Volume 3 ALL Units

Explain the purpose of a budget.

A budget is a detailed plan for the acquisition and use of financial resources over a specified time period

What are the responsibilities of the pharmacy cost center manager?

To monitor pharmacy expenditures and maintain data used in preparation of the pharmacy budget.

What types of data need to be collected from the RMO and Medical Logistics before you can prepare the pharmacy budget?

Historical cost and workload data for use in projecting future pharmacy expenditures; Medical Logistics provides reports regarding what was purchased and what quantities were purchased.

List the considerations that must be included in budget preparations

Medication, equipment, maintenance contract renewals, personnel contracts renewals, the reference library, TDYs, rental contracts, and non-medical supplies.

Why is the pharmacy allocated funds in quarterly allotments?

To prevent excessive overspending.

How can pharmacy leadership correct under-execution of the pharmacy budget?

Consider potential formulary additions, reducing restrictions on medication dispensing, or possibly ordering extra supplies on upcoming seasonal medications.

To what purpose do property management responsibilities limit the use of government property?

Official.

what is public property?

Everything owned by the US government.

who has responsibility for public property?

Government employees, both military and civilian

Under what circumstances will MEMO take action to transfer a custodian’s property or have it assigned to an authorized successor?

Before a property custodian is relieved from duty, transferred, separated from service or absent from the account in excess of a 45-day period.

What list does the MEMO give to a newly appointed custodian when custodial responsibility is to be assumed?

Custody receipt/location list.

what document should you fill out for equipment that is on loan?

AF Form 1297, Temporary Issue Receipt.

why should property custodians retain AF Form 601 on items they have turned in until the item is removed from their account’s custody receipt/locator list?

It can provide proof the item has been turned in, thus relieving the custodian from liability.

List three reasons you should contact your BMET shop when a piece of pharmacy equipment is in need of repair, maintenance, or calibration

(1) BMET can determine if the equipment is under contract or warranty.

(2) If you contact the company for services yourself, you could also be held responsible for obligating the government.

(3) Failure to notify BMET may result in a loss of replacement equipment when the time comes for replacement. When the piece of equipment needs to be replaced because it can no longer be repaired, there is no record for justification.

what is pecuniary liability?

A monetary obligation

List four general purposes of a ROS

(1) Research and investigate.

(2) Assess monetary liability.

(3) Provide documentation to support adjustments.

(4) Provide commanders with case histories for corrective action.

what agency initiates a ROS when property is lost, damaged, or destroyed by an individual or an organization?

The organization that has possession of the property.

what are the requirements for the appointment of a ROS investigation officer?

Must be “disinterested” and have no interest in the custodianship, care, accountability, or safekeeping of the property.

What agency reviews the ROS if financial responsibility is assessed against an individual?

Legal office.

when should DD Form 1131 by used?

When individuals admit liability, and want to make a cash payment.

When should DD Form 362 be used?

When individuals admit liability for damaged or lost property and want to pay, but don’t have enough money to pay cash.

List the documents that determine your facility’s local formulary.

The DOD’s UF, the BCF, and the ECF

How does the DOD’s P&T function determine drugs to be selected for inclusion on the UF?

It evaluates clinical and cost effectiveness of drugs in a therapeutic class

What criteria must a drug meet to be listed on the BCF?

The drug is classified as formulary or generic on the UF; the drug is in a therapeutic class that supports the scope of practice for Primary Care practices; the drug is determined to provide greater value than other UF drugs in that therapeutic class by the DOD P&T function’s determination of the relative clinical and cost effectiveness of the drug.

What type of drugs are contained in the ECF?

Drugs within therapeutic classes that support more specialized care than the drugs listed on the BCF.

List the reasons a beneficiary may choose not to use the MTF pharmacy for filling his or her prescriptions

(1) Distance from the MTF.

(2) Disabilities which make travel difficult.

(3) Familiarity with local civilian network pharmacy.

(4) Convenience of using TRICARE’S Home Delivery Program

(5) Other personal reasons.

Under what circumstances can a patient receive a non-formulary drug from the MTF even though, by law, MFTs are prohibited from carrying non-formulary drugs?

These prescriptions may be approved through the non-formulary special order process that validates the medical necessity for use of non-formulary drugs in lieu of drugs that are on the MTF formulary

As a member of the Armed Forces, what type of support does DMLSS provide for you?

Medical logistics

What does a prime vendor provide you with?

Next day delivery of brand specific medical supplies.

How does the prime vendor program benefit you as a customer?

It shortens the logistics pipeline and makes it more reliable

what are the two types of prime vendor contracts you may deal with as a logistics manager?

PVP and PVM.

Under what three exceptions are you not obligated to use PVP?

MILSPEC, emergency, or unavailability.

What two methods can you use to submit PV orders through DMLSS?

Online or off-line.

Within how many hours can you expect a PV to deliver an emergency order to you?

Six.

what type of order is for items you need delivered within 24 hours?

JIT.

what type of PV order is delivered directly to you as the customer?

DRS.

What form must you complete when ordering Schedule II narcotics from a PV?

DEA Form 222.

What report would the P&T function use to recommend that pharmaceuticals with low consumption rates be deleted from the formulary?

The Product Activity Report

Under what circumstances is the Using Activity Issue/Turn-In List signed?

When controlled drugs or equipment items are being received or turned in.

What monthly listing contains all issues, issue reversals, and turn-ins for a using activity?

Using Activity Issue/Turn-In Summary

What agency requires the supply custodian to maintain a list of all hazardous items issued to the pharmacy account?

The EPA.

What information does the Exception Report contain?

What items you will not be receiving from the PV the next day

When purchasing pharmaceuticals, pharmacies are directed to comply with all pharmaceutical contracts posted by which agency?

DLA-TS

What two reports do DLA and their customers use to monitor MTFs who are purchasing equivalent off contract pharmaceuticals instead of the mandatory contract item?

The National Contract Compliance Summary Report and the NCCR.

According to AFI 44–102, how often must NCCR results be reported to the P&T function?

Quarterly.

How often is a review of national contracts mandated by AFI 44–102?

Monthly.

List the steps involved in monitoring pharmaceutical contracts and ensuring compliance with those contracts.

(1) Monitor for new/changed product contracts on items contained on the MTF formulary reviewing the national contract list.

(2) Update the DMLSS system to reflect the specific NDC number for the product needed to be purchased.

(3) Run new product shelf tags for new/updated products.

(4) Ensure all satellite pharmacies update product information to reflect new contracts.

(5) Identify and track contracted products on manufacturer backorder status to ensure prompt return to contract products upon release.

(6) Continue periodic monitoring of pharmacy contracts to ensure continued compliance.

What must be conducted monthly in an effort to reduce pharmaceutical costs?

Price analysis of non-NCL items.

What information does the BPR include?

Total number of items and cost of items identified as candidates for change based on BPR pricing and estimate of potential savings for items purchased using the BPR recommendation.

How long is the BPR maintained?

Two years.

What type of medications are mandated by DOD in an effort to save money?

Generic

What does AFI 44–102 prohibit for civilian prescriptions?

Special purchase of brand-name drugs if not on formulary.

Why might your MTF be required to buy a brand-name product instead of its generic equivalent?

Brand-name product may be under national contract.

Who publishes quality assurance messages that notify customers about potential problems with medical supplies and equipment?

DODMMQC office.

What should you do when you have equipment that operates unsatisfactorily or a medication that causes unexpected ill effects?

Stop using the equipment or suspend dispensing of the medication, notify medical logistics, and initiate a materiel complaint.

What types of items are included in a Category I medical materiel complaint?

Supply or equipment items determined by use or a test to be harmful or defective to the extent that their use caused or may cause illness or death.

Who approves Category I medical materiel complaints, and to what office are these complaints referred?

MTF commander; Medical Logistics Office.

What types of items are included in a Category II medical materiel complaint?

Supply items suspected of being defective, deteriorated, or otherwise unsuitable for use.

What does the note code “D” mean?

That an item is subject to deterioration in 36 months or less.

What environmental conditions should be considered when storing items?

Proper temperature, ventilation, humidity, light, and sanitation.

If an item is to be stored in a cool place, what temperature range would that indicate?

Between 8 and 15°C (46 and 59°F).

What term describes storing items with shortest expiration dates in front of longer dated ones?

Stock rotation.

What AFI list procedures for handling drug product recalls?

AFI 41–209, Medical Logistics Support.

What information must be obtained about a drug that has been recalled?

Drug identification, including generic name, trade name, strength, dosage form, size, manufacturer, and lot number.

What CHCS report can help determine what patients may have received a recalled drug?

DUR

What restrictions do MTFs have when choosing a contractor for their return drugs program?

The facility is free to choose a contractor based on its needs.

After a facility chooses a contractor and signs a contract for its return drug program, how long is the facility committed to that contractor?

One year

In what monetary form do facilities receive rebates for their return drug program items?

PV credits

Any monetary value earned from the return drug program must be used within what time frame?

120 day

List the three main unauthorized actions CHCS users should avoid.

Probing, data scavenging, and penetration

Define probing.

Exercising system options to see what access the system allows, or what information can be obtained even though you do not need this information.

What CHCS function can detect if an unauthorized user has been looking at patient information?

24-hour audit trail.

What are three methods of cleaning a computer keyboard?

Using a soft cloth dampened with a manufacturer-recommended cleaning solution, vacuuming, or using air canisters.

What narcotics system menu function decreases the quantity of a controlled drug that was returned to the manufacturer because of a recall?

DECREMENT FROM CONTROLLED INVENTORY (DCI).

What narcotic system menu function logs an entry in the Activity Log of the issue file record, as well as the Controlled Transaction Audit Log, and increments the quantity back into the inventory?

CANCEL A VERIFIED ISSUE (CNV).

What narcotics system menu function assigns an issue number and generates a label for dispensing?

NEW ISSUE ENTRY (NEW).

After typing a prescription for a controlled drug in CHCS, what other action must be taken to decrement the vault inventory, and who normally performs this function?

COMPLETE RX TRANSACTION (CRT); the narcotics custodian.

What narcotics system menu function would you use to return a controlled prescription that was not picked up by the patient?

RETURN RX TRANSACTION (RRT).

Which report allows you to sort patient information by MEPRS code, drug, and patient?

Outpatient DUR

The stock issue movement report may be sorted by what two criteria?

Stock item or ward/clinic location.

Which report can assist you in determining your peak work hours for staffing?

HOURLY VOLUME REPORT (HVR)

Which report displays or prints a summary of all prescriptions that were filled or refilled for a specified date range?

OUTPATIENT SUMMARY REPORT (OSU).

The ADL can be accessed through which support menu operation?

BULK/CLINIC ISSUE MENU (BIM).

Which option is used to add a drug to a ward or clinic’s ADL that has been approved by the P&T function?

STOCK ITEM FILE MENU (SIF).

What are the two CHCS formulary maintenance classifications for drugs stocked by the MTF?

Formulary and nonformulary.

Which CHCS formulary menu option allows you to set minimum and maximum dosages for drugs based upon a patient’s age?

MIN/MAX DOSE PARAMETERS (MMP).

What information does the IV file maintenance menu contain?

IV room parameters are defined, and recipes are created.

Which CHCS NAR option allows you to add a new product to the controlled item file database or edit an existing one?

CREATE INVENTORY RECORD (CIR).

What does the narcotic site definition menu option of the CHCS narcotic system maintenance menu allow you to do, and what is the purpose of assigning a MEPRS code to the site?

To name and set up site parameters for the narcotic vault in which you are working; the code is used to report workload performance.

Which option is the control point for the drug warning system for the entire CHCS system and allows you to set the level of clinical screening performed by the system both at the physician order entry and in the pharmacy subsystems?

OUTPATIENT SITE PARAMETERS (SIT).

How often does CHCS perform an allergy screening?

Any time a prescription is entered into the system.

What is the difference between a medication allergy and medication intolerance?

Symptoms such as anaphylaxis, severe hives or itching, difficulty breathing, or chest tightness would be defined as allergies to medication; side effects can include headache, nausea, stomach upset, diarrhea, and drowsiness, which can become pronounced and impede the patient from normal functions.

What is a clinical screening, and when is one generated?

It is the result of CHCS conducting a quality check and finding a problem; a clinical screening is automatically conducted on each prescription that is entered into the system.

For what types of situations will CHCS generate a clinical screening warning?

Warnings can be generated by

(1) an interaction between two medications,

(2) a duplication of the same medication,

(3) an allergy to a medication,

(4) an overlap in the therapeutic class of medications, or

(5) an overdose in a certain medication.

What are the three types of prescriptions that can be verified?

POE, hardcopy, or refills.

What is the preferred method for entering prescriptions according to AFI 44–102?

POE

What is the first step to check in the prescription verification process?

Patient information

To what does “route of administration” refer?

How a medication is introduced into the body

How many times can a schedule II prescription be refilled?

None

What type of number does a civilian prescription need if it’s written for a controlled substance?

DEA