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09/12/18 MD -- Patient's Own Medications Changes - INFO FOR PHARMACISTS - CLARIFICATION

From: Michele Durda
Sent: 12 September, 2018 09:38 AM
To: Pharmacists
Subject: Re: Patient's Own Medications Changes - INFO FOR PHARMACISTS - CLARIFICATION

As we have begun the process of restricting the use of patient's own medications, some questions have come up

Therefore, I wanted to provide clarification on the following topics:

When can a patient use his/her own supply?

* The new policy is not a BAN on the use of the patient's own supply
* The goal is to REDUCE the use of the patient's own supply by not letting the patient use his/her own supply for medications that we have in stock
* For medications that we do not have in stock in the pharmacy, we do allow the patient to use his/her own supply (unless it is a medication "banned" by P&T - the only "banned" medication I am aware of is domperidone)
* Orders for herbals and dietary supplements can be discontinued automatically per P&T. However, if a patient would like to take his/her own herbal/dietary supplement that has been continued in the hospital with a physician order, we can approve the use of the patient's own supply
* Remember this can be a big customer service issue; please help the nurse communicate this information to patients in a patient friendly way by explaining the available options

Where should patient's own medications be stored if the patient is going to be using them in the hospital?

* Nurse administered POM are stored in the medication room in a clean plastic bag
* Non-controlled substances should be stored in the green pharmacy in-box (or patient specific bin where applicable), unless the medication requires refrigeration
* Refrigerated medications are stored in the Pyxis refrigerator
* Controlled substances are stored securely in Pyxis

Please let me know if you have any additional questions

From: Michele Durda
To: Pharmacists
Sent: Monday, August 27, 2018 12:25:49 PM
Subject: Patient's Own Medications Changes - INFO FOR PHARMACISTS
Attachment: POM for Pharmacists August 2018

After 1Chart implementation, nurses will be SCANNING all medications (including the patient's own supply) at the bedside

What does this mean for Pharmacy?

* The verifying pharmacist must visually verify the patient's own supply AND apply an appropriate IDENTIFYING barcode
* This should be done on the nursing unit whenever possible (to prevent lost medications); never tube patient's own medications
* Centralized pharmacists may hand the visual verification step off to the next shift (if there are no doses due prior to the next shift)

Why can't this be done by the nurse or a pharmacy technician?

* The barcode being applied to the medication connects the product to an order (and identifies the product contents)
* This is equivalent to dispensing a medication, which is out of the scope of nurses and pharmacy technicians
* Think about what would happen if the barcode label was placed on the wrong medication bottle

How are we going to manage this new role?

* By minimizing the use of the patient's own supply as much as possible - please see attached flyer on the recent guideline update

Why are we starting now?

* There will be a large number of practice changes with 1Chart. By beginning the process of restricting the use of patient's own supply and having the pharmacist visually verify the patient's own medications that are used, we are easing into the practice changes that can begin now.
* There will be more changes later (labeling process)

How will I know if I should use the patient's own supply?

* If the medication is not built in iCare, check FORMWEB for formulary status and if applicable, check to see whether any medication is in stock; the patient's own medication may be used if the medication is non-formulary and/or not in stock
* If the iCare entry indicates the patient's own supply should be used
* If you are informed by central pharmacy that the medication you verified is not in stock
* It is a medication that is obviously unavailable to pharmacy (investigational drugs, specialty pharmacy drugs, some compounded drugs, etc.)

What if there is a physician's order to use the patient's own supply?

* Check to see whether the medication is in stock
* If in stock, adjust the order to use the hospital's medications and add a comment "Use of hospital meds per P&T"
* Instruct the nurse to send the medication home with a family member or send to Security as a valuable

Please view the attached flyer for important information about this change. This policy update is also being discussed at staff meetings between now and the end of September.

--

Michele Durda, Pharm.D.

Medication Safety/Drug Utilization Pharmacist