Pharmacy Management for Off-Hour Dispensing

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Questions and Answers

What is the purpose of an emergency box or 'STAT BOX' in a hospital?

To provide quick access to necessary supplies for each floor or ward (correct)

To maintain a record of patient billing

To store medications for 24-hour pharmacy use only

To store physician's personal medication

Where should an emergency box be placed in a hospital?

In a physician's office

Inside the pharmacy only

In a secure room with limited access

In an accessible place known to all ward personnel (correct)

What is the purpose of a night drug-supply cabinet?

To charge floor stock medications on each floor (correct)

To store medications for pharmacy staff only

To provide refrigerated compartments for vaccines

To provide an additional storage for narcotics

Who is responsible for maintaining the inventory of a night drug-supply cabinet?

Pharmacy staff Signup and view all the answers

What is a drawback of using physicians to dispense medications during off-hours?

Physicians are overworked and short-staffed Signup and view all the answers

What is the purpose of a pharmacist-on-call system?

To provide 24/7 pharmacy services to patients Signup and view all the answers

How is a pharmacist-on-call system typically staffed?

On a rotational basis to avoid burdening any individual Signup and view all the answers

What is an advantage of a pharmacist-on-call system?

It allows for more than one institute to utilize the service Signup and view all the answers

What is the role of a nurse in relation to an emergency box?

To withdraw medications and medical items and charge them on the patient's file Signup and view all the answers

What information should be included in the pharmacy record for each medication movement?

Date, time of issue, patient care area, drug name, strength, and dosage form, and quantity delivered or returned Signup and view all the answers

Who is responsible for the proper safeguarding and handling of controlled substances in a hospital?

Administrator Signup and view all the answers

What should accompany each request for new supply of controlled substances in a ward stock?

A duly signed sheet and provision of empty vials Signup and view all the answers

Who can write a prescription for controlled substances?

Licensed and authorized physician or registered resident Signup and view all the answers

What should be done with narcotic prescriptions after administration?

They should be retained for records Signup and view all the answers

How often should narcotics be audited for count and use?

In every shift change Signup and view all the answers

What is a benefit of the complete floor stock system in an inpatient dispensing system?

Reducing the number of pharmacy personnel required Signup and view all the answers

What is meant by 'floor stock drugs' in the context of inpatient dispensing?

Drugs stored in the medicine cabinet of the nursing unit Signup and view all the answers

What records should personnel involved in research maintain for controlled substances?

Receipt records, dispensing records, and administration records Signup and view all the answers

What is the advantage of the complete floor stock system in terms of drug returns?

Elimination of drug returns Signup and view all the answers

Who should sign the order for administration of controlled drugs?

Physician Signup and view all the answers

What is the purpose of maintaining registers for dispensing of controlled substances?

To ensure accountability Signup and view all the answers

What is a disadvantage of the complete floor stock system?

Increased drug inventory on the pavilions Signup and view all the answers

What is the Envelope method?

A method of charging floor stock drugs Signup and view all the answers

What is a benefit of the review of medication orders by the pharmacist?

Reduced medication errors Signup and view all the answers

What is a disadvantage of the complete floor stock system in terms of nursing time?

Greater inroads on the nurses' time Signup and view all the answers

What is a benefit of the complete floor stock system in terms of drug availability?

Ready availability of the required drugs Signup and view all the answers

What is a disadvantage of the complete floor stock system in terms of storage facilities?

Lack of proper storage facilities on the ward Signup and view all the answers

What type of error occurs when a medication is administered outside a predefined time interval from its scheduled administration time?

Wrong Time Error Signup and view all the answers

What is the main cause of transcription and/or interpretation errors?

Illegible handwritten prescriptions Signup and view all the answers

What type of error occurs when a patient is given a dose that is greater or less than the amount ordered by the prescriber?

Dose Error Signup and view all the answers

What type of error occurs when a drug product is dispensed or administered in a different dosage form than that ordered by the prescriber?

Dosage Form Error Signup and view all the answers

What is the main difference between Omission Error and Unauthorized Drug Error?

Omission Error involves failing to administer a medication, while Unauthorized Drug Error involves administering an unauthorized medication Signup and view all the answers

What type of error occurs when a medication is not prescribed for a patient despite being indicated for their condition?

Omission Error Signup and view all the answers

What type of error occurs when a prescriber's orders are not reviewed for appropriateness or when clinical or laboratory data is not used for adequate assessment of patient response?

Monitoring Error Signup and view all the answers

What is the common characteristic among Wrong Time Error, Dose Error, and Dosage Form Error?

They all involve discrepancies between the prescriber's orders and the medication administered Signup and view all the answers

What is the main difference between Transcription and/or Interpretation Errors and Monitoring Errors?

Transcription and/or Interpretation Errors involve misinterpretation of prescriptions, while Monitoring Errors involve failure to review prescribed regimens Signup and view all the answers

What type of error occurs when a drug is dispensed or administered after its expiration date?

Deteriorated Drug Error Signup and view all the answers

What is a common factor contributing to medication errors in hospital administration?

Inadequate policies regarding safe use of medication Signup and view all the answers

What is the primary reason for inadequate labeling of drugs and allied items in a nursing station?

Use of non-professional personnel in areas requiring professional judgment Signup and view all the answers

What type of error occurs when a drug is administered using an inappropriate procedure or improper technique?

Administration Technique Error Signup and view all the answers

What is a common factor contributing to medication errors in hospital personnel?

Overburdened personnel Signup and view all the answers

What type of error occurs when a drug is administered through the wrong route?

Route of Administration Error Signup and view all the answers

What is a common factor contributing to medication errors in hospital facilities?

Inadequate storage and equipment facilities Signup and view all the answers

What type of error occurs when a drug is prepared incorrectly before dispensing or administration?

Drug Preparation Error Signup and view all the answers

What type of error occurs when a patient's response to prescribed therapy is not adequately monitored?

Monitoring Error Signup and view all the answers

Study Notes

Off-Hour Dispensing

Emergency Box (also known as "STAT BOX") is an essential part of 24-hour pharmacies, especially in small hospitals, and can be placed on each floor/ward by expanding the inventory of necessary supplies.
The box should be placed in an accessible location known to all ward personnel.
The nurse withdraws medicine and medical items, charges them on the patient's file, and sends them to the pharmacy for record purposes.

Night Drug-Supply Cabinets

Night supply cabinets are an adjunct to charging floor stock medications on each floor.
They can be a simple cabinet or a large installation with a narcotic vault and refrigerated compartments.
The cabinet should be constructed along the pharmacy wall, accessible from inside and outside the pharmacy.
The pharmacy must maintain the cabinet's inventory periodically.

Use of Physician

More drawbacks are associated with this system, which is discouraged.
Factors include the burden and shortage of physicians, and unfamiliar surroundings for physicians in the pharmacy.

Pharmacist-On-Call

Organizations contract with pharmacists to serve them round the clock, if required, by visiting the pharmacy on call.
This may be supported by bonus or extra payment plans or allowances.
The pharmacy record should include information such as date, time of issue, patient care area, drug name, strength, and dosage form, quantity delivered or returned, and names and signatures of pharmacy and patient care area staff involved.

Distribution of Controlled Substances

For each medication movement, the pharmacy record should include date, time of issue, patient care area, drug name, strength, and dosage form, quantity delivered or returned, and names and signatures of pharmacy and patient care area staff involved.
For each medication movement, the record in the patient care area should include date, time of receipt, "Issued by Pharmacy" or "Returned to Pharmacy", drug name, strength, and dosage form, quantity added or subtracted from inventory, new balance, and names and signatures of pharmacy and patient care area staff involved.

Responsibility for Controlled Drug Substances in Hospital

The administrator is responsible for the proper safeguarding and handling of controlled substances in the hospital.
The pharmacist in chief is responsible for purchasing, storing, accountability, and proper dispensing of controlled substances.
Registers must be maintained for dispensing of controlled substances.

Ward Stock for Controlled Substances

Stock is replaced by a duly signed sheet and provision of empty vials.
Each request for a new supply is accompanied by a controlled drug administration form.
For any drug that is lost or wasted, the nurse in charge must prepare an incident form.

Doctor's Order for Administration of Controlled Drug

Orders should be duly signed by a physician in non-edible ink.
Prescriptions can only be written by licensed and authorized physicians or registered residents.

PRN or SOS Orders

Should be discouraged and not entertained.
Telephone or verbal orders are only allowed during necessity, and the nurse should write the order, which should be signed by a physician within 24 hours.

Miscellaneous Regulations

Ward supplies of controlled medicines should only be used for patients on the ward.
Narcotic prescriptions are not refilled.
Prescriptions are retained for records.
Physicians may not prescribe narcotics for personal use.

Control of Narcotics by Nurses

Narcotics are audited for count and use in every shift change.
Each shift has a designated nurse for narcotics control.
Both the nursing staff from the new and old shifts sign the records.
If a discrepancy is found, it should be reported to the pharmacy.

Research Use

Personnel involved in research should be registered under DRAP rules.
If there are multiple locations, each location should be registered separately.
Each personnel should keep records of research and controlled substance use, including receipt records, dispensing records, and administration records.

Inpatient Dispensing

Pharmacist reviews all medication orders directly.
Provides for interaction between pharmacist, doctor, nurse, and patient.
Provides closer control of inventory.

Complete Floor Stock System

A supply of drugs is stored in the medicine cabinet of the nursing unit, serviced by a unit dose system.
Drugs stored in the nursing station depend on the specialty of care and are termed floor stock drugs.
It should be in minimum quantity.

Advantages of Complete Floor Stock System

Ready availability of required drugs.
Elimination of drug returns.
Reduction in the number of drug order transcriptions for the pharmacy.
Reduction in the number of pharmacy personnel required.

Disadvantages of Complete Floor Stock System

Medication errors may increase due to the elimination of medication order review.
Increased drug inventory on the pavilions.
Greater opportunity for pilferage.
Increased hazards associated with drug deterioration.
Lack of proper storage facilities on the ward may require capital layout.
Greater inroads are made upon the nurses' time.

Envelope Method

Medication errors may result from the failure to review a prescribed regimen for appropriateness or the failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy.

Classification of Medication Errors

Monitoring errors result from the failure to review a prescribed regimen for appropriateness or the failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribed therapy.
Transcription and/or interpretation errors are made during the transcribing or interpreting of prescriptions due to causes including misinterpretation of abbreviations, illegible handwritten prescriptions, and misinterpretation of spoken prescriptions.
Omission errors occur when a dose is not administered to a patient before the next scheduled dose or failure to prescribe a drug product indicated for the patient.
Wrong time errors occur when medication is administered outside a predefined time interval from its scheduled administration time.
Unauthorized drug errors occur when medication is dispensed or administered to a patient without a legitimate prescriber's authorization.
Dose errors occur when medication is dispensed or administered to a patient in a dose that is greater than or less than the amount ordered by the prescriber.
Dosage form errors occur when medication is dispensed or administered to a patient in a different dosage form than that ordered by the prescriber.
Drug preparation errors occur when a drug product is incorrectly formulated or manipulated before dispensing or administration.
Route of administration errors occur when medication is administered through the wrong route.
Administration technique errors occur when an inappropriate procedure or improper technique is used in the administration of a drug.
Deteriorated drug errors occur when medication is dispensed or administered that has expired or has compromised physical or chemical dosage-form integrity.

Factors Contributing to Medication Errors

Hospital administration-related factors:
- Inadequate policies regarding safe use of medication
- Inadequate policies governing reporting of incidents in the institution
- Inadequate policies concerning performance of tasks for supportive personnel
Personnel-related factors:
- Lack of hospital pharmacist
- Lack of administration nurse
- Overburdened personnel
Technique-related factors:
- Use of non-professional personnel in areas requiring professional judgment
- Inadequate labeling of drugs and allied items for the nursing station
Facility-related factors:
- Inadequate storage and equipment facilities
- Inadequate drug station on patient care areas

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Description

Learn about the importance of emergency boxes and night drug-supply cabinets in 24-hour pharmacies, and how to manage them effectively. Understand the role of nurses and pharmacists in off-hour dispensing.