Long-Term Care Pharmacy Flashcards
Who can administer/dispense medications in a LTC setting?
Licensed physician or registered professional nurse or other personnel with applicable licensing requirements, patient, or patient’s caregiver
Institutional dispensers can dispense pursuant to what?
An Rx (duh)
Controls in an institutional setting require what?
A dispensing record as well as a administration record of the CS
Controlled substances can be administered from a sealed ER kit when?
Upon the order from the prescriber
If the order for a CS was a verbal, what does it also need?
Needs to be reduced to writing and countersigned by the prescriber in 72 hours
What does the LTC facility need to let the pharmacy know?
They have to let them know whenever they pull something from the ER box
Who can access meds in a LTC without pharmacy staff?
Bulk stocks of CS may be distributed within the institution to the wards/floor stocks/OR/ER and carried as substocks of the hospital
AKA: this wouldn’t require pharmacy to be present when they pull it
How long must labeling and recording requirements be kept?
5 years
CSs can’t be dispensed in what?
Customized patient med packages
Expiration date for drugs re-packaged in house
12 months or 50% of the time remaining to the manufacturer’s expiration date, whichever is less
Repackaged drugs can be returned for re-dispensing when?
Basically, when the drugs are intact and they didn’t use any doses from the blister packs and it’s returned within 90 days
The pharmacy has to reimburse the nursing home if that’s the case
Storage of CS in LTC
The facility has to have separately locked, permanently affixed compartments for storage except when the facility uses single unit package drug distribution systems
CS 1-2 storage in LTC: where should they be kept?
GSA class 5 rated steel cabinet or equivalent safe approved by the BNE
When does a safe have to be bolted to the floor?
If it weighs <750 pounds
Components of the CS cabinet (locks, doors, etc.)
The door of the cabinet must have a multiple position combination lock, a relocking device, and a steel plate at least 1/2-inch thick
Components of a CS vault
Multiple position combination lock, relocking device, ad 1/2-inch thick steel door
New construction of a CS cabinet
Floors, wall, and ceiling should be no less than 8 inches of reinforced concrete
Where should C3s-C5s be stored?
A securely locked cabinet
Where can CS be stored?
Dispersed throughout the stocks of non-controlled substances in a manner to obstruct theft or diversion provided the pharmacy is locked when not in operation
basically, you can mix it in with the rest of the non-controls
OR you can keep it in a stationary, securely locked cabinet
Rule on patient-specific controlled substances (in terms of the med cart and the other meds they have)
A 72-hour supply can be stored with the patient’s other meds in a locked cart or storage unit
What should a controlled substance administration sheet contain?
Type of CS
Doses and # of doses furnished to substock
Date and hour of administration
Patient’s name
Name of prescribing practitioner
Quantity administered
Balance on hand after each administration
signature of administering nurse
What constitutes as an “emergency” to pull from the ER box?
Administration of the drug is necessary for proper treatment
No alternate treatment is available
Not possible for the practitioner to write a written order before administering the drug
PRN orders for CS are not valid beyond what time frame?
72 hours
When can a standing order or specific CS order for individuals be extended for beyond 7 days, and for how long?
Stabilized patient with convulsive disorders, chronic spasticity, minimal brain dysfunction in an institutional setting, patients in LTC facilities, prisons that possess class III CS licenses can have CS orders for up to 30 days
Standing orders or specific controlled substances orders for individual patients to be administered at specified times shall not be valid after what?
7 days,
In a hospital setting, who can write CS orders?
A PA
In a hospital setting, what does a CS order written by a PA need?
A countersignature from the physician within 24 hours of writing the order (aka the MD doesn’t need to sign it immediately!)
Components of a LTC Controlled Substance ER box
Each kit can contain a 24-hour supply of up to 10 different controlled substances, 3 of which can be injectables (all are in unit-dose packaging)
Where should the ER kits be stored?
Stationary, double-locked system
Drug regimen review should be reviewed by a pharmacist how often?
Monthly
What else can also be in a ER kit?
Up to 5 noninjectable, unit-dose packaged medications, NTG
If a blister pack is returned and partially used, what can you not do with it?
Add more meds to it
Can’t empty and repackage them
Can drugs dispensed in bulk containers be returned
No
Where should the ER kits be stored?
Near the nurse’s station
Floor stock medications: how often do they need to be checked?
Monthly
Floor stock medications: what are they limited to?
Floor stock meds that are on a facility’s approved floor stock med list
