Exam 2 Powerpoints Flashcards
Importance of communication
ineffective communication ID as root cause for nearly 66% of all reported sentinel events
2010-2013: communication among top 3 root causes of sentinel events reported
Data from Join commission continue to show importance of communication in patient safety
Communication considerations
Audience
Mode of communication
Standards associated with specific mode of communication
Power of nonverbal communication
Characteristics of Effective communication
Complete
Clear
Brief
Timely
SBAR
Framework for team members to effectively communicate info to one another
Situation - what is going on w/ patient
Background - What is clinical background or context
Assessment - what do you think problem is
Recommendation/request - What would I recommend? what do I need from you?
handoff
Transfer of info during transitions in patient care
include an opportunity to ask questions, clarify and confirm
Both authority and responsibility are transferred
Components of handoff
Responsibility: person aware of assuming responsibility
Accountability: you are accountable until both partiers aware of transfer
uncertainty: clear up all ambiguity before transfer complete
Communicate verbally
Acknowledged: ensure handoff is understood and accepted
Opportunity: evaluate the situation for both safety and quality
Check - Back
Closed-loop communication strategy used to verify and validate info exchanged
asked: “Administer the influenza vaccine to Mrs.Green who is in Room 6.”
respond “ So you want me to give Mrs.Green, who is in room 6, an influenza vaccine?”
consequences of conflit
2008, employees spent 2.8 hrs per week dealing with conflict
equal ro ~ $359 bil in paid hrs, or 385 mil working days
Sources of conflict
Personal differences
Informational Deficiencies
Role Ambiguity or Incompatibility
Environmental Stressors
Disagreement over methods rather than outcomes
Steps for Conflict Resolution
ID source of conflict
Look beyond the incident
Request solutions
ID solutions everyone can support
Find agreement
Ineffective approaches to conflict resolution
Compromise
Avoidance
Accommodation
Dominance
Change from brand to generic
Interchange is mandated unless the practitioner indicates “ no substitution” in accordance with the law.
Flow of prescription
Drop off - receive prescription Prescription entry - enter into computer Scan Rx File Hard copy Execute Rx production Preform pre-quality check Prepare for RPh final check Put away stock bottles Pick up Offer patient counseling Register transaction Patient counseling
OU
Both eyes
OD
right eye
OS
left eye
AU
Both ears
AD
Right ear
AS
Left ear
aa
of each
HA
Headache
WA
While awake
HS
at bedtime
AC
Before meals
PC
after meals
1 KG
2.2 lbs
1 Fluid oz
30 ml
1 lb
454 gram
1 ounce
28.35 (use 30 gram)
1 ml
20 drops
1 tsp
5 ml
1 tbsp
15 ml
1 liquid ounce
30 ml
1 pint
480 ml
1 gallon
128 oz
Mass Board of Pharmacy
Responsible for….
public safety in the drug procurement and dispensing process
Licensing pharmacists, interns, techs and tech trainee
licensing community, long-term-care, home infusion, nuclear and compounding pharmacy. Hospital pharmacies will be added to BOP
licensing drug distributors/wholesalers
PSUD
Pharmacy intern law
complete 2 years of academic curriculum or standing beyond 2nd year
registered by the board
under direction of a preceptor
practical experience prerequisite for pharmacist licensure exam
can engage in full range of activities conducted by pharmacist provided that they are under direct supervision by preceptor, name tag has to say intern
Pharm tech law
have name tag that says name and pharm tech
can really the pharmacists “offer to counsel”
request and accept refill auth as long as no changes
cannot perform DUR, provide clinical conflict resolution, contact prescribers to clarify an order or modify therapy, provide patient counseling, validate dispensing, receive new drug orders or transfer prescription
Pharmacist to support staff rations
1:4 - pharmacist to support
1 of 4 is certified pharm tech, 1 is intern, or 2 certified tech
1:3 ratio - 1 of three is intern or certified tech
clerks, secretaries, messengers and other non pharmacy personal don’t count
Pharm tech trainee
at least 16 yr old
in HS or equivalent
no prior convictions
have name tag as trainee
work up to 1000 hrs if 18 or older before tech registration is required
tech check regulation
CPhT can verify inventory management functions using non-patient specific C-6 meds from pharmacy to patient care without verification of pharmacist
ex. transferring med from carousel or tallest to Pyxis or omnicell automated dispensing device
license healthcare professional must use an electronic device with bar code scanning or other validation at time of admin
Preceptors and APPE students
up to 4 interns as long as they aren’t processing, verifying or dispensing medications
if APPE students are split between multiple medical teams, there needs to be a license pharmacist directly supervising the student on each team
Pharmacy manager of record
Make sure pharmacy preceptor are adherent to all ratios
ensure all students licensed as interns prior to start of internship
ensure interns under direct supervision at all times
in event of sick calls or absences, staff schedules must be adjusted accordingly
CI
Illegal drugs
CII
highly addictive, including narcotics and stimulants
no refills, expire 30 day after written
In MA, only up to 7 day supply can be dispensed for short term treatment, exceptions for cancer or other long term needs must be documented
partial filing of CIIs is allowed, but balance is not allowed to be filled and MD must be notified
Handling CII
accountability and security direct responsibility of the pharmacist
pharm tech and intern can assist in transporting CII
CII inventory requirements
keep perpetual inventory of each controlled substance in schedule II which has been received, dispensed or disposed
inventory must be reconciled at least once every 10 days
inventory is a written record of the amount of all schedule II which are physically present
Expired CIIs
must be inventoried and be separate from in date stock but kept in secure location
Filing of prescriptions
CIIs in 1 file
CIII-CV in second file
Syringed no prescription needed but if one provided, filed separately
CVI in third file
sale of hypodermic syringes and needle
no limit on number and type of requested syringes and needles
no record keeping requirements or limitations
pharmacies strongly recommended to stock single unit-of-use syringes for individual sale
Collaborative Drug Therapy Management
CDTM
passed 2009
agreement between pharmacist and supervising physician
allows for extension of current therapy up to 30 days
modify drug therapy for certain indications
cant diagnose, or prescribe II-V
Pharmacist CE requirements
20 hours every year
5 contact hours in sterile compounding
3 hours in complex non-sterile compounding
IF pharmacist oversees, prepares products or verify orders that require sterile compounding then….
5 law hours, 15 hours CE which can include sterile/non-sterile compounding
Vaccinators - 5 hours every 2 years
Graduate pharmacists
year they graduate, don’t have to get CE credit
year after, its required
graduate from other state must be registered as an intern in MA until they take the MA license exam
Naloxone-Opioid OD treatment
All retail pharmacies required to have standing order for naloxone dispensing
pharmacies must stock product
pharmacist can dispense either based on a prescription or standing order
Immunizations
persons 3 years of age or older can get if doctor order and take the training course
Pharmacist admin of medications for mental illness or substance abuse disorder
pharmacist or intern can admin to people over 18
need a valid prescription
first dose should be admin by or under physicians supervision
Drug loss
must be reported to DEA within 1 business day
Copy of DEA form 106 must be submitted to BOP
MA board report within 7 days
Within 30 days, report with investigation results, police reports and other related documentation
Drug loss causes
Employee pilferage/diversion
break-in
lost in transit
customer theft
Armed robbery
Other known or unknown loss
MA prescription awareness Tool
prescribers and pharmacists must log into stewed database to determine if patient is filling multiple prescriptions from multiple providers at multiple pharmacies
for all C-II,III and benzo
Substance Use disorder
pharmacists and other health professionals can be up to 25% rate, general public is 10%
MA pharmacy SUD program
For Pharmacists, interns, techs
voluntary, confidential
5 year program
E prescribing
allowed for CII-CVI
sent electronically by physician to a pharmacy selected by the patient
Telepharmacy
pharmacy done remote
central fill pharmacies
fill for one or more other pharmacies
CII-CV delivered to pharmacy where prescription originated for final dispensing
CVI can be shipped to patient
