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 TIME

DAILY 0900

QAM 0900

BID 0900, 2100

TID 0800, 1600, 2200

QID 0800, 1300, 1700, 2200

HS 2100

Q2H 0200, 0400, 0600, 0800, 1000, 1200, 1400, 1600, 1800, 2000, 2200, 2400

Q3H 0600, 0900, 1200, 1500, 1800, 2100, 2400, 0300

Standard Medication Times

SCHEDULE TIME

Q4H 0600, 1000, 1400, 1800, 2200, 0200

Q6H 0600, 1200, 1800, 2400

Q8H 0600, 1600, 2400

Q12H 0900, 2100

AC 0730, 1130, 1630

PC 0930, 1330, 1830

AC + HS 0730, 1130, 1630, 2100

PC + HS 0930, 1330, 1830, 2100

DIURETICS 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 hands3. Check patient allergies4. 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 InpatientMedication 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 GASTROINTESTINAL RESPIRATORY

Anaphylaxis Diarrhea Wheezing

Angiodema Constipation Increased Respirations

Fever Nausea, Vomiting

Skin Reaction Hemorrhage URINARYOliguria

DERMATOLOGICAL HEMATOLOGICAL Bladder Spasms

Rash Anemia Failure

Petechiae Leukopenia

Erythema Thrombocytopenia SPECIAL SENSES

Phlebitis Abnormal Coagulation Taste perversion

Urticaria Appetite Changes

Reportable Drug Reactions

ELECTROLYTE & FLUID IMBALANCE

ENDOCRINE / METABOLIC

VASCULAR

Hyperkalemia Hypothyroid Dysrhythmia

Hypokalemia Fever Bradycardia

Hypernatremia Hypoglycemia Tachycardia

Hypocalcemia Sexual Function Hypertension

Fluid Retention ENT / ORAL Hypotension

NEUROLOGIC Tinnitus

Headache Hearing Loss MUSCULOSKELETALDyskinesia Stomatitis Muscle weakness

Convulsions PSYCHIATRIC Arthritis

LIVER Depression Arthralgia

Hepatitis Confusion Myalgia

Jaundice Hallucinations

Drugs Most Commonly Involved in ADR’s

ORAL FORMS OF: INJECTABLE FORMS OF:

Kayexalate (Sodium Polystyrene Sulfonate) Antihistamines (Benadryl)

Imodium Atropine

Lomotil Cogentin (pine)

Flagyl / Vancomycin Oral Dextrose 50%

Kaopectate Epinephrine

Atarax / Vistaril (Hydroxyzine) Narcan (Naloxone)

Vistaril

TOPICAL FORMS OF: Compazine

Calamine Lotion Dilantin (Phenytoin)

Local Anesthestics Mephyton (Phytomadione-Vitamin K)

Corticosteroids (Topicort) 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