fipp 6 final

quality

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

quality/cost

value \=

safe, effective, patient centered, timely, efficient, equitable

NAM aims for healthcare quality

10%

about \____ of US citizens lack healthcare insurance

CAHPS

survey that asks questions about the quality of care that patients were receiving

administrative

planning should occur at the \____________ level

provider

implementation should occur at the \_____________ level

pharmacopeia

USP - united states \_______________

USP

drug reference that serves as a standard for pharmacy related topics

797

USP chapter that oversees sterile compounding

800

USP chapter overseeing hazardous drug handling

sterility

absence of viable microorganisms

sterilization

process or method by which all viable forms of microorganisms are removed or destroyed

pyrogen

fever-producing organic substance arising from microbial contamination

depyrogenation

destruction of pyrogens from a solution, usually in terms of injectable medications

compounded sterile preparation (CSP)

a compounded sterile parenteral dosage form that will be parenterally administered

compounding/storage conditions, microbial growth potential, BUD

sterile preps can be differentiated by what conditions?

immediate-use CSPs

sterile preparations that would put patient at risk due to delay in therapy - only used in emergencies

category 1

category of usp 797 - least controlled environment; BUD of less than 12 hours at RT or 24 hours in fridge

category 2

category of usp 797 - must be compounded in a clean room with ISO 5 or better; variable BUDs

category 3

category of usp 797 - requires sterility testing, higher requirements for personnel qualifications

contamination

microbial presence, excessive bacterial endotoxins, variability from the intended strength of correct ingredients, etc.

people

number 1 source of contamination

reconstitution

sterile compounding does not include...

6 months, 3 months

compounding personnel must be evaluated every \__________ initially for category 1 and 2 and every \_______________ for category 3

sterilized alcohol

you must use routine application of \_______________ throughout compounding

3

ISO class \__ is the "cleanest"

8

ISO class \__ is the "dirtiest"

7

per usp 800, the ante-area must be iso class...

primary engineering control

device or room that provides an ISO Class 5 environment for the
exposure of critical sites when compounding CSPs.

laminar airflow, hepa filters

PEC air quality is maintained by...

laminar airflow workbench

a type of hood, usually with a horizontal airflow, in which sterile products are prepared

standard operating procedure

every facility that participates in compounding must have its own \______________ for all aspects of compounding activities

master formulation record

form to document all activities and products used in the compounding process

expiration date

time during which a conventionally manufactured drug product may be expected to maintain its labeled identity, strength, quality, and purity, provided it is kept under the labeled storage conditions

beyond use date

date or date/hour after which the CSP must not be used, stored, or transported because its required characteristics cannot be ensured

quality assurance

set of written processes that at a minimum verifies, monitors, and reviews the adequacy of the compounding process

quality control

the observance of techniques and activities that demonstrate that requirements are met

3 years

personnel training, certifications, SOPs, laboratory equipment records, complaints, etc. must be kept for \__________

pyrex

type 1 glass containers are made of...

treated glass

type 2 glass containers are made of...

plasticizers

plastic containers contain \_______________ to improve softness/flexibility

stabilizers

plastic containers contain \________________ to prevent degradation due to heat or light

antioxidants

plastic containers contain \____________ to prevent oxidation and improve shelf life

sterile single-dose containers

container intended for parenteral, inhalation, irrigation, otic, or ophthalmic administration

sterile multi-dose containers

container that permits withdrawal of successive portions of their contents without changing the strength, quality, or purity of the remaining portions

preservative

sterile multi-dose containers always contain a...

dextrose solution

crystalloid, vehicle/fluid replacement solution

normal saline

0.9% sodium chloride; crystalloid vehicle w/ fluid replacement

ringers solution

Na, K, Ca, Cl similar to concentrations in blood; Lactated also includes lactate

ampule

type of single dose container, is a hermetically sealed glass container. when drawing solution out, a filter needle or straw must be used

over-the-needle catheter (INT)

single lumen catheter that is good for most iv fluids and medications but are not suited for home use

midline catheter

single or double lumen catheter that is inserted into a larger vein below the axillary line

picc line

single, double, or triple lumen catheter that is inserted into the peripheral venous system

long-term

picc lines are advantageous because they have \____________ iv access

trained personnel

picc lines can only be inserted by...

tunneled catheter

A catheter that is tunneled through the skin and subcutaneous tissue to a central vessel; the entrance point of the catheter is distant from the entrance to the vascular system.

central line

An IV catheter that is placed in a large vein, usually in the neck, chest, or groin

implantable port

intravenous access device that is completely under the skin, is placed in the vein on the upper chest wall, and exits the body near the xyphoid process, axilla, or abdominal wall

trissels

book about IV drug compatibility and stability

25 kcal/kg/day

tpn kcal goals

4 kcal

protein has \___________ per gram

3.4 kcal

dextrose has \______ per gram

10 kcal

lipids have \_________ per gram

30%

lipids generally comprise about \_______ of total kcal in 3 in 1 tpn

picc, central

iv TPN should be administered via a \_________ or \____________ line

emr

electronic record of an individual's health-related
information that can be created, gathered, managed, and consulted by authorized
clinicians and staff within one health care organization

ehr

inter-organizational system, aggregate all of the data being generated by individual EMRs

phr

systems used by patients

errors

emrs can cause a reduction in medical \___________

epic

most common hospital emrs

body temperature, heart rate, resp rate, bp

traditional vital signs

95.9-99.5

normal oral body temperature in F

97.9-100.1

normal temporal body temperature

60-100 bpm

normal heart rate

tachycardia

fast heart rate

bradycardia

slow heart rate

12-20 breaths per minute

normal respiratory rate

apnea

absence of breathing

dyspnea

difficulty breathing

orthopnea

difficulty breathing when lying down

hyperventilation

increased rate and depth of breathing

hypoventilation

decreased rate or depth of air movement into the lungs

130/80

goal bp for diagnosed htn

orthostasis

Low blood pressure from standing up from a sitting or lying down position

bmp

measures electrolytes, acid-base balance, kidney function, blood sugar; reported via fishbone diagram

fluid imbalance

abnormal sodium levels

diuretics, hyperglycemia

hyponatremia is commonly caused by...

insulin, diuretics

hypokalemia is commonly caused by...

calcium

hypokalemia can be treated with \_____________ supplementation

acid-base

chloride and bicarbonate have an \______________ balance

serum creatinine

standard lab for the detection of kidney disease

135-145 mEq/L

normal sodium levels

3.5-5.0 mEq/L

normal potassium levels

95-105 mEq/L

normal chloride levels

22-28 mEq/L

normal HCO3 values

hyperventilation

low bicarb is caused by...

hypoventilation

high bicarb is cause by...

0.6-1.2 mg/dL

normal creatinine range

blood urea nitrogen (BUN)

assesses renal function