Week 1 - Hospital Stations

• Develop a prioritized problem list for a patient case

• Describe the workflow through inpatient pharmacy practice

• Recognize different technologies that can be found in hospital pharmacy practice

• Discuss advantages and disadvantages of hospital pharmacy technology as it relates to patient safety

Learning Objectives

• List problems in order of SEVERITY

• Problem #1 should be the MOST important issue (chief complaint, reason for admission,etc.)

• Problem #2 should be whatever is UNCONTROLLED (TDM, HTN,etc)

• Everything else can be in varying order if it’s controlled

Station 1 points - Prioritization of problem

• Med ordered by MD

• Pharmacist evals order and verifies

• Pharm tech fills med

• Pharmacist verifies product 

• Med transported to patient care area

• Nurse checks med before dispensing (barcode scan)

• Nurse admins medication to pt. 

• Pt. is monitored for ADRs

Inpatient pharmacy workflow steps

• Meds are dispensed in unit-dose packaging

• Products differ than community-IV

• 24 hour care for all patients

Inpatient workflow points about meds and products

• Tube

• Hand deliver

• unit staff pick up

• Pyxis

Ways that medication is transferred/transported in hospital?

in the EHR!
- EPIC, meditech, etc

Where do pharmacists evaluate and verify med orders?

• Advantages: reduce error, improve appropriate med use, more efficient than paper

• Disadvantages: ALERT FATIGUE, too much technology, communication issues

• Ways to alleviate alert fatigue: be conscientious about what alerts, try to eliminate unnecessary alerts, place limits on when an alert triggers

What Dr. H does!

Advantages and Disadvantages of Computer Prescriber order entry

• Automated Dispensing Cabinets: 

  • Advantages: efficiency, reduced delay in getting medication to patient, good for hand delivered meds

  • Disadvantages: RN may override med order, wrong meds can be stocked, accurate inventory counts

• Dispensing Robots: 

  • Still require pharmacist to check certain percentage of orders

  • Must be manually stocked

  • Robots have no clinical reasoning

Automated dispensing cabinets points/Robots

• Medication Management Systems: 

  • Medication carousels 

  • Houses inventory, reduces space, increases efficiency, reduces med errors

• Programmable Infusion Devices: 

  • Advantages: reduces med errors, helps RN in med admin

  • Disadvantages: malfunction, user error

Med Management systems and infusion devices points

• Parenteral 

• Rectal

• Nasogastric

• Orogastric

• Buccal 

• Sublingual 

• eye/ear

• Transdermal 

• Nasal 

• Inhalation

Alternative routes of administration of drugs

1. Flush tube w/ 30ml water

2. Draw med into syringe

3. Attach syringe to tube

4. Push plunger/Administer

5. Flush tube again

6. Consider if med can be crushed, capsule opened, alternative formulation, etc. 

Steps to administration of NG tube meds

• Infiltration: 

  • IV needle becomes dislodged from vein and seeps into tissue

  • Swelling, tenderness

• Extravasion: 

  • medication/IV solution is a vesicant

  • Chemical burns, blistering, tissue damage

  • Immediate attention needed 

infiltration of needle vs extravasation

<100 mL; >100 mL

Small volume IV bags are ____ while large volume are ____

preservatives

patient allergy

neonates/children

epidural and intrathecal

Multidose vials have ______, and should be avoided/not preferred in these populations: