midterm Flashcards
what is the mission of pharmacists
to help people make the best use of medication
name 4 elements of care as it relates to pharmacy services in a hospital
-monitoring medication use
-optimizing medication therapy
-medication delivery
-preparing, packaging, and labeling medications
name 4 considerations of medication storage and preparation areas
-sanitation
-temperature
-light
-moisture
name 4 things to consider when putting together a formulary
-meet on a regular basis
-review medications for safety
-P&T committee responsible for developing and maintaining written criteria for drug selection
-formulary requests for specific populations should be addressed (pediatric, geriatric)
medication acquisition - 4 things to consider
-competitive bidding
-group purchasing
-medication shortages
-cost-effective patient services
4 reasons for drug shortages
-manufacturing/quality problems
-shortage of API
-supply and demand
-natural disasters
pharmacy’s role in drug shortages - 4 key points
-inventory system should be designed to detect low inventory levels and alert staff
-work with suppliers and collaborate with physicians for alternatives
-staff should check reliable sources (ASHP and FDA have websites)
-strategies for identifying alternate therapies
-campaign for awareness
4 components of medication therapy monitoring
-therapeutic appropriateness of the med regimen
-therapeutic duplication or omissions
-appropriate dose/route/frequency
-patient adherence
antimicrobial stewardship
-policies to reduce transmission of infections
-educate health professionals/patients/public about the topic
-proper antimicrobial utilization
-multidiciplinary groups and committees
-pharmacists should monitor patient’s lab reports to check for resistance
4 aspects of the joint commission
-evaluates and accredits more than 22,000 HC orgs in US
-global driver of quality improvement since 1951
-independent and non profit
-GOLD SEAL OF APPROVAL awarded after successful accreditation survey - establishes continuous improvement in patient care
4 aspects of the joint commission accreditation survey
-all surveys unannounced
-surveyors are highly trained experts in their respective fields
-surveyors trace a pt experience to see if their care meets organization’s standards
-pharmacy falls under medication management standards
4 examples of medication management
-storage and handling
-preparing and dispensing
-sterile compounding
-anti-coagulation
4 examples of high alert medications
controlled substances
look alike sound alike
insulin
meds with narrow therapeutic range
NIOSH classification for hazardous drugs
carcinogenity
teratogenicity
genotoxicity
organ toxicity
AT LOW DOSES
4 error prevention strategies for look alike sound alikes
-minimize verbal orders
-tall man lettering
-meds should be separated from each other and not stored side by side
-med bins should be labeled with look alike sound alike sticker
4 asp goals
-reduce toxicity
-optimize patient outcomes
-limit unnecessary antibiotic use
-promote appropriate selection of antibiotics
4 times the laminar flow hood should be cleaned
-beginning of each shift
-before each batch
-after spills
-end of shift
sterility tests of the laminar flow hood should be conducted according to….
USP797/USP800
to determine colony forming units of bacterial/fungal growth
4 general principles of compounding
-personnel are trained and documented
-ingredients purchased from reliable sources and stored properly
-all equipment cleaned and properly maintained
-only authorized personnel allowed
purpose of USP 795
-non sterile compounding
-provide compounders with good compounding practices for the preparation
dispensing
and administration of non sterile compounded formulations
engineering/facility design 4 considerations
-air quality (affects microbial contamination)
-temp 20 degrees c or cooler
-only authorized personnel and materials (for compounding and cleaning) permitted in buffer area
-viable air sampling every 6 months
4 personnel standards
-well trained and routinely monitored
-aseptic technique
-#1 source of microbial contamination is personnel
-special attention given to garbing
sterile compounding involves creating medication….
-in a controlled environment
-free from viruses
-free from bacteria
-free from fungal grwoth
will be administered IV injusion, injection, intraocular, or intrathecal
why do we need standards for sterile compounding
-med may be sup-potent
-uper potent
-contaminated
-could expose pt to death
4 points on history of USP
-found in 1820
-mission is to improve global health through public standards that ensure quality, safety, and benefit of medication
-NO ROLE IN ENFORCEMENT
-gov agencies responsible for enforcement
-standards used by manufacturers and regulatory agencies
impact of drug shortages on hospital
-higher hospital expenses
-increased labor costs
-worsen pt health outcomes
4 reasons for recalls
-microbial contamination
-pH failure
-dissolution failure
-deviation from good manufacturing processes
4 criteria for formulary
-need
-effectiveness
-risks (ADR, abuse potential)
-acquisition cost
-monitoring parameters
how often is hospital formulary reviewed
annually
4 benefits of 340b
-providers can stretch their limited resources to better serve vulnerable communities
-hospitals use 340b to provide free care for uninsured, FREE VACCINES,
-money saved allows hospitals to use that money to spend on their uninsured pts
-mental health services
drug procurement
-process of acquiring supplies through purchase from manufacturer, distributor, or contracted supplier
-helps ensure availability of right meds in right quantities at reasonable prices
-timely delivery to avoid OOS
-drugs have recognized standards of quality
4 advantages of GPO contracts
-reduction of duplicate purchasing efforts among institutions
-reduction of contract labor costs for institutions
-standardization of products
-long periods of price protection
wholesale acquisition cost
-manufacturer list price when sold to wholesalers
-most expensive – is suggested retail price without any discounts
-set by manufacturer and sold to wholesaler
-price pharmacy pays is based on listed WAC
