Hospital Pharmacy

Question 1

Closed Loop Medication Management
- Errors

Answer 1

• Clinician ordering
• Transcription/Verification
• Dispensing
• Administration

Mistakes most common at Clinician Ordering and Administration

Question 2

Non-Sterile Compounding

Answer 2

Creams and Ointments

Question 3

5 Distinct Journeys

Answer 3

1. Warstock
2. Patient Specific Dispensing
3. Narcotic and Control Drugs
4. Sterile Compounding
5. Non-sterile Compounding

Question 4

Parts of a Barcode

Answer 4

1. Quiet Zone
2. Start Character
3. Data
4. Stop Character
5. Quiet Zone

Question 5

Sterile Compounding

Answer 5

IV and Injectables
- Patient specific

Cytotoxics, Gene Therapy, Parenteral Nutrition

Question 6

Administration
- Reducing Errors

Answer 6

• Barcode Patient Information
• Electronic Medication Administration Record
• Barcode Medication Administration

Question 7

Ideal State of Bardcoding

Answer 7

Every product has a
- GTIN + Expiry Date + Lot Number

Question 8

Dispensing
- Reduce Errors

Answer 8

• Automated Dispensing System (ADS)
• Dispense Queue
• Dispense Preparation
• Dispense Checking
• Unit Dose Packaging

Question 9

ADC

Answer 9

Automatic Dispensing Cabinet
- Profiled, can only take out medications that have been verified by pharmacy
- Non-Profiled, less checks

Question 10

Current State of Medication Barcoding

Answer 10

No consistiency
No standards set by Health Canada
- Only the Barcode Standard for Vaccine Products in Canada, which isnt that good

Question 11

Patient Specific Dispensing

Answer 11

Medications not found in ward stock
- Packaged, Checked, Distributed to patient

Oral medications are individually packaged per tablet

Question 12

Clinician Ordering
- Reduce Errors

Answer 12

• Computerized Provider Order Entry
  –> Ordering stuff within a computer
• Clinical Decision Support
  –> Allergy and Drug Interaction Alters
• Medication Reconciliation
  –> Done at Admin, Transfer, Discharge

Question 13

Wardstock

Answer 13

Medications available in the patient care unit

Question 14

Centralized Model

Answer 14

Pharmacist stays in dispensary unit

Question 15

Critical Care vs Ambulatory Care

Answer 15

Critical Care have large wardstock Ambulatory Care have limited warstock

Question 16

Barcode Standard for Vaccine Products in Canada

Answer 16

GTIN should be on primary vaccine
- However, barcodes can differ in each stage of shipment

Pallet –> Case/Shipper –> Secondary –> Primary

Question 17

Two Dimensional Barcodes

Answer 17

QR Code, Aztec, Datamatrix

Question 18

Closed Loop Management

Answer 18

1. Electronic Order Entry
2. Review and Verify Order
3. Dispense Barcoded Medication
4. Store Medication Securely
5. Assess Patient
6. Scan Patient and Barcoded Medication
7. Administer Medication
8. Document Appropriate findings
9. Care Decision

Question 19

Narcotic and Control Drugs

Answer 19

Specialized Wardstock
- Stored separately in a locked pharmacy/patient care area

Governed by federal legislation

Count is done at end of shift

Question 20

Decentralized Model

Answer 20

Pharmacist provides direct patient care
- Divides their shifts between distribution and clinical activities

Hospital also has automatic drug dispensary units

Question 21

Transcription and Verification
- Reduce Errors

Answer 21

• Fully Integrated Electronic Order System
• Pharmacist Verification Queue
• Standardized Medication Catalog

Question 22

One Dimensional Barcodes

Answer 22

UPC, ISBN, Code 128, GS1 Databar