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 ## Footnote **Non-Time-Critical**

Question 28

**ADE**

Answer 28

**Adverse Drug Event** i**njury, harm, or undesirable health outcome due to drug therapy​**

Question 29

**MIDIS**

Answer 29

**Transitions of Care: Check _EACH MEDICATION_**for**MIDIS** ## Footnote **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**