THE PHARMACY TECHNICIAN Foundations and Practices SECOND EDITION

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THE PHARMACY TECHNICIAN Foundations and Practices SECOND EDITION CHAPTER 9 Health-System Pharmacy The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

State Standard • 12) Formulate a list of facility, equipment, and supply requirements (e. g. , space requirements, prescription file storage, cleanliness, and reference materials) required for a retail pharmacy as compared with a hospitalbased pharmacy. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Objectives • Students will be able to… § Identify the different types of Health System Pharmacies § Identify defining factors of each Health System Pharmacies § Create a Venn Diagram that compares and contrast a Retail Pharmacy to a Health Systems Pharmacy. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Figure 9 -1 A health-system pharmacy is often located within a hospital. Source: Mark Winfrey/Shutterstock The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Also called institutional pharmacy • Provided to residents of: § Long-term care facilities (nursing homes) § Hospitals § Hospices § Other residential facilities (prisons, etc. ) • Responsible for all patients' medications The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Health-system pharmacist § Ensures drug therapies are: • • Appropriate Effective Safe Used correctly § Identifies, resolves, and prevents medication errors The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Around-the-clock delivery service • Counsel patients on proper medication use • Provide drug information and recommendations to doctors and nurses • Drug therapy review in long-term care settings The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Often work with: § § § Physicians Nurses Therapists Dietitians Laboratory personnel Other professionals The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Automated dispensing systems provide safe drug storage for medications required in emergencies or after hours. • Controlled dispensing systems § Individually packed blister packs (unitdose packages) The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Figure 9 -6 The unit-dose system makes it very easy to track a patient's medications. Source: Doug Martin/Science Source The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Hospital pharmacies § Most prevalent type of health-system pharmacy § Located within a hospital facility serving admitted patients or those being discharged § More than 5, 750 registered hospitals in the U. S. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Hospital classifications § § § Community-based Federal government Psychiatric Long-term care Institutional hospital units • Categorized by location and size § Rural or urban § Bed capacity The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Long-term care facilities § Provide rehabilitative, restorative, or ongoing skilled nursing care to patients/residents, who need assistance with activities of daily living The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Long-term care facilities § Laws like OBRA (1987, 1990) and HCFA's 1990 nursing home regulations recognize that drug therapy services for institutional patients are best delivered by long-term care pharmacists. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Hospices § Provide palliative care (designed to help ease suffering) and supportive services to individuals at the end of their lives § Operate 24 hours a day/7 days a week, in patient's homes and facility-based settings The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Hospices § Pharmaceutical, physical, social, spiritual, and emotional care to patients and families during dying and bereavement The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Nursing homes § Skilled and custodial care for elderly who don't need hospital acute care but can no longer manage independent living The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Nursing homes § Called health centers, havens, manors, homes for the aged, nursing centers, care centers, continuing care centers, living centers, or convalescenters § Average number of beds per facility: 102 The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Health-System Pharmacies • Correctional facilities § Also called prisons § Individuals are physically confined and deprived of a range of personal freedoms. § Usually part of the criminal justice system § Correctional facility pharmacies oversee provision of pharmaceutical services to inmates. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Doctor of osteopathy (DO) § Licensed, trained to examine patients, diagnose illnesses, to prescribe and administer treatments using manipulative techniques on the musculoskeletal system in conjunction with conventional treatments The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Doctor of medicine (MD) § Licensed, trained to examine patients, diagnose illnesses, to prescribe and administer medication The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Doctor of medicine (MD) § Within a hospital, most MDs specialize in a particular field, for instance: • • Cardiologist: heart and circulatory system Oncologist: cancer OB/GYN: obstetrics and gynecology Surgery: treatment through manual or instrumental procedures The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Physician assistant (PA) § Licensed, trained to coordinate patient care under the supervision of a medical or osteopathic doctor § Authorized to prescribe medication, with restrictions on prescribing controlled substances § Can treat a limited array of illness § Sometimes on staff at a pharmacy The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Certified nursing assistant (CNA) § Certified to assist RNs and LPNs in providing patient care § Not permitted to administer medication • Licensed nursing assistant (LNA) § Licensed to assist RNs and LPNs in providing patient care § Not permitted to administer medication The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Licensed practical nurse (LPN) § Licensed to provide basic care under supervision of RN § Permitted to administer medication The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Nurse practitioner (NP) § Licensed to work closely with a physician in providing patient care § Authorized in most states to prescribe medications under physician supervision The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Hospital Staff • Registered nurse (RN) § Registered to assist physicians with specific procedures, administer medications, and provide patient care The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Activity • • Complete drug cards for the following… § Temazepam § Phentermine § Quinapril Per St. 12) Formulate a list of facility, equipment, and supply requirements (e. g. , space requirements, prescription file storage, cleanliness, and reference materials) required for a retail pharmacy as compared with a hospital-based pharmacy. Create a detailed Venn diagram comparing and contrasting retail pharmacies to Health Systems Pharmacies. You will create 1 for each of the following health system pharmacy types § Hospital § Nursing Home § Correctional Facility The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Objectives • Students will be able to… § Identify the organization of a health systems pharmacy § Identify components of a Policy and Procedure Manual § Create a policy and Procedure manual The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Organization of Hospital Pharmacies • Different structure than communitybased pharmacies • Centralized pharmacy § Operated out of one location: the inpatient pharmacy (IP) § Medications delivered to various patient care units throughout the facility from one central location The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Organization of Hospital Pharmacies • Decentralized pharmacy § Requires duplication of staff, inventory and equipment § Central, inpatient pharmacy (IP) • Medication packaging, centralized inventory, sterile product preparation, preparation and delivery of medication carts. Serves patients admitted to the facility The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Organization of Hospital Pharmacies • Decentralized pharmacy § Outpatient pharmacy • For patients who are being discharged from the hospital or treated by a physician in the hospital but do not require overnight admission • Retail-style pharmacy within the hospital facility The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Organization of Hospital Pharmacies • Decentralized pharmacy § Satellite pharmacies • Receiving, processing, and dispensing medication orders for individual patients • Often for specific patient care areas, such as operating rooms, oncology, or pediatrics The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Policy and Procedure Manual • A health-system pharmacy may have a unique policy and procedure manual to establish specific guidelines and systems for the operations of the facility. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Policy and Procedure Manual • Policies § Definitive methods or courses of action, determined by an organization or department • Procedures § Step-by-step directions provided to achieve the policies The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Policy and Procedure Manual • Resource to: § Ensure quality assurance throughout the department § Implement quality control measures, which can reduce medication errors § Reduce the time required to train employees The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Policy and Procedure Manual • Resource to: § Communicate job responsibilities and scope of authority § Document compliance for regulatory agencies and accreditation organizations The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Policy and Procedure Manual • Organization § Alphabetical • Policies and procedures are listed alphabetically according to their official titles The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Policy and Procedure Manual • Organization § Categorized • Policies and procedures are divided into topical categories, such as organization, personnel policies, administrative policies, professional policies, and facilities/equipment The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Protocol • Protocols are written agreements of a specific plan of action concerning a patient's care. • Usually created from a formed committee of clinical caregivers such as physicians, nurses, and pharmacists • Pharmacy's involvement involves proper use of medications. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Formulary • Medications that are kept in Stock • Important to choose beneficial yet costeffective formulary • Health-system pharmacies responsible for maintaining the medication formulary; inventory control, ordering medications, contracts with wholesaler • Medications are chosen for a formulary by the health systems P&T committee. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Formulary • Pharmacy and Therapy Committees (P&T) § Physicians from various specialties, pharmacist, and other health care workers with experience in clinical decision making § Meets several times a year § Reviews medications on the current formulary, adding and deleting medications as appropriate The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Dispensing Systems • Floor stock § Medications are kept on each floor for distribution to patients. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Dispensing Systems • Floor stock § Computerized systems making this system easier to monitor and fill. • Technician stocks floor unit with predetermined bulk supply after pharmacist checks order. • Computerized system tracks inventory, records who has accessed the unit, and even bills the patient. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Dispensing Systems • Patient prescription stock system § Inefficient, wasteful, difficult to monitor § After reviewing medication orders for a floor, technician takes medications to pharmacist for verification, then takes the medications to the floor; usually three days supply. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Dispensing Systems • Patient prescription stock system § Once opened, medication cannot be returned to the pharmacy; considered to have been dispensed and to have left control and closed system of the healthsystem pharmacy. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Dispensing Systems • Unit-dose system § Most efficient § Easy to track a patient's medications § Each medication order is filled in the pharmacy in as close to administration form as possible; no more than a 24 hour supply dispensed at one time. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Activity • Complete drug cards for the following… § Sidenafil § Ondansetron § Oseltamivir • Create a policy and procedures manual (using information from the ppt. or from internet sources) for a health systems pharmacy that you are the administrator for. • Include… § Roles of responsibilities of each employee § Emergency Procedures for Tornado, Fire, and Intruder § Medication Order Entry into the computer system The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

State Standard • 21) Create either an electronic or paper profile detailing the order entry process** per industry standards for each of the following: a hospital, a freestanding pharmacy, and a retail-based pharmacy. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Objectives • Students will be able to… § Identify parts of a medication order used in a hospital pharmacy § Types of medication orders used in a hospital pharmacy § Create a presentation that compares the order entry process for a medication order in the hospital, a free-standing pharmacy, and a retail pharmacy. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Form used in health-system pharmacies instead of prescription pad • Multipurpose tool for communication among various members of the health care team • Can be used to order medications, lab work, special diets, and X-rays or other medical procedures The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Medication order components § Patient information • • Name Room/bed number Hospital ID number Birth date/age The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Medication order components § Medication information • • • Name Dose Frequency of administration Route Signature of prescriber Date and hour the order was written The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Types of medication orders § Standing (or Scheduled) order • When patient is to receive a specific medication at specific intervals throughout the day § PRN order • When patient is to receive a medication only as necessary, as with pain medication The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Types of medication orders § STAT order • When patient requires a medication immediately; urgent order that takes priority over other orders and requests The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Types of medication orders § STAT order • Emergency medication order • For a medication required for a physician to respond to a medical emergency The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Types of medication orders § STAT order • Investigational medication order • Used in facilities that participate in research programs; ordered, prepared, and administered according to stringent protocols specific to the research program The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Point of entry § Computer that allows nursing staff to scan original order to pharmacy § Order appears in queue on pharmacy monitor. § Pharmacy technician clicks on order to bring up scanned copy. § Usually in order of time stamp, unless STAT order The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Point of entry § Paper orders • Technician picks up orders from patient floors on a scheduled basis and brings them to the pharmacy. • Technician transcribes orders into order entry system. • Care must be taken to verify all information. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Point of entry § Computerized physician order entry (CPOE) • Becoming more prevalent in healthsystems settings • Physician electronically orders patient's medication directly via computer. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Point of entry § Computerized physician order entry (CPOE) • Order transmitted directly to pharmacy computer • Substantial time savings, and reductions in errors and duplications The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

The Medication Order • Point of entry § Bar code point of entry • National Drug Code (NDC) number • Transmits drug information to pharmacy • Verification system works well if number entered correctly. • Pharmacy technicians should be aware of advantages and pitfalls. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Receiving medication orders § Submitted electronically using POE or CPOE system § Pneumatic tube devise § Handed directly to pharmacist § Faxed to pharmacy § Institutional computer system § Technician collection The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Receiving medication orders § Order entry • Hard-copy medication order forms may be entered into the computer system by pharmacy technicians, pharmacists, nursing clerks, nurses, or even physicians. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Receiving medication orders § Order entry • Must contain: • • • Patient name Patient hospital ID number Room number/bed number/location Drug name Drug quantity (if STAT) The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Receiving medication orders § Order entry • Must contain: • • Route of administration Frequency of administration Ordering physician Date and time of order The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Receiving medication orders § Verification • Each order must be screened by the pharmacist for correct order entry, potential interactions, allergies, drug utilization review, and formulary utilization The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Receiving medication orders § Order preparation • Medications must be counted out. • Lot and UPC numbers matched • Expiration dates checked The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Dispensing medication orders § Filling prescriptions or medication orders is one of the most basic duties of a pharmacy technician in any healthsystem setting. § Final check is the sole domain of the pharmacist. § State laws regarding the RPh review prior to distribution The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Expediting emergency orders § STAT or emergent orders constant in health-system setting § Pharmacy responsible for filling order and sending to nursing unit for administration The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Processing Medication Orders • Expediting emergency orders § Know your health system's protocol. § Quick response to emergency orders highlights pharmacy efficiency and importance in patient care The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Activity • Complete drug cards for the following… § Methotrexate § Avanafil § Budesonide • Per St. 21) Create either an electronic or paper profile detailing the order entry process** per industry standards for each of the following: a hospital, a free-standing pharmacy, and a retail-based pharmacy. • You need to research the industry standard for the order entry process and create a presentation (google slides or prezi) that details the process for a hospital, a freestanding, and retail pharmacy. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

State Standard • 31) Research common software and databases used by pharmacies to manage electronic medical records and prescriptions. Understand the uses and capabilities of these programs as they relate to the roles and responsibilities of the pharmacy technician. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Objectives • Students will be able to. . § Identify the roles of a pharmacy technician while working in a health systems pharmacy. § Identify types of software that are used in a health systems pharmacy. § Research the Pyxis system that is used widely in health systems pharmacy. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • • • Data collection and reporting Surveys and inspections Education Maintenance Dispensing/inventory management The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • Tasks requiring quality assurance § Compounding IV or chemotherapy agents • Bar code • Do not inject medication in IV bag before pharmacist verification. • Double check your work. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • Tasks requiring quality assurance § Compounding IV or chemotherapy agents • Make sure label is correct. • Make sure all labels are applied. • Daily nursing unit inventory The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • Tasks requiring quality assurance § Medication order entry § Filling medication orders § Service to other health-system professionals § Timely medication delivery The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • Tasks requiring quality assurance § Turnaround times for STAT orders § Supplementing floor stock and automated dispensing cabinets § Inspect pharmacy nursing unit and emergency code cart. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • Providing requested information to the pharmacist § Decentralized format • Pharmacist or pharmacists work together with technicians assigned to the decentralized unit § Centralized format • Pharmacist will rely on technician to provide information pertinent to patient care The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • Record maintenance and management • Medication cassettes • Unit-dose preparation § Documentation § Bulk repackaging • Packaging special doses § Documentation The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Pharmacy Technician Job Responsibilities • Floor stock inspections § Expired, discontinued and recalled meds • Crash carts § Equipment § Drugs • Compounding § Preparing custom-ordered medications The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Tech-Check-Tech • System of medication verification where one technician checks the work of another technician • SBOP must approve. • Health system must apply for licensure. • Has been proven safe and effective: one study showed a 99. 8% accuracy rate The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Tech-Check-Tech • Regulations established SBOP • Institution may add own standards • Institutional policies based on needs of particular institution • Methodical approach The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Medical Information Systems • Standard equipment in health-system pharmacy • Health system will usually have proprietary system. • Must follow HIPAA regulations • Automated dispensing cabinets § Pyxis § Omnicell The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Medical Information Systems • Characteristics of typical database § Stores large amounts of sensitive patient information § Data on all aspects of patient care • Lab results • Relating to patient medication consultations The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Medical Information Systems • Characteristics of typical database § Pharmacy's inventory and formulary § Sensitive departmental and employee information The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Productivity and Workflow Management • Productivity § How quickly or efficiently the pharmacy is able to produce their services for the patient and other health-system professionals • Workflow § Steps the health-system pharmacy uses to produce a product • Collaborating with other departments The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Investigational Drug Products • New drugs must be approved by FDA § Phase I • A handful of volunteers selected for drug testing and levels of toxicity § Phase II • Several doses are used in order to determine which dosage works best with the fewest side effects The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Investigational Drug Products • New drugs must be approved by FDA § Phase III • Double-blind and controlled placebo studies to see how well the drug works The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Investigational Drug Products • Development § Pharmacy's clinical team usually takes on investigational drug trials in healthsystem pharmacies. § Or investigational drug team within the pharmacy department • Record keeping • Standard policies and procedures The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Activity • Complete drug cards for the following… § Doxazosin § Ibandronate § Catopril • You will be researching the Pyxis medication system, and creating a brochure over it. Include the following information. § How it works § Pro’s of the system § Con’s of the system § Who can access the system § Steps to remove a medication § Steps to put back a medication § Steps a pharmacy technician must take to fill the machine. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Summary • Health-system pharmacies serve onsite patients. • Include hospital pharmacies and various residential settings • Practice more varied than community pharmacy practice • Institutional setting is evolving. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Regulatory Agencies • State board of pharmacy § Registers and regulates pharmacists and pharmacy technicians § Practice of pharmacy is governed at the state level. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Regulatory Agencies • State board of pharmacy § Do not govern hospital pharmacy departments (unlike community pharmacies) just the individuals who work in them § SBOP regulations vary from state to state. The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Regulatory Agencies • Drug Enforcement Agency (DEA) § Any institution, manufacture, or wholesaler who deals with the use, manufacturing, or selling of controlled substances must be registered with the DEA, including health systems pharmacies The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Regulatory Agencies • Drug Enforcement Agency (DEA) § Unique DEA number must be used for all transactions involving controlled substances. • Letters preceding health-system pharmacy DEA number identifies the type of institution The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Regulatory Agencies • The Joint Commission § Surveys, inspects, and accredits health systems, such as hospitals (including the pharmacies), every three years § Unannounced inspections § Joint Commission accreditation necessary for Medicare reimbursements and many third-party insurance company payments The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Regulatory Agencies • Centers for Medicare and Medicaid Services (CMS) § Administers Medicare, Medicaid, SCHIP, HIPAA, CLIA, and several other healthrelated programs § Inspections to ensure guideline compliance § CMS approval needed for Medicare and Medicaid reimbursement The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved

Regulatory Agencies • State Department of Public Health (DPH) § Regulates hospitals, including the hospital pharmacy department(s) § Conducts inspections to ensure that the facility is in compliance with DPH regulations and criteria The Pharmacy Technician: Foundations and Practices , 2 e Copyright © 2014 by Pearson Education, Inc. Mike Johnston All Rights Reserved