufacturers are required by the Food and Drug Administration (FDA) to recall products that are affected by the following issues: ● Incorrect labeling. ● Production or packaging errors. ● Contamination of a particular batch of medication. ● FDA mandated removal from the market due to safety reasons. PharmacyTech.EliteCME.com Page 60 ● Any error that occurs that prevents the medication from meeting the guidelines of the FDA or manufacturer. Manufacturers can also voluntarily recall products if they are concerned about minor issues, such as potential tampering with products, or if their quality control teams find an inconsistency in the drug manufacturing process. This is known as market withdrawal. Recalls are classified into three classes: ● Class I recall: Medications are recalled because they may cause serious harm to a patient's health, potentially including death. ● Class II recall: Medications are recalled because they can cause temporary or reversible health effects, and are at a low risk of causing serious harm. ● Class III recall: Medications are recalled for reasons that are unlikely to have adverse health consequences, such as labeling errors, defects in the containers, or abnormal color or odor. When a recall has been issued, the manufacturer or wholesaler informs the pharmacy by mail, fax, or electronic message. The recall notice contains information on the drug products being recalled, including the drug name, expiration date, and lot number. It also contains information on why the recall is being issued and how to return recalled medication to the manufacturer. Once a recall notice is received, the pharmacy should then check its shelves for the affected lot numbers and expiration dates of the product. If the pharmacy has any recalled products on its shelves, they should be removed immediately and segregated from the regular stock. Recalled products can be returned to the manufacturer or reverse distributor, and the pharmacy should receive credit for returned products. Any stock that has been lost to a recall should be reordered if necessary to maintain the pharmacy's inventory. Depending on the severity of the reason for recall, the recall can extend to the stock that a patient has received as well. If this is the case, patients who may have received recalled medication should be contacted, and the pharmacy should attempt to recover the affected medication to send back to the manufacturer. Patients whose medication has been recalled should have their medication replaced with unaffected medication, free of charge. Even if the pharmacy does not have any products that are listed on a recall notice, its completion should still be confirmed in the computer system. Documentation of the completion of recalls is important to maintain the safety of the pharmacy's medication inventory and therefore patient safety as well. Tech alert! Recalls should be completed the same day they are received to prevent patients from receiving recalled medications!

Receiving When products are shipped to the pharmacy from an external wholesaler or manufacturer,

Receiving When products are shipped to the pharmacy from an external wholesaler or manufacturer, the pharmacy team must take several steps to properly receive the shipment. The technician receiving the order from the delivery driver should first verify that the quantity of boxes or totes delivered matches the expected quantity of packages. The packaging should then be inspected before opening to see whether it has been tampered with. Then the package may be opened, and inspected for damaged or outdated products. If any products are damaged, outdated, or otherwise unfit for use, it should be brought to the attention of the wholesaler as soon as possible. These products should be separated from the pharmacy's stock to prevent accidental use. The packaging should contain an invoice, which should be used to check in the order. The invoice lists the name, strength, and dosage form of medications shipped, as well as the cost of each product, the quantity shipped, and notations if items are unavailable or a lesser quantity was shipped. It also includes the total cost of the order and information on the location of the wholesaler and requesting pharmacy. Each product shipped should be matched up with the invoice to verify that the quantity, strength, package size, and number of units match what was ordered. The prices printed on the invoice from the wholesaler should match up with the prices listed on the purchase order. Any discrepancies should be discussed with the wholesaler and entered into the pharmacy's computer system to allow for accurate accounting. After verifying that the products received match the products listed on the invoice, the invoice should be signed and dated, and set aside for accounting

Receiving controlled substances Controlled substances

Receiving controlled substances Controlled substances should be shipped separately from other medications. When checking in controlled substances, it is especially important to verify that the packaging has not been tampered with before opening it. A pharmacist must check in controlled substances upon arrival at the pharmacy; the pharmacy technician should ensure controlled substances are given immediately to the pharmacist when they arrive.

Receiving damaged

Receiving damaged , outdated, excessive, or incorrect orders If any products are received damaged or outdated, or if the pharmacy accidentally ordered a product it does not need, it may be eligible for return to the wholesaler. The wholesaler generally has policies and procedures dictating what medications may be returned for credit, and these rules must be followed to properly receive credit for returns. Wholesalers often require credit to be requested before the product is sent back, and will send documentation to the pharmacy if the credit request is approved. This documentation should include the original purchase order number, the item number of the item to be returned, the quantity being returned, and the reason the item is being returned. This documentation must be sent with the product when it is shipped to the wholesaler, and a copy must be retained at the pharmacy as well. If a pharmacy technician discovers that the order has been filled incorrectly upon receipt, the technician should contact the wholesaler to figure out a resolution. Wholesalers will often send the correct product in the next shipment and accept return of any products received that were not ordered as well. The wholesaler may need to send return paperwork for the products that were not ordered before they can be sent back.

Receiving investigational drugs

Receiving investigational drugs Investigational medications may be received in a similar manner to regular medications, though the invoices must be kept in a separate area for this type of medication. Policies and procedures of the facility should be followed for receiving and storing these medications. A logbook of receiving, dispensing, and returning investigational drugs may be required, depending on the facility's rules and state laws.

Receiving medications with special storage conditions

Receiving medications with special storage conditions Any shipped products that require special storage conditions, such as freezing or refrigeration, should be checked in first and stored in their proper place. These products should be addressed first to avoid damage or decreased potency of the product. Chemotherapy medications are considered hazardous substances, and should be shipped separately. Policies and procedures of the facility should be followed carefully when handling these products to prevent accidental exposure to these potentially dangerous medications. Special precautions for hazardous substances can be found on the Material Safety Data Sheets (MSDS) that are provided to the pharmacy from the manufacturer for any hazardous agent. Some of these medications may require special shipping procedures because the U.S. Postal Service and other shipping companies have special precautions for hazardous materials. After medications with special conditions are put away, the remainder of the order can be put away as well. When putting an order away, it is important to put the newest stock behind older stock to ensure that products with shorter expiration dates are used before those that will last longer.

Receiving new products

Receiving new products New medications and newly introduced generic products are constantly going onto the market. Many pharmacies wait to order new medications until a patient brings a prescription for them, but some, especially large chain pharmacies, are set up to receive new generic products based on their usage of the brand name version. These products are often shipped from the wholesaler or company warehouse, and should include an invoice that should be checked upon arrival and paid according to the accounting procedures of the pharmacy

Refrigeration

Refrigeration 6 Some drugs require refrigeration to maintain the stability of the medication. In general, refrigerated medications need to be stored between 36-46 degrees F. Thermometers should be placed in the refrigerator to maintain adequate temperatures; ideally a thermometer with a probe that remains in the fridge and connected to an external reader outside of the refrigerator should be used to minimize the number of times the door is opened. A temperature log should be used to document the temperature of the refrigerator twice a day to ensure the products are stored adequately. Medications stored in the refrigerator should be given space between each item to allow adequate airflow between products. Medications should not be stored on the refrigerator door or in bins; they should be placed on shelves in the middle of the refrigerator to ensure the most stable temperatures. If a product that requires refrigeration is kept out of the fridge for longer than the recommended amount of time described by the manufacturer, it may need to be discarded or given a shorter expiration date. The manufacturer can decide whether a medication should be given a shorter expiration date, and may be contacted for guidance if a medication was left out of the refrigerator for longer than the recommended amount of time. If possible, refrigerators should be plugged into an outlet that is set up to receive power from an emergency generator in case of a power outage. To maintain adequate temperatures for drug storage, they should never be unplugged, and should be marked with a tag to ensure there is no confusion. Multiple refrigerators often are used for drug storage in a pharmacy. Outpatient pharmacies may have one or more refrigerators used for its main refrigerated stock, as well as a separate refrigerator for medications that are awaiting pick-up by the patient. All refrigerators should have their temperatures monitored and recorded twice daily to ensure proper drug storage. Tech alert! Pharmacy staff should not ever store food or drinks in the refrigerator that is used to store medications. State pharmacy laws exist in many states prohibiting this practice.

Repackaging medications

Repackaging medications Medications that are not available in unit dose packaging can be repackaged by the pharmacy for use in the inpatient setting. To repackage medications, a machine is used to fill small plastic packets or plastic blister packs with individual doses of medication. The machines can range from simple manual machines that separate the medication into each blister package, all the way to automatic machines that can fill each package as well as create labels with all required information for each unit dose. There are five reasons for repackaging bulk medications into unit dose packaging. These are: PharmacyTech.EliteCME.com Page 62 ● Some medications are not available in unit dose packaging and must be repackaged into unit doses for use in the hospital setting. ● Some unit dose medications are much more expensive than the bulk version, so the hospital pharmacy may repackage the bulk version to save money. ● Repackaging medication increases the speed at which the medication is ready to use because the pharmacy does not have to order in unit doses and wait for them to be delivered. ● Unit dosing allows all of the drug information to be printed on each package, decreasing the risk of errors. ● If the unit dose is not used for a particular patient, it can be added back to the pharmacy's stock and reused at another time. When repackaging medications, personal protective equipment should be used and good manufacturing practice (GMP) guidelines and state law must be followed. There are many GMP guidelines that can be applied to any step of the drug manufacturing process. Several of these guidelines apply when repackaging medications, including: ● Ensuring the equipment is clean and in good working condition. ● Prepackaging medications that originated from a bulk bottle that had not been previously opened. ● Only one medication should be prepackaged at a time. ● A registered pharmacist must verify all medications for accuracy and completeness. ● The packaging must be appropriate for the medications being repackaged. Repackaged medications must include either a six-month expiration date from the time of repackaging or 25 percent of the remaining time of the manufacturer's original expiration date, whichever is shorter. 5 Repackaged medication labels must also include the generic name and strength of the medication, dosage form, and the name of the manufacturer and lot number. The packaging used for repackaging medications should comply with the manufacturer's recommendations for drug storage, including UV light-resistant packaging if needed. A log must be maintained to keep track of all repackaged medications so that repackaged medications may be traced back to the original manufacturer, expiration date, and lot number in case of a recall. The log must contain these items as well as the date of repackaging, the name of the medication, the pharmacy-assigned lot number, the quantity of medication that was repackaged, and the initials of the technician and pharmacist involved in repackaging. The pharmacist must verify all repackaged medications for quality assurance. Repackaging of medications to create unit dose packaging can be done for both liquid and solid dosage forms. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires all medications to be patient-specific to decrease the risk of errors and contamination. This means all liquid medications must be in unit dose packaging; whole bottles may not be sent to a patient's room for continuous use. Oral syringes or dosing cups may be used.

Returns

Returns There are several different types of returns that need to be completed regularly to maintain the pharmacy's inventory. Return paperwork and other records must be kept for at least two years or longer, depending on state-specific laws.

Rotation of stock

Rotation of stock Regardless of the type of organization a pharmacy uses, there are several procedures that should be followed when stocking shelves to ensure stock is circulated properly and minimize risk of error. When restocking shelves, the technician should make sure to place newer bottles behind older bottles, and organize stock with the shortest expiration date in front of similar products with longer expiration dates. This is to ensure older stock is used up before newer stock, to minimize the number of expiring products. Shelves should also be organized with an adequate amount of space between similar products to prevent staff from picking the wrong product to fill a prescription.

Schedule II controlled substances

Schedule II controlled substances Schedule II medications should be stored separately from other medications and are generally kept in a locked cabinet that only the pharmacist can access to prevent theft or diversion. Refrigerated Schedule II controlled substances must be stored in a locked refrigerator, separate from any non-Schedule II refrigerated medications. Schedule II medications may be organized alphabetically by brand, generic, or the name listed on the bottle, whichever is preferred by the pharmacy and pharmacist. The stock of Schedule II controlled substances must be continuously monitored and recorded in a perpetual inventory log by the pharmacist as prescriptions are filled. Ordered Schedule II controlled substances must also be recorded in the perpetual inventory log upon receipt, and any recalls, damaged products, or outdated products must be recorded as they occur as well.

Bulk packaging

Selling multiple items pre-bagged or packaged in a container so customers buy just a few more than they normally would

Stock organization

Stock organization The medications stocked in the pharmacy can be organized in many different ways. Some pharmacies organize medications alphabetically by the medication name on the bottle, so similar brand and generic products may not be located next to each other. For example, lisinopril may be next to lithium, instead of next to its brand name, Zestril. Other pharmacies organize medications alphabetically by brand name, with the generic next to the brand name product. In this situation, Prilosec and omeprazole would be placed next to each other, because omeprazole is the generic form of Prilosec. Organization can also be done alpha-generically, where all products are organized in alphabetical order by their generic name; in this case, Crestor would be found under R, because its generic name is rosuvastatin. Some pharmacies have separate sections for certain types of medications that are not mixed in with the stock bottles of pills. Depending on the needs of the pharmacy, separate areas may be used for birth control pills, liquids, topical treatments, injectable medications, and inhalers. Some pharmacies even have sections for the fastest moving medications, to keep them close to the dispensing counter for easier use. Hospital pharmacies should also have a separate area for IV bags and medications that have been compounded in anticipation of receiving an order from a prescriber. These products should be compounded in small quantities to avoid manufacturing, because pharmacies may compound small quantities of medications but not manufacture large quantities of them without an additional license. A logbook should be maintained, including the date and quantity of medication produced, the lot number and expiration date of any products used in compounding, and the initials of the pharmacist performing quality assurance verification. These medications should be labeled, stored in a designated area, and checked for outdated products regularly. Regardless of the type of stock organization used, error prevention strategies should be incorporated as well. Separating similar looking bottles or products that are different dosages of the same medication with dividers will help prevent technicians and pharmacists from pulling the wrong medication off the shelf to fill an order. Stickers or signs can also be used for high-alert medications or those that are prone to more dangerous errors. An example of this is warfarin, a blood thinner, which is available in several dosages. Placing dividers between the dosages and using signage to alert the technician to the higher potential risk of error will help prevent potentially dangerous errors from o

Storage of medications

Storage of medications at points of use Automatic dispensing systems Medications stored on nursing units or various departments in the hospital setting have different needs based on the area where they are located. For example, the medication storage machine located in an intensive care unit will have different medication needs than that in the pediatric ward. The pharmacy technician should be aware of the medication needs of each machine based on its location, which can help to decrease errors. Knowing what medications should be in a machine located on a pediatric floor as compared to an intensive care unit will help pharmacy technicians do their part in preventing potentially fatal medication errors. Code or crash carts In the hospital setting, crash carts are trays of medication that are used when a patient's medical condition is rapidly decompensating, such as when the patient's heart stops or they stop breathing, also known as a code. These lifesaving medications are used to rapidly restore the patient to a stable condition, and must be readily available in patient care areas. Crash carts generally contain injectable medications to achieve rapid effects in emergency settings, and are covered with an easy to remove plastic sheet and numbered lock, so it is easy to identify when a tray needs to be replaced. There are generally three types of trays - adult, pediatric, and neonatal - that ideally should be three different colors to avoid confusion, and they should be stored in separate areas in nursing units to avoid confusion during a code. It is the responsibility of the pharmacy to refill and replace crash cart trays as they are used, and to know the location of each tray in the hospital. When refilling a crash cart tray, it is important to ensure that all medications in the tray are located in exactly the same place every time in every tray. This is because when a code occurs, doctors and nurses must work rapidly to restore the patient's medical condition, and having the medications in the same location every time decreases the risk of errors when quickly grabbing medications from the tray. It is also important to check the expiration dates of the products in crash carts and replace soon-to-expire products regularly. The earliest expiration date of any product in the tray should be noted on the top of the tray to facilitate replacement of expiring medications as that date approaches.

SEE CONFUSED DRUG LIST

Table 1. FDA-Approved List of Generic Drug Names with Tall Man Letters Drug Name With Tall Man Letters Confused With acetaZOLAMIDE ,acetoHEXAMIDE acetoHEXAMIDE ,acetaZOLAMIDE buPROPion busPIRone busPIRone buPROPion chlorproMAZINE chlorproPAMIDE chlorproPAMIDE chlorproMAZINE clomiPHENE clomiPRAMINE clomiPRAMINE clomiPHENE cycloSERINE cycloSPORINE cycloSPORINE cycloSERINE DAUNOrubicin DOXOrubicin dimenhyDRINATE diphenhydrAMINE diphenhydrAMINE dimenhyDRINATE DOBUTamine DOPamine DOPamine DOBUTamine DOXOrubicin DAUNOrubicin

.Tall Man lettering

Tall Man lettering Tall man lettering is the practice of writing part of a drug's name in upper case letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors

High Alert Drugs (PINCH)

The Clinical Excellence Commission has summarized high-risk medications in the acronym A PINCH (anti-infective agents; potassium and other electrolytes; insulin; narcotics and other sedatives; chemotherapeutic and immunosup- pressive agents and heparin and antico- agulants). these medicines include anti-infective agents, anti-psychotics, potassium, insulin, narcotics and sedative agents, chemotherapy and heparin and other anticoagulants. These medicines are represented by the acronym 'A PINCH'. The poster below can be used to assist hospitals in raising awareness of A PINCH medicines. High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients Why is heparin high alert? Unfractionated heparin (UFH) is associated with a high rate of drug-related problems due to either its inherent pharmacologic properties or an extension of these properties often caused by medication errors.

Safety stock

The amount of stock that is carried to account for fluctuations in demand or order cycle times

Basic stock

The amount of stock that is carried to meet an average demand level

Inventory turnover days

The average number of days' worth of stock on hand[Formula: 365 (days in year) ÷ inventory turnover]

order cycle

The total amount of time that elapses from the time a customer places an order until the time the product is delivered to the customer.

Automatic dispensing systems

There are many different machines available to help pharmacies fill prescriptions in both the community and hospital setting. They range from simple machines that pills are poured through for counting to elaborate robotic machines that can print labels, count pills, and put them in prescription vials. Maintenance of automatic dispensing systems is an important part of the pharmacy technician's responsibilities in facilities that have these machines. Because the machines can be very elaborate and require a lot of user input to work correctly, there are many different ways errors can occur. The pharmacy department should have a written safety plan to ensure the machines are properly filled and maintained, and technicians should ensure these regulations are followed closely.2

Unclaimed prescriptions In community pharmacies,

Unclaimed prescriptions In community pharmacies, prescriptions that have not been picked up in a timely fashion by the patient must be returned to the pharmacy shelves to use for other patients. Most pharmacies have policies that require prescriptions to be restocked 7-14 days after they are initially filled. Many pharmacies have automatic reports that print daily to notify the technician of which prescriptions have been waiting for pick up for too long. Many insurance companies are billed for products that have been sitting on the shelves for more than 14 days, so it is important to not only restock these products for accurate inventory management, but also to prevent insurance fraud as well. When an insurance company is billed for a prescription that a patient has not received, it can be considered insurance fraud, and if the insurance company is a federally funded program, such as Medicare or Medicaid, it can be considered a greater violation of the law. Violations can be associated with hefty fines that can affect the profitability of the pharmacy. Restocking these prescriptions on a daily basis will ensure the pharmacy is compliant with insurance company standards and the law as well as allowing these medications to be added back to the inventory to be used for other purposes. Tech alert! Calling patients a few days before returning their prescriptions to stock will help to minimize the number of unclaimed prescriptions that need to be returned to the shelf!

Unit dose packaging In hospitals

Unit dose packaging In hospitals or inpatient pharmacies, medications are often packaged individually for ease of use by the nursing staff and to decrease contamination of unused medication by sick patients. Individually packaged medications, or unit dose packaging, can be used for many dosage forms, using packaging such as vials, ampules, individual blister-packed medications, or dosage cups for liquid medications. Unit dose packaging must be labeled properly and must include the generic name and strength of the medication, dosage form, the name of the manufacturer, expiration date, and lot number. Medications sent from the wholesaler in unit dose packaging generally have the required information on the packaging already, but the pharmacy technician should be aware of these requirements.

tall man lettering

Uppercase letters used within a drug name to highlight differences between look-alike drug names

see confused drug list 2

Valtrex (valACYclovir) and Valcyte (valGANciclovir). The generic names for these 2 drugs are strikingly similar, and both the brand and generic names of the products start with the prefix "val," contributing to look- and sound-alike confusion. Both have uses associated with cytomegalovirus (CMV) and may be used in immunosuppressed patients with HIV or transplant patients. Valtrex is used in the treatment of shingles (herpes zoster), cold sores (herpes labialis), and genital herpes (herpes genitalis), and as prophylaxis for prevention of CMV in patients with advanced HIV or after transplantation. Valcyte is used in the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome and also for prevention of CMV in kidney, heart, and kidney-pancreas transplant patients.Errors have involved physicians prescribing the wrong drug, as well as nurses and pharmacists who confused the drugs while transcribing and dispensing them or misinterpreted the drug name due to poor handwriting. A pharmacist notified ISMP about a colleague who noticed that a heart transplant patient received valACYclovir in error for 10 days. The drug had been chosen incorrectly by the prescriber from a computer selection screen.Strongly consider using both the brand and generic names when referring to these drugs, and determining their purpose when processing the orders. Using tall man letters when listing the drugs in computerized inventories may help reduce the risk of medication errors (consider using valACYclovir and valGANciclovir.) You might also be able to configure a computer alert to warn of the risk of mix-ups during order entry.Sertraline and cetirizine. A pharmacy student recently reported a mix-up that occurred between the seasonal allergy drug cetirizine and the antidepressant sertraline. A nurse left a telephone prescription on the pharmacy's voice mail system for cetirizine 10 mg. The pharmacist interpreted the order as sertraline, however, due to the way the nurse pronounced the drug name. The prescription was processed as sertraline 100 mg and dispensed to the patient. The patient caught the error when she read the antidepressant medication guide in the bag with her prescription bottle. Although the patient did not take the medication, she was very upset about the mix-up. Just as for handwritten prescriptions, prescribers and their agents should include the purpose of the drug with all telephone prescriptions, including those left on a voicemail system. Drug names, especially those that have been confused, should always be spelled out. Also, digits for dosages should be sounded out (eg, one-five instead of fifteen). PT

What are look alike sound alike medications?

What are look alike sound alike medications? Look Alike Sound Alike (LASA) medications involve medications that are visually similar in physical appearance or packaging and names of medications that have spelling similarities and/or similar phonetics.

What are the top 5 high alert medications?

What are the top 5 high alert medications? The five high-alert medications are insulin, opiates and narcotics, injectable potassium chloride (or phosphate) concentrate, intravenous anticoagulants (heparin), and sodium chloride solutions above 0.9

What are the top 5 high alert medications?

What are the top 5 high alert medications? The five high-alert medications are insulin, opiates and narcotics, injectable potassium chloride (or phosphate) concentrate, intravenous anticoagulants (heparin), and sodium chloride solutions above 0.9%.

tall man lettering

What is an example of Tall Man lettering? For example, in tall man lettering, "prednisone" and "prednisolone" should be written "predniSONE" and "predniSOLONE", respectively.

What is inventory control in hospital pharmacy?

What is inventory control in hospital pharmacy? Inventory control of drugs plays a pivotal role in hospital management. Drug inventory control of hospital pharmacy is very essential in order to provide continuous supportive services. The inventory management of drugs is very essential, as it is adversely affected by the consumption rate and purchasing cost of drug

What is inventory in pharmacy?

What is inventory in pharmacy? A sufficiently stocked pharmacy inventory typically includes basic stock plus safety stock. Basic stock is the amount of inventory carried on hand to meet an average demand level, while safety stock is the amount of inventory kept on shelves to account for fluctuations in demand.

What is the classification of a drug?

What is the classification of a drug? Addictive drugs may be classified as Stimulants, Depressants, Hallucinogens, or Opioids on the basis of their effects. Furthermore, the United States government classifies addictive drugs as controlled substances in five schedules.

What medications should the pharmacy keep in stock?

What medications should the pharmacy keep in stock? The medications that each pharmacy should keep in stock will vary greatly depending on the type of pharmacy and the customer base of each pharmacy location. A hospital pharmacy will carry a very different inventory than an outpatient pharmacy because different medications and dosage forms are commonly used in each setting. Insurance carriers and hospital formularies will also play a role in governing which medications are commonly used in a particular pharmacy.

Why Magnesium sulfate is considered a high risk medicine?

Why Magnesium sulfate is considered a high risk medicine? Intraveneous magnesium sulfate has the potential to cause serious harm or death when used incorrectly. The currently available licensed products require complex calculations, dilution and administration often by staff working under pressure in emergency or urgent situations

just in time

a logistics process in which goods arrive when needed for production, use, or sale rather than sitting in storage

high-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. We hope you will use thislist to determine which medicationsrequire specialsafeguardsto reduce the risk of errors. This mayinclude strategiessuch asstandardizing the ordering, storage, preparation, and administration of these products; improving access to information about these drugs; limiting access to highalert medications; using auxiliary labels; employing clinical decision support and automated alerts; and using redundancies such as automated or independent double checks when necessary. (Note: manual independent double checks are not always the optimal error-reduction strategy and may not be practical for all of the medications on the list.)

adrenergic agonists, IV (e.g., EPINEPHrine, phenylephrine, norepinephrine) adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol) anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine) antiarrhythmics, IV (e.g., lidocaine, amiodarone) antithrombotic agents, including: anticoagulants (e.g., warfarin, low molecular weight heparin, unfractionated heparin) direct oral anticoagulants and factor Xa inhibitors (e.g., dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, fondaparinux) direct thrombin inhibitors (e.g., argatroban, bivalirudin, dabigatran) glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide) thrombolytics (e.g., alteplase, reteplase, tenecteplase) cardioplegic solutions chemotherapeutic agents, parenteral and oral dextrose, hypertonic, 20% or greater dialysis solutions, peritoneal and hemodialysis epidural and intrathecal medications inotropic medications, IV (e.g., digoxin, milrinone) insulin, subcutaneous and IV liposomal forms of drugs (e.g., liposomal amphotericin B) and conventional counterparts (e.g., amphotericin B desoxycholate) moderate sedation agents, IV (e.g., dexmedetomidine, midazolam, LORazepam) moderate and minimal sedation agents, oral, for children (e.g., chloral hydrate, midazolam, ketamine [using the parenteral form]) opioids, including: IV oral (including liquid concentrates, immediate- and sustained-release formulations) transdermal neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium) parenteral nutrition preparations sodium chloride for injection, hypertonic, greater than 0.9% concentration sterile water for injection, inhalation and irrigation (excluding pour bottles) in containers of 100 mL or more sulfonylurea hypoglycemics, ora

high alert medications

drugs that bear a heightened risk of causing significant patient harm when used in error

high alert drugs

increased risk for harm if used in error

LASA medications

look alike sound alike

tall man lettering

medication names that have mixed case lettering in the description name, which helps reduce errors between medication names that either look or sound alike

high alert medications

medications that have a high risk of causing patient harm when used in error

11 Retail Pharmacy Inventory Management Tips to Boost Profits

separating inventory,Inside: Get ready to get your pharmacy inventory in order. These pharmacy inventory management tips can help you better manage your inventory—and boost profits. You invest a lot of money in your pharmacy inventory. Managing it effectively can lead to better cash flow and greater profitability. And we're not only talking about everyday pharmacy inventory best practices like stock rotation. When products expire on your shelves or you run out of fast-moving items, you lose sales and patients' trust. These issues can also harm your relationships with your suppliers. Get ready to get your pharmacy inventory in order. These 11 pharmacy inventory management tips can help you more efficiently manage your inventory—and boost profits. 1. Reduce inventory stockpiling When back-of-store shelves overflow with a surplus of products, cash flow slows down. You've tied up your cash in a lot of inventory. If those products don't move off your shelves—and fast—you could face cash flow issues. Maybe you'll have to draw on your line of credit to pay your wholesalers? Or, you'll need to invest more of your personal cash into your business. What to do: Avoid accumulating excess inventory. Instead, stock up slowly. And, track your sales to pinpoint the medications that move quickly—and the ones that don't. 2. Keep enough inventory on hand Too little inventory can mean lost sales. If you don't have the prescriptions patients need, they won't wait. They'll walk out your door and go to another pharmacy. What to do: Keep an adequate supply of base stock and as little safety stock as possible. Think of base stock as the foundation from which you fill prescriptions day in and day out. And, think of safety stock as the inventory you hold to protect against uncertainty. You need to find the right balance between enough base stock and as little safety stock as possible. Read next: How to Maximize Rebates and Profitability on Pharmacy Inventory 3. Remove slow or dead product Slow or non-moving items tie up your cash flow. They sit on your shelves without earning you a penny. What to do: Use your pharmacy software capabilities to run reports that identify your productive inventory, slow inventory and dead inventory. For example, run a report to find drugs not dispensed in the last 120 days. If an NDC hasn't been filled, you can pull it from your shelves and return it to the wholesaler. You can also sell it to a service that purchases open bottles at reduced prices. 4. Incentivize pharmacy technicians Consider giving a small reward to pharmacy technicians to find about-to-expire or dead inventory. When pharmacy technicians regularly check for short or outdated drugs, you can save money by returning them to the manufacturer. And, pharmacy technicians can spot dead inventory before it expires. You'll always have medications on the shelf that you need but that don't move quickly. Just don't overlook them too long. What to do: Give pharmacy technicians a small reward for finding slow-moving and expired inventory. Offer an extra vacation day or a free lunch. 5. Conduct regular reviews Consistently check your inventory, such as every quarter, to adjust for dispensing trends in your area. You can even designate an employee to handle this task. Certain factors can account for fluctuations in different types of medications dispensed. Use these regular reviews to identify trends so you can order more effectively. Inventory trends to look for: Frequently-ordered items Loss of product Product costs Seasonal differences Sell rates What to do: When you regularly review your inventory, you can account for trends and better maintain your inventory levels. Perform these regular reviews in addition to your yearly physical inventory count. 6. Engage your patients If you have patients who need rarely-used or expensive drugs, ask them to remind you shortly before refill time. With a little notice, you can order the item only when needed. That way you don't keep unnecessary expensive drugs on your shelves and you can order exactly what you need. What to do: Maintain great relationships with your patients and they'll likely help you out. 7. Buy quality product When you buy consistently reliable products, you can improve your pharmacy inventory management. Not only will you know the products you purchase meet quality standards, but you can reduce operational headaches, too. Low-quality drugs can end up costing your pharmacy. You'll lose labor costs, time and resources to deal with the negative outcomes associated with poor quality products. What to do: Choose products from suppliers that meet the track-and-trace requirements of the Drug Supply Chain Security Act (DSCSA). Also, look for suppliers certified through the Healthcare Distribution Alliance (HDA). And, check that your suppliers are Verified-Accredited Wholesale Distributors, or VAWD-certified, through the National Association of Boards of Pharmacy (NABP). Here's a guide to why you want to make sure your wholesalers are VAWD-certified. And, here's why you want your distributors to be HDA members. 8. Incorporate automation Streamline your pharmacy inventory with an automatic inventory management system. You'll reduce costs and improve efficiency. An automated system will help your pharmacy maintain accurate inventory levels. With an automated inventory management system, you'll know: The inventory on hand Items available to fill the next prescription The inventory on order What to do: Find ways to automate your pharmacy inventory management. Whether that's improving how you use your pharmacy management system or investing in a complete automation solution. 9. Place fewer orders If you place several small orders throughout the day, you spend more time preparing orders and putting away orders than you need to. What to do: Place larger orders fewer times throughout the week. This practice can save you money over the long term. For example, if you place three large orders throughout the week and place the occasional must-have base stock order, you can organize a more effective work schedule. With consistent orders, you can plan ahead and place more staff on the days when you'll need to put away larger orders. And, you can cut back staff hours on other days. 10. Look at the numbers You can't improve your pharmacy inventory management if you don't know the numbers behind the medications. Inventory-specific calculations you need to know: Total inventory Total inventory (as a percentage of sales) Inventory turnover Inventory turn days Accounts payable turnover Accounts payable turn days What to do: Get a better picture of your cash flow and profitability with these metrics. For a full review of these metrics (and more!) check out this pharmacy metrics guide. Calculating these metrics can help you improve your pharmacy inventory management. 11. Don't rely on secondary suppliers If your pharmacy has a primary contract with a wholesaler, you could hurt your bottom line if you buy inventory from secondary suppliers too often. Think beyond the sticker price. The time and resources spent shopping secondary suppliers could cost you in the long run. Complying with your current primary contract to earn rebates outweighs buying one bottle of medication at a good price. What to do: If you're concerned about the cost structure of your current primary wholesaler contract, consider resources to help. ProfitGuard, a primary wholesaler contract negotiation and management service from PBA Health, can help negotiate a competitive contract for your pharmacy. The service forms regional groups of pharmacies and bids the group's business across multiple national wholesalers. This creates a true market competitive negotiation for your pharmacy.

Safety Stock

the amount of inventory carried in addition to the expected demand

order cycle

the time between recognition of need until the product is delivered and ready for use

order cycle

the time between the receipt of orders in an inventory system