NAVMED P-117 ch 21 pharm ops Flashcards
Who assigned the number of pharmacy techs assigned to each facility?
BUMED
What chapter of P117 is pharmacy operations and drug control?
21
What are the three ways that a pharmacy may be operated without a pharmacist?
1) by military trained pharmacy techs
2) using a tele-pharmacist
3) remote pharmacist
Checking orders
Managing standards
Who is responsible for the operation of the pharmacy?
Commanding officer
Do DOD MTFs have to abide by state and federal laws?
Yes
When a commissioned officer pharmacist is not assigned to an MTF who will be responsible for the pharmacy?
Civilian pharmacist or HM-8482
What is the NEC for pharmacy tech?
8482
What will the CO of a BSO-18 MTF without an active duty pharmacist assigned have to do?
Ensure that pharmacy operations are revised through site visits and inspections
For non-BSO-18 activities without a pharmacist, the CO may assign responsibility to whom?
Enlisted pharmacy tech under the supervision of a physician or nurse practitioner
Who’s responsibility is it to establish policies to ensure rational prescribing, quality of drugs prescribed are not excessive, and drug dispensing is based on the scope of care of the MTF?
Commanding officer
Who’s responsibility is it to ensure that the staffing levels, funding and pharmacy scope of practice Aligned to meet the mission of the MTF?
CO
Who’s responsibility is it to ensure safe medication use I’d in compliance with pharmacy regulator and accreditation standards?
CO
Who’s responsibility is it to ensure safeguards are adequate to mitigate or prevent drug diversion?
CO
Who’s responsibility is provide drug information to authorized individuals in the proper writing of prescriptions?
Pharmacy department
How frequent is the pharmacy department required to conduct inspections of all areas where pharmaceutical are dispensed?
At least monthly
Pharmacy inspections should include:
5
1) adequate labeling
2) appropriate storage condition
3) stock levels,
4) evaluation of condition and potency based of expiration
5) check markings of storage areas for expired drugs
How should medications be dispensed?
In ready to administer form to the maximum extent possible
How much, of most medications, should be available at a patient care area at any given time? Unless an automated due lending system is in place?
Not more than 24 hour supply
Who’s responsibility is it to ensure prescription are filled only for eligible beneficiaries?
Pharmacy department
What happens I’d a specific. Pharmaceutical is not in a government co tract?
The mtf shall purchase the item that offers he beat value for the government.
How are authorized generic medication rated in the orange book?
A/B
What ordering system shall MTFs use to order medications?
DMLSS
defense medical logistics standard support
The pharmacy and therapeutics committee is a function of _______ and will meet at least ____.
Medical staff
Quarterly
Who makes up the The pharmacy and therapeutics committee?
4
Representatives from: Medical Nursing Risk management Pharmacy
The local The pharmacy and therapeutics committee shall ensure compliance with what?
TRICARE uniform formulary policies
Who develops and recommends policies and procedures relating to selection, distributing, handling, use and administration of drugs?
The pharmacy and therapeutics committee
Who is responsible for minimizing unnecessary duplication of drugs, Drug combinations or therapeutic equivalence?
The pharmacy and therapeutics committee
Who is responsible to oversee drug usage evaluations and reviews
The pharmacy and therapeutics committee
Who participates in risk management and quality improvement activities related to medication use
The pharmacy and therapeutics committee
DoD authorize prescribers may include who
Medical and dental Corps officers optometrists physician assistants pharmacist physical therapist podiatrist nurse practitioners Veterinarians Civilian physicians employed by the Navy
When can prescriptions written by civilian practitioners other than those employed by the DOD be filled?
The prescription item is on the MTF formulary and a pharmacist verifies the prescription per currently Regulations
True or false:
Pharmacies will fill all valid non-controlled prescriptions that are presented regardless of the geographical location of the beneficiary or prescriber.
True
Medical department personnel shall not countersign more rewrite non-MTF Practitioners prescriptions without doing what?
the provider serving care for the patient for the diagnosis supported the specific medication needs
Who shall authorize IDCs in writing to prescribe or provide medications?
The IDCs assigned Physician supervisor
What instruction series provides guidance for training certifying and supervising IDCs?
OPNACINST 6400.1
What electronic order entry form must authorize prescribers. Use to prescribe medications?
DD form 1289
Can retired military physicians possessing a current license use the DD form 1289 to write prescriptions for personal use?
Yes
What information must be provided on the DD form 1289?
8
Patients full name
Date prescription was written
patients age or date of birth and wait under 12 years or younger
Name of drug
form of drug dosage size written a metric system
quantity of dispensed
Clear directions for the Patient
Valid legible signature of the prescriber
Outpatient prescription containers must be labeled properly with what 11 things?
- The MTF dispensing the prescription to include phone number
2) Identification prescription number
3) Patients name
4) Date the prescription is originally filled and date refilled
5) Full name of drug strength and quantity dispensed
6) Prescriber’s name
7) Fillers and checkers initials
8) Number of refills remaining
9) Beyond use date
10) Proper cautionary labels as indicated
11) Other requirements per federal law
When can telephone or oral prescriptions be accepted?
In an emergency or under exta-ordinary situations
Under what circumstance will prescriptions for animals be filled?
If they are owned by the government
How will prescription medications for oral use by outpatients be dispensed normally?
Child resistant containers Unless patient or prescribing physician requested conventional caps
In what year was the poison prevention packaging act signed and amended?
1970 2008
Can MTF pharmacies provide medications intended for the purpose of home intravenous infusion?
No,
Patients should be referred to case management to seek benefits advisory staff to Coordinate home health care services
Can MTF pharmacies. Dispense pharmaceutical samples from sale representatives to patients?
No
What conditions would be present for a pharmacy personnel to not fill prescription?
(6)
Ineligible, incompatible, if there is a question of: dosage, interaction, allergy, or method of administration
How many forms of identification are required to receive medications
2
How should pharmacy personnel report and record all medication errors including near misses?
Via commands error reporting mechanism and BUMED guidance
A prescription for schedule two medications must be filled within how many days of the Date originally written?
30
The pharmacy can fill prescriptions for controlled substance classification Three, four, or five as long as filled within how many months of the date originally written?
6
Schedule two through five medications are not limited to a reasonable quantity of medication as defined by MTF policy not to exceed how many days supply?
100
Deploying members may receive up to how many days supply of medication schedule 3 to 5 medications?
180
A prescription for non-control medication shall be filled within how long of original date Written?
1 year
Prescriptions maybe refilled if authorized by the describer of to how long from the date originally written?
12 months
Whenever possible, women who take oral contraceptives on a long-term basis should be given a prescription for how many packets with one refill?
6
Non-control prescriptions marked with PRN refills may refill up to how long from their original date written?
One year
Can medication refills be refilled from MTF other then the MTF that originally. Filled the medication?
.
Can a police officer, agent of NCIS, agent of the CO, or any other agent of higher authority removing original prescription from the pharmacy’s file for the purpose of an investigation?
Yes, all requests shall be approved through the command legal office or appropriate authority
Can injectable medications to be administered by home health care agencies be dispensed by the MTF pharmacy?
No, patients receiving home health pharmacy services should refer to case manager for coordination of care
When can refills for Maintenance medications being requested?
When 75% or more of the prior prescription has been used
What is the primary means of inpatient drug distribution and fixed inpatient treatment facilities?
Unit dose system or automated medication dispensing systems, which include the pharmacist interpreting the physicians orders and monitoring inpatient medication needs.
How frequent will checks be made by the pharmacy of all nursing care units or other areas where medications are dispensed Administered, or stored?
Monthly
Monthly checks conducted by the pharmacy of nursing areas and other areas of medication will include what Six things?
1) Drugs for external use be stored separately from internal and injectable medications.
2) Drugs are not overstocked
3) Drugs are stored following current established standards
4) Once discovered outdated and unusable drugs should be segregated and return to the pharmacy immediately.
5) There is an adequate and properly supply of emergency medications
6) All drugs in the area are properly labeled
Why would a medication have an automatic stop order?
Impending expiration of drug order
Recommended drugs to be included in automatic stop order policies are?
(5)
1) Antibiotics,
2) anticoagulants,
3) controlled substances,
4) hypnotics,
5) sedatives.
What happens to a patient’s medication orders when transferred to a different level of care? transfer to ward or surgery transfer?
Automatically canceled and rewritten
Inpatient self-care and discharge medication should be labeled how?
As outpatient prescriptions
How much pharmaceutical inventory will be managed to ensure stock levels of pharmaceuticals on and are not excessive?
In general, not to exceed 30 day supply based on historic utilization patterns potential urgency of medication use administrative costs in addition to considering the limit for the supply system
How frequent will MTS establish drug inventory par or stock levels That reflect the level of care prescription workload and mission?
Annually
MTFs shall conduct inventory of all drugs stock and pharmacy At least how frequent?
Annually
How will investigational drugs be stored and processed through the pharmacy?
(What instruction)
BUMEDINST 6570.3 series
Cytotoxic drugs will be controlled prepared, administered, and disposed of in accordance with what instruction?
BUMEDINST 6570.3
Manufacturing and handling of sterile product so follow what recommendations?
USP 797
When was the controlled substance act signed?
1970
How many schedules of medication are there?
5
Define:
Drugs with no acceptable medical use and a very high abuse potentional.
Schedule 1
Define:
Drugs having an acceptable medical use and a very high abuse potential
Schedule 2
Define:
Drugs having an acceptable medical use which are considered to have lessening degrees of abuse potential.
Schedule 3,4,5
Can alcoholic beverages be stocked or dispensed from navy MTFs?
No
Which schedule of medications require vault or safe storage and inventory by the CSIB?
1 and 2
What does CSIB stand for?
Controlled substance inventory board
how will locked up medications safe combination numbers be provided to the CO?
Sealed envelop
For schedule 1 and 2 drugs locked in a safe, how frequent must the combination be changed?
Every 6 months
Upon change in the custodian
Any suspected compromise of the combination
How frequently will pharmacy custodians conduct inventory of schedule 3-5 drugs
Biennial
Around 01may of odd numbered years
How can PAs and nurse practitioners prescribe schedule 2-5 controlled substances?
If they have permission from the CO
True or false:
Prescriptions for controlled substances can be filled at any MTF.
False
Can only be filled in local area
Who can be designated in writing by the CO for custodial responsibility of controlled substances?
(3)
Pharmacy officer
Civil service pharmacist
Commissioned officer
Schedule 3-4 controlled substances:
How many day supply should be dispersed for minimal working stock?
4 days
MTF commanders should strongly consider upswing what technology to minimize the risk of drug diversion?
Closed-caption video
What does DHPD stand for ?
Drugs with high potential for diversion
In regards to amount of controlled substance inventory, what does the term percent threshold mean?
Percent of inventory unaccounted for when comparing the difference between the amount ordered and amount dispensed for a particular DHPD
How frequent must DHPD lists be reviewed?
Annually
All pharmacies with CHCS and a narcotic vault should require what?
Electronic inventory of controlled substances
Current and new contract employee pharmacy positions will require what?
Drug testing provisions equal to that required of GS or NSPS employees.
How do automated dispensing machine (Pyxis) work?
Allow for dispensing using user ID, password, and BioID technology
What is a paperless controlled prescriptions tracking system in CHCS?
Controlled prescriptions menu
Schedule 1 and 2:
The frequency of the custodian’s inventory must occurred at least how often?
Weekly
Ward emergency kid and ADC:
What does ADC stand for?
Automated dispensing cabinet
Ward emergency kid and ADC:
Who is responsible to maintain and inventory Ward emergency kid and ADC?
The main pharmacy which supplied the controlled substances
Ward emergency kid and ADC:
When can corpsman remove and use medications out of the Ward emergency kid and ADC?
In emergency/urgent situations
Under direct supervision of a privileged provider
Ward emergency kid and ADC:
How frequently must unannounced inventory of schedule 1 and 2 controlled substances be conducted?
Quarterly
Or more frequently
CSIB will have at least how many members?
3
CSIB:
At least one member must be____.
A commissioned officer
Also one member must be: Medical corps Dental corps MSC Nurse corps
Except when not available
CSIB:
Who can be a member of CSIB?
Senior enlisted E7-E9
DON civilians GS-7 and above
CSIB:
True or false:
No member of the board may be directly responsible for the substances being inventoried.
True
Who needs to be notified upon the discovery of theft or significant loss of any controlled substance?
DEA
Who determines is a significant loss of controlled substances occurred?
Head of pharmacy department and senior CSIB member
What form must be used to report a theft or significant loss of controlled substances?
DEA Form 106
When reporting a theft or significant loss of controlled substances you must prepare an original DEA Form 106 and three copies. What do you do with each copy?
Original and one copy:
Nearest DEA office
One copy:
BUMED
one copy:
MTF regional pharmacy rep
One copy
Nearest NCISIf approved by the CO how can destruction of controlled substance be accomplished?
In the presence is a member of the CSIB
What type of alcohol can be used by an MTF?
Ethyl
Directly issued to the lab
Must be quarterly audited
True or false:
Duplicate, carbon copy, photographic reproduction, preprinted, rubber stamped, or addressographed orders can be used to prescribe controlled substances
False
How many controlled substances can be on the same prescription?
None
Each has to be separate for filing purposes
A copy is made of the prescription and the original gets files with the controlled substances and the copy goes with all other meds
Which schedule medications can be refilled?
3-5
What happens if the pharmacy can not completely fill a schedule 2 medication?
A partial can be dispensed if PT requests
If it cannot be filled in 72 hours provider must be notified and a new prescription written.
How must prescriptions be filed and maintained at the pharmacy?
A separate file for schedule 2
Schedule 3-5 in one folder
What form is used to account for all controlled substances used in compounding of pharmaceutical preparation?
NAVMED 6710/1
Who will be charged with custodial duties at burdening care units?
RN, medical or dental officer
In a nursing care unit when could medication storage areas not be locked?
If personnel working in the area have a continuous unobstructed view of the area
Each burdening care unit, clinic, or other activity drawing controlled substances from the pharmacy shall maintain a loose-leaf notebook containing what two forms?
NAVMED 6710/4 narcotic and controlled drug inventory-24 hour
NAVMED 6710/1 narcotic drug Account record
True or false:
Personnel accepting controlled substances delivery from a pharmacy to a nursing care unit cannot be the same individual who submitted the request of the said substance.
True
Can scheduled controlled substances be stocked in emergency crash carts?
No
How can branch clinics Not able to order a controlled substance directly from prime vendor?
Request delivery from main pharmacy in the same manner as hospital nursing care unit and clinics are supplied
When is the NAVMED 6710/4 narcotic and controlled drug inventory 24 hour accountability record completed?
After completing the end of shift inventory of all controlled drugs prior to being relieved.
How frequent must bursting unit supervisors audit the nursing care unit controlled substance supplies?
At least weekly
On the NAVMED6710/1:
What format will be used to record medications?
In Arabic numerals
Eg 0.5ml
On the NAVMED6710/1:
When the unit expended to the patient is a fraction dose how will it be recorded?
The unit administered shall be placed in parenthesis before the number of units in expended column
On the NAVMED6710/1:
What happens if a single dose of controlled substance is accidentally damaged, contaminated, or if PT refused by the patient after it was prepared?
The dose shall be destroyed
A brief statement of the circumstance shall be entered in the form
On the NAVMED6710/1:
What happens if multiple doses of a controlled substance becomes damaged or contaminated?
The supervisor shall record the disposition of the drug, including date, amount of drug, and brief statement of disposition, and new balance
How frequent will The pharmacy report to the director of nursing services all NAVMED 6710/1s Outstanding 30 days from date of issue?
Monthly
The nursing supervisor shall remove all completed NAVMED 6710/4 Over _____ old from the narcotic and control” and transfer the completed NAVMED 6710/4 To the pharmacy for storage in the amount of ____.
three months
two years
What form will be used to provide clearly definable materials sources (manufactures names, lot number, and expiration)?
NAVMED 6710/2
Compounding/Pre-pack log
When can all prescriptions, formularies, and drug list be destroyed?
After two years
