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Flashcards in Pharmacy Services Deck (45):

When can a facility allow for an un-licensed personal to administer drugs?

-Both- 483.60/19.1501
Can allow unlicensed to administer if State LAW permits under the guidance of a LN
1-When it is under the general supervision of a LN
2-when the person is a: Nurse Student, OR -Texas-
Med Aid (Med A) Student, OR -Texas-
Med A with a current permit. -Texas-


What must the facility provide when it comes to Pharmacy Services?

-Both- 483.60/19.1501
facility must provide ROUTINE and EMERGENCY drugs and biologicals to its residents. Either by:
1-In House Pharmacy OR
2-Outside Recourse --see: Admin 19.1906


Services of a Pharmacist must be either:

-Both- 483.60/19.1501
1-In house -Both-
2-or contracted out-Both-
3-And in good standing with -Texas board of Pharmacy- Texas-


Pharmacist job in a facility is to:

-Both- 483.60/19.1501
1-provides consultation on ALL of pharmacy services-Both-
2-Establishes a system of records for:
receipt and disposition of all controlled drugs-Both-
3-determines drug records are in order -Both-
4-an account of all controlled drugs is maintained
reconciled; -Both-
5-Consultant pharmacist hours must be sufficient to meet the needs of the residents-Texas Only-
6-Record of what the Consultant pharmacist services, consultations, are. and record must be maintained at the facility-Texas Only-


How often must the drug regimen for each resident be reviewed?

-Both- 483.60/19.1501
At least once a month by the pharmacist.


Where must the drug regimen review be stored?

In the clinical record of the resident


Who must the pharmacist report any drug irregularities?

-Both- 483.60/19.1501
1-Attending physician and
**and these reports MUST be acted upon.


What is required in the storage of drugs and biological?

-Both- 483.60/19.1501
1-Must be locked
2-Must be under proper TEMP
3-Only authorized personnel may have access to keys


How must drugs and biologicals be labeled?

1-in acceptance with professional principals-Both-
2-and in compliance with Texas state board of Pharmacy laws and regulations 291-Texas Only-
3-Correct Cautionary instructions
4-experation date


What kind of drugs need to be under a "permanent locked and affixed compartment"

Any schedule II drugs, and any drugs subject to ABUSE.

* Must be under ONE lock at ALL times - NAB p.54

List of some Schedule II Drugs:
Codeine / Opium / __Codone / Morphine / OXY__ / Methadone / Fentanyl


Who decides on what pharmacy is to be used for the supply of drugs?

The person or entity that is paying for the drugs.

If resident is paying for his/her own drugs they can decide on what pharmacy supplies the drugs.
** any changes to this must be recorded on proper form , and maintained by facility


Resident can choose any pharmacy as long as:

-Texas Only-19.1502
Pharmacy can provide service on a 24 hour basis (emergency)
Medication must be delivered on a timely basis.
Must have a drug distribution system in place.


How often does the consulting pharmacist required to enter notes on the residents clinical record?

-Texas Only-19.1503
Once a MONTH


Who is responsible for pharmaceutical services?

-Texas Only-19.1503
The DON and the Pharmacist


How many hours must the consulting pharmacist put in a month?

FED- Number of hours is determined by the STATE
Number of hours required need to be "sufficient to meet the needs of the residents" [ No requirement ]


Who is responsible for drug security when medications are self-administered? Who determines if the resident CAN be a person that can SELF-Administer?

Must be determined
1-The facility
** in addition to maintaining accurate information , and medication compliance.
2-Interdisciplinary Team - /1994 Final Rules/F176/483.10(n)/19.418p


Where must medication carts be placed when not in use?

-Texas Only-19.1504
Must remain secured in a designated area.


What type of Drugs must be destroyed? when must they be destroyed?

-Texas Only-19.1504
Drugs of:
1-Deceased residents,
2-Old expiration date
3-and discontinued drugs

**and once a quarter must be destroyed
** DEA (Drug Enforcement Administration) Monitors the Proper Storage and Destruction of DRUGS


What happens if a drug is discontinued, but then later is Re-instated?

-Texas Only-19.1504
Discontinued drugs may be reinstated if reordered prior to destruction.


What happens to the drugs if a drug is direction has been changed?
Ex: of Direction is BY Mouth, or Crushed

-Texas Only-19.1504
If existing medication can still be given correctly with the new change, THEN medication MUST NOT be destroyed. ** and must a fix a "change of direction sticker"


Who can take Verbal ORDERS?

-Texas Only-19.1506
1-licensed nurse,
3-physician assistant or a physician


After taking a Verbal order what is the time limit on when it should be recorded and signed?

-Texas Only-19.1506
Immediately recorded and signed by the person receiving the order


Are verbal orders of schedule II drugs ok?

-Texas Only-19.1506
Only in an emergency


Who can prescribe drugs?

-Texas Only-19.1506
1-resident's physician OR
2-consulting physician, OR
3-dentist, podiatrist, OR
4-other individual allowed by law to prescribe


When should medications be released to the resident?

-Texas Only-19.1507
1-One the written or verbal authorization of the attending physician
2-When resident leaves on furlough - and then only enough drugs must be given to cover time gone.


What is the ORDER of medication release when a resident is being transferred?

-Texas Only-19.1507
1-New Facility
2-The resident himself
3-Family of the resident


What is considered a medication Error?

-Texas Only-19.1508
not limited to:
1-wrong medication,
2-wrong time
3-wrong dosage strength,
4-wrong route,
5-omitting a medication,
6-wrong resident


Who and when must nurse staff report an adverse drug reaction?

-Texas Only-19.1508
1-To the residents physician
2-a TIMELY manor (depending on the reaction of the drugs)


What documentation is required when a adverse reaction to drugs occurs?

Must be documented in the resident recorded, and an incident report must be filed.


Can drugs or biologicals be prepared by one person and the administered by someone else?

Must be prepared and administered by the same person
under unit-of-use package distribution systems and self medication of self


When can a LN NOT consult the treating physician, dispensing pharmacist, or consultant pharmacist when deciding on if to crush drugs?

When the medication is not:
1-time-released OR
2-enteric coated
* otherwise may exercise professional judgment
* If a do not crush is is overridden by a nurse, must be documented in the clinical record, as to why.
* there is an approved list of ok to crush.


What must the controlled substances (NARC) (schedule II, III & IV) drugs record contain?

1- prescription number,
2-name, and strength of drug,
3-date received by the facility,
4-date and time administered,
5-name of resident,
7-physician's name,
8-signature of person administering dose
9- original amount dispensed
with the balance verifiable by drug inventory


When must (schedule II, III & IV) (NARC) drugs be inventoried?

at every shift change


What are the steps in Drug Administration?

Texas Only -19.1508
1-Check the physician ORDERS
2-ID the RESIDENT before giving the DRUG
4-Drugs are PREPARED and ADMINISTERED by SAME person
5-DRUGS with NAMES are ONLY given to those PEOPLE.


Can internal and External Drugs be STORED together under the resident name?

NO, Internal and External drugs must be separated.


What type of drugs are covered as part of there benefits?

Over the counter Drugs are covered under medicaid.


When is it OK for residents to take home medications after being discharged?

With Written NOTE from a DOCTOR


If a LABEL is UNREADABLE or MARRED but the DRUGS themselves are ok. Is it still ok to use those DRUGS?

NO, an label that is unreadable or torn must be returned to the pharmacy


If DRUGS are outdated, Deteriorated , Discontinued can they be stored in the Medication Room?



What is concetered to be POLYPHARMACY

NAB p.55
9 or more DRUGS.
** The 9 or more policy includes vitamins
Pharmacist need to be aware of this.
** Rule of thumb the pharmacist will report to the MD at least yearly how many residents have 9 or more drugs.


Who can and should authorize "drug switches" when a pharmacist notices there should be one?

1-Attending Physician
**In addition to having the AP, make the switch , you should also notify the DON.


What is the difference between "dispensing" a drug and “Administering" a drug

Administering- is the process of GIVING the medication to a resident
Dispensing - is process that includes the interpretation of a prescription; selection, measurement, and packaging or repackaging of the product (as necessary); and labeling of the medication or device pursuant to a prescription/order


When talking about the pharmacist and medical director what is a rule of thumb? When talking about the Medical Director , DON, and pharmacist what is the rule?

1-Rule of thumb: it has to do with policy and procedure of the facility, and drug administration, dispensing, ect..
2-If MD/ DON, and Pharmacist then it is the pharmacist that has found something that needs reporting, and he must report it to the MD and the DON. 483.60-c- / 19.1501-4-


What is the criteria for "Unnecessary Drugs"

(i) In excessive dose (including duplicate therapy); or
(ii) For excessive duration; or
(iii) Without adequate monitoring; or
(iv) Without adequate indications for its use; or
(v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
(vi) Any combinations of the reasons above.


Who approves the the EDK? (Emergency Drug Kit?

1-The Medical Director
2-Pharmacy provider
** The allowance of a EDK is approved by the state.