1. PharmacyInstruct patient and family that medications need tobe taken home or kept in the hospital pharmacy. Sendmedications home if at all possible. If medications are sent home, document in CPSI which family member took possession of the medications. If medications are sent to the pharmacy, they are bagged, sealed and appropriately labeled in a patient valuable bag. These bags are found in the Business Office at the Cashier’s desk if none are available on the unit. Continued on next slide
2. Pharmacy (continued) • Once medications are placed in the bag the receipt is torn from the patient valuable bag and placed in the patient’s chart indicating there are medications to be returned to the patient at discharge. • If home medications contain any controlled medications then the admitting nurse will count and cosign receipt with another nurse at the patient’s bedside and secure bagThese medications are documented along with date, time andlist of medications sent to pharmacy on the Home MedicationInventory eform. If medications are sent home no medicationinventory eform is required.
3. Pharmacy (continued)If a patient’s home medication is unavailable from the hospitalpharmacy: The nurse or pharmacist will contact the physician and request to use the home medication. If physician agrees, the patient is notified and permission is requested to use the home med. If the patient does not agree, pharmacy is notified. If the patient agrees, an order is written specifying the patient’s home medications may be used. The pharmacist then verifies the identity of the medication prior to administration of the first dose. If the medication is a controlled substance, the medication will be kept in the Pyxis and a patient specific controlled drug administration record is kept.
4. Pharmacy (continued)Home Medication Inventory eform When medications can not be sent home and are sent to the pharmacy the Home Medication Inventory eform is used to list the names and amounts of medications sent to the pharmacy. This form is used for both non-controlled medications and controlled medications. These medications will pull from the Home Medication List eform so they will not have to be retyped. If there are controlled medications taken to the pharmacy, two nurses along with the patient or family member (if available) will sign the form when the medications are counted, bagged, sealed and removed from the patient’s room.
5. Pharmacy (continued)Home Medication Inventory eform continued: The eform is then signed by nursing and pharmacy when the medications are taken to pharmacy AND when they are taken back from pharmacy. When the medications are returned to the patient or family, the Home Medication Inventory eform is signed by the nurse and the patient or family member who is taking possession of the medications. The eform is then placed in the patient’s chart under the nurses’ notes tab. It is important to always check at discharge to see if the patient has any medications in the pharmacy that need to be returned to the patient. If a patients home medications are not picked up within 30 days following discharge, they are discarded in accordance with health department regulations related to controlled and non-controlled medications.
6. Pharmacy (continued)Standing Orders The physician must write “May Use Standing Orders” in order to use their standing orders If the physician does not write this, they are called for orders as needed Standing orders are written on an as needed basis, for example, if your patient needs something for nausea you would check the physician on call’s standing orders and write the order for the appropriate medication. It is written S.O. /MD’s name/Nurse’s name The order is then faxed to the pharmacy
7. Pharmacy (continued) Transdermal TNG patches ordered once daily are left in place for 12 hours during a 24-hour period unless the physician specifically requests an alternate schedule Transdermal TNG patch is placed on the upper arm or chest in a clean, dry area as free from hair as possible Patches should not be over scar tissue or areas of obvious skin irritation Transdermal patches should be removed prior to MRI studies and replaced upon return The standard administration times of TNG patches are: • 9:00 a.m. - patch applied • 9:00 p.m. - patch removed
8. Pharmacy (continued) Medication information is provided regarding all medications NEW to the patient’s routine Give medication information sheets to the patient at the bedside with regards to all new medications that the patient will be discharged home on Include instructions to the patient/caregiver regarding the dose, use, times, food-drug interactions, cautions, and side effects – Provide diet information for specific drugs requiring dietary precautions When appropriate, education regarding current medications is also included especially if patient is on high alert meds like Coumadin or insulin or if the dosage of a current med has changed