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What are some requirements do most hospital pharmacies require?
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CH 17: Pharm

Chapter 17: Hospital Pharmacy

QuestionAnswer
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.
Created by: imaliha2003
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