Institutional Pharmacy Operations PDF

Institutional Pharmacy Operations Don Tyson, Pharm.D., BCPS Director of Pharmacy Piedmont Athens Regional [email protected] About me Originally from Tifton, GA ABAC Alum BS Pharm, PharmD UGA Residency UGA/ARMC Clinical Pharmacist/Coordinator for 13 years Director of Ph...

Institutional Pharmacy Operations Don Tyson, Pharm.D., BCPS Director of Pharmacy Piedmont Athens Regional [email protected] About me Originally from Tifton, GA ABAC Alum BS Pharm, PharmD UGA Residency UGA/ARMC Clinical Pharmacist/Coordinator for 13 years Director of Pharmacy for 14 years Hobbies – Volunteer landscaping (Habitat for Humanity) and gardening Active member – Hull Baptist Church (Deacon and Sunday School teacher) About Piedmont Healthcare Private, not-for-profit Cardiac Care – Transplants and LVAD – Open Hearts – Marcus Heart Valve Center – Partner with the Cleveland Clinic Transplant Care – kidneys, livers, pancreases Cancer Care - partner with MD Anderson Women’s Services Orthopedics Neuro/spine Pediatrics and Neonates Home Health About Piedmont Healthcare 23 hospitals 65 Urgent Care Centers 25 Quick Care Locations 1875 Piedmont Clinic Physician Practices and 3100 Piedmont Clinic Members __________________________________ Over 44,000 employees – Piedmont employees more Georgians than any other company Recognized by Newsweek in 2023 as one of America’s Greatest Workplaces for Diversity and as one of the Greatest Workplaces for women Ranked by Forbes list in 2022 as one of the best large employers in the US Piedmont Athens Regional Medical Center 391 beds and growing Hospital Pharmacy – 24/7 – 80 employees – Decentralized staffing – PGY1 Residency program – Ambulatory clinics Retail Pharmacy – Main campus – Oconee campus Home infusion Services Specialty Pharmacy Pharmacy Work Environment Must facilitate safety, efficiency and customer/patient satisfaction – Centralized main operation High security area (limited access) Needed to house inventory Sterile/Extemporaneous Compounding – Emergency operations ability Ability to operate with major system failures (lighting/power, network related issues) Redundancy is important – Accessible to patient care area Tube system Decentralized units vs. Decentralized staff Pharmacy Work Environment Staffing – Must flex for workload – FTE’s Amount of staff allowed Determined by statistic – Charged doses – Adjusted admissions – Turn around time goals – Skill mix – Pharmacist to technician ratio Medication Safety Safety is “job one” IOM Report 1999 Medical Errors (including medication errors) – Third Leading cause of death in the US (BMJ 2016;353:i2139) 250,000 people/year (could be as high as 400,000) Heart disease #1, Cancer related deaths #2 Medication error vs adverse events – Medication error often is a “preventable” adverse event Medication Safety Medication use process – Needs multiple checks to prevent errors – Prescribing – Dispensing – Administering – Monitoring Medication Safety Performing “Five Rights” of med administration – Right patient – Right drug – Right dose – Right route – Right time Verbal and Telephone orders – Should be the exception – Readback and verify requirement TALLman Lettering – List developed and maintained by ISMP Medication Safety Look-Alike Drug Names with Recommended Tall Man Letters (www.ismp.org) sample: Medication Safety CPOE – Required – Reduces errors associated with handwritten orders – Order sets standardize care – Introduces opportunity for errors unique to CPOE Wrong patient Keyboarding errors (Patient wt – Kg vs Lb) Alert fatigue issues Medication Safety Bedside barcode scanning – A required element of medication safety – Pharmacy receiving dept Plays key role No med allowed for use that is not scannable – Changes in product due to contracts or shortages – Clinical system generates barcode for compounded products (e.g. IVPB’s, IVF’s) – Polices must reinforce requirement and processes Items not scannable – Return to pharmacy vs. five rights Medication Safety Safety huddles – 1-3 times per day – Department level and Institution level – Culture of openness about issues No blame environment Self reporting Near misses needed to prevent errors reaching the patient – Debriefings Timeline of events around error Improve awareness Foster solutions by staff Medication Safety Medication Safety Medication use evaluation – Data driven One time vs continuous Formal vs informal – Measure Appropriateness Cost effectiveness – Justification of product or service – OFI’s (DNV, JCAHO) Medication Safety Compounding – United States Pharmacopeia (USP) Standards USP 795 (Non-sterile compounding) USP 797 (Sterile Compounding) USP 800 (Hazardous Medications) – Compliance Accreditation agency (DNV, JCAHO) Board of Pharmacy Purchasing Performed by one more individuals, with responsibilities – Purchasing – Inventory management – Contracts – Shortages – Processing invoices Vendors – Primary Wholesaler – Fluid vendor – Sterile Compounder 503A 503B Purchasing 340B Purchasing – Qualifications Disproportionate share hospital Rural Referral Center (Orphan drugs not allowed) Critical access hospital – Discounted prices (50% AWP) – Must have qualified outpatients to utilize – Program designed to stretch federal dollars to care for the indigent, but non-indigent patients can qualify – Audited by HRSA – Penalties for noncompliance Purchasing – Drug Shortages Purchasing – Drug Shortages Purchasing – Drug Shortages Purchasing – Drug Shortages Automation Automated dispensing cabinets (ADC’s) – “Cabinet-centric” design minimize cartfill >90% meds on unit Emergency meds – Allows stock to be ready for retrieval on nursing unit – Controlled substance use/waste tracking – Barcode scanning enhances safety Automation Anesthesia Systems – Drug at the point of use – Eliminates manual systems (i.e. kits) – Tracking of use/waste – Prints label for syringes “pulled up” – Barcode scanning for enhanced safety Automation Carousels – Increase inventory turns – Barcode scanning for product input and output – Condenses space needed for inventory Case A newly trained pharmacy tech realizes for the second time she has accidently pulled Levetiracetam (Keppra) 500 mg tablets for Levofloxacin (Levaquin) 500 mg tablets. She knows she is not the only one making this error. What action(s) might she suggests to proactively prevent this error from happening? Case A new pharmacist is verifying a dose of enoxaparin. The order for 1 mg/kg q12hr calculates via EPIC to to be 120 mg q12hr. She remembers seeing the patient on rounds and recalls her being a smaller elderly woman. What actions should be taken, considering the situation? Case It is reported there is less than two weeks supply of lorazepam 2 mg/1ml vials commonly stocked in Pyxis units around the hospital. – The ASHP drug shortage page indicates all NDC’s of this drug product are going to to be in short supply due to increased demand due to a manufacturer having quality related issues. – The pharmacy can obtain 10mg/10 ml vials but is allocated to the amount they can receive each week. Your thoughts on how to manage this situation?