Institutional pharmacy practice

Question 1

What are the three practice models in hospital pharmacy?

Answer 1

• the drug distribution-centered model
• clinical pharmacist-centered model
• patient-centered integrated model

Question 2

Describe the drug-distribution centered model

Answer 2

this is the model where pharmacists less commonly initiate changes in drug therapy for a patient and primarily process new med orders, distribute medications, and assess MD orders as they are written. They are less involved in the med use process.

Question 3

what is primary care?

Answer 3

this is care that is provided in a doctor’s office or outpatient clinic that a patient goes to regularly

Question 4

what is secondary care?

Answer 4

this is a specialist doctor, emergency treatment, and even hospitalization

Question 5

what is tertiary care?

Answer 5

this is care that requires specialized equipment and expertise

Question 6

describe the clinical-pharmacist-centered model

Answer 6

in this model the pharmacist can either be distributive or clinical. The Distributive Pharmacist reviews and verifies the medication orders, checks the meds made by the technicians, and takes the responsibility for the dispensing. The Clinical Pharmacist participates with the other members of the medical team and spends most of their time in the patient care areas. They focus mainly on MTM services and has little or no responsibility for medication dispensing. The pharmacist can only be one type or the other!

Question 7

What is a Distributive Pharmacist? What model is this in?

Answer 7

The Distributive Pharmacist reviews and verifies the medication orders, checks the meds made by the technicians, and takes the responsibility for the dispensing. This is in the distribution model and the clinical pharmacist model as well.

Question 8

What is the clinical pharmacist ? What model is this in?

Answer 8

The Clinical Pharmacist participates with the other members of the medical team and spends most of their time in the patient care areas. They focus mainly on MTM services and has LITTLE OR NO RESPONSIBILITY FOR MED DISPENSING. This is only in the clinical pharmacy model.

Question 9

What is the Patient-Centered Integrated Model?

Answer 9

This is the model where the pharmacist takes on both possible roles, but for one specific patient. They are their pharmacist just as the doctor is the patient’s doctor.

Question 10

What is a centralized pharmacy and what are the pharmacist’s roles here? (5)

Answer 10

This is where the pharmacists and the technicians all work in one centralized location in the hospital (usually the basement). Here the pharmacist is responsible for coordinating the dispensing activities, supervising the technicians, doing sterile and non-sterile compounding, handling controlled substances, and maintaining the automated dispensing cabinets.

Question 11

What is a decentralized pharmacy?

Answer 11

This is a pharmacy (usually smaller than central) that is located in specific units of the hospital.

Question 12

What is the pharmacist’s role in a decentralized pharmacy?

Answer 12

This pharmacist provides clinical services and education and participates as a member of the medical team. This pharmacist can form treatment plans and contact physicians for medication recommendation if necessary. They do med-rec and drug therapy monitoring. They even participate in codes, transitional care, and patient/staff education.

Question 13

what are advantages and disadvantages of centralized pharmacies?

Answer 13

Advantages: fewer staff members are required which decreases cost of employment
Disadvantages: no face to face interactions and it takes a long time to transport medications to patients all over the hospital

Question 14

what are advantages and disadvantages of decentralized pharmacies?

Answer 14

Advantages: face to face interactions and the pharmacist can do rounds with the medical team to make drug suggestions
Disadvantages: this requires more pharmacists and technicians and will increase the cost of employment/drug inventory

Question 15

What is antimicrobial stewardship? Which pharmacist is in charge of this?

Answer 15

This is a role of the decentralized pharmacist to make sure that antibiotics are not being over used because of the hug battle we have with bacteria and infectious diseases right now.

Question 16

Which pharmacist is responsible for discharge medications?

Answer 16

the decentralized pharmacist

Question 17

How are laws and regulations in regards institutional pharmacy practice?

Answer 17

usually laws are more general and regulations add specificity to the laws

Question 18

who presents regulations?

Answer 18

regulatory agencies

Question 19

What is a regulatory agency?

Answer 19

regulatory agencies are law enforcement bodies that protect the public, impose fines, and take legal action for the patients

Question 20

What are the 5 federal regulatory agencies?

Answer 20

• FDA (food and drug administration)
• DEA (drug enforcement agency)
• CMS (centers for medicare and medicaid services)
• CDC (centers for disease control and prevention)
• OSHA (Occupational safety and health administration)

Question 21

What are the 2 state regulatory agencies?

Answer 21

State Board of Pharmacy and the Department of Public Health

Question 22

What is the United States Pharmacopeia?

Answer 22

This is a NONgovernmental standards setting organization that set forth <795> for non-sterile compounding, <797> for sterile compounding, and <800> for hazardous drugs

Question 23

What is accreditation?

Answer 23

This is the VOLUNTARY process a hospital goes through in which an outside agency assesses the quality of care provided by a hospital.

Question 24

Can accreditation facilities fine hospitals or impose legal action against them in any way?

Answer 24

no

Question 25

What is an example of an accrediting organization?

Answer 25

The Joint Commission (its the oldest and the largest)

Question 26

What are practice guidelines?

Answer 26

These are VOLUNTARY guidelines that a profession develops themselves and imposes on themselves. They should exceed the minimum requirements of law.

Question 27

Who has the ultimate responsibility for the medication use/management process in the hospital?

Answer 27

The Pharmacy and Therapeutics Committee

Question 28

Who makes up the Pharmacy and Therapeutics Committee?

Answer 28

All individuals involved in the medication use process: medical staff, pharmacists, nursing representative, and hospital administration.

Question 29

What does the therapeutic committee do?

Answer 29

The following:

• establish and maintain the drug formulary
• develop policies and procedures
• Evaluate and promote use of drug therapy guidelines
• perform medication use evaluations
• review medication error reports
• review adverse drug reaction reports

Question 30

What is tertiary care?

Answer 30

this is healthcare the requires highly specialized equipment and expertise such as transplant surgery, neurosurgery, etc.

Question 31

What is the hospital formulary?

Answer 31

a continually updates list of medications and related information, representing the clinical judgement of pharmacists, physicians, and other experts in the diagnosis and treatment of disease and promotion of health that includes but is not limited to: a list of improved medications, medication policies and guidelines, drug information, medication safety information, decision support tools

Question 32

what are therapeutic equivalents/alterniatives?

Answer 32

these are drug products that have different chemical structures but the same pharmacological effect and is expected to have the same adverse effects as well

Question 33

what is therapeutic interchange/substitution?

Answer 33

this is the authorized exchange or substitution of a therapeutic alternative with approved written guideline with the P&T committee

Question 34

what is accreditation?

Answer 34

this is the voluntary process that a hospital chooses to go through where an outside accrediting service comes and assesses the quality of care provided by the hospital or healthcare facility

Question 35

What is The Joint Commission?

Answer 35

This is the oldest and largest accrediting service

Question 36

What is a Medication Use Evaluation (MUE)?

Answer 36

This is a performance-use evaluation that focuses on evaluating and improving medication-use processes with the goal of optimal patient outcomes

Question 37

What is an adverse drug reaction (ADR)?

Answer 37

an injury caused by taking a medication

Question 38

what is antimicrobial stewardship?

Answer 38

this is a coordinated program that promotes the appropriate use of antimicrobials with the goals of optimizing patient outcomes and minimizing the unintended consequences of overusing antimicrobials like resistance. They overall act to reduce health care costs.

Question 39

what is cost avoidance?

Answer 39

an intervention that reduces or eliminates additional expenditure that may have been caused

Question 40

What is the NPSG and what is their goal?

Answer 40

This is the National Patient Safety Goals where the job is to look at all of the old prescriptions, look at al of the new prescriptions, and resolve any discrepancies between them.

Question 41

What are practice guidelines?

Answer 41

These are voluntary guidelines that the hospital sets for themselves that directs their work efforts and fulfill the minimum requirements of law.

Question 42

What is the Medication Use Process?

Answer 42

a multidisciplinary approach where members of the interprofessional team monitor the effects of medications on the patient

Question 43

What three qualities must a drug have to be included in the formulary?

Answer 43

• appropriate drug therapy
• patient safety
• cost effective