June 2011

Inpatient Pharmacy Workflow Processes and Daily Routine

Course Objectives

• Identify at least two steps involved in developing a strategic plan for improving a health system's process for preparing Compounded Sterile Products (CSPs).

• Discuss the need for patient safety-related improvements in the process for preparing CSPs in many health-system pharmacy departments

• Leverage HIT, data management, and workflow to strive toward the patient-centered medical care model

Course Objectives

• 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

Overview

• 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.

IV Menu Site Parameter Configuration

• IV Menu > Supervisor Option > Site 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 numbers.

• After admixture, technician separates IVs 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 manufacturer 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 two 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 hours):• 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.

UD Menu Site Parameter Configuration

• Unit Dose Menu > Supervisor Option > Inpatient 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

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 hours

• 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

• Number 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.

Daily UD Workload:Enter Units Dispensed

• 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 (Sites with ADM)

• Bypassing Enter Units Dispensed entry:• At first patient, enter “^^^” to skip to the end.• Program automatically accepts units needed

equals units dispensed for each item.• Caution - if any item is not marked as WS the

program will double count:• Pick List doses plus doses removed from ADM

• Good Practice – do the complete Enter Units Dispensed, at least periodically.

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

Summary

• Inpatient Package Daily Routine Tasks:• IV Menu:• Ward List, Mfg List, Scheduled Labels• Other options as needed

• UD Menu:• Pick List, +/- Cart Fill, Enter Units Dispensed• Other options as needed