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Pharmacy Practice > Exam 1 Powerpoints > Flashcards

Exam 1 Powerpoints Flashcards

1
Q

OBRA 90

A

Law passed to ensure safe medication use for Medicaid patients

Requires pharmacist to offer counseling

Provided in one-way, provider-centered manner

Time-consuming process

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2
Q

New Script Prime questions

A

What did provider tell you this medication is for?

How did provider tell you to take this medication?

What did provider tell you to expect?

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3
Q

Refill Prime questions

A

What are you taking med for?

How are you taking it?

What kind of side effects are you having?

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4
Q

Questions to avoid

A

Leading and Double-barreled

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5
Q

Benefit of Open-ended questions

A

Encourages more insightful response

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6
Q

Leading question

A

Question suggests the preferred response…

ex. You don’t miss any doses of your meds do you?

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7
Q

Double-barreled question

A

Compound question….

Ex. Do you take herbal products AND supplements?

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8
Q

Patient counsel

Intro

A

Introduce self
Ask who med for
Purpose and length of counsel
Get patient consent

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9
Q

Patient counsel

Verify info

A

Name, Address, D.O.B, Med allergies, current med diagnosis, other prescription meds, OTC/herbal/vitamin,/supplements?

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10
Q

Patient counsel

Final Verification

A

Teach-back method

Confirms or disconfirms patient knowledge

summarize key points

Ask for additional questions and encourage follow up.

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11
Q

Co-Op vs APPE

A

Co-Op:
Employee, Provider, Get paid, Evaluation

APPE:
Student, Consumer, Paying Tuition, Grade

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12
Q

Goal setting

A

Usually done around 2nd month, after familiar with job and opportunities

Develop 4 to 5 goals with supervisor or preceptor

Create S.M.A.R.T goals, Specific, Measurable, Attainable, Realistic, Timely

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13
Q

Goals of Co-Op

A

Links study to work, then work to study

Should provide learning opportunities, within one’s field of study and opportunities to reflect

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14
Q

Components of Co-Op learning model

A

Preparation:
Pretty much learn about Co-Op in PHMD 1201, go over everything you need to know

Activity:
Work in a Pharmacy “Practice” setting, complete Co-Op/IPPE competencies that meet accreditation req, Utilize Co-Op reflection and assessment platform

Reflection:

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15
Q

Co-Op golden rule

A

Cant take more than 1 job

If you take 1 job, cant go back and change position because of a better job.

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16
Q

Components of Co-Op learning model

A

Preparation:
Pretty much learn about Co-Op in PHMD 1201, go over everything you need to know

Activity:
Work in a Pharmacy “Practice” setting, complete Co-Op/IPPE competencies that meet accreditation req, Utilize Co-Op reflection and assessment platform

Reflection:

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17
Q

Types of Sources

A

Primary (Research)
Secondary
Tertiary (Farthest from Research)

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18
Q

Tertiary Literature

Pro vs Con

A

Advantages:
Convenient, easy to use, info reflects widely accepted practices, often referenced.

Disadvantages:
Lag time (less current), Incomplete/errors/bias, Lack of expertise by authors and editors, incorrect interpretation
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19
Q

Tertiary Examples

A

Textbooks, Compendia, Review Articles, Clinical Practice Guidelines

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20
Q

Secondary Literature

A

Tools or systems that direct user to relevant literature

Secondary sources index the primary and some tertiary literature

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21
Q

Secondary Examples

A

Medline, Embase, Cochrane Library, Google Scholar

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22
Q

Primary Literature

A

Published and unpublished original research studies and reports

Intro new knowledge or enhances existing knowledge

Articles from refereed or peer-reviewed journals are preferred

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23
Q

Primary Literature

Pro vs Con

A

Advantages:
Most current source of info, foundation for 2nd and 3rd sources, sets standard of med care

Disadvantages:
Difficult to search, many journals available but not all east to access, requires critical eval and possibility of flaws in methodology or statistical analysis, not always practical or efficient

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24
Q

Primary Examples

A

Randomized controlled trials, Cohort Studies, Case Reports, Journals, Survey Research

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25
Q

Appropriate Websites for Info

A

Common sense

Wikipedia, google, SDN, Buzzfeed etc aren’t credible

Health on the net Foundation (www.hon.ch) does all the work for you and sites get reviewed

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26
Q

Appropriate Websites for Info

A

Common sense

Wikipedia, google, SDN, Buzzfeed etc aren’t credible

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27
Q

Resources for general product info

A

Package insert, Lexicomp, Microdex, AHFS Drug info

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28
Q

Resource:

Compatibility/Stability

A

Trissel’s or King Guide

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29
Q

Resource:

Natural Products

A

Natural medicine

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30
Q

Resource:

Pregnancy

A

Briggs

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31
Q

Resource:

Pregnancy

A

Briggs

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32
Q

Drug Info request:

Physician calls, asks dosing for augmentin 5 yr old boy dog bite

A

Ask:

Weight, How bad is bite, any allergies, any other medical conditions or meds, can they swallow pills.

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33
Q

Systemic Approach to answer question

A

Receive, Research, Respond, Record

34
Q

Manufacturing

A

prep, packaging, and labeling of meds in large quantities that are not intended for a specific patient

35
Q

Compounding

A

prepping a med that is not commercially available in strength, conc, or form needed for specific patient

36
Q

History Sterile Compounding Guidelines

A

1993 - Technical Assistance Bulletin on Quality Assurance for Pharmacy-Prepared Sterile Products

2000 - Updated and published as ASHP Guidelines on Quality Assurance for Pharmacy- Prepared Sterile

2014 - ASHP guidelines on compounding sterile preparations replaced guidelines

37
Q

Timeline of Sterile Compounding Regulations

A 
1995 - USP 1206
2004 - USP 797
2008 - 1st revision USP 797
2016 - USP 800
2019 - 2nd revision USP 797 and enforcement of USP 800
38
Q

Ante room

A

ISO Class 8 or cleaner room.

Transition room from unclassified area to buffer room. garbing, hand hygiene, etc can be performed here

39
Q

Buffer room

A

ISO Class 7 or cleaner

Can only be accessed through ante room

40
Q

Primary Engineering Control (PEC)

A

provides an ISO Class 5 environment for sterile compounding

41
Q

Horizontal (Laminar Airflow Workbench)

A

HEPA filter back wall, air moves from back wall to front…towards you

42
Q

Vertical (Laminar Airflow Workbench)

A

HEPA filter located top of area, air gets blow down and flows out

43
Q

Object placement Horizontal Laminar flow

A

Side by side, 6 in from edge. Not directly in front of each other

Don’t want to block airflow, even with hands when doing things over tops of vials or syringe

44
Q

Cleaning inside PEC

A

Clean and disinfect daily

Sporicidal monthly

45
Q

Cleaning outside PEC

A

Clean, disinfect and apply sporicial monthly

46
Q

Hood Cleaning

A

Want to clean closest to farthest from HEPA filter

Clean from back to front (Horizontal)

Top to bottom but also back to front (Vertical)

47
Q

Critical Point Syringe

A

Plunger, Needle Hub and Needle

48
Q

Garbing

A

Bouffant Cap, Face Mask, Beard Cover, Shoe Covers

49
Q

Hand Hygiene

A

Clean nails, wash up to elbows 30 sec, use lint free towel to dry

50
Q

Gowning Process

A

Put on gown, hand sanitize and put on gloves

51
Q

Aseptic Process

A

Set up: gather materials needed to make compound, perform all calculations before entering clean room

Compounding: Process of actually manipulating the med

Final Check (Done by pharmacist):
Visually inspect for particulate matter
Confirm accuracy of ingredients
Check label, lot, expiration dates
Document it all
52
Q

Compound Sterile Product Labeling

A 
Assigned Internal ID number
Active ingredients, amounts and concentrations
Route of Admin
Storage conditions
BUD
53
Q

Medication Adherence

A

The degree to which the person’s behavior (including med taking) corresponds with the agreed recommendations from a healthcare provider

54
Q

Compliance

A

Passively complying with medication regimen

55
Q

Adherence

A

Active, voluntary choice of patient

56
Q

Persistence

A

Measure of the duration of time from initiation to gaps in treatment

57
Q

Consistency

A

How regular a patient takes their medication

58
Q

Skipped dose:

A

consciously not taking dose

59
Q

Dose self-adjustment

A

altering regimen without consulting prescriber

60
Q

Discontinuation

A

self-stopping medication altogether

61
Q

Discontinuation

A

self-stopping medication altogether

62
Q

Medication Adherence means taking med….

A

In right amount, at right time, in the right way and for the right duration

63
Q

Consequences of Medication Non-adherence

A

unable to accurately asses efficacy of the med

Loss of confidence by the patient in the efficacy of mediations and expertise of care team

Poor clinical outcomes including decrease quality of life and increase morbidity and mortality

Economic loss due to decreased productivity, hospitalization, provider visits

64
Q

Assessing adherence

A 
Pill counts
Prescription refill history
Patient Self-report
Direct observation therapy
Blood level
Urine Sample
Clinical response
65
Q

5 Dimensions of adherence

A 
Health system/ HCT-factors
Social/economic factors
Therapy-related factors
Patient-related factors
Condition-related factors
66
Q

Risk factors for non-adherence

A

Complex drug regimen, difficult admin route, side effects, chronic conditions, dissatisfaction with care, financial status, fear of addiction, etc

67
Q

Suspect med adherence issue when

A

New med same disease

Increase dose of existing chronic med

New med used to treat complication of chronic disease

New med used to treat potential adverse effect from current chronic med

68
Q

How to ask adherence questions

A

Probing - ask in a way that elicits the most info from them

Open-ended

Be an active listener and give adequate time for them to response, nonjudgemental approach, acknowledge issues they face and try to focus on why med is important

69
Q

Strategies to improve med adherence

A

1 combination drug (if available)

patient reminder tools such as pill boxes, blister packs, automatic dispenser, etc

Make taking med a habit, attach to an existing habit such as brushing teeth or eating breakfast

70
Q

Med error

A

Any preventable event that may cause or lead to inappropriate med use or patient harm while the med is in control of the health care professional, patient or consumer

can occur at any step in the process, include miss counting, etc. doesn’t have to reach the patient

71
Q

Ways to prevent error community setting

A

Avoid multitasking

find a counting system

Double check work

Keep notebook to write down info

ask for help if needed

72
Q

Ways to prevent error institutional setting

A

Keep area clean all times

Create a system or method for yourself

Avoid distractions

Ask for help if unsure

73
Q

Ways to prevent med error IV room

A

keep area clean

How to do thing in Horizontal vs vertical hoods

Take time, don’t rush

stay on side of caution, double wipe if doubt

check calculations

Ask for help if needed

74
Q

Systems approach to med error

A

Root cause:
Retrospective…collect data, reconstruct error, analyze sequence of events….Goal = Identift How and Why occurred

Tracking system:
Prospective….. Identify error prone situations and failure mode….Goal = prevent errors from occurring.

75
Q

Just culture

A

Promotes a learning org

Focus on sequence of events that led to error

Encourages transparency

Recognizes individuals should not be help accountable for fail systems out of their control

Zero tolerance for reckless or negligent behaviors

76
Q

Strategies to reduce med error

A

computerized provider order entry system

automated drug distribution systems

Bar-code scanning

Smart IV infusion pumps

77
Q

Aids to help reduce errors

A

ISMP
Confused drug names
Do Not Crush List
High Alert meds

Joint commission
Error-prone abbreviations
Tall man letters

Forbidden abbreviations

78
Q

Medication Reconciliation

A

formal process for identifying and correcting unintentional medication discrepancies across transitions of care

goal is to prevent harm from meds, widely recommended patient safety strategy

79
Q

Transitions of care

A

The movement of a patient from 1 setting of care to another

80
Q

Process of Medication reconciliation

A

Collect: a complete and accurate list of the home meds

Compare: the home med list with an new orders at all transition points

Correct: any discrepancies

Communicate: the updated list to the next provider(s) of care

81
Q

Source of obtaining info

A

Patient, family/caregiver, patients med bottles, community pharmacy, etc

82
Q

Goals of reconciliation process

A

ensure med changes are intentional

Unintended discrepancies should be discussed with provider

Patient should be educated on any changes to ensure understanding

Pharmacy Practice (13 decks)

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