Nursing Orientation to Pharmacy Randa Yehia-Abdelal, PharmD Clinical Pharmacy Coordinator at Muhlenberg Regional Medical Center

Pharmacy hours of operation: *Main Pharmacy is open 24 hours Pharmacy telephone numbers: Main Pharmacy ext. 2128 IV room ext. 3118 Clinical Pharmacist ext. 2968 (pager = 3079)

Pharmacy hours of operation:

*Main Pharmacy is open 24 hours

Pharmacy telephone numbers:

Main Pharmacy ext. 2128

IV room ext. 3118

Clinical Pharmacist ext. 2968 (pager = 3079)

The Path of a Medication Order Any order that was faxed appears as an electronic image called “MedDirect” for the pharmacist to view, verify and dispense.

The Path of a Medication Order

Any order that was faxed appears as an electronic image called “MedDirect” for the pharmacist to view, verify and dispense.

Med Direct Dispensing

Pharmacist: Victor The order is profiled by the pharmacist where it is screened for therapeutic duplication, correct & appropriate dosing, drug-drug &/or food-drug interactions, allergies and therapeutic compatibility

Pharmacy Director: Dennis No orders can be entered in the computer without height, weight, and allergy information!

Gosh, I hope I didn’t scare them away…

Pharmacy Supervisor: Diane All 24 hour patient medication supply are stored in the patient’s cassette in a medication cart and cart exchange will be done from 12:30pm to 1pm

Hi, my name is Mayanna, I am a pharmacy technician

All IV’s are stored in the IV refrigerator or in slots located in the medication room If a specific IV cannot be stored under refrigeration the storage conditions are printed on the IV label

All IV’s are stored in the IV refrigerator or in slots located in the medication room

If a specific IV cannot be stored under refrigeration the storage conditions are printed on the IV label

Pharmacy Robot ROBOT-RX automates the storage, dispensing, returning, restocking and crediting of bar coded medications This system assures that the right medication is dispensed for the right patient which in return frees the pharmacist to support more productive clinical activities

ROBOT-RX automates the storage, dispensing, returning, restocking and crediting of bar coded medications

This system assures that the right medication is dispensed for the right patient which in return frees the pharmacist to support more productive clinical activities

ARM Medication bags

Hello, I am Ronnie, I am also a pharmacy technician & I love my job!

AdminRx Using a scanning device, nurses and therapists can check medications, dosages and when medications should be given, thus ensuring that the five rights are met : {medication, dose, time, route, & patient}

Using a scanning device, nurses and therapists can check medications, dosages and when medications should be given, thus ensuring that the five rights are met :

{medication, dose, time, route, & patient}

However, despite all of its features and ability to improve patient medication safety, AdminRx does not take the place of good nursing judgment and critical thinking skills AdminRx places a lot of emphasis on the skills of the nurses and therapists and the need for Nursing, Pharmacy and other departments to function in a cohesive manner in order to improve patient safety

However, despite all of its features and ability to improve patient medication safety, AdminRx does not take the place of good nursing judgment and critical thinking skills

AdminRx places a lot of emphasis on the skills of the nurses and therapists and the need for Nursing, Pharmacy and other departments to function in a cohesive manner in order to improve patient safety

Floor stock Medications “ Floor stock”medications are medications on each nursing unit that are there for convenience in administering to the patient the “first dose” If floor stock is used, a replacement slip with the patient’s name must be sent to the pharmacy for replacement Examples of our floor stock : Maalox, Benadryl (diphenhydramine), digoxin, furosamide, magnesium citrate, heparin flushes, normal saline flushes, vitamin K injection (Nursery usually)

“ Floor stock”medications are medications on each nursing unit that are there for convenience in administering to the patient the “first dose”

If floor stock is used, a replacement slip with the patient’s name must be sent to the pharmacy for replacement

Examples of our floor stock :

Maalox, Benadryl (diphenhydramine), digoxin, furosamide, magnesium citrate, heparin flushes, normal saline flushes, vitamin K injection (Nursery usually)

Transfer of Medications with Patients The transferring nurse is responsible for transferring any medication (including IV medication)with the patient Medication cannot be legally transferred to another institution or sent home with a patient or their family. Please use the transfer checklist to assure that patient’s medications are appropriately transferred

The transferring nurse is responsible for transferring any medication (including IV medication)with the patient

Medication cannot be legally transferred to another institution or sent home with a patient or their family. Please use the transfer checklist to assure that patient’s medications are appropriately transferred

Missing dose request A request form is used for missing doses Monthly nursing unit inspections All patient care areas are inspected once a month to assure proper storage of medications, that no medications have deteriorated (expired), and assure that there is proper compliance in medication administration/handling procedures

Missing dose request

A request form is used for missing doses

Monthly nursing unit inspections

All patient care areas are inspected once a month to assure proper storage of medications, that no medications have deteriorated (expired), and assure that there is proper compliance in medication

administration/handling procedures

Automatic Stop Orders Nutrition support orders are written daily Narcotics (schedule II) must be written or renewed every 3 days Anticoagulants must be reordered every 2 days (except Lovenox & SQ heparin) Schedule III, IV, and V controlled medications (sedatives, barbiturates, tranquilizers) every 7 days Antibiotics must be reordered every 10 days Oxytocics must be reordered every 24 hours All plasma-derived products must be reordered every 24 hours (Ex., Albumin)

Nutrition support orders are written daily

Narcotics (schedule II) must be written or renewed every 3 days

Anticoagulants must be reordered every 2 days (except Lovenox & SQ heparin)

Schedule III, IV, and V controlled medications (sedatives, barbiturates, tranquilizers) every 7 days

Antibiotics must be reordered every 10 days

Oxytocics must be reordered every 24 hours

All plasma-derived products must be reordered every 24 hours (Ex., Albumin)

IV admixtures service All IV’s at MRMC are prepared by the pharmacy’s IV admixture service. However, some exceptions maybe the following medications: Corticosteroids for injection (except pediatrics) Methyldopa (Aldomet IV) TPA (Activase) IV Bactrim IV vials (trimethoprim/sulfamethoxazole) Protonix IV (pantptazole

All IV’s at MRMC are prepared by the

pharmacy’s IV admixture service. However,

some exceptions maybe the following

medications:

Corticosteroids for injection (except pediatrics)

Methyldopa (Aldomet IV)

TPA (Activase) IV

Bactrim IV vials (trimethoprim/sulfamethoxazole)

Protonix IV (pantptazole

IV Nutrition support Orders for TPN or PPN must be sent to the main pharmacy by 2:00pm to be made that day Orders received after 2:00pm will be made the following day & the unit will hang D10In the interim Orders are valid for one 24 hours supply of IV nutrition support (supplied in a single 24 hour bag of solution). Orders must be rewritten or renewed every 24 hours, every day for every patient All patients receive a new bag of solution at approximately 5:00pm, every day, which is hung at 8:00pm, on every patient, every day Any solution remaining from the previous day’s bag at 5:00pm is discarded when the new bag is hung

Orders for TPN or PPN must be sent to the main pharmacy by 2:00pm to be made that day

Orders received after 2:00pm will be made the following day & the unit will hang D10In the interim

Orders are valid for one 24 hours supply of IV nutrition support (supplied in a single 24

hour bag of solution). Orders must be rewritten or renewed every 24 hours, every day for every patient

All patients receive a new bag of solution at approximately 5:00pm, every day, which is

hung at 8:00pm, on every patient, every day

Any solution remaining from the previous day’s bag at 5:00pm is discarded when the new bag is hung

Adverse drug reactions Please report any suspected or known adverse drug reaction to the pharmacist covering by filling out the following green ADR form No need to include the name of the person filling out the form, just the name of the patient

Adverse drug reactions

Please report any suspected or known adverse drug reaction to the pharmacist covering by filling out the following green ADR form

No need to include the name of the person filling out the form, just the name of the patient

Safety reports In our hospital newsletter we publish incidents that may have happened in the hospital or other healthcare facilities related to medication dispensing, administration or dosing errors that may have caused harm or had the potential to cause harm to patients. This is just one effort to try to alert our clinicians so that these incidents can be avoided in the future

Safety reports

In our hospital newsletter we publish incidents that may have happened in the hospital or other healthcare facilities related to medication dispensing, administration or dosing errors that may have caused harm or had the potential to cause harm to patients. This is just one effort to try to alert our clinicians so that these incidents can be avoided in the future

Safety Report Entry

Therapeutic interchange program Switch Prilosec, Aciphex, Nexium (Proton-pump inhibitors) to Protonix Switch Zantac and Tagamet to Pepcid Switch Milk of Magnesia with cascara to Milk of Magnesia HMG-CoA reductase inhibitors – Pravachol (Pravastatin) Epogen/Procrit to Aranesp (darbopoetin) Switch Xopenex to albuterol for nebulizer

Switch Prilosec, Aciphex, Nexium (Proton-pump inhibitors) to Protonix

Switch Zantac and Tagamet to Pepcid

Switch Milk of Magnesia with cascara to Milk of Magnesia

HMG-CoA reductase inhibitors – Pravachol (Pravastatin)

Epogen/Procrit to Aranesp (darbopoetin)

Switch Xopenex to albuterol for nebulizer

Restricted Drugs Synercid – Restricted to Infectious Disease Zyvox – Restricted to Infectious Disease Xigris – Ristricted to Infectious Disease Cancidas – Restricted to Infectious Disease Vfend – Restricted to Infectious Disease Cubicin – Restricted to Infectious Disease Tygacil – Restricted to Infectious Disease Continued…..

Synercid – Restricted to Infectious Disease

Zyvox – Restricted to Infectious Disease

Xigris – Ristricted to Infectious Disease

Cancidas – Restricted to Infectious Disease

Vfend – Restricted to Infectious Disease

Cubicin – Restricted to Infectious Disease

Tygacil – Restricted to Infectious Disease

Continued…..

Hepatamine – Restricted to hepatic failure patients Aloxi – Restricted to Oncology Emend – Restricted to Oncology Chemotherapy – Restricted to Oncology Versed – Restricted for Anesthesiology, Endoscopy & Special procedures in designated areas Ropivacaine (Naropin) – Restricted to Obstetrics Angiomax- Restricted to Cath Lab Suboxone- Restricted to Dr. Hashmi for opioid dependence

Hepatamine – Restricted to hepatic failure patients

Aloxi – Restricted to Oncology

Emend – Restricted to Oncology

Chemotherapy – Restricted to Oncology

Versed – Restricted for Anesthesiology, Endoscopy & Special procedures in designated areas

Ropivacaine (Naropin) – Restricted to Obstetrics

Angiomax- Restricted to Cath Lab

Suboxone- Restricted to Dr. Hashmi for opioid dependence

Pain Team Consultation Pain Team consulting services will now be offered to inpatients at Muhlenberg. This service will primarily be focused on managing acute/chronic pain through pharmacologic therapy Non-pharmacological therapy will also be offered to inpatients in conjunction with pharmacologic management. Non-pharmacologic mode of therapy will include music, guided imagery, journaling, humor, prayer, and relaxation The pain team will see patients within 24 hours of physician’s written request (order) except weekends The pain team will consist of the clinical pharmacist, clinical nurse specialist and/or an oncology nurse The pain team will make patient rounds on a routine basis and make recommendations documented in the progress notes. Any recommendations written by the Pain Team will not be processed without the attending physician’s approval

Pain Team consulting services will now be offered to inpatients at Muhlenberg. This service will primarily be focused on managing acute/chronic pain through pharmacologic therapy

Non-pharmacological therapy will also be offered to inpatients in conjunction with pharmacologic management. Non-pharmacologic mode of therapy will include music, guided imagery, journaling, humor, prayer, and relaxation

The pain team will see patients within 24 hours of physician’s written request (order) except weekends

The pain team will consist of the clinical pharmacist, clinical nurse specialist and/or an oncology nurse

The pain team will make patient rounds on a routine basis and make recommendations documented in the progress notes. Any recommendations written by the Pain Team will not be processed without the attending physician’s approval

Thank You

Thank You