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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 |
|
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|
|
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 |
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