From: Andrew Koehler
To: Erin Reed
Cc: Pharmacists
Sent: Wednesday, September 27, 2017 3:14:28 PM
Subject: Re: Hospice Family Care Inpatient Unit

We are not automatically subbing to formulary items. The pts will either have an order for a drug in Pyxis or they will use their own home supply. Pyxis will contain all drugs on the standing order set and many more options for comfort care. There will be very few chronic disease meds. MDs have a list of the meds available in Pyxis and they have been encouraged to use those items.

The nurse will determine how they will need to get the med (either in Pyxis or POM). They can check the entire pyxis list from the console. If there is a med needed for a patient that is not in Pyxis or a POM, we have a policy for obtaining an Rx from a retail pharmacy and that will be utilized as a POM. HH med stock from the carousel is a last line option for supplying a med to a pt.

From: Erin Reed
To: Andrew Koehler
Sent: Tuesday, September 26, 2017 3:46:53 PM
Subject: Re: Hospice Family Care Inpatient Unit

I have some questions...

If a drug that is ordered is not in their pyxis can we auto sub to our formulary items if they are ordering a drug that is not on our formulary if they are getting from our supply?

How would we know that an ordered drug is not in their pyxis??  It could be very time consuming to look up every drug verified to see if they have the medication or not...I'm assuming they would stock all the items in pyxis that are on their routine orders?

Thanks, 
Erin Reed Pharm.D., BCPS

From: Andrew Koehler
To: Pharmacists
Sent: Monday, September 25, 2017 2:17:59 PM
Subject: Hospice Family Care Inpatient Unit
Attachment: NetSmart screen shots      Q Responsibilities - HFC              Medication not available in Pyxis or POM

Hello Pharmacists,

I wanted to give an update on the Hospice Family Care inpatient unit (a Huntsville Hospital owned organization). The new facility at Redstone Village in South Huntsville is a 15 bed inpatient Hospice that will be opening to patients on Oct 9th. The facility has its own pharmacy license for drug inventory and a non-profiled Pyxis device for drug delivery. HH main pharmacy will be providing support with 24h order verification.

The Q, central and midnight pharmacists will be responsible for these orders. HFC will function as a fax back unit and will work similar to ED. They have their own EMR called NetSmart. This is loaded on the central and Q computers and it's a read only system for pharmacists. The pharmacist will receive scanned orders from HCS tagged as "Hospice". They will check NetSmart to confirm correct order entry and check order against drug-drug, drug-disease, and drug-allergy interactions. The pharmacist will fax back the order to Nurse_Follow_Up just like an ED order.

All HFC patients will have a standard comfort care order set ordered on admission. The nurses will only activate and enter orders that are necessary for the patient at the time they are needed. Hopefully this will limit the number of orders that will need to be reviewed at one time.

Nursing staff will have the HHM central pharmacist as the on call resource for drug information.

NetSmart logins will be coming later this week. Please make sure you can access the EMR and change your temporary password once you get your login.

Please review the attached screen shots and order review policy. If you have additional questions, please contact me or Steven.

Thanks for your help in taking care of our patients at the end of their life journeys.

-AK
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Andrew Koehler, Pharm.D., BCACP
Clinical Pharmacist