Download Pharmacy Support at GBMC

Medication Administration &
Pharmacy Services at GBMC
Key Pharmacy Personnel
• Clinical Pharmacists
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Process orders into patient profiles
Verify appropriate medication dosing
Provide education to medical staff
Monitor for drug-drug/fooddrug interactions
– Order/Problem resolution
– Antibiotic dosing
Key Pharmacy Personnel
• Certified pharmacy technicians/
Pharmacy Technicians
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–
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Answer phones/initial problem resolution
Prepare TPN and IV medications
Prepare patient medications
Retrieve expired or discontinued medications
Cart exchange/patient reconciliation/drug deliveries
• Pharmacy aides
– Deliver medications to the units
– Retrieve expired or discontinued medications
An Overview of Services
• Location
– 5th floor main hospital
• Fax numbers
– 3099 for routine orders
– 6936 for STATs
• Telephone number
– 2771
• Hours of operation
– 24/7
• Schedule of deliveries
– 1 hr stat/2 hr routine
Procuring Medications
• FAX
– Primary method of sending
orders
– Fax all orders promptly
– Fax respiratory and IV
orders
– For STAT Orders: Use
STAT fax line and call for
STAT orders (given within
one hour)
• Order Entry
– Enter in an order in
Meditech (Search for
“PHA”) for missing
medications
– Enter in an order in
Meditech (Search for
“PHA”) for IV refills 2
hours before needed
Procuring Medications
• Medications can be found
in patient bins in cabinets
on nursing bays or in
medication room (always
locked)
• AcuDose(R)
– Used for controlled
substances, select
medications, and PRNs
– Obtain access after the
Charge Nurse or Manager
notifies pharmacy
– Generic nomenclature
• Tube system
– Majority of meds are sent
through the tube
(no chemo, narcotics, or
LV)
• Pick up window
– STATs
– Controlled substances
• Requires GBMC ID
badge-RN,physician,NP
• Must sign for meds
Procuring Medications
• NeighborCare Pharmacy (Outpatient Pharmacy)
– Discharged patients can fill their prescriptions before
leaving the hospital (GBMC Inpatient Pharmacy may provide
“used” inhalers, creams, etc upon written order..isolated cases….requires
2 hour lead time)
– Delivery to employees and patients on units in the
hospital
– Hours of operation….Mon-Fri = 8am - 6pm,
Sat, Sun = 8am - 12 noon
Standard Medication Times
• Standard Medication times are utilized by
the pharmacy, unless otherwise directed by
the physician
SCHEDULE
TIME
DAILY
0900
QAM
0900
BID
0900, 2100
TID
0800, 1600, 2200
QID
0800, 1300, 1700, 2200
HS
2100
Q2H
0200, 0400, 0600, 0800, 1000, 1200,
1400, 1600, 1800, 2000, 2200, 2400
Q3H
0600, 0900, 1200, 1500, 1800, 2100,
2400, 0300
Standard Medication Times
SCHEDULE
TIME
Q4H
0600, 1000, 1400, 1800, 2200, 0200
Q6H
0600, 1200, 1800, 2400
Q8H
0600, 1600, 2400
Q12H
0900, 2100
AC
0730, 1130, 1630
PC
0930, 1330, 1830
AC + HS
0730, 1130, 1630, 2100
PC + HS
0930, 1330, 1830, 2100
DIURETICS
0900, 1700
Basics of Medication Administration
• Antibiotics must be administered within 2
hours of order
• All once daily medications will be
administered on the first day ordered unless
already taken by patient before admission to
the unit, or otherwise ordered by prescriber
to start at another date/time
Basics of Medication Administration
• All antibiotics, antivirals, and antifungals
prescribed as daily or q24h will remain on a q24h
schedule and be assigned a standard dose time
closest to the time of the initial dose
• Medication is considered on time if administered
within one hour of the standard dose time (before
or after)
• Subsequent doses will be administered at evenly
spaced intervals so that the medication is on the
standard administration time schedule at the end
of the first 24-hour period
Acknowledging Medications
• All medications must be acknowledged
before they can be administered using the
Meditech BMV/eMAR system
• Acknowledging a medication in the MAR
means that the order has been transcribed
correctly by pharmacy
• A medication must only be acknowledged
once
Process of Inpatient
Medication Delivery
1. Verify patient name, date of birth, drug, dose,
route, and scheduled time on the MAR in
Meditech
2. Wash hands
3. Check patient allergies
4. Remove medications from patient bins or
acudose, checking drug, dose, and route with the
MAR and take into patient room
5. Open the MAR on the screen in the patient’s
room
Process of Inpatient
Medication Delivery
6. Identify patient by checking patient’s armband,
and asking the patient to state their name and
date of birth
7. Scan patient’s armband with barcode scanner
(wait for on screen verification)
8. Begin scanning the medications you will be
administering, explaining the purpose and
potential side effects of any new medications
Process of Inpatient
Medication Delivery
9. Administer medications to the patient, ensuring
that any PO meds are completely swallowed
before leaving room
10. After verifying that meds have been swallowed
or are infusing, press File on the screen to save
all documentation in the MAR
11. Any education provided during medication
administration should be documented on the
education record in Meditech PCS
Non-administration of Meds
• Any medications that are not administered
are recorded using the Non-Admin function
• A reason is required to be entered for any
non-administered medications (i.e. Hold
dose, Pt refused, Sleep, etc.)
• If medication is unable to be administered,
appropriate documentation may be entered
as a note in Meditech PCS
STAT Medications
• When advised by a physician that a STAT order has been written:
– Nurse shall attach a STAT sticker to the order form near (but
not obscuring) the order
– The order shall be immediately faxed to the pharmacy on the
STAT fax line (x6936)
– For all units live with the eMAR: When a STAT medication is
taken from the AcuDose as an emergency medication, it shows
on the eMAR as “STK Med Once,” and meds should be
scanned and administered as appropriate
– For all non-eMAR units: When a STAT medication is taken
from the AcuDose as an emergency medication, it shall be
recorded as “given” on the order sheet
• STAT, NOW and IMMEDIATE medication orders shall be
processed, dispensed, and administered within one hour of the
order date and time
Adverse Drug Reactions
• Definition of an ADR
– Any response to a drug
which is unintended,
undesirable, or unexpected
• Should be reported
immediately to physician
– Need to document
physician notification in
notes
• ADR HOTLINE
– Call Ext. 2377 and leave a
message
Reportable Drug Reactions
ALLERGY
GASTROINTESTINAL
RESPIRATORY
Anaphylaxis
Diarrhea
Wheezing
Angiodema
Constipation
Increased Respirations
Fever
Nausea, Vomiting
Skin Reaction
Hemorrhage
URINARY
Oliguria
DERMATOLOGICAL
HEMATOLOGICAL
Bladder Spasms
Rash
Anemia
Failure
Petechiae
Leukopenia
Erythema
Thrombocytopenia
SPECIAL SENSES
Phlebitis
Abnormal Coagulation
Taste perversion
Urticaria
Appetite Changes
Reportable Drug Reactions
ELECTROLYTE &
FLUID IMBALANCE
ENDOCRINE /
METABOLIC
VASCULAR
Hyperkalemia
Hypothyroid
Dysrhythmia
Hypokalemia
Fever
Bradycardia
Hypernatremia
Hypoglycemia
Tachycardia
Hypocalcemia
Sexual Function
Hypertension
Fluid Retention
ENT / ORAL
Hypotension
NEUROLOGIC
Tinnitus
Headache
Hearing Loss
MUSCULOSKELETAL
Dyskinesia
Stomatitis
Muscle weakness
Convulsions
PSYCHIATRIC
Arthritis
LIVER
Depression
Arthralgia
Hepatitis
Confusion
Myalgia
Jaundice
Hallucinations
Drugs Most Commonly Involved in ADR’s
ORAL FORMS OF:
INJECTABLE FORMS OF:
Kayexalate (Sodium Polystyrene Sulfonate)
Antihistamines (Benadryl)
Imodium
Atropine
Lomotil
Cogentin (pine)
Flagyl / Vancomycin Oral
Dextrose 50%
Kaopectate
Epinephrine
Atarax / Vistaril (Hydroxyzine)
Narcan (Naloxone)
Vistaril
TOPICAL FORMS OF:
Compazine
Calamine Lotion
Dilantin (Phenytoin)
Local Anesthestics
Mephyton (Phytomadione-Vitamin K)
Corticosteroids (Topicort)
Protamine
Digibind
Romazicon
Corticosteroids
(Solumedrol/Solucorte/Decadron)
Medication Errors
• What constitutes a medication error?
– A dose of medication that deviates from the physician’s
order or from standard hospital policy and procedure
– Omission of an ordered medication
• Why should medication errors be reported?
– Non-punitive approach to improve hospital processes
– Evaluate and correct systems
• How do I report a medication error?
– Notify the physician
– Document in progress notes
– Complete Medication Incident Report (Form 720-63)
Medication Safety Basics
- Always know your medications before
administering them - It is the responsibility
of the licensed personnel to know actions,
dosage range, and side effects of
medications
- Drug reference information is available on
nursing units and on-line (micromedix or using
the monograph feature of the MAR).
Medication Safety Basics
- Identify your patient before giving any
medications
- The nurse who prepares a medication must
administer it
- Before mixing any medications, check
their compatibility with a pharmacist
- Always dispose of needles/syringes in a
sharps container. Do not recap needles.
Please take the Pharmacy Medication Administration
post-test and turn in the passing certificate to your
agency