From: Andrew Koehler
To: Pharmacists
Cc: Laura Rhys
Sent: Friday, April 27, 2018 3:14:05 PM
Subject: Hospice Tips for Pharmacists
Attachment: Hospice Tips -- Adding a Patient to HCS

Hi,

We have been live with the Hospice Family Care inpatient facility almost 6 months. We currently have 8 beds with a planned expansion to 15 beds. We have some new nurses working now and several more scheduled to start soon.
Thank you all for helping through some of the early bumps as we got this facility off the ground.

The following are some tips to help with common problems that nurses may call central pharmacy about.
You can reach the nurses desk at 256-799-5570

1. If a patient does not associate in HCS when the "B Number" (hospice medical record number) is entered in the Hospital# field, it likely means the patient either was not set up correctly in HCS or was not set up at all. See attached document. The nurse must put the B number in both the Hospital Number and Medical Record Number fields. They can go back to Patient->Update Patient to correct this. 

2. If a patient is not crossing over to the hospice Pyxis terminal, they may have entered the wrong unit or the admission date may need to be reset. Have them log in to Pyxis ES then go Settings->Patients->Visit Reconciliation. Have them search for the pt by the B number then select. Have them ensure Hospice is the unit listed and then have them change the admit time to today's date and time. Once saved, it may take 5 minutes to cross over to the Pyxis Terminal.

3. The Pyxis at hospice is non-profiled so the nurse may pull any med on any patient. If a nurse has questions about which med should be pulled for a given order, you can check current inventory via Pyxis ES and Med Inventory->Manage Inventory.

4. Currently, hospice is using a pre-built kit loaded in Pyxis for a 50mg/50mL NS Morphine Drip and a 50mg/250mL NS Dilaudid Drip. These are subject to change based on availability of drug. These are set up similar to the Angiomax kits in the Heart Alert box. The instructions for preparation are on the outside of the kit. If the nurse has questions, you can find these instructions in S:\PHARMACY-SHARED\Hospice\Labels

5. Any other IV infusions or PCAs are to be obtained from one of the home infusion companies (ie Continuum, BriovaRx, Lincare). If they have already tried these companies and none of them can supply the order, please have them contact me.

6. Drug routes: I have had several questions about drug routes. One common one is glycopyrrolate and if it can be given SubQ. There is literature showing that it can be given SubQ and has been used successfully this way in palliative patients. We will also be using more rectal routes for PO meds through a Macy Catheter. Please still evaluate for appropriateness (ie do not cush meds).

6. Remind nurses that the hospice pharmacist is there on Monday, Wednesday and Friday. If it's a problem that can wait until the pharmacist is there next, please just send that pharmacist an email and CC me. The hospice pharmacist schedule is on ScheduleAnywhere.

Please let me know if you have any issues with hospice orders so I can take corrective action or re-train when I am there.

Thanks again for all of your help

AK
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Andrew Koehler, Pharm.D., BCACP
Supervising Pharmacist - Hospice Family Care Pharmacy Clinical Pharmacist - Huntsville Hospital