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Pharmacy Practice > Exam 1 Powerpoints > Flashcards

Exam 1 Powerpoints Flashcards

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1
Q

OBRA 90

A

Law passed to ensure safe medication use for Medicaid patients

Requires pharmacist to offer counseling

Provided in one-way, provider-centered manner

Time-consuming process

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2
Q

New Script Prime questions

A

What did provider tell you this medication is for?

How did provider tell you to take this medication?

What did provider tell you to expect?

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3
Q

Refill Prime questions

A

What are you taking med for?

How are you taking it?

What kind of side effects are you having?

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4
Q

Questions to avoid

A

Leading and Double-barreled

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5
Q

Benefit of Open-ended questions

A

Encourages more insightful response

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6
Q

Leading question

A

Question suggests the preferred response…

ex. You don’t miss any doses of your meds do you?

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7
Q

Double-barreled question

A

Compound question….

Ex. Do you take herbal products AND supplements?

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8
Q

Patient counsel

Intro

A

Introduce self
Ask who med for
Purpose and length of counsel
Get patient consent

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9
Q

Patient counsel

Verify info

A

Name, Address, D.O.B, Med allergies, current med diagnosis, other prescription meds, OTC/herbal/vitamin,/supplements?

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10
Q

Patient counsel

Final Verification

A

Teach-back method

Confirms or disconfirms patient knowledge

summarize key points

Ask for additional questions and encourage follow up.

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11
Q

Co-Op vs APPE

A

Co-Op:
Employee, Provider, Get paid, Evaluation

APPE:
Student, Consumer, Paying Tuition, Grade

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12
Q

Goal setting

A

Usually done around 2nd month, after familiar with job and opportunities

Develop 4 to 5 goals with supervisor or preceptor

Create S.M.A.R.T goals, Specific, Measurable, Attainable, Realistic, Timely

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13
Q

Goals of Co-Op

A

Links study to work, then work to study

Should provide learning opportunities, within one’s field of study and opportunities to reflect

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14
Q

Components of Co-Op learning model

A

Preparation:
Pretty much learn about Co-Op in PHMD 1201, go over everything you need to know

Activity:
Work in a Pharmacy “Practice” setting, complete Co-Op/IPPE competencies that meet accreditation req, Utilize Co-Op reflection and assessment platform

Reflection:

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15
Q

Co-Op golden rule

A

Cant take more than 1 job

If you take 1 job, cant go back and change position because of a better job.

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16
Q

Components of Co-Op learning model

A

Preparation:
Pretty much learn about Co-Op in PHMD 1201, go over everything you need to know

Activity:
Work in a Pharmacy “Practice” setting, complete Co-Op/IPPE competencies that meet accreditation req, Utilize Co-Op reflection and assessment platform

Reflection:

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17
Q

Types of Sources

A

Primary (Research)
Secondary
Tertiary (Farthest from Research)

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18
Q

Tertiary Literature

Pro vs Con

A

Advantages:
Convenient, easy to use, info reflects widely accepted practices, often referenced.

Disadvantages:
Lag time (less current), Incomplete/errors/bias, Lack of expertise by authors and editors, incorrect interpretation
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19
Q

Tertiary Examples

A

Textbooks, Compendia, Review Articles, Clinical Practice Guidelines

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20
Q

Secondary Literature

A

Tools or systems that direct user to relevant literature

Secondary sources index the primary and some tertiary literature

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21
Q

Secondary Examples

A

Medline, Embase, Cochrane Library, Google Scholar

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22
Q

Primary Literature

A

Published and unpublished original research studies and reports

Intro new knowledge or enhances existing knowledge

Articles from refereed or peer-reviewed journals are preferred

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23
Q

Primary Literature

Pro vs Con

A

Advantages:
Most current source of info, foundation for 2nd and 3rd sources, sets standard of med care

Disadvantages:
Difficult to search, many journals available but not all east to access, requires critical eval and possibility of flaws in methodology or statistical analysis, not always practical or efficient

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24
Q

Primary Examples

A

Randomized controlled trials, Cohort Studies, Case Reports, Journals, Survey Research

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25
Appropriate Websites for Info
Common sense Wikipedia, google, SDN, Buzzfeed etc aren't credible Health on the net Foundation (www.hon.ch) does all the work for you and sites get reviewed
26
Appropriate Websites for Info
Common sense Wikipedia, google, SDN, Buzzfeed etc aren't credible
27
Resources for general product info
Package insert, Lexicomp, Microdex, AHFS Drug info
28
Resource: Compatibility/Stability
Trissel's or King Guide
29
Resource: Natural Products
Natural medicine
30
Resource: Pregnancy
Briggs
31
Resource: Pregnancy
Briggs
32
Drug Info request: Physician calls, asks dosing for augmentin 5 yr old boy dog bite
Ask: Weight, How bad is bite, any allergies, any other medical conditions or meds, can they swallow pills.
33
Systemic Approach to answer question
Receive, Research, Respond, Record
34
Manufacturing
prep, packaging, and labeling of meds in large quantities that are not intended for a specific patient
35
Compounding
prepping a med that is not commercially available in strength, conc, or form needed for specific patient
36
History Sterile Compounding Guidelines
1993 - Technical Assistance Bulletin on Quality Assurance for Pharmacy-Prepared Sterile Products 2000 - Updated and published as ASHP Guidelines on Quality Assurance for Pharmacy- Prepared Sterile 2014 - ASHP guidelines on compounding sterile preparations replaced guidelines
37
Timeline of Sterile Compounding Regulations
``` 1995 - USP 1206 2004 - USP 797 2008 - 1st revision USP 797 2016 - USP 800 2019 - 2nd revision USP 797 and enforcement of USP 800 ```
38
Ante room
ISO Class 8 or cleaner room. Transition room from unclassified area to buffer room. garbing, hand hygiene, etc can be performed here
39
Buffer room
ISO Class 7 or cleaner Can only be accessed through ante room
40
Primary Engineering Control (PEC)
provides an ISO Class 5 environment for sterile compounding
41
Horizontal (Laminar Airflow Workbench)
HEPA filter back wall, air moves from back wall to front...towards you
42
Vertical (Laminar Airflow Workbench)
HEPA filter located top of area, air gets blow down and flows out
43
Object placement Horizontal Laminar flow
Side by side, 6 in from edge. Not directly in front of each other Don't want to block airflow, even with hands when doing things over tops of vials or syringe
44
Cleaning inside PEC
Clean and disinfect daily | Sporicidal monthly
45
Cleaning outside PEC
Clean, disinfect and apply sporicial monthly
46
Hood Cleaning
Want to clean closest to farthest from HEPA filter Clean from back to front (Horizontal) Top to bottom but also back to front (Vertical)
47
Critical Point Syringe
Plunger, Needle Hub and Needle
48
Garbing
Bouffant Cap, Face Mask, Beard Cover, Shoe Covers
49
Hand Hygiene
Clean nails, wash up to elbows 30 sec, use lint free towel to dry
50
Gowning Process
Put on gown, hand sanitize and put on gloves
51
Aseptic Process
Set up: gather materials needed to make compound, perform all calculations before entering clean room Compounding: Process of actually manipulating the med ``` Final Check (Done by pharmacist): Visually inspect for particulate matter Confirm accuracy of ingredients Check label, lot, expiration dates Document it all ```
52
Compound Sterile Product Labeling
``` Assigned Internal ID number Active ingredients, amounts and concentrations Route of Admin Storage conditions BUD ```
53
Medication Adherence
The degree to which the person's behavior (including med taking) corresponds with the agreed recommendations from a healthcare provider
54
Compliance
Passively complying with medication regimen
55
Adherence
Active, voluntary choice of patient
56
Persistence
Measure of the duration of time from initiation to gaps in treatment
57
Consistency
How regular a patient takes their medication
58
Skipped dose:
consciously not taking dose
59
Dose self-adjustment
altering regimen without consulting prescriber
60
Discontinuation
self-stopping medication altogether
61
Discontinuation
self-stopping medication altogether
62
Medication Adherence means taking med....
In right amount, at right time, in the right way and for the right duration
63
Consequences of Medication Non-adherence
unable to accurately asses efficacy of the med Loss of confidence by the patient in the efficacy of mediations and expertise of care team Poor clinical outcomes including decrease quality of life and increase morbidity and mortality Economic loss due to decreased productivity, hospitalization, provider visits
64
Assessing adherence
``` Pill counts Prescription refill history Patient Self-report Direct observation therapy Blood level Urine Sample Clinical response ```
65
5 Dimensions of adherence
``` Health system/ HCT-factors Social/economic factors Therapy-related factors Patient-related factors Condition-related factors ```
66
Risk factors for non-adherence
Complex drug regimen, difficult admin route, side effects, chronic conditions, dissatisfaction with care, financial status, fear of addiction, etc
67
Suspect med adherence issue when
New med same disease Increase dose of existing chronic med New med used to treat complication of chronic disease New med used to treat potential adverse effect from current chronic med
68
How to ask adherence questions
Probing - ask in a way that elicits the most info from them Open-ended Be an active listener and give adequate time for them to response, nonjudgemental approach, acknowledge issues they face and try to focus on why med is important
69
Strategies to improve med adherence
1 combination drug (if available) patient reminder tools such as pill boxes, blister packs, automatic dispenser, etc Make taking med a habit, attach to an existing habit such as brushing teeth or eating breakfast
70
Med error
Any preventable event that may cause or lead to inappropriate med use or patient harm while the med is in control of the health care professional, patient or consumer can occur at any step in the process, include miss counting, etc. doesn't have to reach the patient
71
Ways to prevent error community setting
Avoid multitasking find a counting system Double check work Keep notebook to write down info ask for help if needed
72
Ways to prevent error institutional setting
Keep area clean all times Create a system or method for yourself Avoid distractions Ask for help if unsure
73
Ways to prevent med error IV room
keep area clean How to do thing in Horizontal vs vertical hoods Take time, don't rush stay on side of caution, double wipe if doubt check calculations Ask for help if needed
74
Systems approach to med error
Root cause: Retrospective...collect data, reconstruct error, analyze sequence of events....Goal = Identift How and Why occurred Tracking system: Prospective..... Identify error prone situations and failure mode....Goal = prevent errors from occurring.
75
Just culture
Promotes a learning org Focus on sequence of events that led to error Encourages transparency Recognizes individuals should not be help accountable for fail systems out of their control Zero tolerance for reckless or negligent behaviors
76
Strategies to reduce med error
computerized provider order entry system automated drug distribution systems Bar-code scanning Smart IV infusion pumps
77
Aids to help reduce errors
ISMP Confused drug names Do Not Crush List High Alert meds Joint commission Error-prone abbreviations Tall man letters Forbidden abbreviations
78
Medication Reconciliation
formal process for identifying and correcting unintentional medication discrepancies across transitions of care goal is to prevent harm from meds, widely recommended patient safety strategy
79
Transitions of care
The movement of a patient from 1 setting of care to another
80
Process of Medication reconciliation
Collect: a complete and accurate list of the home meds Compare: the home med list with an new orders at all transition points Correct: any discrepancies Communicate: the updated list to the next provider(s) of care
81
Source of obtaining info
Patient, family/caregiver, patients med bottles, community pharmacy, etc
82
Goals of reconciliation process
ensure med changes are intentional Unintended discrepancies should be discussed with provider Patient should be educated on any changes to ensure understanding

Pharmacy Practice (13 decks)

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