Midterm Study Flashcards
1
Q
Pharmacy services in a hospital must meet 5 requirements
A
- Accepted ethical practices
- Accepted professional practices
- Legal requirements
- Patient needs
- Drug use control responsibilities
2
Q
What are the essential functions of the pharmacy services dept at a hospital?
A
- Drug procurement
- Prep and distribution
- Control
- Evaluating and communicating drug info
- Reviewing DUR
- Monitoring for ADRs
- Developing a formulary
- Monitoring drug expenses
- Maintaining patient profiles
- Pharmacotherapy
- Emergency release drugs
3
Q
What is the pharmacy technicians role in interpreting a physician’s order?
A
- Calculate dose, volume & day supply
- Select appropriate drug
- Ensure no misinterpretation of strength, dose, directions
- Count, pour, weigh, mix
- Select appropriate container (distribution of drug, dosage form, ASO policies)
- Independent Double Check
- Release product
4
Q
What is the role of the RPhT in the hospital’s drug distribution system?
A
- Dispense medications to patient care units
- Check floor stock on units, noting issues, quotas, schedules and expiry dates
- Process admissions, transfers and discharges and coordinates med delivery
- Transport medications to units
- Repackaging stock meds for specialty care units, nurses
- Med recycling
- LOA or PASS med processing
- Maintain dispensing records
5
Q
What is the role of the RPhT in the IV ADmixture servies?
A
- Prepare sterile products while adhering to NAPRA standards
- SVP, LVP, TPN, OPTH, Irr, Dialysis, Chemo
- Maintain supplies
- Record keeping
- Liaison with patient care unit to determine quotas/orders
- Training/Competency assessment
- Help develop protocols & worksheets
6
Q
What is the role of the RPhT in special drug control?
A
- N&C drugs (repackage, determine quantities for restock, delivery, distribution, obtain signatures, mix methadone doses, maintain records, rotate stock, purchasing, destruction, identify diversion, resolve count issues)
- Night Cupboard (Reconcile stock used with orderes, replenish stock, maintain log, look for expired product, complete annual recall and rotate stock)
- Crash Cart (Restock, Issue new, Replenish used/expired product, Complete annual recall, document issues)
- Investigation drugs (Dispense drug upon written order by investigator, arrange proper delivery, maintain drug inventory, re-order drug, document returns and shipping)
- Emergency Status Drugs (Assist in procuring drug for patient, store, prepare, distribute, record issues, credits and expired product)
- Restricted drugs (Dispense as per police, obtaining signatures and maintaining records)
- Medication Incidents (completes reports, submits reports to designated individuals, maintains files & reports, assists with investigation)
7
Q
What is the role of the RPhT in drug information systems?
A
- Search drug literature
- Obtain articles and files
- Create and update sterile and non-sterile compounding worksheets
- Update filing system
- Transmit mail to staff
- maintain computer hardware, update software
8
Q
What is the role of the RPhT in Materials management?
A
- Determines what meds to order, how much and where they are coming from
- Issues PO (confirm shipment is coming to hospital, confirm price, via phone/fax/mail/electronic/courier?)
- Reconcile PO to received products
- Items priced and entered in expiry log
- Items stocked
- Backorders are communicated, alternate sources explored
- Check for drug recalls, complete paperwork, package and ship back to supplier
- Request authorization to return expired, short-dated, or over-stocked items
- Maintain all documentation
9
Q
What is the role of the senior pharmacy tech?
A
- Assigns work to coworkers
- Prepares monthly schedule for tech staff
- Collect and report statistical info
- Hiring, reviews, training
- Independent double check of processed orders, repackaged floor stock, and N&C drugs
- Participates in department committees
- Provides education
- Participates in purchasing and implementing new tech
- Medication room safety audits
10
Q
What is the role of the RPhT in pharmaceutical care?
A
- Assist in drug distribution activities
- Can preform order-entry but it is always checked by a pharmacist
- Hospitals with CPOE, order has already been verified by RPh and techs can handle all tech aspects
11
Q
Are all patient orders checked in the hospital?
A
- Some hospitals have RPh check all patient orders and others only have RPh check first doses with following doses checked by techs.
- Independent double check is implemented differently depending on hospital policies
- All checks must be done by regulated staff
12
Q
What is the role of the RPhT in preforming technical checks?
A
- note missed doses
- note increases/decreases in prn dosing
- file incident and discrepancy reports
- perform audits on patient care units
- note credit irregularities
- make recommendation to increase work flow effectiveness and efficiency
13
Q
What does the RPhT need to do before interviewing a patient for the BPMH?
A
Gather information
- 6 month med history from pharmacy
- Use ODB, Clinical connect etc. to see what medications where dispensed
- Be familiar with common drug shapes, colors
14
Q
What is the RPhT looking for during their BPMH interview?
A
- potential discrepancies with doctor’s order & how patient actually takes their medications
- asking open ended questions to determine habits, compliance, schedule, OTC, inhalers, eye drops, topicals etc.
15
Q
How often should a BPMH be preformed?
A
- Admission, transfer, discharge
- When new med is ordered, changed
16
Q
Medication is only dispensed upon receipt of a medication _____________ written by a physician assigned ________ privileges. Residents can prescribe for in-patient and out-patient of hospital they work at. Consultants require authentication by attending.
A
order, clinical
17
Q
What are the different types of legal medication orders in a hospital setting?
A
- written
- telephone (require name of designated person transcribing order, date, time, authentication within 24 hr, T.O.,)
- verbal (require name of designated person transcribing order, by doctor physical present on patient care unit, only in emergencies, V.O., authenticated within 24 hr)
- CPOE (Computerized provider order entry)
18
Q
What are some requirements for a legal medication order?
A
- Must be on institutional order sheet (non-CPOE)
- Using SI metric units
- Using ONLY abbreviations approved by institution
19
Q
What information needs to be included on a medication order?
A
- Patient information (Name, room/bed, hospital ID, birthdate)
- Med info (generic name, strength, dose, route, frequency/time, # of doses or time limitation (ASO assigned), date/time of order, signature and printed name)
- Error is stroked out and indicated by physician on order
- Any change after order is entered is treated as a discontinued order
20
Q
What does a CPOE entail?
A
- Orders are entered into an EHR by provider with privileges (Doctor, NP, Midwives, Dieticians) in real time and signed with a click
- RPh review and verifies orders in que
- RPhT’s don’t need to enter orders and focus on preparing, distributing, technical checks
21
Q
What are some benefits of a CPOE?
A
Fast order entry
Eliminates transcription and interpretation errors
EHR provides real time checks on interactions
Each health care professional focuses on their own specialty
22
Q
What are some downsides to CPOE?
A
Complacency on order entry
Short-forms can cause confusion and med errors
Implementation is very involved
23
Q
Why is the 24hr clock used in institutional settings?
A
- Avoids confusion with AM & PM times that occur
24
Q
When does the day begin and end in 24hr time?
A
0001 (12:01am), 2400 or 0000 (12:00am)
25
A physician will order a medication by frequency (bid) and the nurse and pharmacy staff will interpret the frequency as a specific time based on the normal hours of administration determined by hospital policy. True or False?
True
26
What information is important to remember re: Regularly Scheduled Medications?
- Medications ordered on regular basis
- BID, TID, QD
- Admin times follow hospital policy
- Certain units might have exceptions
- Certain med might have exceptions
- Certain parameters might apply (if this, then that)
27
PRN medications?
- Medications administered on a "need" basis
- Do not follow admin times
- Frequency/intervals must be noted on med profile and admin record
- Time must be indicated once first dose has been administered and conform to frequency parameters for next dose
28
What information is required for patient entry?
Patient Info: Name, hospital #, bed location, DOB, Gender, weight, height, allergies
Admission date
Doctor name
Medical service
Diagnosis
Medications (dose, form, route)
Hours of admin
Date med ordered, discontinued, ASO
29
What orders require authentication?
Telephone orders, change order notice, verbal orders
30
What is a CHANGE ORDER NOTICE?
Changes to med order that are initiated by pharmacy
31
What is a STAT order?
Non-recurring medication that is required immediately
- available as floor stock in cupboard or in ADM
- can be telephone order, must present original order for pick-up or at delivery in emergency situations
32
Standing orders?
Pre-determined treatment protocols
- pre-printed physicians orders
- post-op pain control
- ICU coronary
- streptokinase
- dobutamine infusion
- nitroglycerin infusion
- potassium protocol
- Reviewed annually and approved by medical advisory council
- dose, flow rate, frequency allow for flexible dosing
- documented in patient's clinical record
- copy of order sent to pharmacy
33
What is the purpose of a MAR?
Documents all medications administered to patient
- time given
- person responsible for admin
Legal document verifying medication administration
- record that 6 "rights" are being adhered to
34
What are the three types of MARS?
1. Scheduled
2. PRN
3. Continuous
35
Scheduled MAR
- Regularly scheduled medications administered based on daily frequency
- NON-Recurring medications given as ONE TIME doses that are NOT PRN
36
PRN MAR
- List PRN medications and frequency
- Must check MAR to determine if patient falls within parameters before administering
37
Continuous Medication MAR?
- List of all continuous running IV infusions that are ordered
- Orders that can be stopped or started based on need
- Concentration of IV, Current rate, Initiation time
- Helpful for pharmacy to determine infusion needs
38
Paper MARS
Blue/black ink for patient information
Room #, ASO in pencil
Red ink for allergies, night meds, DC'd meds
MAR must be checked and initialled by second nurse after transcribing orders from physician order sheet or recopied to new sheet
Transcription errors must be recopied and line drawn through original entry with "error" denoted and initialed by staff member
Meds not given are documented
39
E-MARS
WOW (workstation on wheels)
- Review med orders, prepare medications, verify patient, scan medications, document administration
- updated in real time
- data can be reviewed at any time
40
What is an Addressograph?
Area of MAR that contains a copy of patient info:
Name, DOB, patient #, room #, Attending, Gender
41
Considerations for indicating dose on MAR
- Actual dose for single entity product
- Number of tabs/caps for combo product
- Liquid (mg calculated with available formulary) for single entity, total amount in mL for combo solutions
42
Considerations for indicating route on MAR
- NO ASSUMPTIONS
- PO, SL, IM etc. must verify if not stated
43
Considerations for indicating frequency
- Latin abbreviations are ok
- Actual admin times noted
- Interval noted
44
Recording dates on a MAR
Paper - date med was administered, chrono order, dd/mm/yy
E-MAR - upcoming admin times show alarm (1hr before/after), if nurse is late MAR will not let nurse record dose without explanation
45
What are some rules for preventing medication errors?
Medication orders must be legible
Avoid abbreviated drug names
Avoid ambiguous Latin abbreviations and Roman numerals
Always place a 0 before a decimal
Never place a 0 after a decimal
Don't use u for units
Use mcg NOT ug for microgram
Indicate directions for use and notation for purpose
46
What is range dose order?
Dose is stated as range and must be checked to see if the order exceeds the high or is below low dose or exceeds the recommended treatment period.
Examples: 200-400 mg, q4-6, IM/PO
47
What should PRN orders contain?
Criteria for drug (pain, fever, nausea)
Minimum interval of time between doses
48
What do medications with repeat clauses require?
- criteria for use
- amount to be repeated
- number of repeat doses
- conditions for repeating dose
49
When do ASO's apply?
Only if duration and amount is not indicated on order
50
What is the purpose of an ASO?
- Avoid prolonged admin of potent drugs
- Allow for reevaluation of patients needs for med after time period
- Prevent patients from taking drugs beyond time of required therapy
51
