Hospital Pharmacy Lecture 2 powerpoint Flashcards
Orders
Not only used for Medications
Also used to order:
Labs
Diet
____________
Dressing ________
Etc
Imaging
Dressing changes
How are orders placed?
Computerized Physician Order Entry (CPOE)
Verbal & ____________ Orders
Paper/_______________ orders
Telephone orders
handwritten orders
Order
Inpatient
Requirements:
Drug
Dose
Route
_______ Form
Frequency
_________-start and stop times
Ordering Provider
Dosage Form
Duration
Order is what is used inpatient setting aka hospital
Prescription which is used outpatient setting so in the community pharmacy
Abbreviations to use that are correct
mcg, right,left ear,each ear, right eye, left eye, each eye, bedtime, mL, discharge, discontinue,injection,intranasal, NAS, half-strength, bedtime,units,daily, do not use trailing zeros for doses in whole numbers instead use 1mg, use zero before a decimal point (ex: 0.5mg), use mg,ml without a terminal period
__________ Medication Orders
Require specific indications for administration
Should not overlap with another PRN medication with the same indication
PRN medication orders
PRN Medication Orders
May be order together:
Tylenol 500 mg Q8H PRN mild pain
Ibuprofen 600 mg Q6H PRN moderate & severe pain
Docusate PRN constipation, no BM > 24H, 1st line
Miralax PRN constipation, no BM > 24H, 2nd line
Should NOT be ordered together:
Tylenol 500 mg Q8H PRN pain
Ibuprofen 600 mg Q6H PRN pain
Docusate PRN constipation
Miralax PRN constipation
Hospital Formulary
Dictates what medications a hospital has on hand & what medications providers within the organization may order for _________ use
inpatient
Hospital Formulary
Dictates what medications a hospital has on hand & what medications providers within the organization may order for inpatient use
Only applies to inpatient medications
Or clinics with hospital supplied medications
P&T Committee oversees hospital formulary
Factors that are considered for hospital formulary
______, Pt __________, Hospital Location/Size/Services offered, Drug availability/shortages
Cost
Demographics
What happens if a medication is not on formulary?
________________
List of P&T approved substitutions
Allows pharmacists to interchange the medication without contacting the provider
What types of medications does this commonly occur with?
__________, ______, OTC allergy medications
Therapeutic Interchange
Inhalers
PPIs
Hospital Formulary
RESTRICTED MEDICATIONS
Restricted to certain patient populations
Ex: Meropenem (IV antibiotic)
Requires __________ to be used inpatient
ID approval
Non-Formulary medications
If the medication is not on
formulary, there is no formulary
alternative, & the patient needs to
continue this medication while in
the hospital
Requires approval by ________
pharmacy management
Medication Reconciliation
The PROCESS of creating the most
accurate list possible of ________
medications the patient is __________ taking
& prescribed
How the patient _______their medications
Not just prescriptions, Not just pills →
Herbal/OTC, injections, patches, topicals, etc.
Open ended questions & patient friendly language are key!
ALL
Currently
takes their medications
When does or should a medication
reconciliation occur?
Prior to _______________
Prior to Discharge
Prior to Planned ________
Any transitions of care!
Admission
Planned Surgery
Transitions of Care
The movement of a patient from one setting or care to another
Settings of care examples
Hospital, ambulatory care clinics, ______ office, __________ facilities, _______care facilities, etc.
PCP office
rehabilitation facilities
long term care facilities
Transitions increase the risk of adverse events due to the potential for miscommunication as responsibility is given to new parties
____________: complex process with lots of “moving parts
Hospital Discharge
First things First
Verify patient information!
Name
________
_______
DOB
Address
Best possible medication history (BPMH)-
Step 1=
Step 2=
Step 1=Collect
Step 2= Confirm
What resources might be helpful?
Patient
What if the patient doesn’t manage their own medications?
____________ or Pharmacy Dispense History
_________Health Record/Patient chart
Medication List from _______ office
Pharmacy
Electronic Health Record
Medication list from PCP office
Information to Determine
Pharmacy
__________
Medications
Taking these medications?
Adherence
______________
Allergies
Last dose (in some settings)
Questions to Ask- Open-Ended
What pharmacy do you use? or where do you get medications from?
What allergies do you have? Reactions?
- What medications are you currently taking?
A. __________
B. Inhalation
C. __________ drops
D. OTC
E. Herbals - How do you take ____ medication?
- What _______ of day do you take your medications?
- How often do you _______ a medication?
- When was your last dose of ________? (as pertinent)
topicals
Eye drops
allergies
time
miss
