20 Questions Flashcards
(20 cards)
How do we prepare for a crisis
-Obtaining the “right” medications
-Having adequate staffing – are we stretched too thin?
-Budgeting – Drugs are expensive.
-Stockpiling – Not enough drugs to go around
-Backorders – Plan for tomorrow, today.
-“I get by with a little help from my friends.”
-Don’t “burn bridges”!
What is public health?
-An organized community effort.
* Aimed at the prevention of a disease.
* Promotion of good health.
* Rests upon the scientific core of epidemiology
Pharmacy Roles in Covid-19Vaccination Clinics
Just Know 5 from here:
- Procurement
- Logistics
- Maintaining integrity of supply chain
- Reconstitution
- Inoculations
- Recordkeeping
- DOH reporting
- Metrics
Safe medication use is an organizational priority which should include the following:
- A culture of safety that is built on a “just” culture
- An event reporting system
- An interdisciplinary medication safety team
- A continuous and ongoing evaluation process of all errors that can assess and reduce risks
ASHP defines a significant adverse drug reaction as anyunexpected, unintended, undesired or excessive response to adrug that :
- Requires discontinuing the drug.
- Requires changing the drug therapy.
- Requires modifying the dose.
- Necessitates admission to a hospital.
- Prolongs a stay in a healthcare facility
- Necessitates supportive treatment.
- Negatively affects prognosis.
- Results in temporary or permanent harm, disability or death.
Examples of Safety Strategies
- Employing barcode technologies
- Standardizing concentrations, diluents or container sizes
- Using commercially available products
- Utilizing auxiliary labels when appropriate
- Using SMART infusion pumps
- Employing evidence based standard order sets and protocols
Profile of a Diverter
- Very persuasive
- Quick to provide explanations- able to come up with clever and elaborate schemes
- Chaotic home/personal life
- Has or had legitimate prescription for the drug that is being diverted
- Works in an area where nursing staff often has increased autonomy
- Volunteers to pick up extra shifts or is always in early or staying late
- May have various practice issues like: charting errors, increased usage of controlled substances vs peers, frequently spills/wastes controlled substances, excessive use of automated dispensing cabinet override feature to remove controlled substances
Why divert?
- Self medicating for pain or health issue
- Supporting an addiction to illegal substances
- Inability to manage stress from work or personal life
- Attempt to resell drug on the black market
- Most common cause: exposure and ease of access
Harm to the Patient
*** Unintentional overdose and death
* Substandard care from an addicted and drug- diverting individual**
** Undue pain and/or anxiety
* Risk of transmission diseases
* Adulterated or contaminated drug
* Blood borne infections
* Sepsis
* Wound infection
Efforts to Prevent Diversion Management Level
- Staff education on signs and symptoms of a diverting individual, dangers and consequences associated with diversion
- Form a drug diversion committee
- Create a protocol for suspected diversion and next steps
- Reporting to law enforcement including DEA, respective professional board, Bureau of Narcotic Enforcement, and Department of Health when diversion is confirmed
- Multi person audits
- Random and unannounced drug screens
Diversion Examples
- Giving a patient part or none of the prescribed dose while documenting that the full dose was administered
- Falsifying patient records in order to steal the available drug supply
- Injecting themselves with the drug and refilling the container with water, saline or other substances
- Dispensing controlled substances in greater amounts than needed in order to pocket the left over medication
RED FLAG WARNINGS
-Coming to work when not scheduled
-Dispensing medication near or at end of shift
-Medicating patients not under their care or for patients even after they are discharged
-Ignoring patient medication management guidelines
-Either no or heavy wasting of drugs
-Holding waste until oncoming shift
Common Risk Points & Methods of Diversion
-Procurement
-Preparation & Dispensing
-Prescribing
-Administration
-Waste & Removal
Return, Waste and Disposal
- To minimize waste, CS are stocked in ready-to-use form as possible (e.g., avoiding the use of multi-dose vials) and in the lowest commercially available units for doses frequently prescribed for patients.
- Waste may include products expiring, products prepared for administration, but not administered to the patient (e.g., when a physician discontinues or patient refuses medication), and drug product remaining in transdermal delivery systems.
- The organization’s waste-handling practices should maintain chain of custody minimize risk of CS diversion.
- CS should be wasted immediately or as close to the time of administration as possible.
Strategies for handling LASA (Look-alike/Sound-alike)medications
- Using both brand and generic name when appropriate
- Using “tall man” lettering or different font
- Include indication for use on order
- Limit use of verbal orders
- Store drugs away from each other, using alerts on the product and in the storage area
Selection and ProcurementBest practices for decreasing risk errors
- Formulary assessment and management
- Standard concentrations
- Safety-alert monitoring
- Safe procurement
- Medication storage management
Examples of Pharmacy Technology
-Computerized Provider Order Entry (CPOE)
(CPOE refers to the process of providers entering and sending medication, laboratory, and radiology orders via an electronic application rather than paper, fax, or telephone.)
-Medication and Inventory Management
BD Pyxis Logistics and CII Safe
ADM (Pyxis/Omnicell)
Unit Dose Repackager
-Emergency Medicine Tray Management (MEDEX TraySafe)
-Simpifi 797 – IV Room management
-TempTrak – Continuous Temperature Monitoring
-Barcode Technology (i.e. Pyxis Inventory Management and KBMA)
-TheraDoc Reporting Tools
ADC Optimization
1)Decentralizing Inventory: (Goal of greater than 90%)
Increase utilization of ADC in patient care areas
Decrease % of Doses filled and sent from Central Pharmacy location
2) Vend to Fill Ratio: (Usual goal of Goal of 8 to 12 vends per fill)
Comparison of how many times a medication is pulled from Pyxis vs the number of times the pocket is filled. Lower ratio means that meds are refilled too often.
Establish processes that apply correct levels when loading new medications and adjusting medication min/max levels on items that are causing increase in refills
3) Stock Out Rate: (Goal of less than 1%)
Identifies the times does a pocket hit zero inventory
Goal is to maintain a low stock out rate with adequate medication stock levels in ADC and establish processes that drive decisions on correcting min/max levels.
Different Types of Drug Alerts in EHR
Drug – Drug – Medication combinations to avoid
Drug – Allergy – Medication can trigger allergic reaction in patient
Drug – Route – Specific route of administration inappropriate or harmful
Drug – Diagnosis – Medication inappropriate/contraindicated based on documented problem/diagnosis
Drug – Age – Medication Dose inappropriate/contraindicated based on age
Drug – Laboratory – Medication dose inappropriate/contraindicated based on lab values (i.e. renal function)
Drug Monitoring – Medication requires specific monitoring parameters to ensure proper usage
Drug Dose Range – specified dose exceeds safe range for single or daily dose.
Excessive Alerts – low-priority medication combinations that should not trigger decision support warnings
Pros/Cons of Barcode Technology
PROS
Improved operational efficacy
Through use of a barcode, manual verification is eliminated. (i.e. Pyxis Replenishments)
Enhanced dispensing accuracy
Barcode scanning allows for built-in quality checks, allowing for greater medication dispensing accuracy.
Decrease Medication Errors
Increased accuracy → minimize patient safety concerns and decreased medication errors
CONS
Barcodes may not be recognized by software and leads to overriding barcodes
Possibility for incidence of medication error
Relies on barcode scanning equipment to be functional (Equipment may sometimes break, leading to inability to scan medications)
