|
|
|
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, 37) |
Ext.82321 |
|
2300-0800 |
Ext.82321 |
Prescription
Order Writing Tips
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)
PHARMACY
SERVICES AT THE
UNIVERSITY
OF
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.
Clinical pharmacists rely upon interaction with the patient care team to
identify patients needing focused medication education. Write an order to
request that the pharmacist meet with your patient. 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.
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 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.
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
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
"passwords" (e.g. fingerprint) scanners are used to ensure positive
identification for Pyxis machine access.
The
medications available in each Pyxis unit are chosen
based upon patient needs of that area.
The availability of each medication is also 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. A detailed log must be maintained in
any hospital ambulatory care area which distributes samples.
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?
Patients may use their own medication
only if:
•
The
medication is not on the hospital
formulary and a reasonable therapeutic
substitution is not available.
•
When the physician,
pharmacist, and patient deem the use of a formulary medication is medically necessary to meet an
individual patient need and this is documented in the chart.
•
The
medication is an investigational
medication provided under protocol as part of the patient’s participation
in an investigational study.
In addition, to any of the three
above circumstances:
·
The
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
medications are not in the original container, the patient must receive
medications supplied by the hospital via the usual medication use process.
A Physician Order must Include:
•
Name, dose,
route, and directions for each medication that the patient is going to
supply.
•
A statement
that the "patient may use their own supply" while in the hospital.
Identification
of Patient's Own Medication before Administration
·
The clinical
pharmacist will identify each patient own medication and document this in the
patient's medical record
Storage of Patient's
Own Medications:
·
The nurse
will collect any medications that are kept in the hospital for secure
storage, in the "Patients Own Medication" section of the Pyxis or in another locked cabinet on the nursing unit,
until discharge.
Administration
of Patient's Own Medications:
·
A nurse must
observe patients taking their own medications to assure that the appropriate
medication and doses are taken at the appropriate time.
·
Documentation
on the medication administration record (MAR) must indicate the medication,
dose and time given.
Procedures
for Medications Kept at the Bedside:
·
A physician
order stating that the medication name, route, dose and frequency along with
a written statement of "at bedside" is
required.
·
A nurse will
administer and document on the MAR.
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
·
Neonatal TPNs are hung between 1500 - 1700
·
All TPN orders
for adults and pediatric patients are due in Pharmacy by
·
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
·
When a new
TPN order is received after
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 will fill these
orders as quickly as possible, but usually within 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 available 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 available 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 |
|
|
BID |
09-21 |
Q8H alt |
|
|
BID alt |
08-17 |
Q12H |
09-21 |
|
TID |
|
Q12H alt |
01-13 |
|
TID ac |
|
Q24H |
09 |
|
TID pc |
|
|
|
|
TID W/MEALS |
|
|
|
|
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 |
|
|
27 |
BID |
08-20 |
|
|
TID |
|
|
|
QID |
08-12-16-20 |
|
|
HS |
20 |
|
46 |
Q6H |
05-11-17-23 |
|
|
Q8H |
|
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
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
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
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
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.
The
Investigational Drug Service can be reached at 82314 or e-mail address invrph@kumc. Usual hour are
EMERGENCY
DRUGS AND CODE BLUE RESPONSE
Code Blue Carts are
located throughout the Hospital and contain a standardized drug tray with
emergency drugs for use in resuscitation of patients. A clinical pharmacist will respond to all
Code Blue calls with a secondary drug box of medication to supplement the
Code Blue cart medications.
DRUG
INFORMATION SERVICES
The
Department of Pharmacy offers an organized Drug Information Service to
promote rational drug therapy by improving availability and use of drug
information to physicians, nurses, pharmacist’s, dentists, dieticians and
other health practitioners.
The
Drug Information Service maintains special journals, texts and reference
sources designed to answer questions about the identification, availability,
pharmacology, pharmaceutics, toxicology, stability, adverse effects, drug
interactions, bioavailability and pharmacokinetics of various
medications. The Drug Information
Service is available to health practitioners from 0830 – 0430 Monday through
Friday.
Questions
concerning drugs or drug therapy on an Inpatient Service should be directed
to the Clinical Pharmacist by paging the pharmacist. If the Clinical Pharmacist is not
available, or the request does not originate on the Inpatient Service, the
request may be referred to the Drug Information Service by calling extension
82328.
Other
services provided by the Drug Information Service include publication of
pharmacy newsletters for physicians, nurses and other health care personnel,
evaluations of drug studies for the Pharmacy and Therapeutics Committee and
coordination of the Adverse Drug Reaction Reporting Program. Drug Audit criteria that has been used in
Patient Care Audits is available from the Drug Information Service as a
source of rational prescribing information.
The
reference book, Drug Information – American Hospital Formulary Service is
available on all nursing units to aid in answering less complex
questions. The Micromedex®
Drug Information System is also available for use via the hospital computer
system.
Drug
utilization reviews are routinely conducted by the pharmacy with P & T
Committee approval. Generally, a
particular drug, therapeutic class, or specific use will be targeted. For example, a drug utilization review
focused on CDC Recommendations for the appropriate Use and Monitoring of Vancomycin.
The
Department of Pharmacy is also the site for the
Resources for
information are extensive, including computerized retrieval of information
from Poisindex®, Identidex®,
and Drugdex®.
The poison center is staffed by pharmacists and critical care nurses
specially trained in toxicology.
Consultants are available in many areas, including botany, herpetology,
mycology, and environmental and industrial medicine. Information is available 24 hours a day,
365 days a year, by calling extension 86633.
The
ADVERSE DRUG
REACTON REPORTING
To
insure continued patient drug therapy safety and to fulfill the role of a
major medical center in the promotion of good health care, all Adverse Drug
Reactions (ADR) must be reported. The
Pharmacy and Therapeutics Committee has defined an adverse drug reaction as
any untoward reaction which is associated with drug therapy and meets any of
the following criteria:
1) Requires treatment with prescription
medications
2) Results in or prolongs patient
hospitalization
3) Results in permanent or temporary
disability
4) Results in patient death
5) Requires reporting to the Food and
Drug Administration
These
reports may include reactions already listed in the package insert. A causal relationship DOES NOT have to be
established between the drug and the reaction, it may only be suspected.
If
the patient is on multiple drug therapy, the most likely agent or agents
should be listed. Any physician,
nurse, pharmacist or other health care professional identifying a POSSIBLE
adverse drug reaction can file a report.
An ADR report may be filed by telephone or by completing a form.
1) Phone – Call ext. 82328 and provide
data regarding the reaction. A form
will be completed by a Drug Information Pharmacist.
2) Form – Forms are kept on all nursing
units and in recovery rooms. The time
to complete a form is minimal. The
patient’s addressograph, the name of the reporter and the name of the
institution reporting the ADR is held confidential and protected from public
disclosure. Completed forms should be
given to the Pharmacy Department by placing them in the Pharmacist’s order
bin on the nursing unit.
Reporters
can designate that the reaction should be reported to the FDA by checking the
appropriate box. The more detailed FDA
reporting form will then be completed by the Pharmacy Department.
Any
questions concerning ADVERSE DRUG
REACTION reporting should be referred to the
All
adverse reactions reported are reviewed by the Pharmacy and Therapeutics
Committee. The University of Kansas Hospital participates in the FDA's MedWatch adverse reporting program.
Drug Problem Reporting
Any drug product
suspected of having a defect should be reported to the Department of Pharmacy
(82328
Nuclear Pharmacy Services
The Department of
Pharmacy provides a Nuclear Pharmacy Service located near the Nuclear
Medicine Service. This pharmacy
service is responsible for the preparation of the various
radiopharmaceuticals used in diagnostic and therapeutic procedures. In addition, the nuclear pharmacy will
provide special preparations needed for patient care or for research
purposes.
AMERICAN SOCIETY OF INTERNAL
MEDICINE PRESCRIPTION WRITING GUIDELINES
The following
guidelines are provided by the American Society of Internal Medicine and the
American Pharmaceutical Association to guide prescribers
in writing prescription orders.
1) The name and strength of the drug
dispensed will be recorded on the prescription label by the pharmacist unless
otherwise ordered by the physician.
2) Whenever possible, specific times of
the day for drug administration should be indicated e.g. “Take one tablet at
3) The use of potentially confusing
abbreviations is discouraged (e.g., qid, qod,
qd)
4) Vague instructions which are
confusing to the patient should be avoided (e.g.,
“Take as necessary” or “Take as
directed”).
5) The indication, symptom or intended
effect for which the drug is being used should be included in the
instructions whenever possible (e.g., “Take one teaspoonful at
6) Metric system measurements (mg, ml,
etc.) should be used instead of outdated apothecary system measurements (grs, oz, etc.).
7) A prescription should specify whether
or not it is refillable. If so, the
number of refills authorized should be indicated. Statements such as “Refill PRN” or “Refill
ad lib” are discouraged. (State
regulations limit the validity of any prescription to one year from the date
of issuance).
8) A separate prescription blank should
be used for each drug prescribed.
9) When hospital prescription blanks are
used, the prescriber should print, as well as sign,
his or her name, phone number and DEA registration number on the prescription
blank.
QUICK REFERENCE
PHARMACY
TELEPHONE NUMBERS
Extension
PHARMACY ADMINISTRATIVE OFFICES 82330
INPATIENT PHARMACY – 24 Hr.
Service 82321
OUTPATIENT PHARMACY 82361
OUTPATIENT FAX LINE 82385
DRUG INFORMATION 82328
DRUG INFORMATION FAX 82350