29 terms

09: Institutional Pharmacy Practice

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Institutional Pharmacy
A pharmacy in facilities where patients receive care on site (e.g., hospitals, extended-living homes, long-term care and hospice facilities); these pharmacies are also found in government-supported hospitals run by the Department of Veteran Affairs, Indian Health Service and the Bureau of Prisons. Because there are fewer hospital pharmacies than community pharmacies, there are fewer job openings for pharmacy technicians in hospitals. Today's pharmacists do not have time to perform many of the tasks they did in the past. Technicians have assumed control of these tasks.
Satellite Pharmacy
Larger hospitals and those with specialized areas may have a central pharmacy in addition to smaller pharmacies at various points throughout the facility. Specialty medications can be stocked in these smaller pharmacies which fill most of the daily medications for the patients on their floors. This practice can accelerate order preparation and delivery. Floor stock for these small pharmacies is supplied by the central pharmacy. These small pharmacies typically are staffed by a pharmacist and a pharmacy technician. The pharmacist's role is to monitor regulatory compliance and oversee all medications dispensed to ensure optimum patient care.
Floor Stock
Drugs not labeled for a specific patient and maintained at a nursing station or satellite pharmacy for the purpose of administration to a patient of the facility. The pharmacy technician must be aware of each units unique inventory and replenish as necessary.
Protocol
All pharmacy employees are responsible for knowing the policies and procedures (P&P) and the standard operating procedures (SOPs) of the pharmacy. These policies outline the standards and guidelines by which a facility operates and the procedures that explain how, when and why the policies are to be executed. Adherence to these policies keeps patients safe and comprises the department's quality assurance and quality control plans. Information contained in the P&P manual concerns daily work routines and responsibilities, benefits, protocols for emergency situations and mandatory training.
Formulary
Hospital protocol defines this list of drugs approved for use by the Pharmacy and Therapeutics Committee. These drugs have become the standard stock carried by the pharmacy and other departments. Drugs are selected for inclusion on this list based on cost, effectiveness, safety of the drugs and patient demographics. If the recommended criteria are not met, the drug is not included on the approved list.
Non-Formulary Medications
Drugs that are not approved for use within an institution unless specific exceptions are filed and accepted by institutional protocols.
The Joint Commission (TJC)
An independent, nonprofit organization that accredits hospitals and other health care facilities in the US; the facility must be accredited to receive Medicare and Medicaid payment. All accredited health care organizations are surveyed every 39 months to evaluate standards compliance. This survey is unannounced.
USP-797
This Document provides guidelines that apply to all settings where CSPs are prepared; it can be enforced by TJC. According to this document, the PEC for preparing nonhazardous CSPs is the horizontal LAFW; hazardous CSPs require either a vertical laminar flow hood or BSC.
Centers for Medicare and Medicaid Services (CMS)
This agency inspects facilities and must give approval for hospitals to provide care and receive reimbursement for patients covered by Medicaid and Medicare. It also regulates other health-related programs such as CHIP and HIPAA.
Department of Public Health (DPH)
This department in each state inspects hospitals and hospital pharmacies to ensure that they are in compliance with state regulations.
State Board of Pharmacy (BOP)
This state-managed agency develops, implements and enforces pharmacy practice standards in that state for the purpose of protecting the public. This agency regulates the pharmacists and pharmacy technicians that work in each hospital facility.
Medication Order
A prescription written for administration in a hospital or institutional setting. This prescription is placed in the patient's chart and uses the medical record number instead of a prescription number. Pharmacists review the patient profile to monitor the effectiveness of the prescribed medications.
Stat Order
A emergency medication order that must be filled immediately, as quickly as is safely possible to prepare the dose, usually within 5 to 15 minutes.
As Soon As Possible (ASAP)
A medication order that must be filled promptly but is not as urgent as a stat order. These orders should be put in front of the new orders. It is the pharmacists responsibility to clarify discrepancies before sending the order.
Standing Order
Written protocols for drugs or treatment that are to be used in a specific situation. This is a preprinted order with a list of medications; it saves the physician from having to write the same order each time he or she performs the procedure. This includes orders for prn drugs.
Point of Entry (POE)
These systems provide electronic access to medical information and drug information data and allow physicians, nurses and pharmacists to directly communicate thereby limiting transcription errors.
Computerized Physician Order Entry (CPOE)
A new technology by which the medication order is sent electronically to the pharmacy. This system eliminates the need to decipher the physicians handwriting. The system checks new medications against current medications for interactions or contraindications. Orders with alerts cannot proceed until the problem is resolved. The system also checks for proper dosage selection based on patient parameters and diagnoses. Medication orders are sent directly to the pharmacy, eliminating the possibility of a lost order. Name alert functions help to reduce errors when two patients with the same last name are on the same floor.
Bar Code Point of Entry (BPOE)
Each unit dose medication is bar coded and can be scanned with a handheld device. This allows the nurse to ensure accuracy of medication dosages before any medications are given. This information is linked to the E-MAR which verifies each dose for the patient. Discrepancies are detected by the scanner which alerts the nurse to the problem thereby preventing medication errors. The patient's vital signs, pain level and other chart notes can be entered from the bedside directly onto the E-MAR. This system helps ensure that the five rights of medication safety are followed, reduces the time required for charting, and creates less paperwork, so the nurse can spend more time with the patient.
Electronic Medication Administration Record (E-MAR)
A computer program that automatically documents the administration of medication into electronic health record (EHR) systems; the report serves as a legal record of medications administered to a patient at a facility by a health care professional.
Investigational Drug
A drug that has not been approved by the FDA for marketing but is in clinical trials; also, an FDA-approved drug seeking a new indication for use. Hospitals conduct clinical trials as the last phase before a drug is approved by the FDA. TJC regulations must be met and strict protocols regulate the ordering, storing, inventory and final disposal of the drug. These drugs are stored separately from other drugs and each has a logbook for auditing. Once the study is complete the remaining drugs are returned to the sponsor along with the log records.
Automated Dispensing System (ADS)
Computerized cabinets that control inventory on nursing floors, in emergency departments, and in surgical suites and other patient care areas. There are 3 main advantages. 1) Inventory control: The patient can be charged exactly as each item is dispensed. 2) Reduced wait time: Nurses can directly access the patient's drugs without waiting for a starter dose to be sent from the pharmacy. 3) Accuracy: Nurses are allowed to take only the specific medication ordered for the patient. Incorrect medication is less likely to be dispensed, the result is improved patient care.
Pyxis
An automated dispensing system often used in hospitals. This system scans and verifies the user's fingerprint before granting access. This helps to ensure the security of the system and ultimate control over access to medications. This information is valuable in solving discrepancies and managing inventory.
Unit Dose (UD)
A single dose of a drug; these are individually repackaged doses used in institutional practice settings. Technicians are responsible for determining which medications need to be repackaged from bulk bottles based on the use of stock by patients. When medication is repackaged, the final check is always done by the pharmacist. TJC requires hospitals to make all medications patient-dose specific.
Periodic Automatic Replenishment (PAR)
A set level of certain medications kept on hospital floors. When the count is lower than this level, the technician can pull the amount needed to restore the original count.
Aseptic Technique
Procedures used in the sterile compounding of hazardous and non-hazardous materials to minimize the introduction of microbes or unwanted debris that could contaminate the preparation. Use of this technique is important in the preparation of compounded sterile preparations (CSP's).
Parenteral Medication
Medication that bypasses the digestive system but is intended for systemic action; this term most commonly describes medications given by injection, such as IV, IM or SC. An IV tech is responsible for the preparation of these medications. Nonhazardous CSPs are prepared using a horizontal LAFW. Chemotherapeutic agents should never be mixed in this type of hood. Hazardous CSPs require either a vertical laminar flow hood or BSC. For safety a special impervious chemotherapy gown must be worn along with eye protection and double gloves.
Labeling Parenteral Drugs
Parenteral drugs must be labeled before they leave the pharmacy. The 7 required parts of a label include: 1) the patient's name, 2) medical record number 3) room number, 4) name of the drug, 5) strength of the medication, 6) name of the solution with which the medication was mixed, 7) the rate of infusion.
Beyond Use Date (BUD)
Defined by USP-797 as the date or time after which a CSP shall not be administered, stored or transported. This date is determined from the date the preparation is compounded and consists of two components, chemical stability and microbial sterility. As the length of time a CSP is exposed to room temperature increases, so does the risk of bacterial growth; therefore the risk level is a function of time and temperature.
Crash Carts
Movable carts containing trays of medications, administration sets, oxygen, and other materials used in life-threatening situations, such as cardiac arrest. The 3 types of trays are: adult, pediatric and neonatal. Each type of tray contains a different strength of drug. When a tray has been used the pharmacy technician refills the missing contents. Never assume that the unused drugs left inside the tray are correct. A common error is failing to differentiate between pediatric and adult strengths.