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Regulations > Pharmacy Services > Flashcards

Pharmacy Services Flashcards

1
Q

When can a facility allow for an un-licensed personal to administer drugs?

A

-Both- 483.60/19.1501
*483.60-
Can allow unlicensed to administer if State LAW permits under the guidance of a LN
-19.1501-
1-When it is under the general supervision of a LN
2-when the person is a: Nurse Student, OR -Texas-
Med Aid (Med A) Student, OR -Texas-
Med A with a current permit. -Texas-

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2
Q

What must the facility provide when it comes to Pharmacy Services?

A

-Both- 483.60/19.1501
facility must provide ROUTINE and EMERGENCY drugs and biologicals to its residents. Either by:
1-In House Pharmacy OR
2-Outside Recourse –see: Admin 19.1906

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3
Q

Services of a Pharmacist must be either:

A

-Both- 483.60/19.1501
1-In house -Both-
2-or contracted out-Both-
3-And in good standing with -Texas board of Pharmacy- Texas-

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4
Q

Pharmacist job in a facility is to:

A

-Both- 483.60/19.1501
1-provides consultation on ALL of pharmacy services-Both-
2-Establishes a system of records for:
receipt and disposition of all controlled drugs-Both-
3-determines drug records are in order -Both-
4-an account of all controlled drugs is maintained
reconciled; -Both-
5-Consultant pharmacist hours must be sufficient to meet the needs of the residents-Texas Only-
6-Record of what the Consultant pharmacist services, consultations, are. and record must be maintained at the facility-Texas Only-

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5
Q

How often must the drug regimen for each resident be reviewed?

A

-Both- 483.60/19.1501

At least once a month by the pharmacist.

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6
Q

Where must the drug regimen review be stored?

A

-Texas-19.1501

In the clinical record of the resident

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7
Q

Who must the pharmacist report any drug irregularities?

A

-Both- 483.60/19.1501
1-Attending physician and
2-DON,
**and these reports MUST be acted upon.

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8
Q

What is required in the storage of drugs and biological?

A

-Both- 483.60/19.1501
1-Must be locked
2-Must be under proper TEMP
3-Only authorized personnel may have access to keys

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9
Q

How must drugs and biologicals be labeled?

A

-Both-483.60/19.1501
1-in acceptance with professional principals-Both-
2-and in compliance with Texas state board of Pharmacy laws and regulations 291-Texas Only-
3-Correct Cautionary instructions
4-experation date

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10
Q

What kind of drugs need to be under a “permanent locked and affixed compartment”

A

-Both-483.60/19.1501
Any schedule II drugs, and any drugs subject to ABUSE.

  • Must be under ONE lock at ALL times - NAB p.54

List of some Schedule II Drugs:
Codeine / Opium / __Codone / Morphine / OXY__ / Methadone / Fentanyl

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11
Q

Who decides on what pharmacy is to be used for the supply of drugs?

A

The person or entity that is paying for the drugs.

If resident is paying for his/her own drugs they can decide on what pharmacy supplies the drugs.
** any changes to this must be recorded on proper form , and maintained by facility

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12
Q

Resident can choose any pharmacy as long as:

A

-Texas Only-19.1502
Pharmacy can provide service on a 24 hour basis (emergency)
Medication must be delivered on a timely basis.
Must have a drug distribution system in place.

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13
Q

How often does the consulting pharmacist required to enter notes on the residents clinical record?

A

-Texas Only-19.1503

Once a MONTH

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14
Q

Who is responsible for pharmaceutical services?

A

-Texas Only-19.1503

The DON and the Pharmacist

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15
Q

How many hours must the consulting pharmacist put in a month?

A

FED- Number of hours is determined by the STATE
-Texas-19.1503
Number of hours required need to be “sufficient to meet the needs of the residents” [ No requirement ]

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16
Q

Who is responsible for drug security when medications are self-administered? Who determines if the resident CAN be a person that can SELF-Administer?

A

-Fed-
Must be determined
-Texas-19.1504
1-The facility
** in addition to maintaining accurate information , and medication compliance.
2-Interdisciplinary Team - /1994 Final Rules/F176/483.10(n)/19.418p

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17
Q

Where must medication carts be placed when not in use?

A

-Texas Only-19.1504

Must remain secured in a designated area.

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18
Q

What type of Drugs must be destroyed? when must they be destroyed?

A 
-Texas Only-19.1504
Drugs of: 
1-Deceased residents,
2-Old expiration date
3-and discontinued drugs
  • *and once a quarter must be destroyed
    • DEA (Drug Enforcement Administration) Monitors the Proper Storage and Destruction of DRUGS
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19
Q

What happens if a drug is discontinued, but then later is Re-instated?

A

-Texas Only-19.1504

Discontinued drugs may be reinstated if reordered prior to destruction.

20
Q

What happens to the drugs if a drug is direction has been changed?
Ex: of Direction is BY Mouth, or Crushed

A

-Texas Only-19.1504
If existing medication can still be given correctly with the new change, THEN medication MUST NOT be destroyed. ** and must a fix a “change of direction sticker”

21
Q

Who can take Verbal ORDERS?

A

-Texas Only-19.1506
1-licensed nurse,
2-pharmacist,
3-physician assistant or a physician

22
Q

After taking a Verbal order what is the time limit on when it should be recorded and signed?

A

-Texas Only-19.1506

Immediately recorded and signed by the person receiving the order

23
Q

Are verbal orders of schedule II drugs ok?

A

-Texas Only-19.1506

Only in an emergency

24
Q

Who can prescribe drugs?

A 
-Texas Only-19.1506
1-resident's physician OR
2-consulting physician, OR
3-dentist, podiatrist, OR
4-other individual allowed by law to prescribe
25
Q

When should medications be released to the resident?

A

-Texas Only-19.1507
1-One the written or verbal authorization of the attending physician
2-When resident leaves on furlough - and then only enough drugs must be given to cover time gone.

26
Q

What is the ORDER of medication release when a resident is being transferred?

A

-Texas Only-19.1507
1-New Facility
2-The resident himself
3-Family of the resident

27
Q

What is considered a medication Error?

A 
-Texas Only-19.1508
not limited to:
1-wrong medication, 
2-wrong time
3-wrong dosage strength,
4-wrong route, 
5-omitting a medication, 
6-wrong resident
28
Q

Who and when must nurse staff report an adverse drug reaction?

A

-Texas Only-19.1508
1-To the residents physician
2-a TIMELY manor (depending on the reaction of the drugs)

29
Q

What documentation is required when a adverse reaction to drugs occurs?

A

Must be documented in the resident recorded, and an incident report must be filed.

30
Q

Can drugs or biologicals be prepared by one person and the administered by someone else?

A

NO,
Must be prepared and administered by the same person
Unless:
under unit-of-use package distribution systems and self medication of self

31
Q

When can a LN NOT consult the treating physician, dispensing pharmacist, or consultant pharmacist when deciding on if to crush drugs?

A

When the medication is not:
1-time-released OR
2-enteric coated
* otherwise may exercise professional judgment
* If a do not crush is is overridden by a nurse, must be documented in the clinical record, as to why.
* there is an approved list of ok to crush.

32
Q

What must the controlled substances (NARC) (schedule II, III & IV) drugs record contain?

A 
1- prescription number, 
2-name, and strength of drug, 
3-date received by the facility, 
4-date and time administered,
5-name of resident, 
6-dose, 
7-physician's name, 
8-signature of person administering dose
9- original amount dispensed
 with the balance verifiable by drug inventory
33
Q

When must (schedule II, III & IV) (NARC) drugs be inventoried?

A

at every shift change

34
Q

What are the steps in Drug Administration?

A

Texas Only -19.1508
1-Check the physician ORDERS
2-ID the RESIDENT before giving the DRUG
3-Record
4-Drugs are PREPARED and ADMINISTERED by SAME person
5-DRUGS with NAMES are ONLY given to those PEOPLE.

35
Q

Can internal and External Drugs be STORED together under the resident name?

A

Q

NO, Internal and External drugs must be separated.

36
Q

What type of drugs are covered as part of there benefits?

A

Q

Over the counter Drugs are covered under medicaid.

37
Q

When is it OK for residents to take home medications after being discharged?

A

Q

With Written NOTE from a DOCTOR

38
Q

If a LABEL is UNREADABLE or MARRED but the DRUGS themselves are ok. Is it still ok to use those DRUGS?

A

Q

NO, an label that is unreadable or torn must be returned to the pharmacy

39
Q

If DRUGS are outdated, Deteriorated , Discontinued can they be stored in the Medication Room?

A

Q

NO

40
Q

What is concetered to be POLYPHARMACY

A

NAB p.55
9 or more DRUGS.
** The 9 or more policy includes vitamins
Pharmacist need to be aware of this.
** Rule of thumb the pharmacist will report to the MD at least yearly how many residents have 9 or more drugs.

41
Q

Who can and should authorize “drug switches” when a pharmacist notices there should be one?

A

1-Attending Physician

**In addition to having the AP, make the switch , you should also notify the DON.

42
Q

What is the difference between “dispensing” a drug and “Administering” a drug

A

Administering- is the process of GIVING the medication to a resident
Dispensing - is process that includes the interpretation of a prescription; selection, measurement, and packaging or repackaging of the product (as necessary); and labeling of the medication or device pursuant to a prescription/order

43
Q

NAB
When talking about the pharmacist and medical director what is a rule of thumb? When talking about the Medical Director , DON, and pharmacist what is the rule?

A

1-Rule of thumb: it has to do with policy and procedure of the facility, and drug administration, dispensing, ect..
2-If MD/ DON, and Pharmacist then it is the pharmacist that has found something that needs reporting, and he must report it to the MD and the DON. 483.60-c- / 19.1501-4-

44
Q

What is the criteria for “Unnecessary Drugs”

A

F329/19.901(12)

(i) In excessive dose (including duplicate therapy); or
(ii) For excessive duration; or
(iii) Without adequate monitoring; or
(iv) Without adequate indications for its use; or
(v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
(vi) Any combinations of the reasons above.

45
Q

Who approves the the EDK? (Emergency Drug Kit?

A

1-The Medical Director
2-Pharmacy provider
** The allowance of a EDK is approved by the state.

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