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An Introduction to Pharmacy Operations
Alex Evans, PharmDPharMerica
Hilo, HI
● Introduce the workflow of a pharmacy● Identify areas where errors can occur● Brainstorm processes to prevent those
errors● Introduce the process of order and product
verification● Practice answering drug information
questions● Apply basic science to two clinical examples
Objectives
Pharmacy WorkflowReceiving Prescription
Order Entry
Pharmacist Review - Order
Filling and labeling
Pharmacist Review - Product
Medication delivery or pickup and counseling
Medication administration
Monitoring
www.ismp.org
(adjudication)
Identify: 1- At least two ways errors can occur for each of these steps 2- At least one practice you could implement in the pharmacy to prevent those errors
GROUP ACTIVITY
Errors and Solutions
Pharmacist Activities
Pharmacy WorkflowReceiving Prescription
Order Entry
Pharmacist Review - Order
Filling and labeling
Pharmacist Review - Product
Medication delivery or pickup and counseling
Medication administration
Monitoring
www.ismp.org
(adjudication)
ISMP Key Elements:○ Patient Information
■ Two identifiers (name, DOB, MR#)■ Allergies■ Weight
○ Drug Information■ Drug and formulation■ Inadequate knowledge of typical doses
○ Communication of drug orders/information■ Inappropriate abbreviations■ Incorrect entry into electronic ordering system■ Sloppy handwriting
Pharmacist step 1: Order Verification
www.ismp.org
What are these for?
www.philly.comhttp://webmm.ahrq.govhttp://www.webmm.ahrq.govhttp://www.ismp-canada.orghttp://www.fda.govhttp://apps.who.int
Pharmacy WorkflowReceiving Prescription
Order Entry
Pharmacist Review - Order
Filling and labeling
Pharmacist Review - Product
Medication delivery or pickup and counseling
Medication administration
Monitoring
www.ismp.org
(adjudication)
● ISMP Key Elements:○ Drug labeling, packaging, and
nomenclature■ Look alike, sound alike
(hydroxyzine/hydralazine)■ Similar drug packaging
● Methods to verify product:■ NDC■ Picture ID■ Description on label
Pharmacist Step 2: Product Verification
www.ismp.org
abcnews.go.comwww.rxrama.comhttp://pharmacythoughts.files.wordpress.com
Safe Medication Practices
www.nyc.govwww.usatoday.comhttp://healthcare.utah.eduhttp://sustainability.baxter.comhttp://jehingr.files.wordpress.comhttp://www.covidien.com
● Syringe pull-back method● Should NOT be used for high-risk
medications○ Chemotherapy○ Pediatric/neonatal○ High alert (ex. heparin)
Checking a sterile compound
http://pharmacypracticenews.comwww.ismp.orghttps://s3.amazonaws.com/http://www.mountainside-medical.com/
Pharmacist verification:● Calculations● Weighing and measuring
(90-110% of label)● Order of mixing● Compounding
techniques
Checking a non-sterile compound
USP <795>www/thecompoundingrx.comwww.pcab.org
● General drug info:○ Lexi-comp○ Micromedex○ Facts and Comparisons
● IV stability and compatibility:○ Trissel's○ Package insert
● Pill identifier:○ Lexi-comp○ Facts and Comparisons○ www.drugs.com
● UptoDate● PubMed
Drug information
● I am infusing Teflaro. How long do I infuse it over? ● I found these pink oval pills. They say "E102" on them.
What are they?● I need to start morphine PO in an opioid-naive patient.
What dose should I start with?● I have a patient on warfarin and I want to start them
on Cipro. Will that be a problem?● I wanted to use an "Extended-interval Zosyn" infusion.
How long does that infusion need to be? If the patient is on dialysis can I still use it?
GROUP ACTIVITY
Application of basic sciences: IV fluids
● Normal (0.9%) Saline● D5W (5% Dextrose)● Lactated Ringers● 1/2 Normal Saline● Hypertonic saline
IV fluids
http://www.safetynett.ca/image/cache/data/saline-500x500.jpghttp://www.chinookmed.com/mas_assets/full/01450.jpg
Application of basic sciences: Antacid chemistry
● Calcium carbonate● Sodium bicarbonate● Magnesium hydroxide● Aluminum hydroxide
Antacid chemistry
www.wikipedia.comhttp://www.scbt.com/images/gels/116654.jpg
QUESTIONS????
1. "Improving medication safety in community pharmacy: assessing risk and opportunities for change." Institute for Safe Medicine Practices. Accessed online March 30, 2013 at http://www.ismp.org/communityRx/aroc/files/ISMP_AROC.pdf
2. "Proceedings from the ISMP sterile preparation compounding safety summit:guidelines for safe preparation of sterile compounds." Institute for safe medicine practices. Accessed March 30, 2013 at https://www.ismp.org/Tools/guidelines/IVSummit/IVCGuidelines.pdf
3. "Medication errors: a year in review." Pharmacy Practice News Special Edition 2011. Accessed March 31, 2013 online at http://pharmacypracticenews.com/download/Med_errors_ppnse11_WM.pdf.
4. "US Pharmacopeia <795> Pharmaceutical compounding - nonsterile preparations." Acccessed March 31, 2013 online at http://www.pharmacopeia.cn/v29240/usp29nf24s0_c795.html.
5. "Example of a failure mode effects analysis for IV patient controlled analgesia." Institute for Safe Medicine Practices. Accessed April 1, 2013 online at http://www.ismp.org/tools/FMEAofPCA.pdf.
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