Long-Term Care Pharmacy

Question 1

Who can administer/dispense medications in a LTC setting?

Answer 1

Licensed physician or registered professional nurse or other personnel with applicable licensing requirements, patient, or patient’s caregiver

Question 2

Institutional dispensers can dispense pursuant to what?

Answer 2

An Rx (duh)

Question 3

Controls in an institutional setting require what?

Answer 3

A dispensing record as well as a administration record of the CS

Question 4

Controlled substances can be administered from a sealed ER kit when?

Answer 4

Upon the order from the prescriber

Question 5

If the order for a CS was a verbal, what does it also need?

Answer 5

Needs to be reduced to writing and countersigned by the prescriber in 72 hours

Question 6

What does the LTC facility need to let the pharmacy know?

Answer 6

They have to let them know whenever they pull something from the ER box

Question 7

Who can access meds in a LTC without pharmacy staff?

Answer 7

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

Question 8

How long must labeling and recording requirements be kept?

Answer 8

5 years

Question 9

CSs can’t be dispensed in what?

Answer 9

Customized patient med packages

Question 10

Expiration date for drugs re-packaged in house

Answer 10

12 months or 50% of the time remaining to the manufacturer’s expiration date, whichever is less

Question 11

Repackaged drugs can be returned for re-dispensing when?

Answer 11

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

Question 12

Storage of CS in LTC

Answer 12

The facility has to have separately locked, permanently affixed compartments for storage except when the facility uses single unit package drug distribution systems

Question 13

CS 1-2 storage in LTC: where should they be kept?

Answer 13

GSA class 5 rated steel cabinet or equivalent safe approved by the BNE

Question 14

When does a safe have to be bolted to the floor?

Answer 14

If it weighs <750 pounds

Question 15

Components of the CS cabinet (locks, doors, etc.)

Answer 15

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

Question 16

Components of a CS vault

Answer 16

Multiple position combination lock, relocking device, ad 1/2-inch thick steel door

Question 17

New construction of a CS cabinet

Answer 17

Floors, wall, and ceiling should be no less than 8 inches of reinforced concrete

Question 18

Where should C3s-C5s be stored?

Answer 18

A securely locked cabinet

Question 19

Where can CS be stored?

Answer 19

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

Question 20

Rule on patient-specific controlled substances (in terms of the med cart and the other meds they have)

Answer 20

A 72-hour supply can be stored with the patient’s other meds in a locked cart or storage unit

Question 21

What should a controlled substance administration sheet contain?

Answer 21

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

Question 22

What constitutes as an “emergency” to pull from the ER box?

Answer 22

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

Question 23

PRN orders for CS are not valid beyond what time frame?

Answer 23

72 hours

Question 24

When can a standing order or specific CS order for individuals be extended for beyond 7 days, and for how long?

Answer 24

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

Question 25

Standing orders or specific controlled substances orders for individual patients to be administered at specified times shall not be valid after what?

Answer 25

7 days,

Question 26

In a hospital setting, who can write CS orders?

Answer 26

A PA

Question 27

In a hospital setting, what does a CS order written by a PA need?

Answer 27

A countersignature from the physician within 24 hours of writing the order (aka the MD doesn’t need to sign it immediately!)

Question 28

Components of a LTC Controlled Substance ER box

Answer 28

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)

Question 29

Where should the ER kits be stored?

Answer 29

Stationary, double-locked system

Question 30

Drug regimen review should be reviewed by a pharmacist how often?

Answer 30

Monthly

Question 31

What else can also be in a ER kit?

Answer 31

Up to 5 noninjectable, unit-dose packaged medications, NTG

Question 32

If a blister pack is returned and partially used, what can you not do with it?

Answer 32

Add more meds to it
Can’t empty and repackage them

Question 33

Can drugs dispensed in bulk containers be returned

Answer 33

No

Question 34

Where should the ER kits be stored?

Answer 34

Near the nurse’s station

Question 35

Floor stock medications: how often do they need to be checked?

Answer 35

Monthly

Question 36

Floor stock medications: what are they limited to?

Answer 36

Floor stock meds that are on a facility’s approved floor stock med list