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An Introduction to
Pharmacy Operations
Alex Evans, PharmD
PharMerica
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 Workflow
Receiving 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 Workflow
Receiving 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.com
http://webmm.ahrq.gov
http://www.webmm.ahrq.gov
http://www.ismp-canada.org
http://www.fda.gov
http://apps.who.int
Pharmacy Workflow
Receiving 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.com
www.rxrama.com
http://pharmacythoughts.files.wordpress.
com
Safe Medication Practices
www.nyc.gov
www.usatoday.com
http://healthcare.utah.edu
http://sustainability.baxter.com
http://jehingr.files.wordpress.com
http://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.com
www.ismp.org
https://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.com
www.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.jpg
http://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.com
http://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.
References

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Alex Evans Intro to Pharmacy

  • 1. An Introduction to Pharmacy Operations Alex Evans, PharmD PharMerica Hilo, HI
  • 2. ● 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
  • 3. Pharmacy Workflow Receiving 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)
  • 4. 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
  • 7. Pharmacy Workflow Receiving 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)
  • 8. 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
  • 9. What are these for? www.philly.com http://webmm.ahrq.gov http://www.webmm.ahrq.gov http://www.ismp-canada.org http://www.fda.gov http://apps.who.int
  • 10. Pharmacy Workflow Receiving 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)
  • 11. ● 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
  • 14. ● 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.com www.ismp.org https://s3.amazonaws.com/ http://www.mountainside-medical.com/
  • 15. Pharmacist verification: ● Calculations ● Weighing and measuring (90-110% of label) ● Order of mixing ● Compounding techniques Checking a non-sterile compound USP <795> www/thecompoundingrx.com www.pcab.org
  • 16. ● 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
  • 17. ● 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
  • 18. Application of basic sciences: IV fluids
  • 19. ● 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.jpg http://www.chinookmed.com/mas_assets/full/01450.jpg
  • 20. Application of basic sciences: Antacid chemistry
  • 21. ● Calcium carbonate ● Sodium bicarbonate ● Magnesium hydroxide ● Aluminum hydroxide Antacid chemistry www.wikipedia.com http://www.scbt. com/images/gels/116654.jpg
  • 23. 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. References