jeffery d. evans, pharm.d . @csfpp. Ricketiest Insidiously. Lecture 1: Introduction to Epidemiology Outline Time I calendar time I time since an event I physiologic cycles I age (time since birth) I seasonality I temporal trends 12/19. chief. - . It also gives the knowledge to how to administer the drug to the patient. • 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. 4. Development of hospital formulary for a tertiary care teaching. Chapter 4: Hospital Pharmacy Practice . Soapbox's Introduction to pharmacy practice ppt video online download. z1980 d 1990 i t d ti f 1980s and 1990s introduction of Cd f G d M f t i Code of Good Manufacturing Practice (GMP) to pharmacy: stringent standards for compounding zTraditionally a major component of pharmacy practice zFrom 1950s onwards a shift towards pre-manufactured products from industry (e.g. Community pharmacy helps to develop charging policies for pharmaceutical services. 280-300) pharmacy is “self-regulated” profession, Consultation skills for pharmacy practice Where did it start ? Presentation Summary : By passing a national examination that evaluates the technicians knowledge and skills needed to perform the work of a pharmacy technician. View and Download PowerPoint Presentations on Introduction To Pharmacy Practice PPT. by jamie al-nasir, school of pharmacy, kingston, Academy of Pharmacy Practice and Management- Nuclear Pharmacy Practice Section APPM-NPPS - Sponsor. steve riddle, bs pharm, bcps qi and medication utilization lead hmc, Safety, Quality, and the Pharmacy Practice Model Initiative: Aligning for Success - . practice of pharmacy is ethically inconsistent with good business. Pharmacy Practice Dr.Izzatullah Khan. what is radiopharmacy?. Clinical pharmacy: evidence-based practice information sources. Cooper and Gunn's Tutorial Pharmacy by Carter … This most likely developed from the observation of very poor business practices used by some firms. Pharmacy Practice - . janet silvester operations committee june 13, 2006. pharmacist education. Family Practice Core Didactic Pharmacy Announcements November 16, 2011 - . Pharmaceutical Incompatibilities. Fundamental Operations in Compunding,Ppt. a hospital pharmacy is concerned. • via facsimile machine • Rules & regulations for narcotics specific to state, Nurse & Pharmacist • Coordinate patient supplies • Develop plan of care • Monitor , document patient’s status • Communicate with physician • Coordinate physician orders • Make appropriate interventions • Assess & educate home care patients • Work jointly to perform organization’s clinical quality assurance activities, Nurse • Primary patient educator • Assesses • patient’s physical status • patient’s adherence to treatment plan • condition of catheter • psychosocial issues • Maintenance of intravenous catheters • Placement of peripheral catheter • Insertion of peripheral long-term catheters or PICC • Schedule & perform all blood work, Pharmacist • Responsible for proper acquisition, compounding, dispensing, & storage of drugs • Responsible for instructing patient & nurse on drugs being administered • Clinical pharmacy roles • pharmacokinetic dosing of vancomycin & aminoglycosides • nutritional support services • input in selection of most appropriate drug for patient • Pharmacist is drug information source for all other team members, Pharmacy Technician • Generates medication labels • Prepares & labels medications • Maintains clean room & drug storage areas • Coordinator of IV room • Works with pharmacist on • mixing schedule, ordering & maintaining drug & mixing supplies, performing quality assurance on compounding activities • Manage warehouse/inventory of non-drug supplies • Track of accounts receivable • Pick/pack supplies for shipment to patients, Reimbursement Specialist • Key to economic viability of company • Interface among insurer, home infusion company, & patient • Coordinate all billing for services • Negotiate price of services with insurers • Well-versed in public aid & government reimbursement programs (Medicaid & Medicare), Patient Service Representative • Controls patient’s inventory of supplies • Contacts patient or caregiver on routine basis • Coordinate pickup of supplies at end of therapy • Pharmacy technician may be responsible for this job, Patient and Caregiver • Involved in development of care plan • Patient has right to be involved • Clearly stated in rights & responsibilities document • Established on initial visit, Antibiotics • Account for 40% - 70 % of current home infusions • Cephalosporins • ceftriaxone (Rocephin) • cefazolin (Ancef) • cefepime (Maxipime) • low incidence of adverse reactions • require minimal monitoring • stable for 10 days -ideal for weekly deliveries • ceftriaxone is often prescribed-given once daily, • many cephalosporins can be administered as IV push, Penicillins • Common IV antibiotics • Difficult to use in home • frequency of dose • stability of medication • allergies • Phlebitis • Ambulatory pumps-often used with penicillins • Other systems used • ADD-Vantage® • Add-Ease®, Vancomycin • Red Man Syndrome • Individualized dosing • Irritating to veins, Other Antibiotics • Azithromycin (Zithromax) • Doxycycline • Fluoroquinolones • Carbapenems • Daptomycin (Cubicin) • Linezolid (Zyvox) • Quinupristin/dalfopristin (Synercid), Antifungals • Uses • transplant patient • immunocompromised patient • Common medications • Intravenous amphotericin B • premedication for reactions • oral acetaminophen and diphenydramine. 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