HCI Exam 2 Memorization

Medication Management Process Steps

1. Selection

2. Procurement

3. Storage

4. Ordering or Prescribing

5. Transcribing and Verifying

6. Dispensing and Delivering

7. Administering/Taking

8. Monitoring and Reporting

Medication Management Process

• conceptual framework for investigating medication activities to ensure proper use, avoid errors, and achieve desired outcomes

• address the expansion of health-system pharmacy services

Largest operating expenses for most pharmacies

Pharmaceuticals

Oversight from pharmacist needed in purchasing when

• drug substitutions

• reasonable stock determination

• controlled substances

• restricted distribution

• investigational drugs

• interactions w MSLs

Section 510 of Federal Food, Drug, and Cosmetic Act

• drug manufacturers must provide FDA with current list of all drugs manufactured/processed

• maintained in NDC directory

NDC required on

• prescription drug

• OTC

• insulin

NDC

• 10 digit, 3 segment

• labeler

• product

• package

• 4-4-2, 5-3-2, or 5-4-1

Written (non-control) Rx requirements

• name of prescriber

• name of drug

• strength of drug

• quantity of drug

• directions

• dated

• signed

Electronic (non-control) Rx requirements

• name of prescriber

• name of drug

• strength of drug

• quantity in numerical format

• directions

• dated

• electronic signature

CII Refill Laws

• no refills

• 1 year expiration

CIII-V Refill Laws

• 5 refills within 6 months

• expires after 6 months

• one time emergency refill (72H)

Non-control refill laws

• expire within 1 year

• up to 12 refills or PRN

Florida Negative Formulary

• Digitoxin

• Conjugated Estrogen

• Dicumarol

• Chlorpromazine (solid oral)

• Theophylline (controlled release)

• Pancrelipase (oral)

Legal Requirements for Label

• pharmacy name and address

• dispense date

• serial number (Rx number)

• patient name

  • animal: species, owner name

• prescriber name

• drug name

• directions for use

• expiration date

• controls only: warning + fill date

CII Transfer Law

• one transfer allowed

• document in writing

• maintain original and transfer Rx for 4 years

C3-5 Transfer Law

• may transfer one time between pharmacies but only if they have already been filled once at original pharmacy

• can transfer e prescriptions

• document in writing

• original and transfer Rx maintained for four years

Direct Purchasing advantage

lower handling fees

Procurement Cost

cost of shipping, receiving, stocking, and bookkeeping of inventory

Carrying costs

• costs inherent in product, often difficult to quantify

• storage cost

• expired products

• insurance

• opportunity costs

Min/Max/Par

• most used for ordering inventory

• Par: periodic automatic replacement

  • min and max quantity limits for each item

• based on services, patient pop, utilization data

Economic Ordering Quantity

• point at which carrying costs = ordering costs

• ensures right amount of inventory ordered per batch

ROP formula

Reorder point = (average daily use rate)(lead time) + safety stock

ITR

• inventory turnover rate

• measures how fast inventory moves

• optimal, individualized for each drug

• to increase, purchase lower quantity more often

• ideal: 8-12 times/year

ITR formula

ITR = (total cost of goods)/(average inventory value)

Perpetual method

track dispensation or sale of products in real time through point-of-sale or inventory management systems

Legally Required Environmental controls

• temperature

• humidity

• air pressure

Legal Requirements from Controlled Rx

• quantity in textual and numeric format

• dated in numerical format

• counterfeit-proof Rx pad

• patient name

• patient address

• prescriber name

• prescriber address

• prescriber DEA

• prescription number

• pharmacist initials

• date filled

• drug name

• drug strength

• directions

• signature

CIII laws

• cannot dispense more than 30 day supply

• expires after 6 months

DAW 0

no product selection indicated

DAW 1

Substitution not allowed by Prescriber

DAW 2

Patient requested brand name

DAW 3

pharmacist selected brand name

DAW 4

generic not in stock

DAW 5

brand dispensed as generic

DAW 6

override

DAW 7

brand mandated by law (negative formulary)

DAW 8

generic drug not available in marketplace

DAW9

brand required by prescription drug plan

Dispensing legal definition includes

• transfer of possession

• clinical review/final verification

• prescription counseling

Dispensing does NOT include

• point of sale

• delivery

• administration

Benefits of automation

• reduce error

• improved use of space and workflow

• improved stock control and management

• free up time to focus on value-based care functions

7 rights of medication admin

• patient

• drug

• dose

• route

• time

• indication

• documentation

Educator

educate patients and their families about the benefits of vaccines

Facilitator

providing a convenient and accessible location for patients to receive vaccines.

Administrator

give vaccine

MTM

• distinct service, or group of services, that optimizes therapeutic outcomes for individual patients

• independent of, but can occur in conjunction with, provision of a medication

99605

first time MTM consult

99606

follow up MTM consult

99607

additional 15 min of consult

Vaccine documentation requirements

• date of admin

• vaccine manufacturer

• vaccine lot number

• name and title of person who administered

• address of where record is

• date printed on VIS

• date VIS given

Retail Pharmacy Sectors

• retail chains

• regional pharmacies

• independent pharmacies

• mail-order/online pharmacies

Retail sector with highest annual Rx revenue

Mail order/online

Retail sector with highest annual total Rx

retail chains

Key factors in selecting pharmacy

• insurance coverage

• distance

Retail chain key strength

geographical scale and resources

Regional pharmacies key strength

integration into customer’s daily life

independent pharmacies

personalized care, timely response

Mail order/on-line pharmacies

speed, convenience, cost

Pharmaceutical Care Model

patient focused

Clinical pharmacy model

quality of care focused

Drug distribution model

medication order focused

Core product

consumer defined

Expected product

situation specific

Augmented product

anything provided beyond what consumer expects

Total Product Concept

value pharmacists provide is not physical drug; exists mainly in services that accompany physical drug

Value-added service

services that accompany tangible product and add value

Pure services

services that need no tangible product to provide value to customers

Symbolic solutions

• provide personal connection

• belonging to something bigger

• with like-minded people

• seeking a transcendent life

Pharmacy Operations

the processes by which resources (people, capital, and materials) are combined to produce goods and services consumed by the public

Pharmacy Services

actions to optimize the process of care, with the aim to improve health outcomes and the value of healthcare

Pharmacy Operations Management

creation, planning, and management of resource capabilities used by a firm to create products or services

Stages to developing plan for new services

1. complete assessment of current services

2. conduct research

3. development of the services

4. implementation and assessment of new services

SWOT analysis

• Strengths: internal, positive

• Weaknesses: internal, negative

• Opportunities: external, positive

• Threats: external, negative

Change in Prescription Department Manager Notification Time Limit

Notify board of pharmacy within 10 days

Closing of pharmacy notification time

notify board of pharmacy ahead of closure, complete requirements within 10 days after closing

DEA Registration

• DEA form 224

• must have board of pharmacy permit before applying for DEA

Employers required to provide fraud, awste, and abuse training within

90 days of hiring

annually after

340b

requires 25-50% discount to covered entities

Pre-purchased inventory model

• the covered entity’s 340B purchased drugs are kept in stock at the contract pharmacy

• when filling other rx, the contract pharmacy uses its own non-340b purchased drugs

Replenishment inventory model

• no 340b purchased drugs are kept in stock at the contract pharmacy

• replaces stock with 340b price

Chronic Health Conditions Covered by Collaborative Pharmacy Practice Agreement

• hyperlipidemia

• hypertension

• anti-coagulation

• nicotine dependence

• opioid use disorder

• hepatitis C

• arthritis

• asthma

• COPD

• pulmonary disease

• type 2 diabetes

• HIV/AIDS

• obesity

Test and Treat conditions

• influenza

• streptococcus

• lice

• skin conditions (ringworm, athlete’s foot)

• minor, uncomplicated infections

Immunization records must be maintained for

5 years

Medicaid

medical assistance program that provides access to health care for low-income families/individuals and assists elders and disabled people with the cost of nursing home care and other expenses

Medicare provides insurance for

• over 65

• disabilities

• end stage renal disease (require dialysis or transplant)

Medicare Part A

inpatient hospital stays, skilled nursing care, some home health, hospice

Medicare Part B

doctor visits, lab tests, medical equipment, outpatient medical services, some preventative care

Medicare part c

privately-administered alternative to parts a/b (original medicare)

medicare advantage plans

Medicare part D

prescription drug coverage

Medicare DME criteria

• usable for 3+ years

• medical purpose

• used at home

Medicaid DME criteria

• usable for 3+ years

• medical purpose

• home and community use

DME standard elements

• required elements of a standard written order/prescription

• master list of items requiring face to face encounter (within previous 6 months) and written order prior to delivery)

• master list of items requiring PA prior to delivery

Compounding

• preparation of customized meds on prescription basis

• meets unique physician and patient need

• medications not commercially available

• preparations often made from scratch

Interpreter

person specially trained to convert oral messages from one language to another

Translator

person specially trained to convert written text from one language to another

CMR

complete medication review

CMS

center for medicare and medicaid

DTP

drug therapy program

MAP

Medication action plan

MMA

medication modernization act 2003