Hospital Pharmacy

2 Introduction Hospital pharmacy: most challenging area to work Some pharmacies open 24 hours a day, 7 days a week Technicians: flexibility needed to work all shifts; multifunctional for all shifts More highly skilled technicians required Fewer job openings for technicians Hospital pharmacy: most challenging area to work Some pharmacies open 24 hours a day, 7 days a week Technicians: flexibility needed to work all shifts; multifunctional for all shifts More highly skilled technicians required Fewer job openings for technicians

3 Introduction (Continued) Tasks taken over by technicians: –IV medication preparation –Loading of patient medication drawers –Patient data entry Tasks taken over by technicians: –IV medication preparation –Loading of patient medication drawers –Patient data entry

4 The Flow of Orders Doctor visits patient; writes medication order (equivalent to prescription) Order: written on doctor’s order sheet; placed in patient’s record Doctor, nurse, unit clerk: input admitting information in patient’s record Many hospitals have gone to electronic charts and ordering Doctor visits patient; writes medication order (equivalent to prescription) Order: written on doctor’s order sheet; placed in patient’s record Doctor, nurse, unit clerk: input admitting information in patient’s record Many hospitals have gone to electronic charts and ordering

5 As orders arrive, they are entered into the computer If an order is unclear or if there is a question, the pharmacist calls the doctor As orders arrive, they are entered into the computer If an order is unclear or if there is a question, the pharmacist calls the doctor The Flow of Orders (Continued)

6 Patient information: –Full name –Date of birth –Medical record number –Diagnosis, weight –Drug allergies Patient information: –Full name –Date of birth –Medical record number –Diagnosis, weight –Drug allergies

7 The Flow of Orders (Continued) Orders arrive in pharmacy around the clock, 365 days a year Various methods used to send orders: pneumatic tube system, fax machine, or online Orders arrive in pharmacy around the clock, 365 days a year Various methods used to send orders: pneumatic tube system, fax machine, or online

8 The Flow of Orders (Continued) As orders are entered labels are produced Technician pulls off printer and fills order Labels placed on small zipper baggies for delivery Name alert stickers used when two patients with same last name on same floor As orders are entered labels are produced Technician pulls off printer and fills order Labels placed on small zipper baggies for delivery Name alert stickers used when two patients with same last name on same floor

9 STAT and ASAP Orders STAT orders: –Filled within minutes –Takes precedence over others –Filled within 15 minutes –Can mean the difference between life and death –Hand deliver ASAP order: –Not as urgent as STAT –Should still be processed quickly STAT orders: –Filled within minutes –Takes precedence over others –Filled within 15 minutes –Can mean the difference between life and death –Hand deliver ASAP order: –Not as urgent as STAT –Should still be processed quickly

10 Aseptic Technique Method used to prevent contamination of an object by microorganisms Use is extremely important in preparing all IV medications, chemotherapy, ophthalmics Samples periodically tested for microbial contamination Method used to prevent contamination of an object by microorganisms Use is extremely important in preparing all IV medications, chemotherapy, ophthalmics Samples periodically tested for microbial contamination

11 Intravenous Technician Description and Duties Responsible for preparing, labeling all antibiotics; large volume drips (heparin); potassium drips; lactated Ringer’s. Replaces unused IV medications (not expired) in refrigerator Daily routine: –Printing of IV labels –Keeping up with changes in patient status –Reconstituting and preparing all IV medications in horizontal flow hood Responsible for preparing, labeling all antibiotics; large volume drips (heparin); potassium drips; lactated Ringer’s. Replaces unused IV medications (not expired) in refrigerator Daily routine: –Printing of IV labels –Keeping up with changes in patient status –Reconstituting and preparing all IV medications in horizontal flow hood

12 Labeling: Description Proper placement of labels ensures visibility of the solution and contents Technician must initial all medications Pharmacist checks each prepared medication before delivery to floors Additional information on labels: –Use of light-protected bags for light sensitive drugs –Refrigerated drugs –Storage requirements Proper placement of labels ensures visibility of the solution and contents Technician must initial all medications Pharmacist checks each prepared medication before delivery to floors Additional information on labels: –Use of light-protected bags for light sensitive drugs –Refrigerated drugs –Storage requirements

13 Controlled Substances: Description Critical job: counting, dispensing, tracking narcotics Each hospital conducts actual count of controlled substances by two nurses every shift All controlled substances counted three times daily All inventories completed by registered pharmacist Returned controlled substances to pharmacy validated in pharmacy Critical job: counting, dispensing, tracking narcotics Each hospital conducts actual count of controlled substances by two nurses every shift All controlled substances counted three times daily All inventories completed by registered pharmacist Returned controlled substances to pharmacy validated in pharmacy

14 Additional Areas of Pharmacy Satellite pharmacies: small specialty pharmacies that supply Emergency Department or entire floor Fill daily medications for patients on their floors Floorstock supplied by central pharmacy Satellite pharmacies: small specialty pharmacies that supply Emergency Department or entire floor Fill daily medications for patients on their floors Floorstock supplied by central pharmacy

15 Discharge Pharmacy Fills prescriptions like a community pharmacy but located in the inpatient pharmacy Doctor’s orders written on special discharge forms Technician processes prescriptions same as outpatient pharmacy Complete orders sent back to floor for nurse to dispense to patient Controlled substances: nurse brings patient down to pharmacy to receive medications and for consultation Fills prescriptions like a community pharmacy but located in the inpatient pharmacy Doctor’s orders written on special discharge forms Technician processes prescriptions same as outpatient pharmacy Complete orders sent back to floor for nurse to dispense to patient Controlled substances: nurse brings patient down to pharmacy to receive medications and for consultation

16 Supplying Specialty Areas Outdated medications returned to pharmacy if expiration is within 3 months Manufacturer will credit Outside company contracted to do drug inventory on expired medications Outdated medications returned to pharmacy if expiration is within 3 months Manufacturer will credit Outside company contracted to do drug inventory on expired medications

17 Technicians also refill crash carts in all areas of the hospital Supplying Specialty Areas (Continued)

18 Patient Medication Filling: Description Traditional role of technician: manually filling medication orders for patients Automated dispensing systems: speed up delivery and ensure accuracy PYXIS, Accudose, SUREMED, Robot RX Traditional role of technician: manually filling medication orders for patients Automated dispensing systems: speed up delivery and ensure accuracy PYXIS, Accudose, SUREMED, Robot RX

19 Patient Medication Filling Duties Medication carts: two rotated daily 24-hour supply Previous medications emptied from drawers before loading to reduce errors Front of drawer: scheduled medications Back of drawer: PRN medications Medication carts: two rotated daily 24-hour supply Previous medications emptied from drawers before loading to reduce errors Front of drawer: scheduled medications Back of drawer: PRN medications

20 Patient Medication Filling Duties (Con’t) Automated Dispensing Systems –No cart exchange –Systems need refilling frequently –Multiple-day supply: entered and delivered to unit on scheduled rounds –Transactions recorded: receipt generated –Helps to reduce error Automated Dispensing Systems –No cart exchange –Systems need refilling frequently –Multiple-day supply: entered and delivered to unit on scheduled rounds –Transactions recorded: receipt generated –Helps to reduce error

21 Pharmacy and Nursing Staff Relationship Pharmacy staff works more with nurses than anyone else in hospital Nurses depend on pharmacy for all medications Nurses make 80% phone calls to pharmacy Pharmacy staff works more with nurses than anyone else in hospital Nurses depend on pharmacy for all medications Nurses make 80% phone calls to pharmacy