+ All Categories
Home > Documents > Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park...

Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park...

Date post: 26-Jun-2020
Category:
Upload: others
View: 5 times
Download: 0 times
Share this document with a friend
9
15200 Community Road Gulfport, MS 39503 Pharmacy Information: Medication Management I. Look alike sound alike medications. 1. GPMC’s policy and procedure on Look-alike sound-alike (LASA) medications can be found on GP Web > Policies and Procedures > Medication Management Manual >Look Alike Sound Alike Medications. 2. A message stating “Look Alike Sound Alike” appears on the Omnicell screen when removing a LASA medication. II. Medication reconciliation. 1. Medication reconciliation must occur within 24 hours of in-patient admission and prior to medication administration for out-patient admission. 2. In-patient home medication lists are compiled in Meditech, printed and placed on the chart for the ED or attending physician review. 3. Outpatient medication reconciliation should occur anytime medication will be administered to a patient by GPMC staff. The reconciliation should be reviewed and signed by either a licensed independent practitioner or a pharmacist. 4. Blanket orders such as “resume home medications”, “resume pre-op medications”, “continue home meds”, “transfer on same meds”, etc cannot be acted upon! Medications must be ordered specifically. 5. Each time a patient transfers levels of care, new orders must be initiated. This can be done by hand writing new orders or using the transfer reconciliation form printed from Meditech. The transfer reconciliation shows all active orders for the patient. 6. All orders for home medication administration must be complete. A complete order is defined as drug, strength if applicable, dose, route, frequency, indication if a PRN medication, and parameters for titration if a titrating medication. 7. Each medication listed on the in-patient medication reconciliation sheet must state if the product is to continue or discontinue during the patients admission. 8. Medication reconciliation sheets must be dated, timed and either signed by a physician or a telephone(TO)/verbal order(VO) taken by appropriate nursing staff. 9. Medication Reconciliation is National Patient Safety Goal Number Eight. 10. TJC Priority Focus Areas for GPMC include: Communication, Information Management, Patient Safety and Assessment and Care/Services. Medication Reconciliation has aspects of all four! III. Medication refrigeration. 1. Medication refrigerator/freezer temperatures must be checked and documented daily. 2. For closed units, medication refrigerators/freezers temperature logs must either have a daily check logged or have some indication the unit was closed documented No documentation closed!! It MUST be documented “CLOSED”. 3. Only the current months log should be present for documentation.
Transcript
Page 1: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

Pharmacy Information:

Medication

Management

I. Look alike sound alike medications.

1. GPMC’s policy and procedure on Look-alike sound-alike (LASA) medications can be found on GP Web > Policies and Procedures > Medication Management Manual >Look Alike Sound Alike Medications.

2. A message stating “Look Alike Sound Alike” appears on the Omnicell screen when removing a LASA medication.

II. Medication reconciliation.

1. Medication reconciliation must occur within 24 hours of in-patient admission and prior to medication administration for out-patient admission.

2. In-patient home medication lists are compiled in Meditech, printed and placed on the chart for the ED or attending physician review.

3. Outpatient medication reconciliation should occur anytime medication will be administered to a patient by GPMC staff. The reconciliation should be reviewed and signed by either a licensed independent practitioner or a pharmacist.

4. Blanket orders such as “resume home medications”, “resume pre-op medications”, “continue home meds”, “transfer on same meds”, etc cannot be acted upon! Medications must be ordered specifically.

5. Each time a patient transfers levels of care, new orders must be initiated. This can be done by hand writing new orders or using the transfer reconciliation form printed from Meditech. The transfer reconciliation shows all active orders for the patient.

6. All orders for home medication administration must be complete. A complete order is defined as drug, strength if applicable, dose, route, frequency, indication if a PRN medication, and parameters for titration if a titrating medication.

7. Each medication listed on the in-patient medication reconciliation sheet must state if the product is to continue or discontinue during the patient’s admission.

8. Medication reconciliation sheets must be dated, timed and either signed by a physician or a telephone(TO)/verbal order(VO) taken by appropriate nursing staff.

9. Medication Reconciliation is National Patient Safety Goal Number Eight.

10. TJC Priority Focus Areas for GPMC include: Communication, Information Management, Patient Safety and Assessment and Care/Services. Medication Reconciliation has aspects of all four!

III. Medication refrigeration.

1. Medication refrigerator/freezer temperatures must be checked and documented daily.

2. For closed units, medication refrigerators/freezers temperature logs must either have a daily check logged or have some indication the unit was closed documented – No documentation ≠ closed!! It MUST be documented “CLOSED”.

3. Only the current month’s log should be present for documentation.

Page 2: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

Pharmacy Information:

Medication

Management

4. For any temperatures that fall out of range, the action taken to bring the temperature back in range must be documented on the log.

5. If a medication refrigerator/freezer is deemed to have been out of range, a pharmacist must be contacted to determine if the product is still usable.

6. Medications are not to be stored in the door of refrigerators (due to uneven temperatures).

7. For insulin stored in the refrigerator, it must have a 28 day expiration noted on the vial – not the date it was opened.

8. Expired medications must be removed from refrigeration.

9. For Omnicells that have medication refrigerators inside, each medication must be documented as being removed for the patient – please do not take additional products while securing a single product.

10. Medication refrigerators/freezers must remain locked at all times.

IV. Medication security. All medications must be under constant surveillance or under lock/key

1. All medication carts must be locked at all times.

2. No medication, flush, etc can be sitting on tops of medication carts, counters or in bins around the nursing units unless under supervision (aka your about to use it).

3. All medications must either be in a LOCKED med cart, LOCKED refrigerator, LOCKED fluid cabinet or Omnicell.

4. All refrigerators and fluid cabinets must be locked at all times.

5. The OR Anesthesia room must be locked.

6. The ED medication preparation room must not have medications left unattended.

7. The ICU med room must be locked and the door closed.

8. Personnel other than nursing should not be in medication preparation areas that have medications storage areas unlocked or unsupervised.

9. Medications cannot be left in a patient room or placed in staff pockets.

10. OR suites cannot have medications left in them after cases close for the day.

V. Abbreviations 1. GPMC’s policy and procedure on abbreviations can be found on GP Web > Policies and

Procedures > Leadership Manual > Abbreviations.

2. A list of “Do Not Use” abbreviations appears. These abbreviations should never be used on medication-related documentation that is handwritten (including free-text computer entry) or on pre-printed forms.

3. Exception for a trailing zero exists: a “trailing zero” may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/tube sizes. It may not be used in medication orders or other medication-related documentation.

Page 3: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

Pharmacy Information:

Medication

Management

4. Abbreviations for medications are discouraged. Unacceptable abbreviations that make an order unclear will be clarified with the prescriber as part of routine pharmacist order intervention prior to implementation of the order.

Do Not Use Potential Problem Use Instead

U (unit) Mistaken for “0” (zero), the number “4” (four) or “cc”

Write “unit”

IU (International Unit) Mistaken for IV (intravenous) or the number 10 (ten)

Write “International Unit”

Q.D., QD, q.d., ad (daily) Mistaken for each other Write “daily”

Q.O.D., QOD, q.o.d., qod (every other day)

Period after the Q mistaken for “I” and the “O” mistaken for “I”

Write “every other day”

Tailing zero (X.O mg) Lack of leading zero (.X mg)

Decimal point is missed Write X mg Write 0.X mg

MS, MSO4 and MgSO4 Can mean morphine sulfate or magnesium sulfate. Confused for one another

Write “morphine sulfate” Write “magnesium sulfate”

M (Thousand) Million Write out Thousand

D or d (day or doses) Misread Write out Day or Doses

T.I.W. (Three times a week)

Mistaken for three times a day or twice weekly resulting in an overdose

Write “3 times weekly” or “Three times weekly”

VI. Medication Procurement After-Hours

1. A pharmacist is on-call anytime the pharmacy department is not open. The Nursing Supervisor has access to the pharmacist on-call.

2. The Nursing Supervisor is not allowed to enter the Main Pharmacy except in emergent circumstances when waiting for the pharmacist on-call to arrive would harm the patient.

3. Nursing obtains medications from the automated dispensing cabinets (Omnicell) after-hours.

4. Two nurses must verify the accuracy of the product with the order if the medication is obtained as an “override” from the Omnicell after-hours.

5. A pharmacist reviews all orders and overrides the next morning when the pharmacy re-opens.

Page 4: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

Pharmacy Information:

Medication

Management

PAIN MANAGEMENT 1. Pain is an unpleasant sensory and emotional experience

2. The patient’s self report is the single most reliable indicator of the existence and intensity of pain

3. GPMC supports the patient’s right to the highest level of pain relief that can be realistically and safely provided

4. Patients have the right to receive appropriate assessment and effective management of pain in addition to participating in care decisions related to pain management

5. Special needs of the patient, such as consideration of personal, cultural, spiritual, and/or ethic beliefs will be taken into account and addressed in regard to the assessment and treatment of pain. Successful pain management includes positive interaction between patient, family and members of the interdisciplinary team.

6. GPMC has defined our pain scale:

Mild Pain – falls in the range of 1-3 on the pain ruler.

Moderate Pain – falls in the range of 4-5 on the pain ruler.

Intense Pain – falls in the range of 6-7 on the pain ruler.

Severe Pain – falls in the range of 8-10 on the pain ruler

7. GPMC’s policy and procedure on Range Orders can be found on GP Web > Policies and Procedures > Medication Management > Range and Multi-Route Orders

8. When given a range order, pharmacy only recognizes the range in the dose field. Frequency ranges are truncated at the shortest frequency.

For example, an order for “Morphine 2 - 4 mg IV Q 4 – 6 hours” would be profiled “Morphine 2 - 4 mg IV Q 4 hours”.

Pain Score Action

1 to 3 (mild) Administer the lowest dosage in the prescribed dosage range

4 to 7 (moderate) Administer middle dosage (if applicable); otherwise, administer the lowest dosage that has been effective; therapy should be initiated at the lowest prescribed dosage and escalated upward as needed

8 to 10 (severe) Administer the highest dosage in the prescribed dosage range

Page 5: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

Pharmacy Information:

Medication

Management

9. Example #1: Dosage and frequency ranges

Order Reads: “Oxycodone 5 mg / Acetaminophen 325 mg 1-2 tabs po q 4-6 hours PRN pain” The patient c/o pain score = 5; patient has not yet received any doses

This order will be profiled on (eMAR) as “Percocet 1-2 tabs po q 4 hours PRN pain”.

Initially, the patient may receive 1 tablet

The patient’s pain must be reassessed (and DOCUMENTED on Meditech as an INTERVENTION note) prior to administration of any additional doses

If the desired effect is not achieved and no adverse reactions have been observed after the initial dose, the patient may receive 2 tablets every four hours as needed for pain.

10. Example #2: Dosage range without frequency range

eMAR Reads “Promethazine 12.5-25 mg po q 6 hours PRN nausea”

Initially, the patient may receive 12.5 mg every six hours as needed for nausea

If the desired effect is not achieved and no adverse reactions have been observed after the initial dose, the patient may receive 25 mg every six hours as needed for nausea.

*Note: If supplemental symptom relief (pain, agitation, nausea, etc.) is needed prior to the next approved frequency, additional incremental doses may be given prior to the next dosing interval timed provided the total dose during the interval does not exceed the maximum prescribed dose.

Page 6: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

HO

W

TO

Discrepancy Resolution

DISCREPANCY RESOLUTION If there is a variance in the narcotic count, a discrepancy will be generated. A receipt will print out (if this configuration setting is enabled) indicating that a discrepancy was generated. To Check for Discrepancies:

1. If there is a discrepancy, the screen saver will reflect that the machine has “Unresolved Discrepancies.” In addition, “BLUE” discrepancy button will appear at the login screen.

2. Log in to the system. 3. Touch the blue RESOLVE DISCREP button (on the lower part of the sc reen). 4. Touch Control Levels 2-5 (this will select all narcotics). 5. Touch the RESOLVE DISCREP button (on the upper right hand part of the screen). 6. If there are discrepancies the OmniRx will display them on the screen. If you wish to print the information, touch the PRINT DISCREP

button (on the lower right hand part of the screen). Steps to ensure an accurate narcotic count and resolve the discrepancies:

1. Log in to the system. 2. Touch the blue INVENTORY MENU button (lower part of the screen). 3. Touch CYCLE COUNT (upper right hand part of the screen). 4. Touch FIND ITEM (upper right hand part of the screen). 5. Select the item that you wish to count from the list of medications. You determine which medications required counting from the

discrepancy report. 6. Push the flashing green button on the front of the medication drawer. 7. Open the drawer and lift the lid of the bin behind the blinking green light. 8. Release the bin lid (it will not unlock unless you do). The system will require a WITNESS ID and PASSWORD. 9. After the witness has entered their ID and PASSWORD, the bin lid will unlock. 10. Open the bin lid and enter the number of medications that are in the bin. 11. Repeat steps four (4) through nine (9) for each item that you wish to count. 12. Touch the Blue RESOLVE DISCREP button (lower part of the screen). 13. Touch Control Levels 2-5 (this will select all narcotics).

14. The first discrepancy will be displayed on the screen. Enter the Discrepancy reason (by typing or by selecting from the LIST OF RESOLVE REASONS). Note: The reasons for the discrepancy vary. Common reasons are listed below.

15. Touch the RESOLVE DISCREP button (upper right hand part of the screen). 16. The system will require a WITNESS ID and PASSWORD. 17. After the witness has entered their ID and PASSWORD, the system will display the next discrepancy. 18. Repeat steps fourteen (14) through seventeen (17) for all discrepancies.

COMMON REASONS FOR DISCREPANCIES:

1. A medication dispensed in liquid was not accurately accounted for. 2. Incorrect count documented by the user. 3. Incorrect count documented by the previous user. 4. The previous user selected “1” but actually withdrew “2.” 5. The previous user selected “2” but actually withdrew “1.” 6. The previous user selected the SKIP button (CANCEL TRANSACTION) which caused the number issued to be reported as “0”, but

withdrew the medication. 7. The previous user closed the drawer during the transaction without removing the medication, which caused the number issued to be

reported as “1.” 8. The previous user indicated that he or she was removing medication although he or she was returning medication. 9. The previous user indicated that he or she was returning medication although he or she was removing medication. 10. Pharmacy personnel entered the incorrect quantity during the restock function.

Note: Researching the reason is primarily a nursing responsibility, however, pharmacy may assist where detailed transactional reports are required. In most cases, the nurse/pharmacist will need to refer to the patient MAR to determine what actually was administered prior to determining the reason. Discrepancies are best resolved prior to the end of each shift, otherwise it is very difficult to determine the real reason f or the variance.

Page 7: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

The GPMC Diversion Action Plan has been updated to better define a process for action in instances of controlled substance loss or inappropriate documentation/storage.

Important definitions to understand include: trend, inappropriate documentation, storage and loss.

Pharmacy will report any instance of loss to the employee’s supervisor, Human

Resources, Risk Management, Ethics and Compliance, the Mississippi State Board of Pharmacy and the DEA. Mississippi State Board of Nursing reports will be forwarded by the Chief Nursing Officer. Instances of theft require an Administrator then local authorities to be informed.

Pharmacy will report any instance of inappropriate documentation or storage to the employee’s supervisor, Human Resources and Ethics and Compliance. Any single incident of loss or trends in inappropriate documentation/storage may result

in disciplinary action. Employees can take the opportunity to correct documentation via a late entry in the

permanent medical record; however, this does not exempt the event from notification of appropriate entities outlined in the policy or the possibility of implementation of disciplinary action.

Take Home Message: The expectation of individual accountability for

appropriate controlled substance storage, documentation, and waste will be monitored. The GPMC disciplinary action policy and procedure will be used to enforce this accountability.

If you have any questions, please direct them to myself or your department director.

Alania Pendarvis Cedillo, Pharm.D., MPH Administrative Director Cardio-Pulmonary, Laboratory, and Pharmacy 228.575.7021 Office Phone 228.575.7025 Fax [email protected]

Pharmacy Policy Update

Page 8: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

Pharmacy Information:

Medication

Management

New Controlled Substance Change effective July 2011 Effective July 1, 2011, any medication containing carisoprodol (Soma) and tramadol

(Ultram) will be placed in Schedule IV, and any medication containing butalbital will be placed in Schedule III in the State of Mississippi.

What this means to Nursing: any partial dose must have the remaining product wasted in

the Omnicell, a countback will be required for these products and you will be held

accountable for documentation of these medications in the same manner as any other

controlled substance.

What this means for everyone: if you use either of these medications personally they can

no longer be transferred from one pharmacy to another and your prescriber can only

give you up to five refills (a six month supply) without providing your pharmacy or

yourself with another prescription.

Pharmacy will be working from today forward transitioning tramadol (Ultram) to

appropriate Omnicell bins and updating the drug dictionary. Carisoprodol is non-formulary, the therapeutic interchange is cyclobenzaprine (Flexeril).

If you have any questions please direct them to a member of your pharmacy team. Thanks,

Alania Pendarvis Cedillo, Pharm.D., MPH Administrative Director Cardio-Pulmonary, Laboratory, and Pharmacy 228.575.7021 Office Phone 228.575.7025 Fax [email protected]

Page 9: Pharmacy Information: Medication Management › NAP › docs › ClinicalSites › Garden Park M… · Pharmacy Information: Medication Management PAIN MANAGEMENT 1. Pain is an unpleasant

15200 Community Road Gulfport, MS 39503

March 7, 2011 Effective immediately, pharmacy will not profile "if okay with" orders based on verbal communications from nursing to pharmacy. An order authorizing the "if" order must be written and sent to pharmacy. Pharmacy will enter a Miscellaneous EMAR entry detailing the specifics of the "if" order. Nursing does not need to document against the Miscellaneous EMAR entry. Pharmacy will discontinue the Miscellaneous EMAR entry when the "if" order has been addressed. Example: Pharmacy will profile a Miscellaneous EMAR entry stating

"Lovenox 40 mg SQ once daily if okay with nephrology. Please write order authorizing administration once nephrology is contacted."

After Nursing has contacted nephrology and the decision is made, the Nurse must write an order addressing the reply. Example 1: Answer No –

Example 2: Answer Yes –

Alania Pendarvis Cedillo, Pharm.D., MPH Administrative Director Cardio-Pulmonary, Laboratory, and Pharmacy 228.575.7021 Office Phone 228.575.7025 Fax [email protected]

PHYSICIAN ORDERS 1/1/01 01:00 “Lovenox 40 mg SQ once daily if okay with nephrology” Dr. Knife, MD

1/1/01 01:10 "Lovenox not authorized by nephrology, please discontinue" T.O. R.B.O Dr. Kidney/Nancy Nurse, RN

1/1/01 01:10 "Lovenox authorized by nephrology as ordered" T.O. R.B.O Dr. Kidney/Nancy Nurse, RN


Recommended