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Ch 9 notes
Institutional pharmacy practice, pharm tech
| Question | Answer |
|---|---|
| prescriptions in an outpatient pharmacy within hospital | filled prescriptions may remain in the pharmacy for 3 days before they are returned to stock |
| US Department of Health and Human Services | ensures that hospitals meet all standards of safe operation |
| each state's board of pharmacy | may inspect pharmacies to guarantee that all personnel are working within legal guidelines; has the authority to fine, and close, noncompliant pharmacies |
| The Joint Commission (TJC) | offers special certifications and accreditations to organizations willing to go through a process and pay a fee for certifications and accreditations to show quality and patient safety; make unannounced visits, called surveys, a minimum of once every 39 months |
| TJC | inspects and accredits long-term pharmacies and hospital pharmacies *(not retail pharmacies) |
| label from medication order | patient's name, medical record number, and room number along with the medication info (drug name, strength, dosage form, route of administration, dose, quantity, and dosing interval) |
| CADM | computerized adverse drug event monitoring |
| BPOE | barcode point-of-entry |
| ADE | adverse drug events |
| PAR | periodic automatic replenishment |
| parenteral medications | bypass the digestive system and are intended for quick systemic action |
| parenteral medications route of adminstration | by injection via the intramuscular or IV route; includes piggyback antibiotics, large-volume IV solutions (i.e. sodium chloride, dextrose, amino acid infusions), and other parenteral medication orders |
| IV preparation areas | required to have a clean room outside the compounding area that meets federal standards |
| clean rooms | buffer the IV admixture room and allow preparation of IV labels and stock to be maintained in a clean yet separate area; must meet USP standards |
| horizontal laminar airflow hoods | are cabinets that direct filtered air horizontally toward the opening of the cabinet, which provides a sterile environment for preparing parenteral medications |
| BSC | biological safety cabinet |
| LAFW | horizontal flow hood; used for preparing nonhazardous IV medications |
| HEPA | high-efficiency particulate air filter; located in back of LAFW |
| tech note LAFW | orientation of the hands must not block the flow of first-air (meaning hands cannot be moved between the vial, needle, or IV bag and the first-air) |
| first-air | the air issuing directly from the HEPA filter |
| blocking the flow of first-air | can allow contamination of the preparation |
| aseptic technique | set of guidelines and procedures used to prevent the contamination of an object by microorganisms |
| aseptic technique is important | in the preparation of all IV medications, IV nutrition solutions, chemotherapy products, and compounded ophthalmic medications |
| chemotherapy compounds are prepared | within a vertical flow hood BSC, glove box, or a compounding aseptic containment isolator (CACI) |
| ISO | International Standards Organization; an international standard-setting body composed of representatives from various national standards organizations |
| USP regulations state that compounding should take place | in a ISO class 8 or better clean room |
| ISO ranks clean rooms | as ISO class 1 (the cleanest) through ISO class 9; the lower the ISO rating, the cleaner the environment |
| contamination | is measured by particle count; HEPA filters capture the contaminated particles |
| ISO class 8 environment | means that the HEPA filter captures 3,520,000 parts per cubic meter that measure greater than 0.5 mcg |
| anteroom | for gowning and degowning, and movement of personnel into and out of the clean room |
| PEC | hood known as the primary engineering control; must provide an ISO class 5 or better environment must be used to perform compounding activities |
| glove box isolators | barrier isolators; can be added to comply with USP standards for smaller hospitals who can not afford a clean room |
| glove boxes | have been found to reduce the possibility of contamination, which is a major concern in error prevention; there are different classes of glove boxes; can be used for higher risk IV admixtures per USP regulations |
| 70% isopropyl alcohol | must be used to clean the hood and after each use |
| air in glove boxes | filtered through a HEPA filter and then through a final HEPA filter before it is exhausted to the outside of the facility (not into the work area) |
| glove boxes are a closed system | unlike the partially shielded vertical flow hood or horizontal flow hood |
| air flow in a glove box | is vertical, therefore hands must not move over the top of any vial, needle, or IV bag; if the hands do move over these areas, aseptic technique is broken |
| USP 800 | guidelines for hazardous IV preparations |
| CYTOCARE | robotic systems that prepare hazardous IV preparations |
| in a room with negative air pressure | the BSC is the proper hood to use |
| BSC's | are partially open front vertical airflow hoods used to prepare chemotherapeutic agents; air is pulled down toward the tabletop filter from the ceiling of the hood which contains the first HEPA filter |
| chemotherapy hood | does not allow the air to leave the container compartment; instead, the air is recycled through a second HEPA filter that removes any particulate matter before the air is recirculated into the work environment |
| vertical air flow in the BSC | helps protect the person preparing the chemo agents from unwanted exposure; hands should not move over or above the items in the vertical flow hood |
| double gloves used in hazardous IV preparations | first pair is worn under the wrist cuff of the gown and the second pair is pulled over the wrist cuff of the gown |
| tech alert for gloves | safe practices recommend that gloves used to prepare chemotherapeutic agents should not be worn longer than 30 minutes. Hands must always be washed before and after removal of gloves |
Created by:
DbaileyC
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