March 2010 Inpatient Pharmacy Inpatient Pharmacy Workflow and Daily Workflow and Daily Tasks Tasks
Dec 17, 2015
• Configure Inpatient Pharmacy v5.0 site parameters for IV and UD menus
• Compare & contrast Inpatient Pharmacy IV and UD reports
• Use Inpatient menu options to perform routine daily IV and UD tasks
• Identify “good practices” for managing workload using Inpatient Pharmacy v5.0
Course Objectives
• Daily inpatient pharmacy workload:
IV Package routine tasks- Printing reports/lists, Printing Labels,
Manufacturing of IV’s, etc
Unit Dose Package routine tasks- Printing pick list, cart-fill (if no Pyxis), entering
doses dispensed, etc.
Overview
IV Menu Site Parameter Configuration
• IV MenuSupervisor OptionSite Parameter Edit• Allows configuration of defaults
– Name(s) of IV Room(s)– Label specifications– “Duration” of orders for various IV types
• (Automatic stop dates different from the defaults may be entered for individual additives in drug file)
– Coverage times (i.e. 24 hour batch time frame)– Devices for output (reports, labels)
Daily Routine for IV Package
• Print Active Order List (optional)– Review, update orders as needed
• Print Ward List
• Print Manufacturing List
• Print Scheduled Labels
• Prepare IV’s, check, deliver to ward
Daily IV Workload – Active Order List
• Prints list of all currently active IV orders– Sorted by ward
• Can be printed at any time• Variety of uses as a “worksheet”
– Take to ward and check IV admixtures for current rates, # of bags needed
– Use to review IV antibiotics against culture results
– Compare to MAR to see if nurses changed any administration times
Daily IV Workload – Ward List
• Ward List prints all active orders– Sorted by ward– Shows # of bags due for 24 hour coverage
• First step in sequence for daily IV batch– Ward List, then Manufacturing List, then
Scheduled Labels (always in this order)
• Ward List is used by pharmacist to check each bag/label prior to delivery to ward
Daily IV Workload – Manufacturing List
• Prints all active orders– Lists all admixtures first
• Sorted by base solution, with totals
– Lists all piggybacks next• Sorted by additive and strength, with totals
• Used by technicians to assemble needed bags & additives, record lot #’s
• After admixture, technician separates IV’s by ward for checking by pharmacist
Daily IV Workload – Scheduled Labels
• Prints labels for all IVs due for 24 hour batch– Labels print in same order as mfg list (batched
by drug/dose)
• “Good practices”:– Check printer before sending print job
• Ensure labels correctly aligned• Ensure adequate # of labels
– Watch labels to ensure they don’t curl back
Other IV Menu options: Reprint Scheduled Labels
• Shouldn’t need to use this often– Especially if you follow “good practices” and watch
the printer during scheduled label print job
• If labels jam partway through print job or run out– Can print selected range of labels– From last usable label to end, or to next usable label
Other IV Menu Options:Individual Labels
• Print labels for one patient
• Program gives 2 choices– Reprint labels– Print New Labels
• Program asks if the labels should “count as daily usage?”– No for reprints, Yes for New Labels
Other IV Menu Options: Suspense Functions
• Allows labels to be “suspended” from printing with the batch
• Labels can later be “released” for printing
• Possible uses– High cost items– Items that may be discontinued– Items unlikely to be re-usable
• Neonatal syringes, oddball admixtures
Other IV Menu Options: Returns & Destroyed Menu
• Used when IVs or IV labels need to be “credited”– Labels that were printed but never mixed
• Use “Cancelled” Option– Labels that were printed and mixed but can be re-used for
another patient• Use “Recycled” Option
– Labels that were printed and mixed and cannot be used for another patient
• Use “Destroyed” Option
Other IV Menu Options: Renewal List & Inpatient Stop Order Notices
• Reports that print orders that will expire in a selected time frame (e.g. next 24 hrs)– Renewal List prints only IV orders– Inpatient Stop Order Notices prints IV orders, U/D
orders, or both
• If your site has automatic stop dates– Use report to notify providers– Provider must decide whether to renew or let order
expire
Automatic Stop Orders (ASO’s)
• Are ASO’s necessary? Helpful?
• “Good practice” suggestion– Eliminate ASO’s in policy for most drugs– Configure RPMS parameters to maximum
allowable stop date– Exceptions to consider: ketorolac, narcotics?– For the exceptions, can set shorter ASO
under orderable item file or additive file
• Unit Dose MenuSupervisor OptionInpatient Ward Parameters Edit
• Allows configuration of defaults– Automatic stop dates for UD orders– Start time calculation
• “Now”, “Next Scheduled” or “Closest Scheduled”
– Automatic printing of MAR labels– Default print devices
UD Menu Site Parameter Configuration
Daily Routine Workload for Unit Dose (UD) Package
• Print Pick List*
• Perform cart fill if no ADM (Pyxis/Omnicell)
• Enter Units Dispensed*
• Report Returns*
* Process differs depending on whether or not your site has Inpatient ADMs with Profiling and Interface
Daily UD Workload:Printing Pick List
• Pick list prints all active UD orders– Sorted by Ward, then Room/Bed– Shows doses needed for next 24 hrs
• Used as worksheet to fill UD med carts
*If Pyxis or Omnicell, do not need to actually print
– Still need to RUN Pick List, but can print to screen or enter “^”
Pick List - with Cart Fill
• # of units dispensed is recorded on line
• Items marked Ward Stock will show “WS” as units needed
• Orders that are schedule type “R” (Fill on Request) will show zero as units needed
• Allows pharmacist to enter into RPMS the doses actually dispensed for each med– Tip: when appropriate, simply “enter” at prompt to
accept that units dispensed = units needed
• Optional: view only prn med orders– For schedule types other than prn, program assumes
units dispensed = units needed
• Program jumps past items listed as WS• When finished, you are prompted
– “May I file this pick list away”?
Daily UD Workload:Enter Units Dispensed
• Bypassing “Enter Units Dispensed” entry– At first patient, can enter “^^^” to skip to end– Program automatically accepts units needed
= units dispensed for each item
• Caution - if any item is not marked as WS the program will “double count”
• (Pick List doses + doses removed from ADM)
• “Good Practice” – do the complete Enter Units Dispensed, at least periodically
Daily UD Workload: Enter Units Dispensed *(Sites with ADM)
Other UD Menu Options:EXtra Units Dispensed
• Used to enter extra unit doses dispensed – e.g. lost, dropped – Fill on Request items (e.g. new tube of cream)
*For sites with ADM (Pyxis/Omnicell):– Use this option if item not stocked in ADM– If item comes out of ADM and nurse removes
extra dose, it is recorded automatically
Other UD Menu Options:Report Returns
• Used to “credit” unit dose meds– When patient is discharged– When order is discontinued
*If your site has ADM with interface– Meds returned to ADM by the nurse will be
“subtracted” in RPMS automatically– Still may need to use this option
• e.g. Albuterol inhaler prn - dispensed but never opened/used