413 - IPPE Hospital Final

Question 1

# Define the term:
Medical Record

Answer 1

aka “Patient Chart”

Documentation of one’s
Medical History / Diagnosis / Care Received

Systemic format followed in
SOAP - Documentation

Question 2

Purpose of:
Medical Record

Answer 2

To provide:
Complete, Accurate, Concise
Documentation

Allows for:
Organized SHARING of info
between healthcare professionals

Question 3

Basic Components of
Medical Record

Answer 3

Notes

Lab Values** + **Test Results

Orders
Meds / MAR / Diet

Allergies

Vitals
BP / HR / TEMP

Demographics
Height / Weight / BMI

Question 4

Advantages of an
EMR = Electronic Medical Record

2015 - 84% of hospitals have EMR

Answer 4

ACCESS

LEGIBILITY

STORAGE

Question 5

Steps to Work-Up a Patient

Answer 5

History & Physical
Why are they here? Relevant PMH.

Weight + Allergies
Dosing + CrCl calculations

Medication Lists
prior to admission + currently ordered meds + Drug Interactions

Labs

Diagnostic Tests

MAR

Flow Sheet

Question 6

MAR

Definition / What’s in it

Answer 6

Medication Administration Record

Used in
conjunction W/ current medication list

Documents:

• *what medications a patient ACTUALLY RECIEVES in hospital**
• can be ORDERED, but NOT actually given*

Includes info on:
Time of Admin / Reasons / Doses withheld

Question 7

Importance of Medical Record for PHARMACIST

Answer 7

Lab Values
P can adjust doses / hold or elminate meds

Allergy Information
P can update/clarify allergies —> into Medical record

Tests
P can use results to make decisions regarding med therapy

Immunizations

Question 8

List all of the places medications are dispensed from in a hospital

Answer 8

Central pharmacy

Decentralized pharmacy

• *Automated medication dispensing device**
• *Medication cabinet / Unit-based cabinet**

Automated distribution cabinet / Automated dispensing machine

Emergency crash carts

Drug boxes/kits

Question 9

Determine how medications are packaged for inpatient use and compare and contrast the differences in medication packaging between inpatient and outpatient settings.

Answer 9

Unit Dose
Single, individually packaged dose of a medication
Labeling requirements:
Drug name / Drug strength / Manufacturer name
Lot number / Expiration date

Pre-Packaging
AKA extemporaneous medication preparation
instead of EXP DATE:
BUD = BEYOND USE DATE
manufacturer BUD or 1year, whatever is SOONER

Question 10

Define inpatient medication orders and

review terminology necessary
for understanding the
order review and verification process

Answer 10

• *Inpatient = ORDERS**
• *means by which a prescriber communicates the desired treatment regimen for a patient**

CPOE

Standard Order Sets

Question 11

Automated Medication Dispensing Device

Describe usual inpatient pharmacy workflows

Answer 11

Question 12

Cart Fill

Describe usual inpatient pharmacy workflows

Answer 12

Cart fill:
the dispensing and delivery of a pre-specified time period’s worth of scheduled medication

Question 13

Dispensing STAT Orders and First Doses

Describe usual inpatient pharmacy workflows

Answer 13

Process for dispensing miscellaneous orders that are needed before cart fill and are not available in an AMDD

Question 14

Medication Order Verification
pharmacist Duties

Answer 14

All medication orders must be reviewed and verified by a pharmacist
Exceptions: emergencies

Pharmacists evaluate each medication order for completeness and appropriateness

Pharmacists must prioritize order verification based on patient acuity

Pharmacists assist with timing orders

Pharmacists determine from where orders will be dispensed

Question 15

What is considered a TRUE ALLERGY?

Answer 15

• GI UPSET - HEADACHE - DROWSINESS*
• *ARE SIDE EFFECTS, NOT allergies**

True Allergy:

• *Uticaria/Hives**
• *Pruritus / Agioedema / Bronchospasm / Hypotension**

Question 16

Dextrose for TPN

Answer 16

50-70%

Final concentration
25% for CENTRAL

10-12.5% for Peripheral

Question 17

Protein for TPN

Answer 17

8.5% 10% or 15%

Max 2.5% for Peripheral in PEDS

Question 18

Advantages for 2-in-1 Formulations

Answer 18

• less risk of*
• *Drug Incompatability**

Increase Ca-Phos Solubility
can add more

Question 19

Adv/Disadv
for 3-in-1 formulations

Answer 19

ADVANTAGES:

• Less RISK* for contamination during admin
• Lower* COST / LESS admin time

Disadvantages
Large PORE FILTER > 1.2um –> more infxn
Higher risk for catheter occlusion
Medication INCOMPATIBILITY
limits CA-PHOS solubility –> risk for neonatal MBD

Question 20

PPN Concerns

Answer 20

MORE VOLUME for adequate energy needs

Short term
due to limited osmolarity = 900-1000 mOsm/L
Dextrose < 12.5% // AA <2.5%

Thrombophlebitis risk

Calcium < 10 mEq/l

Photassium < 40-60 mEq/L

Question 21

What is the most accurate method of IV drug delivery

in NEONATES + CHILDREN

Answer 21

INTRAVENOUS SYRINGE PUMP

does NOT use extention tubing

requires flushing / low volume tubing

Question 22

IM Injection

Recommended Site & Max Volume

Answer 22

MAX 2 mL
per dose for older children

Preferred:
THIGH = Vastus Lateralus
for all children <3 y/o

Vit K / Vaccine / Penicillin

Question 23

USP 797 BUD

Medium Risk Level CSP

Answer 23

More Manipulations than low

• *30 Hours Room Temp**
• *9 Days Fridge**
• 45 Days Frozen*

Question 24

USP 797 BUD

LOW Risk Level CSP

Answer 24

• *Made in Hood**
• *sterile components**

<3 packages

<2 entries into sterile container

• *48 Hours Room Temp**
• *14 Days Fridge**
• 45 Days Frozen*

Question 25

USP 797 BUD

HIGH Risk Level CSP

Answer 25

Non-sterile ingredients

Exposed to Iso Class <5 for >1 hour

• *24 Hours Room Temp**
• *3 Days Fridge**
• 45 Days Frozen*

Question 26

BCMA

Answer 26

Barcode Medication Administration

decreases medication admin errors

• *5 RIGHTS:**
• *Drug / Dose / TIME / Route / Patient**

Question 27

Standard Admin Times

BID / TID / Q4h / Q6H

SCHEDULED

Answer 27

Admin within
1 HOUR
b4 or after the scheduled time

Non-Time-Critical

Question 28

ADE

Answer 28

Adverse Drug Event

injury, harm, or undesirable health outcome
due to drug therapy​

Question 29

MIDIS

Answer 29

Transitions of Care:
Check EACH MEDICATIONforMIDIS

MoA
Indications
Dose
Interactions
Side Effects

Question 30

Steps for Transitions of Care

ADMISSION

Answer 30

• *Medication History**
• note disreprencies*
• *Med Reconciliation of INPATIENT Meds**
• do NOT restart meds W/O indication or had side effect*

Check EACH MED for MIDIS

Drug Allergies
Reconciliation & investigation

Question 31

Steps for Transition of Care

DISCHARGE

Answer 31

Reconciliation of DISCHARGE MEDS

Review Discharge med INSTRUCTIONS

Discharge med COUNSELING

Review MIDIS
for all discharge meds

D/C any RX at patient’s pharmacies that have been DCd

Fascilitate CLINIC APPOINTMENTS
PCP / anticoag

Assure ACCESS
SPECIALIST

Question 32

RXCARES

Answer 32

Various Activities performed by the PHARMACIST

Reconsiliation

X-drug drug interactions

Coordination & communication of Care

Access & Adherence

Risk reduction

Evidence based review / Elimination of meds

Savings

Question 33

Medication Reconciliation Definition

Answer 33

The process of
comparing the medications a patient is taking (and should be taking) to the
new medications that are ordered for the patient
and
resolving any discrepancies or potential problems