March 2010

Inpatient Pharmacy Inpatient Pharmacy Workflow and Daily TasksWorkflow and Daily Tasks

• Configure Inpatient Pharmacy v5.0 site parameters for IV and UD menus

• Compare & contrast Inpatient Pharmacy IV and UD reports

• Use Inpatient menu options to perform routine daily IV and UD tasks

• Identify “good practices” for managing workload using Inpatient Pharmacy v5.0

Course Objectives

• Daily inpatient pharmacy workload:

IV Package routine tasks- Printing reports/lists, Printing Labels,

Manufacturing of IV’s, etc

Unit Dose Package routine tasks- Printing pick list, cart-fill (if no Pyxis), entering

doses dispensed, etc.

Overview

IV Menu Site Parameter Configuration

• IV MenuSupervisor OptionSite Parameter Edit• Allows configuration of defaults

– Name(s) of IV Room(s)– Label specifications– “Duration” of orders for various IV types

• (Automatic stop dates different from the defaults may be entered for individual additives in drug file)

– Coverage times (i.e. 24 hour batch time frame)– Devices for output (reports, labels)

Daily Routine for IV Package

• Print Active Order List (optional)– Review, update orders as needed

• Print Ward List

• Print Manufacturing List

• Print Scheduled Labels

• Prepare IV’s, check, deliver to ward

Daily IV Workload – Active Order List

• Prints list of all currently active IV orders– Sorted by ward

• Can be printed at any time• Variety of uses as a “worksheet”

– Take to ward and check IV admixtures for current rates, # of bags needed

– Use to review IV antibiotics against culture results

– Compare to MAR to see if nurses changed any administration times

Daily IV Workload – Ward List

• Ward List prints all active orders– Sorted by ward– Shows # of bags due for 24 hour coverage

• First step in sequence for daily IV batch– Ward List, then Manufacturing List, then

Scheduled Labels (always in this order)

• Ward List is used by pharmacist to check each bag/label prior to delivery to ward

Daily IV Workload – Manufacturing List

• Prints all active orders– Lists all admixtures first

• Sorted by base solution, with totals

– Lists all piggybacks next• Sorted by additive and strength, with totals

• Used by technicians to assemble needed bags & additives, record lot #’s

• After admixture, technician separates IV’s by ward for checking by pharmacist

Daily IV Workload – Scheduled Labels

• Prints labels for all IVs due for 24 hour batch– Labels print in same order as mfg list (batched

by drug/dose)

• “Good practices”:– Check printer before sending print job

• Ensure labels correctly aligned• Ensure adequate # of labels

– Watch labels to ensure they don’t curl back

Other IV Menu options: Reprint Scheduled Labels

• Shouldn’t need to use this often– Especially if you follow “good practices” and watch

the printer during scheduled label print job

• If labels jam partway through print job or run out– Can print selected range of labels– From last usable label to end, or to next usable label

Other IV Menu Options:Individual Labels

• Print labels for one patient

• Program gives 2 choices– Reprint labels– Print New Labels

• Program asks if the labels should “count as daily usage?”– No for reprints, Yes for New Labels

Other IV Menu Options: Suspense Functions

• Allows labels to be “suspended” from printing with the batch

• Labels can later be “released” for printing

• Possible uses– High cost items– Items that may be discontinued– Items unlikely to be re-usable

• Neonatal syringes, oddball admixtures

Other IV Menu Options: Returns & Destroyed Menu

• Used when IVs or IV labels need to be “credited”– Labels that were printed but never mixed

• Use “Cancelled” Option– Labels that were printed and mixed but can be re-used for

another patient• Use “Recycled” Option

– Labels that were printed and mixed and cannot be used for another patient

• Use “Destroyed” Option

Other IV Menu Options: Renewal List & Inpatient Stop Order Notices

• Reports that print orders that will expire in a selected time frame (e.g. next 24 hrs)– Renewal List prints only IV orders– Inpatient Stop Order Notices prints IV orders, U/D

orders, or both

• If your site has automatic stop dates– Use report to notify providers– Provider must decide whether to renew or let order

expire

Automatic Stop Orders (ASO’s)

• Are ASO’s necessary? Helpful?

• “Good practice” suggestion– Eliminate ASO’s in policy for most drugs– Configure RPMS parameters to maximum

allowable stop date– Exceptions to consider: ketorolac, narcotics?– For the exceptions, can set shorter ASO

under orderable item file or additive file

• Unit Dose MenuSupervisor OptionInpatient Ward Parameters Edit

• Allows configuration of defaults– Automatic stop dates for UD orders– Start time calculation

• “Now”, “Next Scheduled” or “Closest Scheduled”

– Automatic printing of MAR labels– Default print devices

UD Menu Site Parameter Configuration

Daily Routine Workload for Unit Dose (UD) Package

• Print Pick List*

• Perform cart fill if no ADM (Pyxis/Omnicell)

• Enter Units Dispensed*

• Report Returns*

* Process differs depending on whether or not your site has Inpatient ADMs with Profiling and Interface

Daily UD Workload:Printing Pick List

• Pick list prints all active UD orders– Sorted by Ward, then Room/Bed– Shows doses needed for next 24 hrs

• Used as worksheet to fill UD med carts

*If Pyxis or Omnicell, do not need to actually print

– Still need to RUN Pick List, but can print to screen or enter “^”

Pick List - with Cart Fill

• # of units dispensed is recorded on line

• Items marked Ward Stock will show “WS” as units needed

• Orders that are schedule type “R” (Fill on Request) will show zero as units needed

• Allows pharmacist to enter into RPMS the doses actually dispensed for each med– Tip: when appropriate, simply “enter” at prompt to

accept that units dispensed = units needed

• Optional: view only prn med orders– For schedule types other than prn, program assumes

units dispensed = units needed

• Program jumps past items listed as WS• When finished, you are prompted

– “May I file this pick list away”?

Daily UD Workload:Enter Units Dispensed

• Bypassing “Enter Units Dispensed” entry– At first patient, can enter “^^^” to skip to end– Program automatically accepts units needed

= units dispensed for each item

• Caution - if any item is not marked as WS the program will “double count”

• (Pick List doses + doses removed from ADM)

• “Good Practice” – do the complete Enter Units Dispensed, at least periodically

Daily UD Workload: Enter Units Dispensed *(Sites with ADM)

Other UD Menu Options:EXtra Units Dispensed

• Used to enter extra unit doses dispensed – e.g. lost, dropped – Fill on Request items (e.g. new tube of cream)

*For sites with ADM (Pyxis/Omnicell):– Use this option if item not stocked in ADM– If item comes out of ADM and nurse removes

extra dose, it is recorded automatically

Other UD Menu Options:Report Returns

• Used to “credit” unit dose meds– When patient is discharged– When order is discontinued

*If your site has ADM with interface– Meds returned to ADM by the nurse will be

“subtracted” in RPMS automatically– Still may need to use this option

• e.g. Albuterol inhaler prn - dispensed but never opened/used

Summary

• Inpatient Package Daily Routine Tasks– IV Menu

• Ward List, Mfg List, Scheduled Labels• Other options as needed

– UD Menu• Pick List, +/- Cart Fill, Enter Units Dispensed• Other options as needed