413 - IPPE Hospital Final Flashcards
# Define the term: Medical Record
aka “Patient Chart”
Documentation of one’s
Medical History / Diagnosis / Care Received
Systemic format followed in
SOAP - Documentation
Purpose of:
Medical Record
To provide:
Complete, Accurate, Concise
Documentation
Allows for:
Organized SHARING of info
between healthcare professionals
Basic Components of
Medical Record
Notes
Lab Values** + **Test Results
Orders
Meds / MAR / Diet
Allergies
Vitals
BP / HR / TEMP
Demographics
Height / Weight / BMI
Advantages of an
EMR = Electronic Medical Record
2015 - 84% of hospitals have EMR
ACCESS
LEGIBILITY
STORAGE
Steps to Work-Up a Patient
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
MAR
Definition / What’s in it
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
Importance of Medical Record for PHARMACIST
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
List all of the places medications are dispensed from in a hospital
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
Determine how medications are packaged for inpatient use and compare and contrast the differences in medication packaging between inpatient and outpatient settings.
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
Define inpatient medication orders and
review terminology necessary
for understanding the
order review and verification process
- *Inpatient = ORDERS**
- *means by which a prescriber communicates the desired treatment regimen for a patient**
CPOE
Standard Order Sets
Automated Medication Dispensing Device
Describe usual inpatient pharmacy workflows
Cart Fill
Describe usual inpatient pharmacy workflows
Cart fill:
the dispensing and delivery of a pre-specified time period’s worth of scheduled medication
Dispensing STAT Orders and First Doses
Describe usual inpatient pharmacy workflows
Process for dispensing miscellaneous orders that are needed before cart fill and are not available in an AMDD
Medication Order Verification
pharmacist Duties
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
What is considered a TRUE ALLERGY?
- GI UPSET - HEADACHE - DROWSINESS*
- *ARE SIDE EFFECTS, NOT allergies**
True Allergy:
- *Uticaria/Hives**
- *Pruritus / Agioedema / Bronchospasm / Hypotension**
Dextrose for TPN
50-70%
Final concentration
25% for CENTRAL
10-12.5% for Peripheral
Protein for TPN
8.5% 10% or 15%
Max 2.5% for Peripheral in PEDS
Advantages for 2-in-1 Formulations
- less risk of*
- *Drug Incompatability**
Increase Ca-Phos Solubility
can add more
Adv/Disadv
for 3-in-1 formulations
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
PPN Concerns
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
What is the most accurate method of IV drug delivery
in NEONATES + CHILDREN
INTRAVENOUS SYRINGE PUMP
does NOT use extention tubing
requires flushing / low volume tubing
IM Injection
Recommended Site & Max Volume
MAX 2 mL
per dose for older children
Preferred:
THIGH = Vastus Lateralus
for all children <3 y/o
Vit K / Vaccine / Penicillin
USP 797 BUD
Medium Risk Level CSP
More Manipulations than low
- *30 Hours Room Temp**
- *9 Days Fridge**
- 45 Days Frozen*
USP 797 BUD
LOW Risk Level CSP
- *Made in Hood**
- *sterile components**
<3 packages
<2 entries into sterile container
- *48 Hours Room Temp**
- *14 Days Fridge**
- 45 Days Frozen*
USP 797 BUD
HIGH Risk Level CSP
Non-sterile ingredients
Exposed to Iso Class <5 for >1 hour
- *24 Hours Room Temp**
- *3 Days Fridge**
- 45 Days Frozen*
BCMA
Barcode Medication Administration
decreases medication admin errors
- *5 RIGHTS:**
- *Drug / Dose / TIME / Route / Patient**
Standard Admin Times
BID / TID / Q4h / Q6H
SCHEDULED
Admin within
1 HOUR
b4 or after the scheduled time
Non-Time-Critical
ADE
Adverse Drug Event
injury, harm, or undesirable health outcome
due to drug therapy
MIDIS
Transitions of Care:
Check EACH MEDICATIONforMIDIS
MoA
Indications
Dose
Interactions
Side Effects
Steps for Transitions of Care
ADMISSION
- *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
Steps for Transition of Care
DISCHARGE
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
RXCARES
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
Medication Reconciliation Definition
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
