PHARMACY AUTOMATION
description
Transcript of PHARMACY AUTOMATION
Pharmacy Informatics Workgroup
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PHARMACY AUTOMATION
GUIDANCE FOR THE CONTROLLED SUBSTANCE COORDINATOR
Part 1: The Inspection Process
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OBJECTIVES Understand the VHA Handbook 1108.2
requirements that relate to automation Understand what reports should be
requested from the pharmacy prior to performing a routine unit inspection
Understand what reports should be reviewed as part of the overall inspection process.
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The Inspection Process Requirements from VHA Handbook 1108.2
• Inspectors should have a password that permits access to the automated dispensing cabinets (ADC) only when accompanied by an authorized user
• Inspectors must verify source data including a spot check of ADC removals
• Report any unresolved discrepancies to the controlled substance coordinator for further investigation
• Review resolved discrepancies for trending purposes
• Review at least one day’s worth of ADC restocking
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Inspecting an Automated Dispensing Cabinet
Written instructions on accessing the automated dispensing cabinet in use in your facility to perform a narcotic inspection is a handbook requirement.
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Strategies for the Inspection Process
Temporary Password Set Up
• When setting up passwords for the facility inspectors, they may be set up with a temporary password.
• The password can be set up to expire within a selected amount of time.
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Strategies for the Inspection Process
Permanent Password Set Up• The facility controlled substance
inspectors may be set up with a permanent password that only allows the user to act as a witness.
• This password will expire every 90 days similar to other passwords.
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Conducting the Inspection
Area personnel should sign into the automated dispensing cabinet
The controlled substance inspector should sign on as a witness
Access the controlled substances stored in the cabinet.
Count the items in each drawer or pocket Look for any discrepancy in count
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Reports to Request for Inspection
Inspectors must verify source data including a spot check of ADC removals
The handbook requires that the inspectors verify provider orders in the inpatient or clinical setting
Request one day of activity for busy areas or a week to a month of activity for areas that use few controlled substances
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Other Reports to Use in the Inspection of Specialty
Areas Specialty areas such as Operating Rooms,
Cardiac Cath Labs or Colonoscopy Suites may require other reports to verify documentation of administration• OR Reports• Case Reports• Waste/Return Reports
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Automation Specific Controlled Substance
Activity Reports AcuDose Rx: Controlled Substance
Dispense Report MedSelect: Controlled Substance
Inventory Summary Omnicell: Transactions by Date or Specific
Criteria Report Pandora: Med Usage Report/All Station
Events Pyxis: All Station Events
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Delbert Siegmund, Pharm.D.
Chief of PharmacyDanville VAMC
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Verifying Inpatient Orders in CPRS
Verify five randomly selected patients to make sure that there is an administration to a patient recorded for the dose(s) removed.
If your machine allows the addition of emergency or temporary cases, check to see that they are reconciled with the patient’s permanent records.
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Verifying Inpatient Orders in CPRS
Access the patient and go to the “meds” or “orders” tab and find the order for the medication.
Double click on the order and scroll to the bottom of the “inpatient medication details” box.
Look for the date and time of the administration for the episode on your report
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CPRS Screenshot of Meds Tab
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CPRS Screenshot of Inpatient Medication Details
Scroll Down
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CPRS Screenshot of Inpatient Medication Details cont.
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CPRS Screenshot of Inpatient Medication
Details (IV example)
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BCMA Administration Reports
Available in BCMA under “Med Administration History”
Can also access “Med Administration Log” if the episode is recent
Both reports are available in CPRS on the “Reports” tab
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BCMA Medication Admin History Report
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BCMA Reports available in CPRS – Reports Tab
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Verification of Orders in Outpatient Areas
Outpatient Units• Colonoscopy Suite• Same Day Surgery• Cardiac Catheterization Suite
• Work with HAS and Pharmacy to have clinic stop added to the unit
• Area personnel should not have to add patients on a routine basis.
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Verification of Orders in Outpatient Areas
Outpatient CPRS prescription (ex Methadone maintenance)
OR Report (Same Day Surgery) Case Note (Cardiac Cath Lab,
Colonoscopy Suite)
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Jennifer Howard, Pharm.D.Director, Pharmacy Informatics
San Diego VAMC
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Methadone Maintenance Unit
AMS Avatar System
Verify opening amount, amount dispensed, quantity on hand.
Verify 5 orders as previously outlined
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Review Discrepancies Ideally, you should also look at both
unresolved and resolved discrepancy reports• Report any unresolved discrepancies to
the controlled substance coordinator for further investigation
• Review resolved discrepancies for trending purposes
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Automation Specific Discrepancy Reports
AcuDose Rx: Discrepancy by Station, Open Discrepancy By Station
MedSelect: Top 25 discrepancies Omnicell: Pharmacy Discrepancy
Report Pandora: Discrepancy Report Pyxis: All Discrepancies
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Verification of Restock The handbook requires that the at least
one days worth of restocking be verified as part of the inspection process.
A report of restocks will need to be generated from the Pharmacy narcotic vault.• This report may come from Vista, Pyxis
CII Safe or Omnicell Secure Vault
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Automation Specific Restock Reports
AcuDose Rx: Loading and Unloading Report
MedSelect: Restock Summary Omnicell: Transactions by Date or End
of Cycle Report (if site has Secure Vault) Pandora: Narc Vault Reconciliation
Report Pyxis: Med Refill Activities
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End of Shift Count End of Shift Count or Weekly Count
• Not a handbook requirement• May be required by local policy• End of shift discrepancy report• Best Practice
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Inspecting the Pharmacy Narcotic Vault
Automation that may be present in the vault• Pyxis CII Safe or Omnicell Secure
Vault• Fast Fill• Scriptpro SP50• Baker Cells
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Inspecting the Pharmacy Narcotic Vault
Pyxis CII Safe
Omnicell Secure Vault
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Inspecting the Narcotic Vault
Pharmacy Dispense without (VA FORM 10-2638)
LORAZEPAM 0.5MG TAB,UD
Select NAOU: xx QUANTITY DISPENSED (TAB/25): 25// 25
JAN 01, 2001@08:21:51 DISP OMNICELL XX
-25
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Outpatient Robotic Prescription Fill
Fast Fill Baker Cells ScriptPro
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Questions??? Marian Daum - Coatesville VAMC
Delbert Siegmund - Danville VAMC
Jennifer Howard - San Diego VAMC
Dionne Roney - Charleston VAMC
Jolene Hallcroft - Sheridan VAMC