PHAR 413: Hospital Pharmacy Practice Study Guide

What are the components of the medication use process?

Prescribing, Order Verification/Transcribing, Dispensing, Administering, Monitoring.

What is the first step in the medication use process and what does it involve?

Prescribing - Selecting medication based on patient assessment and sending the order to pharmacy.

What considerations should be made during the prescribing step?

Evaluate indication for treatment, consider treatment options, determine correct formulation/route, determine correct dose, write prescription to minimize confusion, and assess patient access to medication.

What activities are involved in the Order Verification/Transcribing step?

Assess order for proper dose and interactions, enter order into pharmacy computer, select product and location for fulfillment, and generate product label.

What is the purpose of the Dispensing step in the medication use process?

To obtain, verify, prepare, label, and dispense the correct medication.

What actions are taken during the Administering step?

Identify need for administration, procure drug, prep patient and drug, administer drug, and document encounter.

What are the key activities in the Monitoring step of the medication use process?

Identify monitoring parameters, place orders for monitoring, assess patient response, document outcomes, intervene as needed, and monitor adherence.

What parameters should be identified during the monitoring of medication?

Baseline levels and goal levels.

What is the significance of documenting the encounter during drug administration?

To ensure accurate records of medication administration and patient response.

What should be assessed when verifying an order in the pharmacy?

Proper dose, drug interactions, allergies, and contraindications.

What is the role of the prescriber in the medication use process?

To evaluate treatment indications, select appropriate medications, and write clear prescriptions.

What factors should be considered regarding patient access to medication during prescribing?

Insurance coverage, availability at the pharmacy, and affordability.

What does the dispensing process involve?

Obtaining the medication, verifying its correctness, preparing it, labeling, and dispensing it.

What types of drug administration routes are mentioned?

By mouth (PO) and parenteral injections (IM, ID, IV).

What is TPN and in what context is it mentioned?

Total Parenteral Nutrition, mentioned in the context of geriatric patients on feeding tubes.

What is the importance of monitoring adherence to medication?

To ensure patients are following their medication regimen and to intervene if nonadherence occurs.

What is the purpose of placing orders for monitoring?

To track the patient's response to medication and adjust treatment as necessary.

What landmark laws, regulations, and standards govern drug procurement?

This topic is mentioned but not detailed in the provided notes.

What is the role of the pharmacy computer in the medication use process?

To enter medication orders and assess appropriateness, addressing discrepancies.

What is the final step in the medication use process?

Monitoring the patient's response and adherence to the medication.

What is drug procurement in a hospital setting?

The requirement of ensuring an efficient supply of medications.

Why is drug procurement important?

It ensures patients receive appropriate and timely treatment.

Who is responsible for drug procurement in a hospital?

The Drug Procurement Officer.

What federal acts govern the procurement of controlled substances?

The Drug Supply Chain Security Act (DSCA) and Federal/State Controlled Substances Acts.

What is required to purchase CII medications?

A pharmacy must use a DEA Form 222, and it can only be ordered by a registrant or individual with Power of Attorney.

What is the Controlled Substances Ordering System (CSOS)?

An electronic system that allows purchasers to order CII medications without a paper DEA Form 222, requiring DEA registration.

What information must be included in orders for controlled substances?

Name of the drug, NDC, strength, package size, number of packages, number of lines completed, signature of authorized purchaser, DEA number, and issue date.

What does the Drug Supply Chain Security Act (DCSA) do?

It protects consumers against counterfeit, stolen, or contaminated drug products and enhances the FDA's ability to trace prescription drugs.

What are the responsibilities of pharmacists in the drug procurement process?

To ensure all medication orders are correct and verify that medications are going to the right patient, drug, dose, route, quantity, and location.

How do medications move from Central Pharmacy to other areas in the hospital?

They are processed in either a non-patient specific batch for restock or a patient-specific batch for individual patients.

What is the role of the pharmacy team in medication orders?

To ensure that there are enough drugs in stock and that the right medication reaches the right patient.

What are distributive functions in pharmacy?

Functions such as filling medication orders, delivering medications, controlled substance distribution, compounding, and maintaining technology.

What are clinical functions in pharmacy?

Functions including admission drug histories, rounds with healthcare teams, monitoring drug therapy, pharmacokinetic dosing, and providing drug information.

What is involved in medication reconciliation?

Conducting admission drug histories.

What is the purpose of rounds with the healthcare team?

To make proactive drug therapy recommendations for patients.

What does the pharmacist check before medications leave the pharmacy?

All medications to ensure accuracy.

What is the significance of reporting ADRs and medication errors?

To improve patient safety and medication management.

What is sterile compounding?

The preparation of medications in a sterile environment to prevent contamination.

What is nonsterile compounding?

The preparation of medications that do not require a sterile environment.

What is TPN in nutritional support?

Total Parenteral Nutrition, which involves writing orders for patients who cannot eat.

What is the role of pharmacists in emergencies like CPR and RRT?

To respond and participate in these critical situations.

What is the importance of drug therapy reevaluation?

To monitor and adjust medication regimens for appropriateness.

What is the process for assessing nonformulary drug requests?

Pharmacists evaluate and approve requests for medications not on the formulary.

What is the purpose of discharge reconciliation in medication management?

It is a component of medication reconciliation that ensures accurate medication lists are provided to patients upon discharge.

What are the key roles in distributive pharmacy services?

1. Check accuracy of all medications prior to dispensing. 2. Participate in the distribution of investigational drugs. 3. Ensure procurement of nonformulary medications as necessary. 4. Accurately and aseptically prepare medications for dispensing. 5. Ensure delivery of medications to the patient care area.

Name types of medication automation technologies.

1. Automated dispensing cabinets (ADCs) 2. Carousel 3. Pneumatic Tube system 4. Pill counter 5. Unit-dose packaging 6. Compounding system.

What documentation is required by the Illinois Automated Dispensing & Storage Systems Code?

Documentation must include the name and address of the pharmacy, manufacturer name and model, and QA policy and procedures.

What is a key regulation regarding the use of Automated Dispensing Cabinets (ADCs)?

ADCs can only be used when a prescription has been reviewed by a pharmacist, except for specific emergency use medications.

What security measures are required for medication automation technologies?

A security system must be in place to prevent unauthorized access and maintain HIPAA regulations.

How long must electronic records related to medication automation be maintained?

At least 5 years.

What is the responsibility of the pharmacist-in-charge (PIC) regarding ADCs?

The PIC is responsible for maintaining the accuracy of restocking ADCs.

What are the benefits of medication automation technologies?

1. Speed: Easier dispensing and time-saving. 2. Safety: More accurate than human processing. 3. Security: Access is restricted to authorized staff.

What role does the Joint Commission play in hospital accreditation?

It accredits healthcare organizations and programs based on standards set by the Centers for Medicare & Medicaid Services (CMS).

What was a significant milestone in the 'Journey to Zero Harm' in 1926?

The American College of Surgeons published the first hospital standards manual.

When was the Joint Commission (JC) formed?

In 1951.

What significant event related to the Joint Commission occurred in 1999-2000?

The IOM report was published, and the JCI published the first comprehensive international quality standards for hospitals.

What was established in 2002 related to patient safety?

The National Patient Safety Goals (PSG) were established, along with other patient safety programs and awards.

What organization was designated by the World Health Organization between 2005-2007?

The Joint Commission was designated as a World Health Organization.

What initiatives were targeted by the Center for Transforming Healthcare from 2008-2015?

Initiatives included Hand Hygiene, Safe Surgery, Hand-off Communications, and Preventing Falls.

What is the purpose of the Joint Commission's annual report regarding hospitals?

To show the number of JCI-accredited hospitals and recognize those driving quality improvement through electronic clinical quality measures.

How do accreditation standards affect hospital pharmacy practice?

They delegate specific roles to pharmacists, require annual evaluations of all drugs, and may overwhelm pharmacists with additional responsibilities.

What roles do pharmacists play in the Pharmacy and Therapeutics (P&T) committee?

Preparing medication monographs, conducting drug utilization reviews, and following through with formulary requests.

What are the National Patient Safety Goals (NPSG)?

Goals established to help accredited organizations address specific patient safety concerns and improve overall patient safety.

Who provides input for the National Patient Safety Goals?

Practitioners, provider organizations, purchasers, consumer groups, and other stakeholders.

What is the overall purpose of the NPSG?

To improve patient safety through close monitoring and identification of patient safety issues.

What is the format of NPSG goals?

They include a broad topic statement and elements of performance detailing what must be done to achieve the goals.

What is Goal 1 of the current NPSG?

Improve the accuracy of patient identification using two patient identifiers.

What is Goal 2 of the current NPSG?

Improve the effectiveness of communication among caregivers by reporting critical results of tests/diagnostics in a timely manner.

What is Goal 3 of the current NPSG?

Improve the safety of using medications by labeling all medications and containers.

What is Goal 6 of the current NPSG?

Reduce patient harm associated with clinical alarm systems by developing easy-to-use alarm systems.

What is Goal 7 of the current NPSG?

Reduce the risk of healthcare-associated infections (HAIs) by complying with CDC or WHO hand hygiene guidelines.

What is Goal 15 of the current NPSG?

The hospital identifies safety risks inherent in its patient population, including increasing suicide awareness and prevention.

How do pharmacy professionals contribute to the NPSG?

They serve as operational, clinical, and safety experts in the medication use and distribution process.

What is the rationale behind the safe medication use guideline?

To reduce adverse drug events (ADEs), ensure patient safety through barcoding, and safely dispense and administer medications.

What is the significance of formularies in hospital pharmacy practice?

Formularies are essential for managing medication availability and ensuring safe medication use.

What are some responsibilities of pharmacists related to medication policies?

Updating formularies, creating monographs, and updating medication policies.

How can accreditation standards overwhelm pharmacists?

By adding responsibilities beyond their initial job descriptions, such as extensive evaluations and bureaucratic tasks.

What is the role of pharmacists in institutional documents?

Pharmacists work on policies, guidelines, and protocols as medication experts.

What is the impact of the Joint Commission on hospital pharmacy practices?

It sets standards that influence the responsibilities and roles of pharmacists in patient care.

What is the importance of medication labeling according to the NPSG?

Labeling ensures that all medications and containers are clearly identified, especially those not being directly administered to patients.

What is the expected outcome of implementing the NPSG?

Improved patient safety and reduced risks associated with medication use and healthcare practices.

What are the three types of drug information resources?

Primary, Secondary, and Tertiary.

What is a Primary drug information resource?

Original thought or direct discovery, offering current data and detailed information but with a narrow scope and costly to obtain. Examples include clinical trials and case reports.

What are the advantages and disadvantages of Primary drug information resources?

Advantages: Current data, detailed. Disadvantages: Narrow scope, costly to obtain.

What is a Secondary drug information resource?

A searchable database that indexes primary literature, providing quick access and abstracts/citations, but may have costs and variable content coverage. Examples include PubMed and Google Scholar.

What are the advantages and disadvantages of Secondary drug information resources?

Advantages: Quick access, provides abstracts/citations. Disadvantages: Cost, ease of searches, content covered.

What is a Tertiary drug information resource?

Contains information gathered from primary and secondary literature, easy to use and readily accessible, but may lag in updates and have less depth. Examples include textbooks and review articles.

What are the advantages and disadvantages of Tertiary drug information resources?

Advantages: Easy to use, readily accessible. Disadvantages: Lag in updates, depth and breadth not as great.

What is the role of pharmacy in developing and abiding by clinical care guidelines?

Ensuring patient safety, proper medication use, and keeping up to date on prevalent medication use information.

How often should a periodic review of medication use information be organized?

Minimally every 3 years.

What is the purpose of Clinical Care Guidelines (CCGs)?

To assist practitioners in formulating healthcare decisions.

What do protocols in healthcare include?

Predetermined criteria defining appropriate care and treatment, allowing non-physicians to initiate orders.

What is Bar Code Medication Administration (BCMA)?

A general safety strategy used to ensure accurate medication administration.

What is the significance of Electronic Health Records (EHR) alerts?

They provide clinical decision support.

What is the pharmacist's responsibility regarding drug information questions?

To provide evidence-based information to advance patient care and answer drug information queries.

What types of questions do pharmacists address in drug information?

Patient-specific, academic, and population-based questions.

What is the importance of policy and procedures (P&P) in a hospital setting?

They establish the absolute standard of administrative practice required by law or regulatory standards.

What does the procedures section of a policy statement include?

The steps to follow to achieve compliance with the policy statement.

What is the purpose of drug pump libraries in medication administration?

To ensure safe and accurate delivery of medications.

What is the role of the pharmacist in maintaining educational resources?

Creating and maintaining the currency of print and online resources on optimal medication use and general health.