Longtudinal 4 Midterm

pharmacy must be under the supervision of licensed pharmacist

-notify board within _ ___ of change in supervising pharmacist

- may not supervise more than 1 pharmacy at the same time

10 days

T/F: federally qualified health care centers can fill non controlled substance prescriptions at one location and deliver them to clinics for pt pick up

T

licensed health care facility

hopsital

a federally qualified health center

institutional pharmacy

physical portion of a licensed healthcare facility is engaged in the compounding, dispensing, and distribution of drugs, devices, and other materials and the provision of services used in the prevention, diagnosis, and treatment of injury, illness, and disease and is registered with ALBOP

managing pharmacy

responsible for supplying prescribed medications for pt in a licensed healthcare facility

the safe operation of any automated dispensing unit used in the facility

must hold current pharmacy permit with ALBOP

MAY BE: pharmacy located in AL, but not within licensed healthcare facility; institutional pharmacy operating as department of licensed healthcare facility

automated dispensing unit

an electromechanical system that performs operations or activities related to the storage and dispensing of medications

can collect, control, and maintain transaction info and records

considered an extension of managing pharmacy

stat medicine cabinet

a enclosure that consists of non controlled drugs needed to effectively manage a patients drug regimen

these meds are not available from any other authorized source in sufficient time to prevent risk of harm to patients

emergency kit

kit consisting of drugs (controlled as well) which are needed to effectively manage a critical care incident or need of a patient

emergency dispensing

prescribing/providing necessary meds to patients being treated by institutional facilities within facility itself or to be taken with the patient upon discharge

positive identification

method by which access to meds and info contained in a ADU in licensed health care facility is limited to only authorized individuals

includes use of user specific password with user specific personal identifier such as fingerprint, personal ID badge, retinal pattern or other unique identifier

1 pharmacist: 4 techs

at least ___ tech must be certified by credentialing organization

two

1 pharmacist: 3 techs

at least ___ tech must be certified

one

___ ____ must establish written procedure for:

-safe and efficient distribution or drugs

-provision of institutional pharmacy services

-recall process for all drugs included on a med recall are returned to pharmacy for proper disposal

supervising pharmacist

drugs __ be admin unless they are precisely identified

admin still requires practitioners order

any drug not to be admin must be given to adult member of patients immediate family for removal from facility

cannot

investigational drugs

inpatient

must be stored in and dispensed from the pharmacy only

complete information on all investigational drugs stored or dispensed must be maintained in the pharmacy

managing pharmacies must obtain approval from ALBOP to use ADU

ALBOP must be notified ___ ___ prior to use

30 days

ADU requirements

supervising pharmacist responsible

pharmacist must always have access

access to drugs and info secured with positive identification

meds for ADU not yet inside ADU stored in secure manner

meds determined by the pharmacy, the facilitys medical director, and nursing leadership

how often must a on site physical inventory of a ADU be conducted

quarterly (every 3 months)

can access ADU

licensed nurses

licensed pharmacists

registered pharmacy techs

respiratory therapists

other healthcare professionals approved by the supervising pharmacist or medical staff

authorized field service personnel

how often are meds for stat cabinet reviewed by pharmacist

annually

stat records must show

amount of med received

name of pt and amount used

prescribing physician

time of med admin

name of individual removing and using med

balance of med in hand

how often should stat cabinet be inspected

monthly

only ___ drugs available for stat cabinet

prepackaged

when stat cabinet accessed, ___ ___ or authorized practitioner and proofs of use are provided

written orders

emergency access to pharmacy

when a drug is not available from floor supplies or cabinet and the drug is required to treat immediate needs of pt whose health would otherwise be jeopardize

only ONE nurse or physician on shift is given access

there must be a prescriber order to remove

emergency kit requirements

list of contents at institution and pharmacy supplying drugs

meds sealed by pharmacist

pharmacist and med staff determine contents

securely stored

each kit labeled

each kit must contain: list of drugs, expiration dates, name, address, # pharmacist

drugs only removed with valid order

notify pharmacist if kit used and reseal in 72 hours

use earliest expiration date of any of the drugs

how long must the course be for parenteral sterile therapy

-didactic and hands on

-high risk requires additional 4 hours

8 hours

parenteral sterile therapy requires __ __ ___ every renewal cycle

2 CE hours

hopsital labels requirements

drug name and strength

directions for proper storage, handling, use, safety

-hospitals not required to include prescriber directions for use

____ ____ not required on:

-individual unit dose units

-floor stock meds which is controlled with proof of sheets

institution name

T/F: hospitals can repackage OTC drugs for own use within facility

T

technical equipment: each pharmacy must have?

-latest edition of facts and comparisons

-hot and cold water in the Rx area

-equipment consistent with the level and type of practice

pharmacists requirements in compounding

verify all rx

approve or reject all components of compounded product, container, closures, labeling

review compounding records

check and recheck operations

maintain cleanliness

oversee personnel

consultant pharmacists

require separate registration

register initially and biennially on even # years

requires initial 10 hour cert and exam with passing score of 75

requires ≥12 live CE hours every 2 years

drug regimen review in LTCs

each resident must be reviewed at least once a month by licensed pharmacist

90 days

PRN meds should be destroyed after _ __ if they have not been used in that period of time

what type of drug needs a third witness to destruction

controls

how long should you maintain record of destruction

2 years

Needed by pharmacy to dispense controlled substances

form 224

report of theft or loss of controlled substances

dea form 106

control 2 inventory

exact count

when do you need an exact count of C III-V

>1000

Order form for CI and CII substances. Must be kept for 2 years.

dea form 222

identifying the area of improvement, making necessary changes, analyzing results, and determining additional changes to make

process improvement

monitor degree to which plan is implemented as deired

process indicator

outcome indicator

specific change in state of service recipient that service is designed to address

change

a relational difference between states; esp btwn states before and after some event

organization

group of individuals working to reach some common goal

organizational change

fundamental reorientation in the way an organization operates

system

group of events or actions in which no item, event, or actions occurs independently

group of independent things working together for a single structure or function

organizational pyramid

tasks, personnel, technology, resources, patients, culture, organizational structure, goals

planned change

changes in products and services, admin systems, organizational size and structure, intro of new tech, advances in info processing and communication

unplanned changes

changing in empolyee demographics

gov regulations

loss of critical personnel

lewvins change model

unfreeze

change

refreeze

unfreeze

creating motivation and readiness to change

-basic communication regarding change

-discussion of threats and opportunities

-use benchmarking data

change

adopting new POV or behavior

transition from old to new

change agent, management exhibits new roles, behaviors

refreeze

integration of the change

training follow up

use of new knowledge and skills

supportive HR practices

force field analysis

method for listing, discussing, and evaluating various forces for and against proposed change

helps look at big picture

driving and restraining forces

hidden traps

status quo

sunk cost

confirming evidence

competency

status quo trap

decision makers display strong bias toward alternatives that perpetuate the status quo

sunk cost trap

choices tainted by emotional investments you accumulate

dont equate loss and gain

make choices to justify past choices

confirming evidence trap

leads us to seek out information that supports our existing instinct or point of view while avoiding information that contradicts it

competency trap

- Occurs when favorable performance with an inferior procedure leads the organization to accumulate more experience with it, thus keeping experience with a superior procedure inadequate to make it rewarding to use.

• Organizations perform badly by applying yesterday's well -learned solutions to today's very different problems.

transcribing/verification technologies

order management systems

pharmacy info management systems

dispensing technologies

solid dosage form or sterile compounding robotics

workflow/inventory management systems

automates dispensing devices

tablet counters

bar code packagers

administering technologies

electronic medication administration records

bar code medication administration systems

smart pumps

accreditation

safe high quality care for pts

required to recieve payment from federally funded medicare and medicaid programs

professional and recognition and reputation

technically voluntary

CMS

establishes minimum health and safety standards that must be met by providers

long term care facilities must demonstrate compliance with requirements for participation

the joint commission

national acrediting organization established to continuously improve the safety and quality of health care provided to public through provision of health care accreditation and related services that support performance improvement in health care organizations

TJC standards

form the basis of the objective evaluation process

based on reported adverse events

developed with input from healthcare professionals and subject matter experts

contain elements of performance

medication management standards

selection and procurement

monitoring

ordering and transcribing

admin

storage

preparing and dispensing

TJC standard format

numbering

standard

rationale for standard

elements of performance

do not use list

U

IU

QD

trailing 0

lack of leading 0

MS

policy

broad general statement that describes the goals and purposes of a document

procedures

the step by step of how a policy should be implemented

policy writing

consistent with the institution mission culture, vision, strategy

no overlap or contradiction with other policies

clear concise simple language

should be capable of implementation

consider stakeholders feedback

easily accessible

procedure writing

developed with the user in mind

what needs to be done can be easily followed by all users

easily updateable and searcheable

list steps to follow in order to comply with policy

one action per step

gender neutral language

use role titles rather than specific names

formulary

a list of medications approved for use

system managed by pharmacy and therapeutics committee

pharmacy and therapeutics committee

oversees policies and procedures related to all aspects of medication use within an institution

recs policy to staff through medical executive comittee

meet every 1-2 months

P&T committee roles

maintain formulary system

evaluate drug therapy guidelines

select meds for formulary inclusion

sets utilization management criteria

eval med use and related outcomes

develop policies and procedures for handling meds

prevent and monitor ADRs and med errors

educate health professionals to optimal use of meds

therapeutic interchange

authorized exchange of therapeutic alternatives in accordance with previously establishes and approved written guidelines or protocols within formulary system

pharmacists can do w/o calling provider

MUE

method for evaluating and improving med use processes with the goal of optimal pt outcomes

med considered for review based on: use, safety, cost

drug monograph components

general info

indication

clinical pharmacology

PK

clinical efficacy

safety

dosing and admin

product availability

cost

overview of market

conclusions and recs

refs

TJC requirements for review

indication for use

clinical efficacy

safety

cost

AL pharmacy collaborative practice act

allows for eligible licensed pharmacist to enter into agreement with eligible licensed physician to allow the two providers to develop join pt care plans for pts under their join care

what pharmacists need a CPA

community setting

can pharmacists have CPAs with NP or PAs

no

quality assurance requirements

physician review and eval of pt care documentation to ensure that all parties are adhereing to collaborative care protocols to optimize pt outcomes and to identify continuous quality improvement needed

conducted on quarterly basis

does collaborative care need to be pursuant to a diagnosis

exception: immunizations, opioid antagonist, screening or testing

yes

provider status

legal recognition of healthcare professional who is eligible to provide direct pt care and obtain payment for these services through medicare part B

what are pharmacists providers under

med dispensing

MTM services

medicare part D

needs assessment

the systemic study of a problem or innovation, incorporating data and opinions from varied sources, in order to make effective decisions or recs about what should happen next

gap analysis

a needs assessment tool to identify specific deficiencies btwn current and desired state

reactive needs assessment

in response to less than desirable results

proactive needs assessment

to identify opportunities to improve

strategic scope

focuses on goals, objectives, and long term directions of entire organization

operational scope

focuses on attainment of individual and team results, daily operations

tactical scope

focus on short term operations

types of gaps

knowledge, skills, practice

gap analysis focus

outcomes column (impacts) and logic model

looks at data from your service to determine if current outcomes of service are at desired level or not