1. Pharmacy Department Overview & Prescription Regulations
House Staff Orientation 2015
University of Utah Hospitals and Clinics
Salt Lake City, UT

2. Overview University of Utah Hospitals & Clinics overview
Department of Pharmacy Services overview
Pharmacy patient care services
Prescription Regulations
Tips for your success

3. University of Utah Hospitals & Clinics
Four Hospitals:
University Hospital
Huntsman Cancer Hospital
University Orthopedic Center
University Neuropsychiatric Institute
Ten Community Health Centers
Several Specialty Centers
Moran Eye Center
Cardiovascular Center
Utah Diabetes Center
Clinical Neurosciences Center

4. University of Utah Hospitals & Clinics
Four Hospitals:
University Hospital
Huntsman Cancer Hospital
University Orthopedic Center
University Neuropsychiatric Institute
Ten Community Health Centers
Several Specialty Centers
Moran Eye Center
Cardiovascular Center
Utah Diabetes Center
Clinical Neurosciences Center
UUHC Pharmacy Services are prevalent in nearly every UUHC location. Do not hesitate to ask for help!

5. UUHC Pharmacy Services
Outpatient Pharmacy Services
14 retail pharmacies
Discharge medication reconciliation and bedside prescription services
Accepts most major prescription plans
Competitive pricing
$4 pricing on many commonly used medications
Possible to fill for a 90 day supply
Mail order available
Accepts e-prescriptions, except C-II medications
Patient Assistance Program
Thrombosis Consult Service
Pharmacists in specialty clinics
Medication therapy management (MTM) in many locations
Medicare Part D enrollment assistance
Various oncology clinics
Cardiovascular
Neurosciences
Internal Medicine
Gastroenterology
Infectious diseases
Rheumatoid arthritis
Endocrine

6. UUHC Pharmacy Services
Infusion Pharmacy Services
Three ambulatory infusion centers throughout the valley that provide services 7 days a week
University Hospital
South Jordan
Huntsman (primarily oncology infusions)
University Home Infusion Pharmacy
Focuses on home intravenous therapy on patients discharged from UUHC facilities
Total parenteral nutrition
Anti-infective agents
Service provides comprehensive insurance reviews and works with medical team to determine most appropriate medication based on vascular access
Service available 24/7:

7. UUHC Pharmacy Services
Inpatient Pharmacy Services
Centralized operations: 24/7
Drug distribution
Medication preparation

8. UUHC Pharmacy Services
Inpatient Pharmacy Services (continued)
Decentralized clinical services on nearly all inpatient units 7 days a week, generally from (some areas have staff until 2300)
Pharmacist rounding and consults
Drug information
Formulary recommendations
Medication monitoring
Medication policy guidance
Epic navigation assistance
Home medication reconciliation

9. Medication Reconciliation
Pharmacy staff will review within 24 hours of admission
Admit Medication History
Within 24 hours– wait if you can
Don’t order all home meds (herbals)– non formulary warning
If we make changes after they have reviewed, they may have to go back to complete the reconciliation (Needs review)

10. Prescription Regulations
First year residents (unlicensed)
Permitted to write for inpatients of affiliated hospitals: includes controlled and non-controlled substances
No outpatient prescription writing permitted
Second year residents and older (licensed, DEA and NPI)
Permitted to write for controlled and non-controlled substances for both inpatients and outpatients
Prescriptions can be filled in any Utah pharmacy
These regulations can be found in the Pharmacy Practice Act and Controlled Substance Act of the State of Utah.
THESE ARE THE MOST IMPORTANT FACTS TO RETAIN FROM THIS PRESENTATION. ALL THE INFORMATION IS IN YOUR RESIDENT MANUAL IF YOU NEED TO REFER BACK TO IT!
First year residents by state law cannot be licensed in the State of Utah. They can now only write prescriptions for inpatients of the affiliated hospital, both controlled and non-controlled substances.
Second year residents that become licensed have no restrictions on for whom or where their prescriptions may be filled as long as they have a federal DEA number for controlled substances and National Provider Identifier.
Make sure that you PRINT your name on the prescription and include a pager number or phone number….many orders need clarification and the pharmacy needs to be able to contact you.
Group 1 (Not enrolled in PECOS, DEA, or NPI--Generally interns and 2nd year
                     Residents)
Inpatient orders
NO co-signature required
Exception of “Admit To” and “DNR/DNI” orders do require co-sign
Documentation by residents does require co-signature or attestation (if billing)
Outpatient orders (includes discharge orders which effectively are outpatient orders)
All outpatient orders and documentation require co-signature
Group 2 (PECOS, DEA, and NPI enrolled)
Orders do not require co-signature
Documentation does require co-signature

11. Prescription Requirements
Prescriber’s name, address, telephone, NPI
Patient’s name and address
Name of medication, strength, dose, quantity, route and directions for use
Prescriber’s signature, printed prescriber’s name, contact number
Date prescription written
# of refills
****For controlled substances*****
Patient’s date of birth
Prescriber’s DEA
****Remember, C-II’s have to be written and cannot be processed electronically
There is a different requirement for Outpatient prescription orders. These are a little more detailed. All items listed are required to be on the prescription. Review each item briefly.
Prescriber’s name, address, telephone number, and DEA number (CS). The address and telephone number is that of the hospital and is already on the hospital rx blank. We are using tamper proof prescription paper for outpatient prescriptions including discharge medication orders.
With the exception of CII scripts, there is no legal restriction against writing for refills on discharge scripts.
Plan ahead for discharge Rx . If patients have funding problems, see the financial counselor before 5pm.
REMEMBER—IF YOU ARE NOT FULLY LICENSED, YOU MAY NOT WRITE PRESCRIPTIONS FOR DISCHARGE MEDS AS THESE MAY BE FILLED AS OUTPATIENT PRESCRIPTIONS. YOU MAY ONLY WRITE FOR INPATIENTS. THIS INCLUDES DISCHARGE MEDS.
CII Controlled Substances cannot be refilled and only a 30day supply can be dispensed.
New changes to the CS Act of Utah makes it possible to write up to 3 prescriptions for a CII, each for a 30 days supply with different dispensing dates….see last page of the handout for complete information. Example; Ritalin prescriptions

12. Other Relevant Rules
Providers MAY NOT write controlled substance prescriptions for personal use or for family members
Medicaid patients:
Providers must be registered as a “limited provider”
If not registered, an attending who is registered must sign the prescription
GME Office handles this process
Medicare patients:
Providers must be registered for Provider Enrollment, Chain and Ownership System (PECOS)
No physician, by law, may write a controlled substance prescription for him/herself or a family member.
Please note the additional requirements for writing prescription for Medicaid patients, and orders/referrals for Medicare patients. If you are not registered in the appropriate databases, your prescriptions cannot be filled and this causes patient inconvenience and dissatisfaction.
You can only become registered in these databases after you are licensed—so first year residents and second year residents, until they are licensed, may only write these with a co- signature of someone with all credentials. Please ask how this is specifically handled in your department.
The GME Office handles the process of getting licensed residents enrolled in these databases as part of the licensing process and can answer any questions you have.

13. Tips for Your Success
Know your pharmacist – some is there to help you all hours of the day
Use Epic – tips
Order sets
Understand phase of care (tip sheets)
Limit use of comment fields
Watch for therapeutic duplication
All PRN orders must have specific instructions (mild, moderate, severe pain) and you may not have 2 meds ordered with the same indication.
Preference list has formulary status
Medication reconciliation of home medications
If possible, wait for the pharmacist to complete the medication reconciliation
DO NOT just reorder medications from the clinic list!

14. Tips for Your Success Know the on-line tools On-line formulary
Pharmacy & Therapeutics Committee approved guidelines, restrictions, and policies
Therapeutic interchanges
IV to PO policy
Restricted medication policy
Medications that require medical director approval (Smartweb – Medical Director)
Outpatient only list
Factor VII (NovoSeven® RT)
Immune Globulin (IVIG)
Other high cost or high impact medications (REMS)
Restricted anti-infectives (Smartweb – Stewardship or ID Pharmacist)
Caspofungin (Cancidas®)
Daptomycin (Cubicin®)
Linezolid (Zyvox®)
OR/ ER bleeding factor VII okay– otherwise medical Director approval
IVIG: policy - work up sheet at the end
Meperidine guideline– not for pain management– rigors, conscious sedation

15. Tips for Your Success Know the on-line tools (continued)
Restricted medication policy
Medications that require medical director approval (Smartweb – Medical Director)
Outpatient only list
Factor VII (NovoSeven® RT)
Immune Globulin (IVIG)
Bivalirudin (Angiomax®)
Dofetilide (Tykosyn®)
Inhaled nitric oxide (INOmax®)
Dalteparin (Fragmin®)
Other high cost or high impact medications (REMS)
Restricted anti-infectives (Smartweb – Stewardship or ID Pharmacist)
Caspofungin (Cancidas®)
Daptomycin (Cubicin®)
Linezolid (Zyvox®)
OR/ ER bleeding factor VII okay– otherwise medical Director approval
IVIG: policy - work up sheet at the end
Bivalirudin (Angiomax®) – restricted to use in cardiac cath lab, and patients with pre-existing heparin antibodies undergoing cardiopulmonary bypass
Inhaled nitric oxide (INOmax®) – restricted to NBICU and for vasodilator
testing in pulmonary hypertension
Dalteparin (Fragmin®) – Restricted for use in oncology patients
Formulary Restriction Policy
Meperidine guideline– not for pain management– rigors, conscious sedation

16. Tips for Your Success
Use Pulse for assistance – there is a wealth of information on the internal website to assist with your prescribing questions
Let us help with the discharge process
Call us early and if possible, engage us days in advance of discharge
Many medications require prior authorization
We want to ensure that the patient has access to the medication and will obtain it upon discharge
Ask us for help!
Pharmacists should be available in most patient care areas or via Smartweb
If you need help off-hours, call the University Hospital Central Pharmacy at