1. WHAT YOU NEED TO KNOW ABOUT HEALTH SCIENCES NORTH Orientation to Pharmacy

2. Overview Health Sciences North Pharmacist Rotations Medication Orders & Pharmacy Communication Forms HSN Formulary The Robot ‘Picksy’ & PickRings Pyxis Medication Administration  MAR: Medication Administration Record Patient Charts MEDITECH

3. Health Sciences North Main Pharmacy: 3 rd Floor Centre Tower Pharmacist (ext. 5511)  8:00 - 21:00 Pharmacy technician on-site  24 hours daily Pharmacist on-call 24 hours (ext. 3196)

4. Pharmacist Rotations L1: Desk A: Emergency Department B: ICU C: Oncology D: E: Evening G: M: N: R: S: 4 th & 5 th Floor South Tower X: Cardiology

5. Medication Orders Orders can be written by:  Physician: MD or Medical Resident with privileges  Clinical Clerk : 3 rd or 4 th year medical student, co-signed by physician  RN Extended Class/Nurse Practitioner  Physician Assistant (PA) under a medical directive, which must be written in the order  2 nd year PA students, co-signed by physician Complete orders include:  Patient identification  Name & SH/SI #  Date & time  Clear legible directives  Signature of ordering provider

6. Medication Orders Medication Order sheets consist of  3 sections per page  1 white page that remains in the patient chart  1 yellow carbon copy page that is processed by pharmacy Orders may be handed to a pharmacist if on the floor or tubed to the pharmacy to be reviewed at the desk

7. Pharmacy Communication Forms Pharmacy completes a Pharmacy Communication form when suggesting a change in drug therapy  e.g., Initiate, Discontinue, Change Yellow carbon copy is processed by pharmacy after MD has reviewed suggestion

8. HSN Formulary Medications on the HSN Formulary are found using Lexicomp  Open Internet Explorer > HSN Intranet > Click ‘LexiComp’  If available the drug will be listed & automatic substitutions as well

9. The Robot ‘Picksy’ & PickRings Many Medication Orders that are processed by pharmacy & entered into MEDITECH are assembled by the robot onto plastic PickRings Picksy, the robot, is located across the hall from the main pharmacy

10. The Robot ‘Picksy’ & PickRings PickRings help organize medication administration & prevent omitted or extra dose errors Medications on the PickRing are organized by administration time & are listed in alphabetical order by generic name PickRings contain patient medications for a 24 hour period

11. Pyxis Pyxis units are used when medications are:  missing from PickRings  dropped or wasted  new orders/first dose  Depending on when the patient arrives to the floor & the bin delivery time, there may not be a PickRing until next delivery time (bins exchanged every 24 hours at specified time for each floor)  STAT orders  narcotics  benzodiazepines Pharmacy will send medications not stocked in Pyxis

12. Medication Administration Medications are given to patients by the nurse preparing the medication The nurse administering the medication must confirm  patient is wearing a current armband  the armband’s patient account number (SI#) & full name matches the information listed on Medication Administration Record (MAR) prior to administering the medication

13. Medication Administration As soon as possible after medication administration, the Medication Administration Record (MAR) should be signed If medication refused/held/not available, reason for omission recorded in MAR An asterisk (*) beside an entry in the MAR directs reader to interdisciplinary note for more detailed information  The MAR is a useful tool o e.g., Dosing of sliding scale insulin can be found in the MAR

14. Patient Charts Sections: EmergencyMiscellaneous History / ConsultsCardiology Notes – M.D.Respiratory OrdersLaboratory Operating RoomBlood Bank MedicationECG Care TrendsTelemetry IN & OUTImaging History / Patient AssessmentLegal Issues Care / Activity Orders: Physician Order Sheets, Admission Medication Order Record (AMOR) Medication: Medication Administration Record (MAR) (if not in separate binder) Miscellaneous: Long-term care MAR, community pharmacy list

15. MEDITECH MEDITECH is the computer program used at HSN for electronic patient records MEDITECH contains:  Patient Demographics  Location in Hospital  Reason for Visit  Allergies  Current Medication Orders  Laboratory Results  Microbiology Results  Imaging Reports  Notes & Other Reports  etc.

16. MEDITECH To access information on MEDITECH:  Login  Pharmacy > Pharmacist Desktop  Rounding: allows you to view patients in a specific unit  My List: allows you to add patients for quick access  Add > Last name, First name (only partial name needed)  Once a patient is selected, can choose:  Patient Profile: demographics, location, allergies, current orders, etc.  EMR: lab results, MD notes, etc.  Interventions: to document

17. MEDITECH Drug Name Dose, Route, Frequency Active, Hold, Discontinued Start Date Stop Date NOTE: This is more of an accounting system, to be sure if patient is receiving medication refer to the MAR

18. Welcome to Health Sciences North