Medication Administration & Pharmacy Services at GBMC

Key Pharmacy Personnel

•

Clinical Pharmacists

– Process orders into patient profiles – Verify appropriate medication dosing – Provide education to medical staff – Monitor for drug-drug/food drug interactions – Order/Problem resolution – Antibiotic dosing

Key Pharmacy Personnel

• •

Certified pharmacy technicians/ Pharmacy Technicians

– Answer phones/initial problem resolution – Prepare TPN and IV medications – Prepare patient medications – Retrieve expired or discontinued medications – Cart exchange/patient reconciliation/drug deliveries

Pharmacy aides

– Deliver medications to the units – Retrieve expired or discontinued medications

An Overview of Services

• Location – 5th floor main hospital • Fax numbers – 3099 for routine orders – 6936 for STATs • Telephone number – 2771 • Hours of operation – 24/7 • Schedule of deliveries – 1 hr stat/2 hr routine

Procuring Medications

• FAX – Primary method of sending orders – Fax all orders promptly – Fax respiratory and IV orders – For STAT Orders: Use STAT fax line and call for STAT orders (given within one hour) • Order Entry – Enter in an order in Meditech (Search for “PHA”) for missing medications – Enter in an order in Meditech (Search for “PHA”) for IV refills 2 hours before needed

Procuring Medications

• • Medications can be found in patient bins in cabinets on nursing bays or in medication room (always locked)

AcuDose (R)

– Used for controlled substances, select medications, and PRNs – Obtain access after the Charge Nurse or Manager notifies pharmacy – Generic nomenclature • •

Tube system

– Majority of meds are sent through the tube (no chemo, narcotics, or LV)

Pick up window

– STATs – Controlled substances • Requires GBMC ID badge-RN,physician,NP • Must sign for meds

Procuring Medications

• NeighborCare Pharmacy (Outpatient Pharmacy) – Discharged patients can fill their prescriptions before leaving the hospital (GBMC Inpatient Pharmacy may provide “used” inhalers, creams, etc upon written order..isolated cases….requires 2 hour lead time) – Delivery to employees and patients on units in the hospital – Hours of operation….Mon-Fri = 8am - 6pm, Sat, Sun = 8am - 12 noon

Standard Medication Times

• Standard Medication times are utilized by the pharmacy, unless otherwise directed by the physician

SCHEDULE

DAILY QAM BID TID QID HS Q2H Q3H

TIME

0900 0900 0900, 2100 0800, 1600, 2200 0800, 1300, 1700, 2200 2100 0200, 0400, 0600, 0800, 1000, 1200, 1400, 1600, 1800, 2000, 2200, 2400 0600, 0900, 1200, 1500, 1800, 2100, 2400, 0300

Standard Medication Times

SCHEDULE

Q4H Q6H Q8H Q12H AC PC AC + HS PC + HS DIURETICS

TIME

0600, 1000, 1400, 1800, 2200, 0200 0600, 1200, 1800, 2400 0600, 1600, 2400 0900, 2100 0730, 1130, 1630 0930, 1330, 1830 0730, 1130, 1630, 2100 0930, 1330, 1830, 2100 0900, 1700

Basics of Medication Administration

• Antibiotics must be administered within 2 hours of order • All once daily medications will be administered on the first day ordered unless already taken by patient before admission to the unit, or otherwise ordered by prescriber to start at another date/time

Basics of Medication Administration

• All antibiotics, antivirals, and antifungals prescribed as daily or q24h will remain on a q24h schedule and be assigned a standard dose time closest to the time of the initial dose • Medication is considered on time if administered within

one hour

of the standard dose time (before or after) • Subsequent doses will be administered at evenly spaced intervals so that the medication is on the standard administration time schedule at the end of the first 24-hour period

Acknowledging Medications

• All medications must be acknowledged before they can be administered using the Meditech BMV/eMAR system • Acknowledging a medication in the MAR means that the order has been transcribed correctly by pharmacy • A medication must only be acknowledged once

Process of Inpatient Medication Delivery

1. Verify patient name, date of birth, drug, dose, route, and scheduled time on the MAR in Meditech 2. Wash hands 3. Check patient allergies 4. Remove medications from patient bins or acudose, checking drug, dose, and route with the MAR and take into patient room 5. Open the MAR on the screen in the patient’s room

Process of Inpatient Medication Delivery

6. Identify patient by checking patient’s armband, and asking the patient to state their name and date of birth 7. Scan patient’s armband with barcode scanner (wait for on screen verification) 8. Begin scanning the medications you will be administering, explaining the purpose and potential side effects of any new medications

Process of Inpatient Medication Delivery

9.

Administer medications to the patient, ensuring that any PO meds are completely swallowed before leaving room 10. After verifying that meds have been swallowed or are infusing, press File on the screen to save all documentation in the MAR 11. Any education provided during medication administration should be documented on the education record in Meditech PCS

Non-administration of Meds

• Any medications that are not administered are recorded using the Non-Admin function • A reason is required to be entered for any non-administered medications (i.e. Hold dose, Pt refused, Sleep, etc.) • If medication is unable to be administered, appropriate documentation may be entered as a note in Meditech PCS

STAT Medications

• When advised by a physician that a STAT order has been written: – Nurse shall attach a STAT sticker to the order form near (but not obscuring) the order – The order shall be immediately faxed to the pharmacy on the STAT fax line (x6936) – For all units live with the eMAR: When a STAT medication is taken from the AcuDose as an emergency medication, it shows on the eMAR as “STK Med Once,” and meds should be scanned and administered as appropriate – For all non-eMAR units: When a STAT medication is taken from the AcuDose as an emergency medication, it shall be recorded as “given” on the order sheet • STAT, NOW and IMMEDIATE medication orders shall be processed, dispensed, and administered within one hour of the order date and time

Adverse Drug Reactions

• Definition of an ADR – Any response to a drug which is unintended, undesirable, or unexpected • Should be reported immediately to physician – Need to document physician notification in notes • ADR HOTLINE – Call Ext. 2377 and leave a message

Reportable Drug Reactions

ALLERGY Anaphylaxis Angiodema Fever Skin Reaction DERMATOLOGICAL Rash Petechiae Erythema Phlebitis Urticaria GASTROINTESTINAL Diarrhea Constipation Nausea, Vomiting Hemorrhage RESPIRATORY Wheezing Increased Respirations HEMATOLOGICAL Anemia Leukopenia Thrombocytopenia Abnormal Coagulation URINARY Oliguria Bladder Spasms Failure SPECIAL SENSES Taste perversion Appetite Changes

Reportable Drug Reactions

ELECTROLYTE & FLUID IMBALANCE Hyperkalemia Hypokalemia Hypernatremia Hypocalcemia Fluid Retention NEUROLOGIC Headache Dyskinesia Convulsions LIVER Hepatitis Jaundice ENDOCRINE / METABOLIC Hypothyroid Fever Hypoglycemia Sexual Function ENT / ORAL Tinnitus Hearing Loss Stomatitis PSYCHIATRIC Depression Confusion Hallucinations VASCULAR Dysrhythmia Bradycardia Tachycardia Hypertension Hypotension MUSCULOSKELETAL Muscle weakness Arthritis Arthralgia Myalgia

Drugs Most Commonly Involved in ADR’s ORAL FORMS OF:

Kayexalate (Sodium Polystyrene Sulfonate) Imodium Lomotil Flagyl / Vancomycin Oral Kaopectate Atarax / Vistaril (Hydroxyzine)

TOPICAL FORMS OF:

Calamine Lotion Local Anesthestics Corticosteroids (Topicort)

INJECTABLE FORMS OF:

Antihistamines (Benadryl) Atropine Cogentin (pine) Dextrose 50% Epinephrine Narcan (Naloxone) Vistaril Compazine Dilantin (Phenytoin) Mephyton (Phytomadione-Vitamin K) Protamine Digibind Romazicon Corticosteroids (Solumedrol/Solucorte/Decadron)

Medication Errors

• What constitutes a medication error?

– A dose of medication that deviates from the physician’s order or from standard hospital policy and procedure – Omission of an ordered medication • Why should medication errors be reported?

– Non-punitive approach to improve hospital processes – Evaluate and correct systems • How do I report a medication error?

– Notify the physician – Document in progress notes – Complete Medication Incident Report (Form 720-63)

Medication Safety Basics

- Always know your medications before administering them - It is the responsibility of the licensed personnel to know actions, dosage range, and side effects of medications - Drug reference information is available on nursing units and on-line (micromedix or using the monograph feature of the MAR).

Medication Safety Basics

- Identify your patient before giving any medications - The nurse who prepares a medication must administer it - Before mixing any medications, check their compatibility with a pharmacist - Always dispose of needles/syringes in a sharps container. Do not recap needles.

Please take the Pharmacy Medication Administration post-test and turn in the passing certificate to your agency