Approval to Administration Module 8: Pharmacy Operations and Supply Chain

What pharmacies dispense drugs to the public?

community and specialty pharmacies

What are institutional pharmacies?

hospitals (acute care) and ambulatory care

What are closed door pharmacies?

mail order pharmacies, central-fill pharmacies, and long term care pharmacies

What are the different long term care pharmacies?

nursing care facilities, assisted-living facilities, correctional facilities, and adult residential facilities

What are characteristics of a specialty pharmacy?

-medication is expensive

-therapy is initiated and maintained by specialist

-drug requires administration by another individual due to significant side effects

What are prescriptions?

written, electronic, telephone, or verbal request for a patient medication in an outpatient setting

Which pharmacies receive prescriptions?

community and LTC

What are med orders?

written, electronic, telephone, or verbal request for a patient medication in an inpatient setting

Which pharmacies receive med orders?

acute care and LTC

What is a closed formulary?

list of medications, developed by a P&T committee, available at a hospital, nursing home, etc which is made up of a small selection of drugs in any given therapeutic category

Which pharmacies have closed formularies?

acute and LTC

What is a computerized prescriber order entry (CPOE)?

an application that allows health care providers to directly enter med orders electronically for patients in an inpatient setting, replaying the more traditional order methods of paper, verbal, telephone, and fax

What is a clinical decision support system?

any system designed to directly aid in clinical decision making, in which characteristics of individual patients are matched to a knowledge base for the purpose of generating patient-specific assessments

What is an Electronic Health Record (EHR)?

an electronic version of a patient's medical history, that is maintained by the provider over time, and may include all the key administrative clinical data relevant to that person's care

Which pharmacies have EHR's?

acute and LTC

What is a medication profile?

community pharmacies only have access to patients' medication profiles maintained by the dispensing pharmacies

What is a prospective drug utilization review (DUR)?

involves a pharmacist evaluating a patient's planned drug therapy before a medication is dispensed

Which pharmacies do DURs?

All

Which pharmacy does unit dose packaging?

acute care

What are the requirements for unit dose packaging?

-nonproprietary name

-dosage form

-strength

-strength of dose and total contents delivered

-special notes

-controlled substance class

-manufacturer/lot #

-expiration date

What are the expiration date requirements for unit dose packaging?

6 months or 25% of time remaining until expiration date assigned by manufacturer, whichever is less

Which pharmacies do multi-dose packaging?

community pharmacies and LTC

What are the labeling requirements for multi-dose packaging?

-name, address, phone of dispenser

-fill date

-Rx number

-Patient name

-Drug name

-strength

-quantity

-directions for use

-cautionary statements

-prescriber name

-beyond use date (usually 60 days!)

What are the community setting filling and packaging methods?

-manual filling

-automated pill counters

-automated vial-filling systems

What is manual filling?

counting tray

What are automated pill counters?

VIVID pill counter

What are automated vial-filling systems?

machines designed to automate pharmacy tasks

What are acute care filling and packaging methods?

automated pharmacy storage systems

What are automated pharmacy storage systems?

talyst auto-carousel

boxpicker automated pharmacy storage system

What are LTC filling and packaging methods?

automated packaging systems

What are automated packing systems?

-unit-dose packaging

-strip or pouch packaging

-bubble cards or punch card packaging

What filling and packaging method happens in all three pharmacy settings?

bar code scanning

What is bar code scanning?

method of verifying correct medication is being filled/packaged/administered

Where are automated dispensing cabinets located in the pharmacy?

decentralized (on units or floor)

What is special about automated dispensing cabinets?

bypasses label printing/filling/checking in central pharmacy

What are automated dispensing cabinets (ADCs)?

decentralized medication-distribution systems provide computer-controlled storage dispensing, and tracking of drugs at the point of care in patient-care units

Who verifies the 5 rights?

-looking at actual products/supplies "staged" by technicians

-looking at images taken by technicians or machine

What is patient/caregiver pick-up?

patient counseling/education

What are pneumatic tube systems?

delivery system between central pharmacy and hospital units, floors, surgical rooms, etc

What pharmacies use delivery people?

Acute care and LTC

What is a med room/storage area?

located in each units of a facility for storage of medications

Which pharmacies do self-administration or caregiver administration?

LTC and acute care

What is Mar/eMAR? (medication administration record)

document that serves as a legal record of the drugs administered to a patient at a facility by a health care professional

What is bedside bar code scanning?

method of verifying correct medication is being administered

What is the system responsible for producing and delivering a product or service?

-procurement

-suppliers

-manufacturing

-distribution

-consumer

what is a supply chain overview?

transformation of natural or synthetic resources into a finished product

What are regulating bodies monitoring ?

-safety

-quality

-quantity

-market flow

-pricing

What is the regulating body over drug related issues in the US?

USFDA

What are potential risks of poor supply chain management?

-substandard

-falsified

-patient safety

-distribution

-inventory expiration

-demand

-operational risk

-competition

-theft

-liability

-outsourcing

What percent of online drug sellers operate illegaly?

95%

What are the three steps of the management process?

1. risk assessment

2. risk control

3. risk review

What is risk assessment?

identify and document potential risk

What is risk control?

eliminating potential threats

What is risk review?

review attempted elimination of threat and assess quality risk management process. mitigate strategic risk