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Pharmacy Informatics Workgroup PHARMACY AUTOMATION GUIDANCE FOR THE CONTROLLED SUBSTANCE COORDINATOR Part 1: The Inspection Process 1.

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Presentation on theme: "Pharmacy Informatics Workgroup PHARMACY AUTOMATION GUIDANCE FOR THE CONTROLLED SUBSTANCE COORDINATOR Part 1: The Inspection Process 1."— Presentation transcript:

1 Pharmacy Informatics Workgroup PHARMACY AUTOMATION GUIDANCE FOR THE CONTROLLED SUBSTANCE COORDINATOR Part 1: The Inspection Process 1

2 Pharmacy Informatics Workgroup OBJECTIVES Understand the VHA Handbook requirements that relate to automation Understand what reports should be requested from the pharmacy prior to performing a routine unit inspection Understand what reports should be reviewed as part of the overall inspection process. 2

3 Pharmacy Informatics Workgroup The Inspection Process Requirements from VHA Handbook Inspectors should have a password that permits access to the automated dispensing cabinets (ADC) only when accompanied by an authorized user Inspectors must verify source data including a spot check of ADC removals Report any unresolved discrepancies to the controlled substance coordinator for further investigation Review resolved discrepancies for trending purposes Review at least one days worth of ADC restocking 3

4 Pharmacy Informatics Workgroup Inspecting an Automated Dispensing Cabinet Written instructions on accessing the automated dispensing cabinet in use in your facility to perform a narcotic inspection is a handbook requirement. 4

5 Pharmacy Informatics Workgroup Strategies for the Inspection Process Temporary Password Set Up When setting up passwords for the facility inspectors, they may be set up with a temporary password. The password can be set up to expire within a selected amount of time. 5

6 Pharmacy Informatics Workgroup Strategies for the Inspection Process Permanent Password Set Up The facility controlled substance inspectors may be set up with a permanent password that only allows the user to act as a witness. This password will expire every 90 days similar to other passwords. 6

7 Pharmacy Informatics Workgroup Conducting the Inspection Area personnel should sign into the automated dispensing cabinet The controlled substance inspector should sign on as a witness Access the controlled substances stored in the cabinet. Count the items in each drawer or pocket Look for any discrepancy in count 7

8 Pharmacy Informatics Workgroup Reports to Request for Inspection Inspectors must verify source data including a spot check of ADC removals The handbook requires that the inspectors verify provider orders in the inpatient or clinical setting Request one day of activity for busy areas or a week to a month of activity for areas that use few controlled substances 8

9 Pharmacy Informatics Workgroup Other Reports to Use in the Inspection of Specialty Areas Specialty areas such as Operating Rooms, Cardiac Cath Labs or Colonoscopy Suites may require other reports to verify documentation of administration OR Reports Case Reports Waste/Return Reports 9

10 Pharmacy Informatics Workgroup Automation Specific Controlled Substance Activity Reports AcuDose Rx: Controlled Substance Dispense Report MedSelect: Controlled Substance Inventory Summary Omnicell: Transactions by Date or Specific Criteria Report Pandora: Med Usage Report/All Station Events Pyxis: All Station Events 10

11 Pharmacy Informatics Workgroup Delbert Siegmund, Pharm.D. Chief of Pharmacy Danville VAMC 11

12 Pharmacy Informatics Workgroup Verifying Inpatient Orders in CPRS Verify five randomly selected patients to make sure that there is an administration to a patient recorded for the dose(s) removed. If your machine allows the addition of emergency or temporary cases, check to see that they are reconciled with the patients permanent records. 12

13 Pharmacy Informatics Workgroup Verifying Inpatient Orders in CPRS Access the patient and go to the meds or orders tab and find the order for the medication. Double click on the order and scroll to the bottom of the inpatient medication details box. Look for the date and time of the administration for the episode on your report 13

14 Pharmacy Informatics Workgroup CPRS Screenshot of Meds Tab 14

15 Pharmacy Informatics Workgroup CPRS Screenshot of Inpatient Medication Details Scroll Down 15

16 Pharmacy Informatics Workgroup CPRS Screenshot of Inpatient Medication Details cont. 16

17 Pharmacy Informatics Workgroup CPRS Screenshot of Inpatient Medication Details (IV example) 17

18 Pharmacy Informatics Workgroup BCMA Administration Reports Available in BCMA under Med Administration History Can also access Med Administration Log if the episode is recent Both reports are available in CPRS on the Reports tab 18

19 Pharmacy Informatics Workgroup BCMA Medication Admin History Report 19

20 Pharmacy Informatics Workgroup BCMA Reports available in CPRS – Reports Tab 20

21 Pharmacy Informatics Workgroup Verification of Orders in Outpatient Areas Outpatient Units Colonoscopy Suite Same Day Surgery Cardiac Catheterization Suite Work with HAS and Pharmacy to have clinic stop added to the unit Area personnel should not have to add patients on a routine basis. 21

22 Pharmacy Informatics Workgroup Verification of Orders in Outpatient Areas Outpatient CPRS prescription (ex Methadone maintenance) OR Report (Same Day Surgery) Case Note (Cardiac Cath Lab, Colonoscopy Suite) 22

23 Pharmacy Informatics Workgroup Jennifer Howard, Pharm.D. Director, Pharmacy Informatics San Diego VAMC 23

24 Pharmacy Informatics Workgroup Methadone Maintenance Unit AMS Avatar System Verify opening amount, amount dispensed, quantity on hand. Verify 5 orders as previously outlined 24

25 Pharmacy Informatics Workgroup Review Discrepancies Ideally, you should also look at both unresolved and resolved discrepancy reports Report any unresolved discrepancies to the controlled substance coordinator for further investigation Review resolved discrepancies for trending purposes 25

26 Pharmacy Informatics Workgroup Automation Specific Discrepancy Reports AcuDose Rx: Discrepancy by Station, Open Discrepancy By Station MedSelect: Top 25 discrepancies Omnicell: Pharmacy Discrepancy Report Pandora: Discrepancy Report Pyxis: All Discrepancies 26

27 Pharmacy Informatics Workgroup Verification of Restock The handbook requires that the at least one days worth of restocking be verified as part of the inspection process. A report of restocks will need to be generated from the Pharmacy narcotic vault. This report may come from Vista, Pyxis CII Safe or Omnicell Secure Vault 27

28 Pharmacy Informatics Workgroup Automation Specific Restock Reports AcuDose Rx: Loading and Unloading Report MedSelect: Restock Summary Omnicell: Transactions by Date or End of Cycle Report (if site has Secure Vault) Pandora: Narc Vault Reconciliation Report Pyxis: Med Refill Activities 28

29 Pharmacy Informatics Workgroup End of Shift Count End of Shift Count or Weekly Count Not a handbook requirement May be required by local policy End of shift discrepancy report Best Practice 29

30 Pharmacy Informatics Workgroup Inspecting the Pharmacy Narcotic Vault Automation that may be present in the vault Pyxis CII Safe or Omnicell Secure Vault Fast Fill Scriptpro SP50 Baker Cells 30

31 Pharmacy Informatics Workgroup Inspecting the Pharmacy Narcotic Vault Pyxis CII Safe Omnicell Secure Vault 31

32 Pharmacy Informatics Workgroup Inspecting the Narcotic Vault Pharmacy Dispense without (VA FORM ) LORAZEPAM 0.5MG TAB,UD Select NAOU: xx QUANTITY DISPENSED (TAB/25): 25// 25 JAN 01, DISP OMNICELL XX

33 Pharmacy Informatics Workgroup Outpatient Robotic Prescription Fill Fast Fill Baker Cells ScriptPro 33

34 Pharmacy Informatics Workgroup Questions??? Marian Daum - Coatesville VAMC Delbert Siegmund - Danville VAMC Jennifer Howard - San Diego VAMC Dionne Roney - Charleston VAMC Jolene Hallcroft - Sheridan VAMC 34


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