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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
Note 
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