Learning Outcomes. Opportunities for students to specialize in certain • Two primary methods • automation • manual • Automated Medication Dispensing Cabinets • Technicians play a key role • Maintain appropriate inventory-frequent adjustments, Manual Cart-Fill Process • Requires use of medication carts or cassettes • medication drawers labeled with patient names • fill-list report is generated • for specific time period–medications scheduled to be given will print • technician will fill each patient’s drawer from fill-list • pharmacist will check the carts for accuracy • tech-check-tech process in some states • technician exchanges cassettes in patient care areas, Emergency Crash Carts • Carts or trays with medications used in emergencies • defined list of medications • Carts/trays are filled by techs & checked by pharmacist • locked and sealed • delivered to designated patient care area, Clinical Services • Pharmacists provide patient-focused services • pharmacokinetic dosing • infectious disease consultations • drug information • nutritional support services • Pharmaceutical care • Pharmacist is advocate for patient • Patient is involved in decision-making process for care, Role of the Technician • Pharmaceutical care model allows for new roles for technician • use of technicians to record laboratory results • screening orders for non-formulary status • identifying orders on the hospital’s restricted list • review & collect missing information for patient • allergies • height • weight, Investigational Drug Services • Clinical trials evaluate efficacy/safety of medications • Study protocol is developed, reviewed, approved by Institutional Review Board (IRB) • Protocol is operating manual for clinical trial • Specific requirements /procedures must be followed, Clinical Trials • Following protocol accurately important • Patient randomized to receive study drug or placebo • Results & recordkeeping may be audited by FDA • Investigational medications must be • stored in a separate section of the pharmacy • limited access, Medication Management • Entire medication process involved • Selection & procurement of drugs • Storage • Prescribing • Preparation & dispensing • Administration • Monitoring effects • Evaluation of entire system, Selection & Procurement • Pharmacy & Therapeutics (P&T) Committee establishes hospital formulary basedon: • indications for use • effectiveness • drug interactions • potential for errors and abuse • adverse effects • cost, Formularies • Closed formulary means choice of drugs limited • Drugs are admitted to formulary by process • physician requests to add a drug to formulary • pharmacists anticipates need • drug monograph is written (by pharmacy) • P&T Committee uses information in monograph to decide whether to add drug to formulary • drugs removed from formulary • when better drugs become available • when purchasing trends show drug longer being used, Formulary & Non-Formulary • Pharmacy technicians key role in procurement • Specific procurement process • Pharmacist may suggest formulary medication to replace non-formulary medication • Pharmacy has procedures to allow for temporary use of non-formulary drug, Storage • Proper storage of medications is critical • temperature • light sensitivity • All medications in hospital are inspected monthly • inspections primarily performed by technicians • referred to as unit inspections, Storage of Controlled Drugs • Specific storage & documentation requirements • Requirements are stringent • based on abuse & diversion potential • Must comply with all legal & regulatory requirements • Technicians need to be trained & knowledgeable about these requirements, Prescribing • Policies & procedures for prescribing medications • Verbal orders are not recommended • Procedures for verbal orders to minimize errors • Helpful if indication is on medication order • Prescribers can enter order electronically or write out • Pharmacists must review medication orders, MAR • Medication order information appears on MAR • MAR=Medication Administration Record • Used by nursing to administer meds • Pharmacist must review all orders before medication administered unless emergency situation • Some hospitals outsource this function to remote sites, Preparation & Dispensing • Unit-ready-to-use form should be provided to nurse • Pharmacy should dispense patient specific unit dose packages to nursing units because: • reduction in incidence of medication errors • decrease in total cost of medication-related activities • more efficient use of pharmacy & nursing personnel • improvement in overall drug control and drug use • more accurate patient billing for drugs, IV Medications • Some IV medications available in unit dose form • Some meds not stable in solution • must be mixed by pharmacy just prior to administration • Technicians: main preparers of IV medications • Prep requires knowledge/skill of aseptic techniques, Extemporaneous Prep • Doses based on patient-specific characteristics • Pediatric patients • require very small doses • unique doses not commercially available • special dilutions made for IV solutions • Extemporaneous oral solutions/suspensions • compounded if patients unable to swallow tablet • crush tablets-follow recipe for solution or suspension, Final Prep Steps • Proper labeling • patient’s name • patient’s location in hospital • medication name • dose • route of administration • expiration date • special directions • bar-codes, Administration • Procedures to ensure timely administration of meds • Procedures to check 5 rights • right medication • right dose • right patient • right time • right route • Some hospitals add 6th right of documentation, Bar Code Systems • Computer systems linked so that • Nurse scans the patient’s wrist band & med bar code • Confirms 6 rights: • Right Patient • Right Drug • Right Dose • Right Time • Right Route • Right Documentation-added on to original 5 rights because without documentation, dose may be given more than once in error, Monitoring • Monitoring effects of medications mandatory • adverse effects • positive outcomes • important component in process • Monitoring uses patient information • laboratory results • patient’s clinical response • medication profile (anti-allergic or antidote orders ) • Technicians may gather info for pharmacists, Evaluating Medication Process • Tracking & identifying trends • adverse drug events • medication errors • performing medication-use evaluation (MUE) • MUE is commonly performed for • high-use drugs • high-cost drugs • high-risk drugs, MUE Process • Data is collected for evaluation of • appropriate use • indications, dose, route, clinical response • Data is tabulated & presented to • appropriate health care providers • hospital committees. 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