We would like to
devote this Special Pharmacy Key to
welcome you to the University of Kansas Hospital. We would like to review the services provided by the Department of
Pharmacy, institutional policies concerning drug use in the hospital and
suggested guidelines for prescription writing.
The goal of this publication is to foster an understanding of pharmacy
services and medication use policies so that safe, efficient and rational drug
use or therapy may continue in this institution.
CLINICAL PHARMACY TEAMS
Patient Care units at University of
Kansas Hospital are divided among pharmacy teams. Coverage during evening and weekend shifts varies slightly. Clinical Pharmacists carry pagers for
accessibility and nursing unit staff or central pharmacy can provide the pager
number for designated pharmacists.
|
Clinical
Pharmacists: |
Pager |
|
DAY
(0800-1500) |
|
|
Team 1 (PED,PICU, 56, 54LDR) |
7972 |
|
Team 2 (Cardiology: 46, 44A) |
7936 |
|
Team 3 (Med/CTS: 41, 45, 52, 53 : 2 RPhs) |
7908/7958 |
|
Team 4 (Trauma/Surg ICU: SIC, 51, 15's) |
7964 |
|
Team 5 (Heme/Onc: 42, MTU) |
7956 |
|
Team 6 (MICU-not 44A, 43, Pt Ed 30F, 27, 37) |
7970 |
|
EVENING (1500-2300) |
|
|
Team 1E (PED,NICU, PICU, 56, 54LDR) |
7972 |
|
Team 2E (Cardio/MIC: 46, MIC, 44A, 51) |
7936 |
|
Team 3E (41, 53, 52) |
7958 |
|
Team 4E (Trauma/CTS: SIC, 45, 15's) |
7964 |
|
Team 5E (Heme/Onc: 42, MTU, 43) |
7956 |
|
Central (27,30F) |
Ext.82321 |
|
2300-0800 |
Ext.82321 |
|
From the National Coordinating Council for Medication
Error Reporting and Prevention ·
Always write legibly ·
When possible include intended purpose ·
All orders should be written in the
metric system except for orders that use standard units such as insulin and
vitamins ·
Spell out units rather than using
"U" ·
Include age and weight when appropriate ·
All medication orders should include
drug name, exact metric dose or concentration and dosage form ·
A leading zero should always precede a
decimal expression of less than one. (0.1 mg….YES!!) ·
Trailing zeros should never be used
(1.0 mg ….NO!) Avoid using abbreviation including those for the drug
name (i.e., MOM, HCTZ) |
UNIVERSITY OF KANSAS HOSPITAL
The Department of Pharmacy provides
comprehensive, 24-hour service to patients, physicians and staff as an integral
part of the teaching, research and patient care programs at The University of
Kansas Hospital.
CLINICAL
PHARMACY SERVICES
Pharmacy Services for inpatients are
provided by decentralized Clinical Pharmacists. The clinical pharmacist
responsible for the medical service and/or nursing unit caring for your
patients is an excellent resource. This
pharmacist is your best liaison with the central Department of Pharmacy when
drug-related questions or problems and any special requests arise.
The Clinical Pharmacist is responsible
for review of the patient medication regimen.
Pharmacists screen for potential problems with medication orders:
dosing, drug allergies, drug interactions, intravenous incompatibility and
more. Physicians are informed of
potential problems and possible drug therapy modification. Pharmacists are actively involved in
monitoring drug therapy and provide pharmacokinetic dosing for selected
antimicrobials. Patient education
during the hospital stay and/or upon discharge maybe provided by Clinical
Pharmacists. A Self-Medication
Educational Program for patients and medication calendars are available for
patients with multiple medications and compliance problems.
Pharmacy notes located in the patient
chart may and/or the electronic medical record, contain information regarding
patient education, compliance assessment, pharmacokinetic dosing or other
information related to patient drug therapy decisions.
THE FORMULARY SYSTEM
The Formulary
System is the accepted method approved by the Medical Staff whereby physicians
select medications to be available for University Of Kansas Hospital patients.
The Pharmacy and Therapeutics Committee evaluates, appraises and selects from
the numerous medical agents commercially available and makes recommendations to
the Executive Committee of the Medical Staff indicating medications which are
the preferred medications for
patient care at University Of Kansas Hospital.
These recommendations require approval by the Executive Committee of the
Medical Staff prior to formulary inclusion.
The evaluation of drugs for admission into the Formulary System is
comprehensive and considers efficacy, safety, and economic issues, all aimed at
promoting rational, cost-effective drug therapy. It also includes comparisons of therapeutic alternatives to
minimize therapeutic duplication in the formulary. The University Of Kansas
Hospital Formulary is the published list of approved medications considered
most useful in providing care for the vast majority of patients, both inpatient
and outpatient, in the University Of Kansas Hospital Health System. University of Kansas Hospital prescribers
are expected to prescribe these approved formulary medications. If medically necessary, non-formulary
medications can be obtained upon request for specific patients during their
hospital stay.
REQUEST FOR NON-FORMULARY DRUGS
When a non-formulary drug is requested,
the pharmacist will inform the prescribing physician of formulary alternatives,
which are therapeutically equivalent, and of their proper dosage. If an acceptable formulary medication is not
identified, the Pharmacy will obtain a small supply of the drug for that
particular patient. A nonformulary service fee fee incurred will be billed to
the patient. A time delay of 24-48
hours should be anticipated since the drugs must be ordered from outside
source.
The
non-formulary drug may be sent home with the patient as a dismissal medication,
if written for, but will be limited to only the remaining supply. It is recommended that another prescription
be sent with the patient for any additional quantity necessary.
If a physician intends to prescribe a
non-formulary drug on a regular basis, it is recommended that a request for
evaluation for Formulary admission be submitted.
FORMULARY ADDITIONS AND DELETIONS
Requests for additions to or deletions
from the University of Kansas Hospital Formulary should be submitted to the
Director of Pharmacy on the Application for Formulary Admission Form to
facilitate consideration by the Pharmacy and Therapeutics Committee. Such requests must be approved by the
Chairman of the Department desiring the drug.
Applications must be complete and must include sufficient supportive
data to enable the committee to make a sound decision. Application forms are available from the
Department of Pharmacy or on the University of Kansas Hospital Pulse at the
following url: http://www2.kumc.edu/pharmacy/formrequest.html. All drugs are admitted on a nonproprietary
name (generic) basis. No drug of
unknown or secret composition will be admitted.
All drug additions
and deletions to the formulary must be subsequently approved by the Executive
Committee of the Medical Staff. Drugs
added or deleted from the formulary will be announced in the Pharmacy
newsletter, the Pharmacy Key. The effective date of the addition or
deletion will be noted in the publication of the Pharmacy Key. The Pharmacy Key can be accessed via the Internet at
the following url:http://www2.kumc.edu/druginfo/pharmkey.html.
DRUG DISTRIBUTION
Unit floor stock is available from
Pyxis units on all patient care units and many diagnostic units. This automation allows authorized health care
professionals to access medications that are on a patient profile and
medications that are considered “PRN” for an individual unit. Biometric "passwrods" (e.g.
fingerprint) scanners are used to ensure positive identification for Pyxis
machine access.
The medications available in each Pyxis
unit are chosen by each nursing unit and its pharmacist. The availability of each medication is based
upon safety, usage and stability.
Prescribed medications that are not available in Pyxis units are
delivered to patient care areas by the Department of Pharmacy in individual
packages which identify each dose (unit dose packaging).
SAMPLES
Professional drug samples are not to be administered to
inpatients. Samples are not to be stored
on the nursing units or hospital patient care areas.
PATIENT’S OWN MEDICATION POLICY
The hospital encourages the use of medications supplied and
administered by the hospital at all times.
Patients may be permitted to use their own medications only under specific limited
circumstances. This limitation is based
on patient safety with product integrity and potential self-administration of
incorrect dosages being issues of concern.
In addition, the risk of
medication error is increased by the use of medications outside of the
normal medication use system.
Handling of patient’s own medications is a time consuming process. Order clarification, medication
identification, documentation, special storage procedures and administration of
these medications outside of the normal system consume valuable hospital
resources. It is prudent to consider
the following procedures when making the decision to use patient’s own
medications.
When May an Order for Patient’s Own Medication Be Appropriate?
• The medication
is not
on the hospital formulary and a reasonable therapeutic substitution is not
available. Consult with the
nursing unit pharmacist if needed.
• Rarely, a
formulary medication may be used from the patient’s personal supply when the
physician, pharmacist, and patient deem the use medically necessary to
meet a specific health care need.
•
The medication is an investigational or study medication
provided under protocol as part of the patient’s participation in an
investigational study. Medications that are not provided by the study shall be
obtained through the pharmacy.
Patient’s own medication must be contained in the original prescription
container that is properly labeled as required by state and federal laws,
identifying the name, strength, dose, route, and directions for use of the
medication. Study medications may
contain information as allowed by the study protocol and must be labeled with
the patient name. If
it is deemed necessary for a patient to use their medication from home, based
on the guidelines above, specific written orders are required. An order stating
only that “the patient may use his or her own medications” will not be
accepted. Medications to be supplied by
the pharmacy must be ordered separately from the patient’s own medication
order.
How to Write an Order for a Patient’s Own Medication
• A statement
that the “patient may use their own
supply” while in the hospital.
• List only the medications that the patient is going to supply.
• Name, dose,
route, and directions for each
medication
Accurate identification of patient’s own medication is vital to the
health care outcomes and safety of the patient. JCAHO standards require that the clinical pharmacist identify each medication the patient is to use from their own supply to ensure that
they are receiving the appropriate medication. Identification needs to be
completed prior to administration of medication to the patient.
Storage of Patient’s Own Medication
Patients should be encouraged to send their own medications that are
not being utilized at KUMC home with a family member or friend. Patient’s own medication that remains in the
hospital shall be securely stored on the nursing unit. These medications will
be stored either in the “Patients Own Medication” section of the Pyxis®
unit or in another locked cabinet on the unit.
Administration of Patient’s Own Medication
Administration of patient’s own medication is similar to the
administration of medication dispensed by the pharmacy. A nurse shall obtain the appropriate
medication at the appropriate time from the patient’s own supply in the Pyxis®
or other locked area. This
administration shall be documented on the medication administration record
(MAR) indicating the medication, dose, and time given. It is discouraged that a patient’s own
medication be kept at their bedside, but if it is necessary to do so, the patient’s own medication order must also
include the statement ”patient may keep
their own medications at bedside”. Controlled
substances, however, may not be kept at the patient’s bedside. The nurse shall observe the patient taking
their bedside medication and document on the MAR the medication, dose, and time
taken.
INTRAVENOUS ADMIXTURE SERVICE
The
Department of Pharmacy prepares all intravenous drug admixtures. The policy ensures that all solutions are
prepared under aseptic conditions and are screened for drug interactions and
incompatibilities. Standard infusion
concentrations have been established for several intravenous drugs. Medication orders for these drugs should be
written in the concentrations that have been established. Except for reasons of
stability, compatibility, and/or volume problems, the standard diluent used in
intravenous “piggyback” orders is D5W 50mL.
A list of Standard and maximum
allowable concentrations for adult intravenous medications can be found in the
May 2001 Pharmacy Key which is located at the following url: http://www2.kumc.edu/druginfo/pharmkey.html
TOTAL PARENTERAL NUTRITION
· The standard
hang time for all adult and pediatric TPN solutions is 20:00.
· Neonatal TPNs
are hung between 1500 - 1700
· All TPN orders
for adults and pediatric patients are due in Pharmacy by 14:00. This includes new and changed orders.
Changes in neonatal orders are due in the Pharmacy by 1300
· For adult and
pediatric patients, the pharmacy will compound the 24 hr supply of TPN for a
patient based on the orders in the Pharmacy at 14:00 and these solutions will
be delivered to the nursing unit by 19:30. Neonatal TPNs will be delivered by
1500.
· When a new TPN
order is received after 14:00 for an adult or pediatric TPN, the pharmacist
will contact the prescribing physician to determine when the order will need to
be processed and if it can be scheduled for delivery the next day at 20:00.
MEDICATION ORDER TURN AROUND TIME
To
prioritize the processing of new medication orders and to establish an
appropriate turnaround time for these orders. The following turnaround times
have been established:
1.
STAT: Stat orders are defined as emergency
medications (medications that are needed only in life threatening situations)
and so written by the prescribing physician.
The physician should call a STAT order to the attention of the nurse so
it can be taken off the chart immediately.
Pharmacy can fill these orders in five (5) minutes if the order is
called down to the central pharmacy.
2.
ASAP/NOW: ASAP
or NOW orders will be written as such by the prescribing physician. These orders will be delivered to the
nursing unit within 30 minutes from the time pharmacy receives the written
order. Exception: Chemotherapy will be
delivered within 2 hours from the time pharmacy receives the written order.
3. ROUTINE ORDERS: Routine orders are all orders not written as
STAT, ASAP or NOW. Routine orders will be delivered within two (2) hours from the
time pharmacy receives them.
SCHEDULED TIMES FOR MEDICATIONS
Standard
schedules have been established for medication administration. Exceptions to
this schedule include selected drugs where levels may be affected by
administration time and upon special request by the prescribing physician.
PROCEDURE:
1. It is the
responsibility of the physician, nurse and/or clinical pharmacist to indicate
the appropriate time schedule for the drug on the order or pharmacy
requisition.
2. If a time
schedule is not indicated on the order, the following schedules will be used:
|
QDAY |
0900 |
Q2H |
02-04-06-08, etc. |
|
QAM |
0900 |
Q4H |
09-13-17-21-01-05 |
|
Daily |
0900 |
Q6H |
06-12-18-24 |
|
QHS |
2100 |
Q6H alt |
09-15-21-03 |
|
QPM |
2100 |
Q8H |
06-14-22 |
|
BID |
09-21 |
Q8H alt |
09-17-01 |
|
BID alt |
08-17 |
Q12H |
09-21 |
|
TID |
09-15-21 |
Q12H alt |
01-13 |
|
TID ac |
07-11-17 |
Q24H |
09 |
|
TID pc |
09-13-19 |
|
|
|
TID W/MEALS |
08-12-17 |
|
|
|
ACHS |
07-11-17-21 |
|
|
|
QID |
09-13-17-21 |
|
|
|
5XD |
09-12-15-18-21 |
|
|
*These
schedules are to be determined by when the order is received in the pharmacy
and what the turn around time for the order needs to be.
Special Schedules:
Unit specific schedules will be limited
to the following:
|
37 |
TID |
09-13-21 |
|
27 |
BID |
08-20 |
|
|
TID |
08-12-20 |
|
|
QID |
08-12-16-20 |
|
|
HS |
20 |
|
46 |
Q6H |
05-11-17-23 |
|
|
Q8H |
06-14-22 |
QID
verses Q6H schedules are not interchangeable and will be interpreted strictly as
indicated above unless the clinical pharmacist suggests a different time
schedule is more appropriate and indicates that schedule on the pharmacy
requisition.
Outpatient
Services and Prescriptions
Outpatients cared for by the University of Kansas Hospital are covered
by a variety of health insurance programs. Reimbursement
practices/requirements, preferred medications and formularies of various
programs differ greatly. To provide comprehensive pharmacy services to all
outpatients, the Outpatient Pharmacy maintains a drug inventory, which not only
includes the University of Kansas Hospital formulary medications but additional
medications as well. While the University
of Kansas Hospital prescribers are encouraged to utilize our preferred
medications, other medications are also available.
Prescriptions filled in the Outpatient Pharmacy must be written only on
a University of Kansas Hospital prescription blank by the University of Kansas
Hospital Medical Staff and the patient must be a patient of the University of
Kansas Hospital. However, verifiable prescriptions from local physicians may be
filled for employees. Prescriptions
written by medical students must be countersigned by a staff physician. The Physician’s name must be legibly printed
or stamped on the prescription in addition to the signature. The KU Outpatient
Pharmacy is open 8:00am - 7:00pm Monday thru Friday and 9:00am - 3:00pm
Saturday and Sunday and most holidays.
CONTROLLED
SUBSTANCES: Schedule II prescriptions must be written on green blanks.
All other prescriptions, including Schedule III, IV and V are to be written on
University of Kansas Hospital buff-colored prescription blanks labeled
"Not Valid for Schedule II Prescriptions". All prescriptions written
for controlled Substances (Schedule II - Schedule V) MUST be written by a physician possessing a Drug Enforcement Administration
(DEA) registration number. All new
staff must sign a signature card to be maintained in the Outpatient
Pharmacy. All prescriptions written for
Controlled Substances must bear the name and address of the patient, the
current date and the DEA number. Refills on Schedule II prescriptions are not
permitted.
DISMISSAL
PRESCRIPTIONS: Prescriptions for
dismissal medications should be written on the Take Home Medication Form, which can be perforated into four individual prescriptions. Keep in
mind that the patient may already have sufficient quantities of maintenance
medications at home and additional quantities will not be reimbursed by
prescription plans. The physician must
complete all appropriate information on each of the four prescription blanks
used and VOID any unused sections of the form.
A signature is required for each prescription and the DEA number must be
included on any prescriptions for controlled substances. As a convenience, patients may have take home medications filled in the University
of Kansas Hospital Outpatient Pharmacy by faxing the order form to ext. 82385.
Patients will be expected to provide any prescription insurance information,
co-payments required by their prescription plan or the full prescription amount
at the time of service. The second copy
of the form will stay in the patient's chart and the original copy is exchanged
for the medications at the University of Kansas Hospital Outpatient Pharmacy or
taken by the patient to the pharmacy of their choice. Writing
prescriptions 24 hours prior to discharge prevents a long wait
for patients ready to go home and allows time to resolve financial issues that
may arise.
DIRECTIONS: Prescriptions written for
outpatients must include adequate directions for the patient. The use of "Take as Directed" does
not provide these patients with adequate directions on the prescription label to
insure proper dosage. All prescriptions
filled by the Pharmacy will be labeled with the name and strength of the
medication.
QUANTITIES: Outpatient prescription quantities are limited to no more than a
one-year supply [six months on controlled drugs-CIII to CV and 30 days for CII
drugs] if so authorized. The medical
staff authorizes the University of Kansas Hospital Pharmacy to dispense lesser
quantities of medication than prescribed per patient request and / or third
party payor limitations. The medical
staff also authorizes the University of Kansas Hospital Pharmacy to provide
equivalent dose and quantity adjustments of an identified drug on the
prescription if required. Such changes
shall be documented on the prescription by the dispensing pharmacist.
REFILLS: Prescriptions may not be
refilled unless the physician specifies the number of refills to be permitted
in the lower left hand corner of the prescription blank, where the following is
printed: "Refill _____
times". Prescriptions written at the
University of Kansas Hospital may be refilled in the Outpatient Pharmacy for
not longer than one year for non-controlled drugs and 6 months or 5 refills for
schedule III, IV and V Controlled Substances per Kansas State Law. Schedule II medications are not refillable
and require a new written prescription for each dispensing.
REFILL
AUTHORIZATION CLINIC: The medical staff authorizes the
outpatient pharmacy to provide an additional 30-day supply of medications to
patients who have no remaining refills.
The medications that have been approved for this service include the
following: antihypertensives, insulin, hormones, diabetic medications, asthma
medications to include inhalers, nonsteroidal anti-inflammatory medications,
seizure medications, DDI, Retrovir, immunosuppressant medications, and OTC
drugs. The outpatient pharmacist mails
a Refill Clinic Notification Form to the prescribing physician. The physician may phone in a new
prescription to the pharmacy, mail a new prescription to the patient, or document
the need for medication evaluation in the patient’s chart for the next clinic
visit. Under no circumstances will the pharmacy issue a second supply without a
new prescription from the physician.
TELEPHONE
PRESCRIPTION ORDERS:
The Department of Pharmacy will accept phone-in prescriptions for KU
outpatients and employees where federal and state law allows. The pharmacy cannot accept telephoned orders
for Schedule II drugs due to the Drug Enforcement Administration regulations
restricting such activity. Phone-in
prescriptions will not be accepted for routine dismissal prescriptions.
INVESTIGATIONAL DRUGS
The Investigational
Drug Service at the University of Kansas Hospital offers a range of research activities
to ensure the safe delivery of quality health care for patients participating
in an investigational drug trial. In
support of the Department of Pharmacy’s
mission, this service assures appropriate procurement, storage, handling, drug
accountability, and information access about the investigational agents
utilized. The Investigational Drug
Service also supports and complies with hospital policy, JCAHO, state and
federal standards. The goal of this
service is to assist and support investigators in meeting their obligations in
conducting clinical drug research at the University of Kansas while promoting
safe and rational therapy for the patient.
The design of the
study and the objectives of the investigator determine services needed by
Investigational Drug Services. A fee
for Investigational Drug Services will be based upon the level of involvement
required or requested as part of the clinical trial.