Pharmacy Workflow Framework 1-20

7/31/2019 Pharmacy Workflow Framework 1-20

1/20

TRIPh

armacy

Pre

imp

lementa

tionwork

flow

TechniciansNurse/Pharmacy

Allergy

Documen

tation

Note:A

llergydocumentationisaninterdisciplinaryworkflowandisrecord

edonmultiplepatientdocumentationsEx.

Physicianorders,allerg

ysheet,MARetc

As

kspa

tien

ta

bou

t

drug,

foo

d,

latex

an

do

thera

llerg

ies

Informa

tionw

ill

t

hen

beseenon

M

ARan

dpa

tien

t

pro

file

Tech

en

ters

allergyin

forma

tion

intoS

oftRx

Copyo

fa

llergy

shee

tissen

tto

tec

hn

iciansor

wri

ttenonme

d

rec.

form

Comp

letes

initial

pa

tien

tinterv

iew

Fillsou

tpa

tien

t

allergyan

d

assessmen

tform

Orig

ina

lco

py

in

chartand

copy

goes

toPha

rmacy

Secon

dtec

h

veri

fiesen

try


2/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Technicians

Au

toMe

dMac

hine-

Stoc

king

NO

YES

Addme

dica

tion

to

she

lfinventoryus

ing

FIFOprocess

Co

llec

ta

ll

medica

tions

for

run

inlaun

dry

bins

Can

isteremp

ty?

Con

tinuew

ith

secon

dary

tas

k

Rece

ive

Me

dica

tion

fromcourr

iers

En

ter

loa

de

dme

ds

to

compu

tersys

tem:

Barco

de,

lot#an

d

quan

tity

Re

loa

dcan

ister,

scanpro

duc

t,dou

ble

chec

k

Wa

itformac

hine

to

promp

tforemp

ty

can

iste

r


3/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Technicians

Au

toMe

dMac

hine

Tray

Fills

Tray

Fills

Ca

lldesign

ated

inspec

tor

toveri

fyin

trays

Filltray

todes

igna

ted

Au

tome

dtrayw

here

cus

tom

lightsprov

ide

apromp

toro

ther

manua

ltray

Re-s

tart

Au

to-Me

d

mac

hine

Pu

llrep

lacemen

tun

it

intoa

lignmen

tw

ith

Au

toMe

dmac

hine,

place

intomac

hine,

close

doors

Remove

lower

(mu

lti

doseo

run

itdose

)

un

itfrommac

hine

when

promp

ted

Sp

liton

etypeo

fp

ill

manua

llyus

ingp

ill

sp

litter

Au

toMe

dgenera

tes

report

Chang

ingPac

kag

ingun

it

Pu

llun

ittoc

leara

pa

thforrep

lacemen

t

un

it

Cleanp

illsp

litteran

d

trays

Re-s

tart

AutoMe

d

mac

hin

e

Process

for

tray

fillsbe

forerun

?


4/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Pharmacy(Rx)/SystemPhysician(MD)

Au

toStop

Orders

YES

NO

Da

tespec

ified?

Drugw

illfallo

ffthe

MARan

dmoves

tothe

drug

history

inSo

ftRxsys

tem

MDwri

tesanorder

withanau

to-s

top

drug

Drugd

iscon

tinue

afte

rwri

tten

num

bero

fdaysor

numbe

ro

fdoses

Note:

o

o

Drugs

tay

discon

tinue

d

Rxw

illa

ttemp

tto

clari

fyifno

da

teis

given

Drugw

ill

au

toma

tica

lly

discon

tinuea

fter

7

days

ifno

clari

fica

tion


5/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

TechniciansPharmacy(Rx)Physician(MD)

Au

toSu

bOrders

YES

NO

Au

toSu

bdrug

Yes

Rxw

illsugges

ta

formu

lary

alterna

tive

MDordersanon-

formu

lary

me

dica

tion

RPhw

illre-wri

te

orderasperau

to

su

bspo

licy

Theme

dw

ill

con

tinueasa

regu

larorder

Tec

hcanpu

t

commen

tinpat

ien

t

So

ftRx

filesay

ing

au

to-su

bs

titute

d

RPhw

illgoan

d

visittheun

ita

ta

later

time

RPhava

ilable

onun

it?

Note:

-Ifpatie

ntisgoinghomethencanputre

ferenceorderofwhatthepatien

twasoriginallyonthisorderis

notactiveandwontgoonthe

MARjustinpatientprofileasareference

whenpatientisdischarged

-Curren

tlynoautomaticautosubsinSoftRx(allmanualprocess)

MDw

illwri

tean

alterna

teformu

lary

drugorder

Sourcenon-form

item

No

Drugmus

tbe

en

tere

dinto

sys

tem

Fo

llow

filling

process

No

tAu

toSu

bdrug


6/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

PharmacistTech1ClinicalTeam/

RPh

Bliste

rPac

kRe

fill/Dosse

tte

Ma

keup

temp

lateo

f

pa

tien

tsme

ds

Turnong

luegun

Findexp

ire

dme

ds

from

inven

tory,

or

usecurren

tinven

tory

Gluemeds

to

works

hee

t

De

liver

MEDCard

to

pa

tien

t

Clinica

lteam

/RPh

ma

kesreques

tfor

pa

tien

tblisterpac

k

RPhinsp

ec

tsblister

p

ac

k

RPhc

loses

blister

pac

k

SCCfillreport

forun

it

toiden

tifySMP

pa

tien

tsperun

it

Pharmacy

tec

h

de

liversme

ds

to

pa

tien

t

Pharm

acy

tec

h

mo

difie

sex

isting

prescript

ions

tha

tcan

beparto

fSMP

program

B

uildMEDCard

Pharmacy

tec

hfills

blisterpac

kper

sc

he

du

le,

leav

ing

pac

ksopen

Pharmacy

comp

letes

SMP

form

inpo

licy

Tec

hup

da

tes

SCC

toiden

tifypa

tient

as

SMP

La

be

ledby

tec

h

an

dc

hec

ke

dby

RPh


7/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Tech2Tech1AutoMed

Cart

Fill

Tec

hre

fers

to

spec

ificcart

fill

sc

he

du

le

A

utoMe

drun

sc

he

du

led

medica

tions

from

ma

chine

forun

it

Tec

hveri

fieseac

h

unit

dosepac

kage

for

dup

lica

tes,

cru

she

dp

illse

tc

Picks

PRNan

d

non-au

tome

d

drugs

Listo

fPRNs

/non-

au

tome

ddrugs

alsosc

he

du

ledto

prin

t

PRNan

dnon-au

to

me

ddrugsare

chec

ke

d

Me

dsput

inbinfor

patien

t

Tec

hw

illcon

tinue

toCasse

tte

Exc

hange

work

flow

Con

firm

ifthesearese

tor

do

theym

anua

llydo

this?

SCCsen

ds

Au

toMe

dtherun

file

Separa

te

me

dica

tion

by

pa

tien

tname

Clipme

dica

tions

intoro

ll/s

trips


8/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Tech1

Casse

tte

Excha

nge

Prepare

/De

liver

Re

turncart

to

pharmacyw

ith

emp

tycasse

tte.

Swap

bins

from

ex

istingcasse

ttew

ith

new

bins.

Loa

dorders

into

casse

tte.

Fo

llowcart

fillprocess

Move

towards

toc

k

areaan

dup

da

te

wards

toc

k.

Wa

lkw

ithcart

to

elevator,

then

to

un

itsm

edica

tion

area

Move

too

ther

casse

tteson

theun

it

an

drepea

tprocess.

Reorgan

ize

traysas

necessary.

Comp

leteward

stoc

kfilllist

(de

livere

donnex

t

un

itrun

)

Chargewa

rds

toc

k

toun

itth

roug

h

SCC

Yes

No

Me

dsare

dumpe

d

ou

t

Mu

ltid

ose

pac

k?

Re

turne

dtos

he

lf

forre-use

Tec

hw

illmovea

ll

non-au

tomu

ltidose

items

(drops,

creams

)intonew

bina

ttimeo

f

exc

hange

No

Le

fto

ver

med

s?

Yes


9/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

PharmacistTech2Tech1MD/RN

Interim

Doses

MDwri

tesanorder

forac

hange

d

order

Order

broug

ht

downor

tec

hp

icks

uporder

from

pharmacy

binon

un

it

Changeorder

is

screene

d

Ifo

ldorde

rin

sys

tem

discon

tinue

old

order

insys

tem

Discon

tinue

dlabe

l

prin

tsou

tan

dis

attac

he

dto

prescrip

tion

E

nterneworder

in

sys

tem

Tec

hveri

fiesorder

iscorrec

t

La

be

lprin

tsout

Picksme

ds

Chec

ksme

ds

Me

dsde

livere

dto

un

it

Approve

d

No

tAppro

ve

d

Nursepu

lls

order

forp

harmacyan

d

pu

tsinp

harmacy

bin


10/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Tech

Casse

tteexch

ange

leftoverme

ds

Prior

tocasse

tte

exc

hange

tec

hw

ill

chec

kfor

leftover

me

ds

Mu

ltidose

pac

k?

Me

dsare

dumpe

d

ou

t

Re

turne

dto

she

lf

forre-us

e

Yes

No

Whataboutunitdosepackagedmeds?

Tec

hw

illmovea

ll

non-au

tomu

ltidose

items

(drops,

creams

)intonew

bina

ttimeo

f

exc

hange


11/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

PharmacistRNTech

Re

fillDoses

(inc

luding

PRNs

)

RNw

illca

ll

pharmacyor

fillou

t

nurs

ing

commun

ica

tion

form

Tec

hw

illp

ickup

allforms

in

pharmacy

binon

un

it

Pharmac

istw

ill

rev

iewon

lyMAR

discrepancy

Shortageo

f

drug

in

Pharmacy

?

Prin

tanextra

labe

l

afteren

tering

into

sys

tem

Keep

labe

lon

wan

tlistboo

k

Fillw

ha

tever

amoun

to

fdrug

they

havepresen

t

Placepu

rchase

orderfo

rdrug

need

ed

Oncearr

ivescan

topup

leftover

me

ds

Yes

Re

filldrug

in

sys

tem

by

tec

h

La

be

lprin

ts

FillMe

d

Tec

h2rev

iews

me

dorder

Drug

de

livere

dto

un

it

No

Tryan

dsource

drug

froms

ites

if

no


12/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Tech2Tech1RN

Narco

tics

Ward

Stoc

kSys

tem

RNfillsnarco

tic

requ

isition

form

(some

timew

illca

ll

or

fillMARreq

form

)

Tec

hen

ters

informa

tion

from

form

intosys

tem

Narco

ticreport

is

prin

tedbyun

it/cart

Tec

hp

icks

narco

tic

tobe

filled

,s

ign

edan

d

ma

intaining

perpe

tualcoun

t

Tec

hche

cks

&

signsna

rco

tic

me

ds

tha

thave

beenf

ille

d

Narco

ticisbagge

d

an

dtakes

toun

it

Tec

hde

livers

wan

tedamoun

to

f

narco

tic

&RN

veri

fiesamoun

t

rece

ive

d

RNs

igns

Narco

tic

Adm

ins

hee

ttha

t

correc

tnarco

tic

wasrece

ive

d

Tec

hs

igns

narco

tica

dm

in

shee

t

Crea

tesan

interdepartmen

tal

trans

fero

fs

tock

an

dc

harge

dto

un

it/cart


13/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

TechRN

Narco

tic

Re

turns

Tec

han

dnurse

williden

tify

narco

tics

tobe

re

move

dfromcart

base

donusage

RNw

illsu

btrac

t

amoun

ttaken

from

Narco

tic

Adm

in

Shee

t

RNw

ills

ign

the

Narco

tic

Adm

in

Shee

t

Tec

hw

itnesses

signa

ture

Narco

ticsare

taken

down

to

Pharmacy

Re

turnen

tere

d

intoSCCbyun

it/

cart

Re

turne

dtos

toc

k

ifexp

irya

llowsan

d

a

dde

dtoperpe

tua

l

coun

t

Tec

h2c

hec

ksan

d

signs

the

logs

coun

t


14/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Tech2Tech

Narco

tic

Me

dSe

lec

t

Reportw

illprin

tin

pharmacy

from

the

me

dse

lec

tw

hich

narco

tics

tofill

Tec

hw

illfill&

chargenarcotic

sin

un

itdosepack

sto

theapp.

Med

Se

lec

t

Bo

thtec

hsw

ill

take

theun

itdose

narco

tics

tome

d

se

lec

tmac

hine

Te

ch1w

illen

ter

drugs

intoMe

d

se

lec

tan

dscan

barco

de

Narco

tic

drawer

willopen

Dotech1an

d2doublecheckeachother?

IfRNhasto

giveanarcotictheprocesswillw

orkthesameasgettingamedica

tionfromtheNightCupboard

Tec

h2c

hecks

the

narco

tics

thatare

picke

dby

Tec

h1

Tec

h2w

illloa

d

Me

dSe

lec

tco

ils

withcorrec

tnarc

an

dc

lose.

Logso

ff

Me

dSe

lec

t


15/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

Tech1Tech1RxMD

Change

Orders

Pharmac

istproposescha

nges

MDinitiatesa

changeus

ing

Phys

icianorder

form

2nd

pharmacy

tec

h

veri

fiespaperen

try

onsepara

te

computer

log

infor

au

thent

ica

tionan

d

labe

lprin

ts

2nd

pharmacy

tec

h

veri

fies

filledorder

1st phar

macy

tec

h

rev

iews

orderan

d

inpu

tstocompu

ter

sy

stem

1st pharmacy

tec

h

fillsorder

Order

isde

livere

dto

un

it

Copy

ispu

lledan

d

sen

ttop

harmacy

Pha

rmacy

tec

h

co

llec

tsorder

from

desig

na

tedbas

ke

t

duringroun

ds

Nurse

han

d-de

livers

anorder

Pharmac

istrev

iews

(screens

)c

hangeson

order

Orig

inalis

filedin

cha

rt

Phys

ician

con

tac

tedfor

veri

fica

tionor

phys

icianc

hanges

Pharmac

istapproves


16/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

PharmacistTech2Tech1Physician(MD)

Discon

tinue

dMe

dications

Pharmacy

Tas

k

MDwri

tesme

dto

be

discon

tinue

don

phys

icianorder

shee

t

Copyo

fp

hys

ician

orders

hee

tgoes

inRx

binonun

it

Tec

hw

ill

pickup

allitemsin

Rx

bin

whenonun

it

Pharmac

istw

ill

screen

the

discon

tinue

dme

ds

orderforerror

Tec

hw

illen

ter

discon

tinue

dme

d

order

intoSo

ftRx

sys

tem

Discon

tinue

dlabe

l

willprin

tou

t

T

ec

hw

illa

ffixlabe

l

onorder

Tec

h2w

illveri

fy

tha

ttec

h1

properly

d

iscon

tinue

dorder

an

ds

ign

Discon

tinue

dm

ed

order

isfiled

Nursepu

lls

d/c

me

dispu

lled

an

d

pu

tinp

harm

acy

binonun

itforp

ick

up

Ifoncart

exchange

dayme

d

remove

dbe

fore

go

ing

toun

it


17/20

TRIPha

rmacy

Pre

Imp

lemen

tation

Work

flow

TechNurse(RN/RPN)

Discont

inue

dMe

ds

RNTas

ks

Me

dbe

ing

discon

tinue

dis

un

itormu

ltidose

RNw

illpu

tun

it

dose

me

dinRx

binon

un

ita

long

withd/cp

hys

ician

ord

ers

hee

t

Tec

hw

illp

ickup

allcon

ten

tso

fRx

bin

Un

itd

ose

me

dica

tioncan

be

reuse

d(nopa

tien

t

info

)

Procee

dw

ith

Discon

tinue

d

me

dsprocess

pharmacy

tas

k

RNw

illloo

kfor

me

din

mu

ltidose

pac

kage

Willc

irc

letheme

d

be

ing

discon

tinue

d

an

dpu

ta

line

throug

hit

Me

dw

illbepu

lled

ou

to

fthepac

kage

an

ddiscarde

da

t

timeo

f

adm

inistra

tion

Discon

tinued

phys

icianorde

r

shee

tw

illgo

inRx

binonunit

Un

itdose

Mu

ltidose


18/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

OtherPharmacyNurse(RN/

RPN)Physician(MD)

D

isc

harge

Me

dica

tions

o

o


19/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

TechPatient/FamilyPharmacistPhysician(MD)

Disc

harge

Prescrip

tion

Pharmac

istw

illgo

throug

hthepa

tien

t

drugpro

file

Pharmac

istw

ill

initiatead

isc

harge

me

drecon

cilia

tion

form

MDw

illrev

iew

the

disc

harge

me

drec

withthe

pharmac

istan

d

drugpro

file

MD/RPhc

hec

ks

discon

tinues

&disc

harge

d

an

dmo

difies

drugorder

accord

ingonp

hys

ician

orders

hee

t

Me

drec

form

fina

lize

dby

pharmac

ist

Signe

dform

becomes

the

listo

f

neworders

Pharmac

ist

rev

iews

listof

ordersw

ithpatien

t

an

dfam

ily

Orderprocesse

d

by

tec

hinSCC

Pa

tien

tuses

listo

f

orderasa

prescrip

tiona

t

loca

ldrugs

tor

e

Orderpu

lled

RPhgenerates

disc

harge

prescrip

tion

MDs

igns

ISTHISFLOW

RIGHT??Doesnt

makesenseacco

rdingtocorrections

made

byteam


20/20

TRIPha

rmacy

Pre

imp

lemen

tationwork

flow

PrivateCourierTorontoRehabDriver

Drivers

Sc

he

du

le

11:3

0am

1:3

0am

8:3

0am

LC

UC

UC

HC

Bickle

UC

HC

Bickle

9:1

5am

Mon,

Tue,

Thursan

dFr

iday

LC

(Thurs

day

on

ly)

2:0

0pm

Documents

Pharmacy Workflow Framework 1-20