Midterm Study Guide - Lecture Material Flashcards
1
Q
What are the 6 catagories of care in Ontario?
A
- Lifestyle Retirement communities
- Outreach Services
- Independent supportive living
- Retirement homes
- Palliative/Hospice Care
- Long term care
2
Q
What is important to know about Adult Lifestyle Retirement Communities?
A
- Owned or rented house or apartment
- Recreational opportunities
- Maintenance and security is provided
3
Q
Outreach Services
A
- Homecare or Community support services
- Provided through CCAC
- Can be funded publicly or privately or though non-profit organizations
4
Q
Independent Supportive Living (housing)
A
- Apartments operated by non-profit and partially funded by MOH
- Purchase supportive services package
- Concierge/emergancy response, recreational programs, 1-2 meals daily
5
Q
Retirement Homes
A
- Can’t manage all ADL
- Governed by the Retirement Homes Act (2010)
- provide security, care, support
6
Q
Palliative/Hospice Care
A
- At home or in home-like setting for terminal patients
- Professionals and volunteers
- Goal: to ensure the emotional, spiritual, physical & practical needs of
both the client & their family are met - Hospice is late-stage
7
Q
Long-Term Care
A
Funded through MOHLTC; profit or not-for-profit
- Assessment through a CCAC is required
- 5 (or less) LTC homes are chosen by the client or representative in order
of preference – put on a waiting list
- Admission to LTC facilities is governed by the Health Care Consent Act- requires informed consent
8
Q
Who is eligible for LTC?
A
- 18 years of age or older
- Valid Ontario Health Card
- Have needs that can be met by the facility
- Not be able to have their needs met in the community by government funded programs
AND… - Require/be at risk for ONE of the following:
- 24 hr nursing care
- assistance with ADL
- daily on-site supervision
- risk of being abused at home
- risk to other persons in present residence
9
Q
How much does LTC cost?
A
PRIVATE: $91/day
SEMI-PRIVATE: $77/day
WARD: $64/day
Can apply for subsidy (ward only) - $1000 a month and based on income
10
Q
Retirement Homes ACT: Fundamental Principle
A
“…..a retirement home is to be operated
so that it is a place where residents live
with dignity, respect, privacy and
autonomy, in security, safety and comfort
and can make informed choices about
their care options.”
11
Q
Fixing Long Term Care ACT: Fundamental Principle
A
“…a long-term care home is primarily the home
of the residents and as such it is to be operated
so that it is a place where they may live with
dignity and in security, safety and comfort and
have their physical, psychological, social, spiritual
and cultural needs adequately met.”
12
Q
What changed with the new updated LTC Act?
A
MAINLY - improving staffing and accountability
* Priority areas include updates to Residents’ Bill of Rights, compliance and enforcement
requirements, complaints, whistle blower protection, visitor and caregiver policy, infection
prevention and control, building infrastructure, emergency planning, menu planning, quality
improvement, communications, annual physical exam requirements, requirements for medical
directors, palliative care, screening requirements including police checks for members of
governing structures, and minimum staffing hours and qualifications.
13
Q
In LTC bill of rights, how many rights are identified for residents?
A
27
14
Q
In Retirement home bill of rights how many rights are identified for residents?
A
10
15
Q
What is the hierarchy in LTC oversight?
A
- Ontario MOH (Sylvia Jones)
- Ontario MOLTC (Paul Calandra)
- Appointed ministry officer as Director
(Director issues licenses)
16
Q
What is Elder Abuse and how many seniors are impacted?
A
Elder abuse “a single, or repeated act, or lack of
appropriate action, occurring within any
relationship where there is an expectation of
trust which causes harm or distress to an older
person.”
10% of seniors experience elder abuse in
Ontario
17
Q
Elder Abuse is often carried out by…
A
Family members
18
Q
Pharmacy Automation
A
An automated pharmacy system is a mechanical system that performs operations or
activities with respect to the storage and packaging of drugs or medications, and with
respect to their dispensing or distribution directly to patients
19
Q
Where is pharmacy automation prevalent?
A
Typically found in pharmacy providers who service Long-Term Care (LTC) facilities, but found more and more in community pharmacies
(expanding to centralized filling locations)
20
Q
What are some advantages to Pharmacy Automation?
A
- Streamline workflow, improve efficiency and
productivity - Decrease potential for human error
- Increased medication security
- More time for pharmacists to spend with patients in expanded scope practices
- Ideal for high volume pharmacies but seeing
more automation in lower volume settings
21
Q
What are some disadvantages to Pharmacy Automation?
A
- Assuming Accuracy
- Relaxed checking practices
- Robots only fill what they are instructed to fill - room for human error
- Only used for about 60% of drugs in pharmacy
- Maintenance issues
22
Q
Multi-dose medication
A
- 7-day repackaged medication
administration - Used for all routine, solid oral medication doses which are administered at a
specific date and time - Physician authorizes meds to be filled in the strip pack for 7 days
23
Q
What are the labelling requirements for strip packaged medication?
A
- Name of pharmacy and patient
- Date, directions, administration date/time
- Med names, dosage form & strength
- Quantities
- Doctor’s name
24
Q
Patient Renewal Requests: What should we verify with patient when they call to fax doctor?
A
- RX actually has zero repeats left
- Which doctor to send the rx to and fax number is correct
- Confirm method of follow-up (calling, texting, setting time for pick-up, delivery)
- Contact details
25
Tax Receipts: What are some important things to remember?
- Confirm interval dates
- Difference between medical expense report and tax receipt
- RPht's can sign official receipt
- Consent is important (always verify and document)
26
Medication History Reports: Important things to note
- Mostly from HCP looking for 6-month history
- Confirm name/DOB
27
Prescription Transfers: Overview
Pharmacists and/or Pharmacy Techs can perform transfers
- Patients can request
- Can be transferred verbally/by signature to pharmacy in Ontario or out of province
28
Transferring pharmacy must provide the following information:
* Name and address of patient
* Name and strength of drug
* Directions for use
* Name and address of prescriber
* Identity of manufacturer most recently dispensed
* Prescription number
* Total quantity of drug remaining to be dispensed
* Date drug was first dispensed and date of last refill
* Quantity most recently dispensed
* Name of member responsible for transfer
29
What information do we need from the pharmacy we are transferring the rx to?
* Date of transfer
* Identity of pharmacy to which prescription was transferred
* Name of member responsible for transfer
* If verbal, the name of member who received transfer
30
When receiving a transfer we must confirm the following:
1. Transfer came from a licensed pharmacy in Canada
2. Transfer has been documented properly
3. Verbal transfers require signature of pharmacist or technician
31
Can an rx be transferred if there are no refills remaining?
No (we can send a copy of the original rx so they can fax doctor for refill)
32
What drugs cannot be transferred?
Narcotics and controlled drugs
- Benzos can only be transferred once (document in sig)
33
What is considered best practice for multiple rx on one sheet?
- fill or unfill prescriptions and then can transfer specific drugs to other pharmacies (do not photocopy)
34
Can pharmacies withhold transfers or force patient to pay for them?
No. They can invoice patient if they wish, but cannot prevent transfer regardless of payment
35
If an rx has already been filled and is waiting for pickup, what should we do before transferring the rx?
Always cancel the prescription before transferring!
36
Pharmacy Service Provider requirements for LTC include:
1. Provide drugs 24/7
2. Each resident has medication assessment, administration records, maintained medication profile
3. System to notify pharmacy provider within 24hrs of admission, medical absence, discharge or death
37
LTC - Care team role of Attending Physician/RN (EC)
Each resident will have a physician/nurse to provide medical care that will provide the following:
- Admission/annual physical exam and write report
- Attend home regularly to provide service/assessment
- Provide after-hour/on-call coverage
38
LTC - Care team role of Director of Nursing and Personal Care (RN)
Resposible for the following:
- Organizing, directing, evaluating nursing care, nursing work and training programs
39
LTC - Care team role of Director of Nursing and Personal Care (RN)
Responsible for the following:
- Organizing, directing, evaluating nursing care, nursing work and training programs
- Min hours in director role
- Other nursing staff (RN, RPN, PSW, PA)
- Administrator and Medical Director
40
LTC - Care team role of Pharmacist/Pharmacy Technician
- Liaison with nursing and dietitian (medication instructions, orders, BPMH, MedsChecks)
- Consult with DOC, Med Director, nursing staff
41
How often must the Administrator, Medical Director, DNPC and Pharmacist meet to review medication management?
Every 3 months
42
How often must the above team meet with the Dietitian?
Every year
43
Requirement for the LTC Medication Management System:
- Must be reviewed and approved by the DNPC and Pharmacy service provider with quarterly evaluations
44
What should happen in a LTC when a medication incident occurs?
- Appropriate response is taken when adverse reactions occur
- A quarterly assessment is carried out and documented of each resident's drug regimen
45
How should drugs be obtained/handled/stored in LTC?
All drugs must come from the pharmacy service provider or the government of Ontario
Drugs are obtained based on resident usage with no more then a 3 month supply kept in the home at a time
Controlled substances are stored in separate, double-locked cupboard in locked area OR separate locked area of locked medication cart
46
Who is allowed to administer drugs in LTC?
Physician, Dentist, RN or RPN unless:
- Trained staff member for topical medications (under supervision)
- Resident can self administer if approved by prescriber in consultation with staff
47
What is required by the LTC in order to provide medication to resident?
An individual prescription or written
direction (medication order) of the
prescriber attending the resident is
required – medication & self-meds
48
What are the requirements for the storage of medications in LTC?
- Original containers
- Resident's drugs are labelled
- Stored in locked drug cabinet or storeroom accessible to nursing staff (RN on duty has keys)
- Protected from heat/light/moisture
- External use only medications are stored separately
49
What medications would be carded in a LTC?
Narcs, controlled meds, PRN, Warfarin, nitro, antibiotics, BC tablets, prednisone, dosage range meds
50
When is it ok for the med cart to be unlocked?
- in sight of the nurse during med pass
- in locked med room
51
Who would we report an adverse reaction/incident to?
- Resident, POA, DNPC, Medical Director, Prescriber, Attending, Pharmacy Service Provider
52
When is Drug Destruction required?
- Drug is discontinued/expired
- Resident discharged or dies
53
What are the requirements for legal drug destruction?
- Controlled drugs are destroyed by RN appointed by DNPC in presence of Pharmacist or Physician (RPhT as of 2014)
- All other drugs by RN + one other staff member appointed by DNPC
54
What needs to be documented for drug destruction in LTC?
Date
RX#
Pharmacy Name
Resident's Name
Drug Name/Strength/Quantity
Reason
Signed by DNPC & Pharmacist or Physician
55
When are drug restraints allowed?
- immediate action to prevent serious bodily harm to resident or others
- must be documented including all assessments and monitoring of resident
56
What records are required to be kept for each resident?
- Own file that includes all medical and drug records
- written records of all matters relevant to resident including incident reports
- Application, history, physical exams, diagnoses, orders for treatment, daily nursing notes, phone orders
- Keep for 10 years after discharge or death
57
What is a MAR or e-MAR?
Medical Administration Record
1. A flagging system to indicate when these meds are to be administered
2. Legal document listing all medications
prescribed for an individual resident
3. Used to document all medications administered
to, omitted, or refused by the resident
58
What is a TAR?
Treatment Administration Record
- Used in place of MAR in some facilities to list all medication AND non-medication treatment orders for a resident
59
What is required documentation for MAR/TAR in LTC?
- RN or RPN signs bottom of MAR/TAR
- All meds are charted by nurse (initial date/time)
- Failure to chart is considered a medication error
- Changes require cross out of old info and new info entered
- MAR copies sent to pharmacy
- All MARs for discharged or expired residents are sent to pharmacy
60
What is the process for charting MAR sheets?
1. New Orders
2. Discontinued Orders
3. Changed Orders
61
New Orders
- Name/strength/dose/route/directions/time/duration/date of order
- mark (score) skipped days
- highlight box to be given and cross out days not given
- fax to pharmacy
62
Discontinued Orders
- Cross out box with med order
- D/C date and initial after last dose
- Remove all discontinued meds from med cart and storage area
- document as surplus
- sent to pharmacy for destruction
63
Changing Orders
- Changes in med order are NEW order after discontinuing old order
- Write in next available space
- New supply ordered OR surplus removed depending on change
- Directions changed AUX sticker
64
What considerations for PRN in LTC?
- Nurse reviews MAR to determine appropriate time interval to administer
- Documented in Progress notes, PRN record or on MAR
65
What is the process for Physician Orders?
1. Doctor calls in order or uses digiPen
2. Pharmacy dispenses medication and sends a RPh/Doc order to LTC home
3. Nurse transcribes order to MAR/eMAR and puts form in chart
4. Doc/RN sign order at next visit (unless digiPen)
5. Order receipt is entered in Drug record
66
What emergency pharmacy services are available to a LTC facility?
- Pharmacy provider will provide through partner pharmacy (can charge dispensing fee)
- Emergency drug box or cupboard at LTC home (stat doses, starter packs (antibiotics), refilled after use
67
What role does the Narcotic Medication Record play in LTC?
- Record amounts of narcotics received from pharmacy
- Signs both record and MAR when administered
- Counts done at beginning and end of each shift (Perpetual inventory)
68
Who started Billing Genie?
Founded by Dr. Shelley Morgan (Pharmacist) and Nicola Sancho-Persad (Pharmacy Assistant) in 2018
69
What problem is Billling Genie looking to solve?
- Billing issues that eat into the time we can spend helping patients
- Rejections are common and add 10-15 min per rx to resolve
- Adds up to 20+ hours a month on billing issues
70
How does Billing Genie help?
- saves phone call to adjudicator
- answer in seconds
- billing hacks for billing glucometers, patient assistance cards, student plans and cards
-
71
What was the last major pandemic before COVID?
Swine Flu in 2009
72
What pandemic had the highest death toll?
Bubonic Plague
73
How has Pharmacist's scope expanded due to COVID?
INITIATE RX - Smoking cessation, 13 minor ailments
ADAPT - Alter dose, dosage form, regimen or route of administration (NOT therapeutic substitution)
RENEW - no more then originally prescribed not exceeding 6 months
74
What precautions does the Pharmacist need to take when RENEWING an RX?
- Must assess patient
- Obtain informed consent (smoking/minor ailments) or implied consent (Adapt/renew)
- Prescription is legal (reference to original prescriber) and patient is advised that they can take rx to another pharmacy if then want
- Document and notify original prescriber in reasonable time frame
75
What is Emergency Assignment Registration?
Graduated tech (not registered) can preform duties of registered tech when supervised by Part A Pharmacist in emergency circumstances
76
What temporary CDSA changes were implemented for pharmacists during the COVID pandemic?
- Accept verbal prescription for controlled substances
- Transfer controlled substances in Ontario
- Can ADAPT or RENEW controlled substance (no therapeutic sub)
77
Can prescribers email prescriptions to a pharmacy?
Yes but:
- Pharmacy has responsibility to ensure validity
- Prescriber has to have patient's consent
- Cannot email rx for controlled drugs
- Follow all standards of practice related to record-keeping
78
How did delivery requirements change for pharmacies during pandemic?
Undelivered medication must be returned to the pharmacy
Professional judgment should be exercised if the recipient may have a communicable disease
(e.g. place in mailbox, have delivery agent wait outside or call the recipient once the
medication is left to confirm it has been received, etc.).
Documentation of the reason for not
obtaining a ‘wet’ signature from the patient or their agent is recommended.
79
What is the scope of the Pharmacy Technician with regard to the COVID vaccine?
We can administer the vaccine under supervision of pharmacist/physician/nurse who is present and accessible (must have CPR/First Aid)
Pharmacy must have COVID-19 Vaccine Agreement with MOH
Ages 6 months to 5 years and all other age groups
Must complete OCP- approved injection training course, register certification with the college, not required to have CPR/First Aid but recommended
In effect until June 30, 2023
80
Can Pharmacy Tech take injection training course before registration?
YES
81
What are "Fomites"?
Objects or material likely to carry infection
82
What is the most important procedure for preventing spread of infection?
Hand Hygiene
83
What routine practices are appropriate for infection control in the pharmacy setting?
1. Washing hands
2. Risk Assessment
3. Risk reduction strategies
4. Education
84
When should you wash your hands?
- When they are visibly dirty
- Immediately after removing gloves
- After handling money
- Immediately after contamination or injury
- After personal body functions
85
Is antibacterial soap always necessary?
Plain soap is fine for routine hand washing
- want to avoid bacterial resistance
- 60% acohol based sanitizer as alternative
- Antiseptic reserved for sterile/invasive procedures
- Contact w/ blood, body fluids
- Contamination risk/immunocompromised patients
86
Disinfectant
usually applied to a surface (countertops, handrails, etc - not the body) for cleaning purposes
87
Antimicrobial
stops or slows the growth of micro-organisms
88
Antibacterial
targets bacteria specifically – saliva, soaps, alcohol sprays/gels
89
Antiseptic
common products include rubbing alcohol [70%] or hydrogen peroxide [3%]
90
Washing Hands best practices
No matter what agent you use, the most important steps of a
proper hand washing technique are to wet hands first, apply cleaner, and
vigorously clean (rub) all aspects of your hands including the palms and backs of your hands, thumbs, fingers, nails and wrists for at least 20 seconds, rinse and then dry your hands properly (best practice is a paper towel). Use that current paper towel to then turn off the tap after you dry.
91
Is domestic waste (human body waste, toilet, shower, tub, sink, laundry) considered biomedical waste?
No
92
Are medical wastes generated by a diabetic at their home considered biomedical waste?
No
93
What are some examples of biomedical waste?
Anatomical: tissues, blood, body fluids (except teeth, hair, nails, urine and feces)
Non-anatomical: Sharps (blades, needles, syringes, laboratory glass that has been in contact with human blood waste, animal blood waste, or bodily fluids)
94
What is best practice for when patients return sharps that are not in proper sharps container?
Do not handle! Have patient put the sharps into the container themselves.
95
What programs fall under the public drug plan (ODB) umbrella in Ontario?
- Seniors Program
- ODSP
- OW
- Home Care
- Trillium
- OHIP+
96
Name some of the major drug insurance companies in Ontario
1. Veterans Affairs (Blue cross)
2. NIHB (ESI)
3. WSIB (Telus)
4. ClaimSecure
5. Manulife (ESI)
6. Green Sheild
7. Great-West Life or Assure (Telus)
8. SunLife (Telus)
9. Johnson (ESI)
97
What are Third Party Carriers?
The organization that actually pays out the claim (we submit directly to them for reimbursement of claim)
98
Important info on Third Party Carriers
- Electronic claim submission is preferred
- Have access to plan formularies, database of subscribers and dependent
- Can call adjudicators for troubleshooting
99
What is a "Policy Year"?
Anniversary date when coverage came into effect - determines when annual deductible is reset – most managed by calendar year (ODB is August 1st)
100
Drug Cost?
the actual cost of the product (usually per tablet/per mL, etc) excluding any mark-up, etc.
101
Co-Pay/Variance?
Set dollar amount applied to each individual Rx dispensed ($0.35, $2.00, $5.00 per
Rx) that the patient is responsible for paying 'out of pocket' (i.e. "portion not covered")
102
Two-tier/Multi-tier Co-Pay?
Varies the portion of the Rx the individual must pay (e.g. 80% of the first
$500 and 100% thereafter)
103
Mark-Up?
Additional amount on top of drug cost
- ODB pays 8% mark-up on drugs under 1000, 6% mark-up on drugs over 1000
- All others ~ 10%
104
Deductible?
Set dollar amount that must be paid by the insured individual before coverage of health
benefits can begin - normally set annually ($10/yr, $20/yr, $50/yr)
105
Dispensing Fee?
Fixed amount to be paid out of pocket by patient before insurance begins to cover any cost
* For ODB the max dispensing fee is $8.83
* Private Plans/Out of Pocket: depends on the pharmacy (i.e. SDM $12.99, Rexall $13.99, Costco $4.49)
106
What is a drug formulary?
* A specific list of eligible drugs (ODB) - revised
periodically
* Created at the request of a plan sponsor & maintained on their behalf by an external, independent group of
HC experts
* Lists drugs physicians are encouraged to prescribe,
pharmacists are encouraged to dispense, and members
are encouraged to use (generic)
* Drug claims are paid in accordance with a formulary
107
What is a "Generic Plan"?
- Only LPI product cost will be paid
- Adjudicated drug cost is based on LPI plus professional fee
- NO SUB eligible under certain circumstances only
- Must flag in system as "No Sub", "Prescriber's Choice"
108
Frozen Formulary?
- Benefit list remains constant as of specific date
- new products are evaluated on individual basis
109
Conditional Formulary?
Each new Health Canada drug is reviewed as it is introduced
- Approved, second-line, denied
110
What are 6 common reasons for rejection of drug claim?
1. DIN not covered
2. Card not in effect
3. Card terminated
4. Single coverage
5. Over-age dependent
6. Cardholder info incorrect
111
Commonly restricted drugs
- Infertility treatments
- Smoking cessation
- Preventative vaccines
- Anti-obesity
- ED
- Migraine
- Lifestyle drugs
112
ODB programs account for _________ spending on rx drugs in Ontario.
43%
113
ODB plans (EXCEPT TRILLIUM) are almost always the ______ payer when billing multiple drug plans.
First
114
When does someone qualify for ODB?
- Turn 65
- live in LTC
- enrolled in Home Care, OW, ODSP, Trillium, OHIP+
115
What is the ID number for all ODB programs?
Health Card number
116
What is the HN?
Province-wide computer network system developed by MOH through ODB
Program that validates eligibility and authorizes payments for most of the cost of the Rxs
117
What is a DUR?
Drug Utilization Review
- All RXs submitted to ODB are logged on the system; analyzes current
prescription data - identify potential drug therapy problems
- Applicable warnings and/or informational messages are sent to the pharmacy via "codes"
- Allows the pharmacy staff to use professional judgment - consult with a patient or prescriber before dispensing a drug
118
What are some example of DUR notices?
Drug-Drug
Drug-Disease
Therapeutic duplication
Double-doctoring
Multiple pharmacies
Fill too soon/too late
Over/under utilization
Drug to age
Drug to gender
119
LU
Start new LU Authorization
120
MN
Dose Change (replacement claim)
121
MO
Valid claim (500-999)
122
MP
Valid claim (1000-9999)
123
MI
No LPI available within 10%
124
MR
Replacement (lost/broken)
125
MV
Vacation supply
126
NH
Initial RX program declined (override initial 30 day supply)
127
PB
Name entered is consistent with card
128
UA
Consulted prescriber and filled as written
129
UG
Cautioned patient, filled at written
130
MM
Replacement claim (drug cost only)
131
How would you bill amounts over 10000?
Break into multiple claims
- MM/MP/MO
- Waive dispensing fee on all claims except the FIRST one
132
OHIP+ - Important facts
- only for those without private insurance
- only need health card
- Override using U code (must sign and scan attestation slip)
- no dispensing fee, deductible, or co-payment
-Special Service Code
133
Trillium Drug Plan
- High cost in relation to income
- Bill trillium directly only if no private plan
- Yearly deductible is based on income (ROA)
- Once deductible is reached, $2.00 copay
- Bill private plan first - submit rest to Trillium manually
- Quarterly deductible period
134
What is the cutoff for high/low income senior for ODB?
22,200 (Single), $37,100 (Couple)
135
High income senior
- $100 deductible (varies for first year depending on birthday)
- Co-pay is $6.11
136
Low income senior
- Co-pay is $2.00
- No deductible
137
What is the code for Ontario Works?
D
138
What is the code for ODSP?
C
139
What is the code for Home Care?
P
140
OW, ODSP and Home Care only pay a _____ co-pay and ____ deductible.
- $2
- NO
141
What is the EAP?
Exceptional Access Program: for drugs not on formulary
- Prescriber must submit application (3 day-6 weeks) via SADIE
142
What is NDFP?
New Drug Funding Program: New injectable cancer drugs administered at hospital or cancer centre
143
What is the SPD
Special Drug Program: Outpatient drugs for specific conditions, hospital in designated areas where drug is dispensed
