Pharmacist Patient Care Services

Flashcards covering key concepts and definitions regarding pharmacist patient care services from the lecture notes.

What does medication assisted treatment include?

all medication used to treat a substance use disorder

What does a pharmacist need to provide medication-assisted treatment?

Appropriate education and training

What can a pharmacist access from a patient?

signs and symptoms of substance abuse disorder through patient interview, physical assessment, and laboratory findings

What should pharmacists develop?

a treatment plan for a patient’s substance use disorder

What should the pharmacist document in medication-assisted treatment?

shall document the assessment, clinical findings, plan of care, and medications dispensed and administered in a patient record system and share this information with a patient’s primary care provider or other prescriber, if one is identified

What is the SB 41: Pharmacy Benefit Manager (PBM) Regulation?

introduces reforms intended to increase transparency and lower prescription drug costs by targeting the business practices of PBMs

What are PBMs forbidden from profiting?

difference between what they charge health plans and what they pay pharmacies for a drug

Mandatory rebate pass-through

PBMs must pass 100% of rebates from drug manufacturers on to health plans and payers. This prevents PBMs from retaining rebates as hidden profits.

Licensing and fiduciary duty

PBMs must be licensed by the Department of Managed Health Care (DMHC) and are held to a fiduciary duty to act in the best interest of their health plan clients

Fairer pharmacy practices

PBMs are prohibited from steering patients to their own affiliated pharmacies. The law also includes protections against unfair reimbursement practices, such as retroactive claim reductions

When can a prescriber dispense a dangerous drug?

The hospital pharmacy is closed and there is no pharmacist available in the hospital, The dangerous drug is acquired by the hospital pharmacy,The dispensing information is recorded and provided to the pharmacy when the pharmacy reopens, The hospital pharmacy retains the dispensing information and, if the drug is a schedule II, schedule III, or schedule IV-controlled substance, reports the dispensing information to the Department of Justice pursuant to Section 11165 of the Health and Safety Code, The prescriber determines that it is in the best interest of the patient that a particular drug regimen be immediately commenced or continued, and the prescriber reasonably believes that a pharmacy located outside the hospital is not available and accessible at the time of dispensing to the patient, The quantity of drugs dispensed to any patient pursuant to this section are limited to that amount necessary to maintain uninterrupted therapy during the period when pharmacy services outside the hospital are not readily available or accessible, but shall not exceed a 72-hour supply, The prescriber shall ensure that the label on the drug contains all the information required by Section 4076

When can a prescriber dispense an unused portion of a dangerous drug acquired by the hospital pharmacy to an emergency room patient upon discharge?

The dangerous drug is not a controlled substance, has been ordered and administered to the emergency room patient, was administered from single patient use multidose packaging and can be self-administered by the patient, including, but not limited to, an inhaler, eye drop, ear drop, nose drop or spray, topical product, or liquid product, Dispensing the unused portion of the dangerous drug is required to continue treatment of the emergency room patient, The prescriber shall ensure that the label on the drug contains all of the information required by Section 4076, The prescriber shall be responsible for any error or omission related to the drugs dispensed

What is Section B&P 4427.2 is amended to read?

An ADDS installed, leased, owned, or operated in California shall be licensed by the board, An ADDS license shall only be issued to the holder of a current, valid, and active pharmacy license of a pharmacy located and licensed in California, A separate application and license shall be required for each ADDS, An ADDS license shall only be issued when the following conditions are met

automated drug delivery system

a mechanical system that performs operations or activities, other than compounding or administration, relative to the storage, dispensing, or distribution of drugs. An ADDS shall collect, control, and maintain all transaction information to accurately track the movement of drugs into and out of the system for security, accuracy, and accountability

automated unit dose system

an ADDS for storage and retrieval of unit doses of drugs for administration to patients by persons authorized to perform these functions

automated patient dispensing system

an ADDS for storage and dispensing of prescribed drugs directly to patients pursuant to prior authorization by a pharmacist

Chart Order

entered on the chart or medical record of a patient registered in a hospital or a patient under emergency treatment in the hospital, by or on the order of a practitioner authorized by law to prescribe drugs, shall be authorization for the administration of the drug from hospital floor or ward stocks furnished by the hospital pharmacy or under licensure granted under Section 4056, and shall be considered to be a prescription if the medication is to be furnished directly to the patient by the hospital pharmacy or another pharmacy furnishing prescribed drugs for hospital patients; provided that the chart or medical record of the patient contains all of the information required by Sections 4040 and 4070 and the order is signed by the practitioner authorized by law to prescribe drugs, if he or she is present when the drugs are given. If he or she is not present when the drugs are given, the order shall be signed either by the attending physician responsible for the patient's care at the time the drugs are given to the patient or by the practitioner who ordered the drugs for the patient on the practitioner's next visit to the hospital

licensed health care facility

a facility licensed pursuant to Article 1 (commencing with Section 1250) of Chapter 2 of Division 2 of the Health and Safety Code or a facility, as defined in Section 1250 of the Health and Safety Code, operated by a health care service plan licensed pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code

health care facility

a facility, other than a facility licensed under Division 2 (commencing with Section 1200) of the Health and Safety Code, that is owned or operated by a health care service plan licensed pursuant to Chapter 2.2 (commencing with Section 1340) of the Health and Safety Code, or by an organization under common ownership or control of the health care service plan; "licensed home health agency" means a private or public organization licensed by the State Department of Public Health pursuant to Chapter 8 (commencing with Section 1725) of Division 2 of the Health and Safety Code, as further defined in Section 1727 of the Health and Safety Code; and "licensed clinic" means a clinic licensed pursuant to Article 1 (commencing with Section 1200) of Chapter 1 of Division 2 of the Health and Safety Code

Licensed health care facility

means a health facility licensed pursuant to Article 1 (commencing with Section 1250) of Chapter 2 of Division 2 of the Health and Safety Code or a facility that is owned or operated by a health care service plan licensed pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and 41 Safety Code or by an organization under common ownership or control with the health care service plan

Licensed Hospital

means an institution, place, building, or agency that maintains and operates organized facilities for one or more persons for the diagnosis, care, and treatment of human illnesses to which persons may be admitted for overnight stay, and includes any institution classified under regulations issued by the State Department of Public Health as a general or specialized hospital, as a maternity hospital, or as a tuberculosis hospital, but does not include a sanitarium, rest home, a nursing or convalescent home, a maternity home, or an institution for treating alcoholics

Hospital Pharmacy

includes a pharmacy, licensed by the board, located within any licensed hospital, institution,or establishment that maintains and operates organized facilities for the diagnosis, care, and treatment of human illnesses to which persons may be admitted for overnight stay and that meets all of the requirements of this chapter and the rules and regulations of the board.

What does a pharmacy have secure and provisions for?

effective control against the theft of dangerous drugs and devices

What procedures does the pharmacy have to protect public?

when a licensed individual employed by or with the pharmacy is discovered or known to be chemically, mentally, or physically impaired to the extent it affects their ability to practice the profession or occupation authorized by their license, or is discovered or known to have engaged in the theft, diversion, or self-use of dangerous drugs

What must a pharmacy have?

maintains a supply of medications which are accessible without entering the pharmacy during hours when the pharmacy is closed, and the pharmacist is not available. Access is limited to designated registered nurses,  is of sufficient size and has an unobstructed area to accommodate the safe practice of pharmacy, premises, fixtures, and equipment are maintained in a clean and orderly condition, The pharmacy sink has hot and cold running water, The pharmacy has a readily accessible restroom, The original board-issued pharmacy license and the current renewal are posted where they may be clearly read by the purchasing public

Nursing Stations

Adequate space is available at ward or nursing station for the storage of drugs and preparation of medication doses. All such spaces and areas can be locked and are accessible to authorized personnel only

What must a member of the pharmacy do every month?

monthly inspections of all floor stock and drugs maintained in nursing  stations

What happens if there is any irregularities?

An intern pharmacist shall report any irregularities to the pharmacist, Any irregularities discovered by a pharmacy technician shall be reported to the pharmacist-in-charge and to the director or chief executive officer of the health care facility within 24 hours

Delivery of Drugs

Delivery to the pharmacy of dangerous drugs and dangerous devices are only delivered to the licensed premise and signed for and received by a pharmacist

How are deliveries to pharmacy in a hospital made?

made to a central receiving location within the hospital. However, the dangerous drugs or dangerous devices shall be delivered to the licensed pharmacy premise within one working day following receipt by the hospital, and the pharmacist on duty at that time shall immediately inventory the drugs or devices

When can a pharmacy take delivery of dangerous drugs?

The drugs are placed in a secure storage facility in the same building as the pharmacy, Only the pharmacist-in-charge or a pharmacist designated by the pharmacist- in-charge has access to the secure storage facility after dangerous drugs or dangerous devices have been delivered, The secure storage facility has a means of indicating whether it has been entered after dangerous drugs or dangerous devices have been delivered

What must the pharmacy provide for delivery of drugs?

transaction history, transaction information, and a transaction statement

Drug Stock

clean, orderly, properly stored, properly labeled and in-date

How are all ward/floor drug stock and drug supplies maintained?

for access when the pharmacist is not available are properly labeled and stored. Records of drugs taken from the drug stock or drug supplies must be maintained and the pharmacist must be notified

What is the pharmacist-in-charge

responsible for the daily operation of the pharmacy, has adequate authority to assure the pharmacy’s compliance with laws governing the operation of a pharmacy

Can a PIC be in charge of another pharmacy?

Yes within 50 driving miles of each other

When should a PIC change be notified to the board?

30 days

Duties of a Pharmacist

Receives a chart order for an inpatient, Identifies, evaluates and interprets the chart order, Reviews patient’s drug regimen and interprets the clinical data in the patient’s medication record, Consults with any prescriber, nurse or health care professional, Calculates drug doses, Supervises the packaging of drugs and checks the packaging procedures and products upon completion

Duties of a Pharmacist

a licensed health care facility who are performing the following functions are doing so in accordance with the hospital’s policies, procedures and protocols which have been developed by health professionals including physicians, pharmacists, and registered nurses, with the concurrence of the facility administrator

Duties of an Advanced Practice Pharmacist

Perform patient assessments, order and interpret drug therapy-related tests, and refer patients to other health care

providers, Participate in the evaluation and management of diseases and health conditions in collaboration with other health care

providers, Initiate, adjust or discontinue drug therapy and shall promptly transmit written notification to, or enter the appropriate

information into a patient record system shared with the patient’s primary care provider or diagnosing provider

Duties of an Intern Pharmacist

performing all the functions of a pharmacist only under the direct supervision of a pharmacist, and the pharmacist is supervising no more than two interns at any one time

Duties of a Pharmacy Technician

Registered pharmacy technicians are performing packaging, manipulative, repetitive, or other nondiscretionary tasks related to the furnishing of drugs, while assisting and under the direct supervision and control of a pharmacist. The pharmacist is responsible for the duties performed by the pharmacy technician

under the pharmacist’s supervision

Duties of Non-Licensed Personnel

permitted to type a prescription label or otherwise enter prescription

information into a computer record system, and at the direction of a pharmacist, may request and receive refill

authorization

Pharmaceutical Service Requirements

Basic information concerning investigational drugs and adverse drug reactions, Repackaging and compounding records, Physician orders, Wards, nursing stations and night stock medications,  Drugs brought into the facility by patients for storage or use, Bedside medications, Emergency drug supply

Medication/Chart Order

The pharmacy receives the original, the electronic transmission, or a copy of the medication order.

Faxed copies, tele-autograph copies, or transmissions between computers are permissible

Labeling and Distribution

Unit dose medication are properly labeled and include the information as required by

BPC 4076, or the information is otherwise readily available at the time of drug

administration

Duration of Drug Therapy

The hospital has policies limiting the duration of drug therapy in the absence of the prescriber’s specific indication of duration of drug therapy or under other circumstances recommended by the pharmacy and therapeutics committee or its equivalent and approved by the executive committee of the medical staff. Limitations are established for classes of drugs and/or individual drug entities