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CH 17: Pharm
Chapter 17: Hospital Pharmacy
| Question | Answer |
|---|---|
| What are some requirements do most hospital pharmacies require? | Require high school diploma or equivalent and a current state pharmacy technician license. |
| What is the nurses' station? | A work station for medical personnel located on a nursing unit. |
| What are ancillary areas? | They are other areas of the hospital that also provide patient care. These areas use medications and are serviced by the pharmacy department. |
| What is the Central Supply area? | An area of the hospital that may carry supplies not provided by the pharmacy (lotion, mouthwash, pill cutters). They are also be responsible for supplying nursing units with dialysis solutions & some premade IV fluid bags. |
| M.D., Medical Doctor | Examines the patients and administers treatment for people suffering from injury or disease. M.D.s write majority of all medication orders. |
| D.O., Doctor of Osteopathy | Same responsibilities as an M.D. but practices a "whole person" approach to medicine. |
| N.P., Nurse Practitioner | Provides basic primary care, works closely with doctors, and can prescribe various medications in most states. |
| R.N., Registered Nurse | Provides bedside care, assists physicians in various procedures and administers medication regimens to patients. |
| R.T., Respiratory Therapist | Evaluates respiratory drug treatments to patients. |
| P.A., Physician Assistant | Coordinates care for patients under the close supervision of a M.D. or D.O. |
| M.S.W., Master's of Social Work | A social worker is concerned with patient social factors such as child protection. |
| Clinical Pharmacist | Additional training and work closely with the medical team. |
| What is inpatient pharmacy ? | A pharmacy located in a hospital that services only those patients in the hospital and its ancillary areas. Responsible for medication preparation and distribution. |
| What is pharmacy satellite ? | A branch of the inpatient pharmacy responsible for preparing, dispensing, and monitoring medication for specific patient areas. |
| Where are satellite pharmacies often located? | Located in the same area as the patient care units they are servicing. |
| What are some responsibilities of satellite pharmacies? | Providing first doses of new medications ordered, emergency medications, and replacing any missing or lost doses. |
| What is the central pharmacy? | The main inpatient pharmacy in a hospital that has pharmacy satellites. It is the place where most of the hospital's medications are prepared and stored. |
| What is batching? | Preparations of large quantities of unit dose oral solutions/suspensions or small volume parenterals for future use. |
| What are some responsibilities of central pharmacies? | Preparing and delivering of unit dose patient medication carts, batching the medications, and covering service areas not covered by the pharmacy satellites. |
| What is the clean room and where is it usually located? | Area designed for the preparation of sterile products. Usually located in the central pharmacy. |
| What is the Institutional Review Board (IRB)? | A committee that assures hospitals research complies with federal, hospital and ethical standards. |
| What is outpatient pharmacy? | A pharmacy attached to a hospital that services patients who have left the hospital or who are visiting doctors in a hospital outpatient clinic. |
| What is unit inspection? | A review of a nursing unit to ensure compliance with hospital medication policies. |
| What are pediatric satellite pharmacies ? | Pediatric doses are often individually calculated based on a patient's weight and frequently require special dilutions since they are much smaller doses. |
| What are operating room (OR) satellite pharmacies? | Help oversee and control drug distribution for all operating rooms, decrease controlled substance loss and waste, reduce inventory expenses, and improve documentation of patient med charges. |
| What are oncology satellite pharmacies? | Require special training to review, prepare, and deliver antineoplastic agents (chemotherapy) for hospital patients. |
| What is a hospital formulary? | A list of drugs stocked at the hospital that have been selected based on therapeutic factors as well as cost. |
| Whose responsibility is it to set up, add, remove, and periodically evaluate medications list on the hospital formulary? | Pharmacy and the Therapeutics Committee (or P&T committee). |
| What is a closed hospital formulary? | A type of formulary that requires physicians to order only those medications on the formulary list. (Some exceptions may apply.) |
| What is a non-formulary ? | Drugs not on the formulary list and not regularly stocked in the pharmacy. May require special form stating why the physician needs it, and may be a delay before the patient can receive it. |
| What is therapeutic interchange? | A policy approved by the hospital P&T Committee that allows the pharmacist to change a medication order to a therapeutically equivalent formulary medication w/o notifying the doctor. |
| What is a pneumatic tube? | A system that shuttles objects through a tube using compressed air as the force; commonly used in hospitals for delivery medications. |
| What are medical or heath records? | Detailed, chronological accounts of a patient's medical history and care. |
| What is electronic medical records (EMRs) or electronic health records (EHRs)? | A computerized patient medical record. |
| What are some different sections in a medical chart? | Demographics, allergies, medical history, medication orders. medication administration record, lab/test results, documentation flow sheet, and progress notes. |
| What is a computerized physician order entry (CPOE)? | A system in which the physician or agent of the physician enters orders directly into the hospital computer system. |
| What is the CPOE useful? | Makes orders more efficient and helps eliminate medication errors due to illegible handwriting. |
| What is a standard order? | A standard medical order for patients to receive medication at scheduled intervals. |
| What is a PRN order? | An order for medication to be administered only on an as needed basis. |
| What is a STAT order? | An order for medication to be administered immediately. |
| What are admission orders? | The initial medications ordered when a patient is administered to the hospital. |
| What is a medication administration record (MAR)? | A form that tracks the medications administered to a patient. |
| What does each medication order must contain? | Medication name, dose, route, and frequency. The order may also include the duration of therapy. |
| What are automatic stop orders? | Used for a certain class of medications like antibiotics or narcotics. These orders are only active for a limited period of time, after which a new medication order is required to continue. |
| What do automatic stop orders help ensure? | Help ensure that the patient's therapy is continually reassessed and monitored. |
| What is a final filter? | A device used to remove particulate matter. The filter should be placed at the end point of an IV line just before it enters the patient's vein. |
| What is tech-check-tech? | A program that allows a specially trained pharmacy technician to check medications prepared by another technician. At least nine states currently allow it. |
| What is the manual order processing ? | Med order is written in the patient chart, a copy of the med order is taken, picked up at a nursing station by pharm tech, the order is entered into the computer, pharmacist reviews & verifies order, then filled and checked, &delivered to nursing station. |
| What is the automated order processing? | Physician or physician agent enters med order in the hospital computer which goes directly to the pharmacy. |
| What are drip rounds? | A process in which the pharmacy technician goes to specific nursing uits to find out what IV drips will be needed later that day. |
| What is the purpose of drip rounds? | Reduce the # of STAT medications and decrease the workload on evening and overnight shifts when there is less staff available. |
| What is a drug recall? | The voluntary or involuntary removal of a drug product by the manufacturer. |
| What is par? | The amount of drug product that should be kept on the pharmacy shelf. May also be assigned to drug products in ADCs. |
| Who is notified when there is something on the invoice but not in the shipment? | The pharm techs supervisor. |
| What is a primary area of concern for inventory control? | Narcotics or controlled substances. |
| Many hospitals require how many people to count narcotic inventory before it is stored? | Two people. |
| If a narcotic medication is damaged for any reason, what needs to happen? | Two people must sign a form to witness the disposal. |
| What is a floor stock? | Supplies, OTC medications, and IV fluids available for immediate use on an nursing unit or ancillary area; these items are not labeled for individual patients. |
| What happens if a medication can not be stocked? | The inventory technician may have to go outside of their usual distributor. |
| What is emergency drug procurement? | To quickly obtain a medication not currently in stock in the pharmacy in situations where the drug is urgently needed. |
| What is the temperature for refrigeration? | 2 to 8 degrees Celsius (36 to 46 F) |
| What is the temperature for freezer? | -20 to -10 degrees celsius (-4 to 14 F) |
| What are extemporaneous compounds? | Medications that must be prepared following a specific recipe or formula, usually because they are not available commercially. |
| What is a bulk compounding log? | A record of medications that are compounded in the pharmacy for non-specific patients. Information must include a list of all the ingredients, amounts used, manufacturer, lot #, and expiration dates of each ingredient. |
| What is reconstitute? | Addition of water or other diluent to commercially made drug bottles of vials in order to make a solution or suspension from a premade powder form of the drug. This may include oral or parenteral products. |
| What is a unit dose? | A package containing the amount of a drug required for one dose. |
| Which medications cannot be divided into unit dose increments? | Eye drops, creams, and metered dose inhalers. |
| What is an automated dispensing cabinet? | A system in which medications are dispensed from an automated cabinet at the point of use. |
| Oral medications are commonly provided to the nursing unit in what ? | In medication carts containing a 24 hour supply of drugs for each patient. |
| How are oral syringes different from IV syringes? | They are not able to accept a needle or fit into a needle free IV tubing. |
| The documentation logs for prepacked medications have what? | Medication name, manufacturer, dose, expiration date, lot number, and pharmacist's initials. |
| What is IVB intravenous piggyback? | A small volume parenteral that will be added into or "piggybacked" into large volume parenteral (LVP). |
| What is a total parenteral nutrition (TPN)? | Protein, carbohydrates and essential nutrients to be given to the patient through an IV line. |
| What is an epidural? | A sterile, preservative-free medication administered into a patient's epidural space (located near the spinal cord and backbone). |
| What is short stability? | Medication that will expire soon after preparation (within 1-6 hours preparation). |
| What is the difference between single-dose and multiple dose vials? | Single dose are preservative free while multi dose contains preservatives. |
| What are nosocomial infections? | Hospital acquired infections that may be caused by viruses, bacteria, or fungus. |
| What is hand hygiene? | A broad term that pertains to proper handwashing or use of antiseptic hand gel/rub. |
| What is the Infection Control Committee? | A hospital committee in charge of the surveillance, prevention, and control of infection within the hospital. |
| What is standard precautions? | An infection control practice where healthcare providers avoid direct contact with blood, mucous membranes, body fluids, and non-intact skin by use of barriers like gloves, goggles, gowns, and face shields. |
| What are HIV Post-Exposure Prophylaxis (PEP)? | Medications for healthcare providers being exposed to HIV infected blood or needles in order to help reduce the chance of contracting HIV. |
| What is an adverse drug event? | A injury or harm due to medication use that may be preventable in some cases but may be unpredictable and unavoidable in other cases. |
| What is medication error? | Any error occurring during the medication-use process. |
| What is the range of severity of ADEs? | Range from allergic reaction to kidney failure to death. |
| What is a common cause of ADEs? | Medication errors |
| Which age group is on a higher risk of ADEs? | Elderly because they are often on multiple medications and have multiple medical problems. |
| What are some error types for medication errors? | Administration error, allergy, compounding error, duplicate therapy, expired product, extra dose, incorrect dosage form, missed dose, omission error, prescribing error, and wrong patient. |
| What is an incident report? | A statement of facts surrounding medical error or incident. |
| What is close call? | A medication safety event that had the potential to cause harm but did not reach the patient. |
| What is a sentinel event? | A patient safety event that results in death, permanent harm, or severe temporary harm. |
| What is a root cause analysis? | A process that evaluates all actions leading to the medical error. |
| What should you look at if a hazardous spill occurs? | Safety Data Sheets |
| What are red bags used for? | Used for items containing blood or infectious wastes. |
| Where should needles or other items that may cut be thrown in? | Red sharps containers |
| Where should drugs that are harmful to the environment or drinking water must be thrown away in? | Black hazardous waste bins. |
| Items with trace amounts of chemotherapy or cytotoxic medications are disposed in what? | In yellow bins |
| What are emergency codes? | Color-based emergency codes systems are used at many hospitals to alert staff to various emergency/safety situations. |
| What is code blue ? | medical emergency |
| What is code pink? | Infant/child abduction |
| What is code red? | fire |
| What is code black? | Bomb threat |
| What is code orange? | Hazardous material incident |
| What is code white? | hostage situation |
| What is code green? | Disaster plan activation |
| What is code gray? | need for security |
| What does the TJC publish (The Joint Commission)? | A list of National Patient Safety Goals, which includes hospitals practices that have been shown to prevent patient harm. |
| Which chapter of the USP-NF talks about hazardous drugs defined by the NIOSH? | 800 |
| What is a code cart? | A locked cart of medications and other medical equipment designed for emergency use only. |
| Who is responsible for maintaining the medication drawers on the code carts? | Pharmacy technicians |
| CCU | Cardiac Care Unit |
| ED | Emergency Department |
| ER | Emergency Room |
| ICU | Intensive Care Unit |
| CT ICU | Cardiothoracic Unit |
| NICU | Neonatal ICU |
| PICU | Pediatric ICU |
| SICU | Surgical ICU |
| OB | Obstetrics |
| OR | Operating Room |
| Who can prescribe medications? | Physicians, Physician assistant, NP, Advanced practice nurses |
| Who can administer medications? | RN, Licensed/vocational nurses, repiratory therapists |
| Who can assist getting meds to patients? | Pharmacists, social workers, patient care techs, pharmacy techs |
| What is voluntary formulary permitted? | Pharmacist may dispense a therapeutically equivalent drug to such prescriptions. |
| What does the Orange Book two letter evaluation code provide? | Allows users to determine whether the FDA has evaluated a particular drug as therapeutically equivalent to other pharm equivalent products. |
| What does the first letter say in the code? | It is bioequivalent |
| What does the second letter say in the code? | Provide additional info on the basis of FDA evaluations such as info about the dosage form. |
| If they are A products what does that mean? | They are bioequivalent. No known of suspected bioequivalence problems. |
| If they are B products what does that mean? | They are not bioequivalent. Known issue could dosage form, etc. |
| If it is labeled AA? | Products not presenting bioequivalence problems. |
| If it is labeled AB? | There was a issue and they fixed it. |
| What is Isotretinoin (Accutane)? | Ordered when other options have failed and it is used for cystic acne. Cannot use if preg or become preg (major birth defects). |
| How many days does it take for the Isotretinoin to be filled? | Once they have written the prescription, a pharmacy needs has 7 days to fill the prescription. |
| What is the I PLEDGE PROGRAM? | Computer program risk management for prescribing and dispensing. |
| Who must be registered in the program? | Prescribers, whoelsalers, patients, and pharmacies must be registered with the program. |
| How do the methods of BC work? | 2 methods of BC one month, before, during, and after treatment. |
| Do you need preg tests? | 2 neg preg tests before treatment and a neg preg test each month during the treatment. |
| What are emergency medications? | Adenosine, atropine, and epinephrine (high alert). |
| What are intravenous electrolytes? | Calcium gluconate, potassium chloride (high alert), sodium phosphate |
| Who gives a list of high alert medications in most settings? | ISMP |
| What does it mean for something to be a high alert medication ? | If someone takes it wrong or gives it wrong then there is a high chance of something going wrong. |
| What are critical care medications? | Amiodarone -anti arrhythmic(high alert), Fentanyl (dosing in mcg), Heparin (large numbers in med errors, Phenytoin - Dilantin (narrow therapeutic range), and Lovenox-anticolagulate (Enoxaparin)- SUB Q |
| What is PTT and INR? | Coagulation tests that see how long to take for the blood to clot to see if the patient is on a blood thinner. |
| What are intravenous anti-infectives? | Acyclovir, Fluconazole-Diflucan, Vancomycin (Vancocin)-small windows of therapeutic indexes |
| What is PHI? | protected health information |
| What was the first part of HIPAA? | HIPAA Privacy Act is the first part (securing PHI) |
| What are questions that should be asked when the nursing unit calls saying the drug isn't there? | Is there a current order?, Correct storage area checked?, When was the med last dispensed or still in pharmacy?, patient transferred to a different unit? |
| What is a purchase order? | Like a grocery list that the manufacturer will check if they have it and will send you the things you need. You only get charged when you receive the items. |
| What is Class 1? | Strong likelihood of causing serious adverse effects or death. |
| What is Class 2? | Temporary but reversible adverse effects or little likelihood of serious adverse effects. |
| What is Class 3? | Not likely to cause adverse effects. |
| DEA form 224 | Application for registration of your site to carry controlled substances. |
| DEA form 222 | used to order schedule 2 drugs |
| DEA form 106 | Used to report theft/loss of controlled substances |
| DEA form 41 | Used to document destruction of controlled substances. |
| When do reconstituted suspensions usually expire? | Short stability (usually expire in 10-14 refrigerator). |
| What is another term for TPN? | Hyperalimentation |
| What is the central line? | It is a line near the subclavian vein where the TPN needs to go in through because the solutes can be harsh on those veins. |
| What is the expiration date for multidose vials? | label multidose vials with new expiration date 28 days from date of opening unless manufacturer date is sooner. |
| What is a common problem with fentanyl ? | It is supposed to be written in micrograms. |
| What are some high-alert medications? | Chemotherapy agents, fentanyl, heparin, insulin U-500, potassium chloride, sodium chloride 3%, vecuronium |
| What type of people should stay away from NSAIDS? | Prone to peptic ulcers and bleeding |
| PACU | Post-Anesthesia Care Unit |
| PEDS | Pediatrics |
| What is the Pharmacy and Therapeutics Committee (P&T) ? | Doctors, nurses, and pharmacists that must meet on a routine basis to make decision on safe and effective use of meds and make decisions on formulary. Also looks at adverse drug reactions. |
| What are restricted medications? | require approval by speciality service |
| What is the temp for cold? | Do not exceed 8 C (46 F) |
| What is temp for cool ? | 8-15 C (46-59 F) |
| What is room temp? | 15-30 C (59-86 F) |
| What is warm temp? | 30-40 C (86-104 F) |
| What is Medication Errors Reporting Form (MERF)? | Informs manufacturers of errors with packaging and labeling. |
| What is FDA Adverse Effect Reporting System (FAERS)? | Adverse effects associated with meds reported through FAERS. |
| What is Med Watch? | Created by FDA which is a medical product safety reporting program for professionals and customers. (equipment, food, cosmetics, etc.) |
| What is Vaccine Adverse Effects Reporting System (VAERS)? | Adverse effects associated with vaccines. Looked over by CDC and FDA. |
| Vaccine Errors Reporting Program (VERP)? | Reported to ISMP by HC provider. |
| What is MedMarx? | Overseen by ISMP and its for reporting errors specifically towards hospitals and health systems. |
| How do hospital pharmacies organize their medications? | Alphabetical order using generic name. |
| What are some medications that need to be refrigerated? | Epoetin, Filgrastim, Fosphenytoin, Most vaccines like Hep B, Pneumococcal Influenza/MMR, chickenpox, and shingles in freezer. |
| When should you stop using the nonaqueous formulations? | No longer than 6 months or the earliest expiration date, in controlled room temp. |
| When should you stop using water containing oral formulations? | No longer than 14 days or the earliest date at controlled cold temp. |
| When should you stop using water containing semisolid/topical formulations? | No longer than 30 days or the earliest date at controlled room temp. |
| When should you recertify equipments? | 6 months |
| When should you monitor temperature? | At least once a day |
| When should you do non viable particle sampling ? | every 6 months |
| When should you do electronic device sampling of viable particles? | Every 6 months |
| When should you do surface disinfection and sampling? | every 6 months |
| How long should you keep the laminar flow hood before use? | 30 min |
| When should you certify LAFW? | 6 months |
| When should you clean the workstation? | Beginning of shift, before each batch, after spills or contamination |
| When should you clean ceilings, walls, and shelves? | Monthly |
| Where do you store hazardous drugs? | Negative pressure room with at least 12 air changes per hour (how many times the air in the room is replaced each hour) |
| Where should antineoplastics go (chemotherapy)? | Separate refrigeration |
| What is compliance error? | Inappropriate pt behavior regarding adherence to prescribed drug regimen. |
| What is monitoring error? | Failure to review a prescribed regimen or problems/failures of using appropriate clinical or lab data assessment of pt response to drug therapy. |
| What is error class A? | No error |
| What is error class B? | Error but no harm for patient |
| What is error class E? | Error occurred that had temporary harm but no intervention |
| What is error class I? | Error and pt. death happened |
| What is the Institute for Safe Medication Practice (ISMP)? | Educates the healthcare community and consumers about safe medication practices. Oversees VERP, MEDMARX, and MERP. |
| What is a black box warning? | FDA's most stringent warning for drugs and medical devices on the market. |
| When should you clean floors and counters? | Daily |
| What is the list of do not crush? | Slow release, extended release, enteric coated, liquid filled. |
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