Department of
Pharmacy Services
Pharmacy Services &
Prescription Regulations
House Staff Orientation
2014
1
Pharmacy Services- Outpatient
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14 Retail Pharmacies
Patient Assistance
Ambulatory Clinic Operations
Thrombosis Consult Service
Home Infusion Services
Refill Center
Specialty Pharmacy
House Staff Orientation
2
Retail Pharmacy
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Discharge medication reconciliation
Bedside prescription service
e-prescribing available
Can fill and refill at any of our locations
Mail order available
Accept most prescription plans
Competitive pricing and up to a 90 day supply
depending on insurance
 “$4” drug list on Intercomm
House Staff Orientation
3
Prescription Writing Rules
for Residents
 First year residents (unlicensed)
– Write only for inpatients of affiliated hospital
– May write for non-controlled and controlled
ONLY for inpatients
 Second year residents (licensed, DEA, NPI)
– Inpatients or outpatients: both controlled and
non-controlled substances
– Filled in any Utah pharmacy
House Staff Orientation
4
More Rules . . .
 Writing for self or family
--Physicians MAY NOT write prescriptions for
controlled substances for self or family members,
EVER!
 Medicaid patients
--Must be registered with Medicaid as a “limited
provider.” If not licensed, an attending who is
registered must sign the prescription. GME Office
handles the process.
 Medicare patients
--Must be registered in PECOS—same as above
regarding licensing—GME handles the process.
House Staff Orientation
5
Prescription requirements
Prescriber’s name, address, telephone, NPI
Patient’s name and address
CS - pts DOB and prescriber’s DEA
Name of medication, strength, dose quantity,
route, directions for use
 Prescriber’s signature, print name, pager
 Date of order
 Refills
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House Staff Orientation
6
Home Infusion Service
 Care plan considers insurance and patient
resources
 Helps determine best vascular access for
medication needs
 Nurses and pharmacists on call 24/7
House Staff Orientation
7
Pharmacy Services - Inpatient
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University Hospital
Huntsman Cancer Hospital
University Neuropsychiatric Institute (UNI)
Orthopaedic Hospital
– Centralized operations
(IV Center & Drug distribution)
– Decentralized operations(patient care unit)
House Staff Orientation
8
Inpatient Medication Process
Prescribe in
Epic CPOE
Verify by
Pharmacist
Prepare/
Package
Deliver or
Dispense
(Omnicell)
Bar Code
Medication
Administration
Monitor
House Staff Orientation
9
Unit Based Pharmacists
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Rounding and consults
Drug information
Formulary recommendations
Monitoring
Medication policy experts
Patient own meds
Epic med ordering assistance
House Staff Orientation
10
Med Reconciliation-Home Medications
Pharmacy staff will review within 24 hours of
admission
Please,
Don’t
Order
Everything!
House Staff Orientation
11
Epic Order Entry Tips
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Use order sets
Understand phase of care (tip sheets)
Limit use of comment fields
Watch for therapeutic duplication
All PRN orders must have specific instructions
(mild, moderate, severe pain) and you may not
have 2 meds ordered with the same indication.
 Preference list has formulary status
House Staff Orientation
12
Drug Information Service
 Provides information to health professionals
 Supports the Pharmacy and Therapeutics
Committee- monographs and evaluations
 Drug Shortages
 Newsletters and alerts via email
 Web Access to a variety of drug information
resources through web site
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Email drug.info@hsc.utah.edu
Phone 801-581-2073
House Staff Orientation
13
Formulary Management
 On-line Formulary
 Formulary Initiatives- guidelines,
restrictions, approvals required
 Therapeutic Interchanges, IV to PO
 Drug shortages
 Non-Formulary requests
House Staff Orientation
14
Formulary Restrictions
Agents restricted to specific
Medical/Surgical Services or to specific
indication
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Bivalirudin (Angiomax®)
Dofetilide (Tykosyn®)
Inhaled nitric oxide (INOmax®)
Dalteparin (Fragmin®)
House Staff Orientation
15
Formulary Restrictions
Agents with criteria for use or
Medical Director approval
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Factor VII (NovoSeven® RT)
Immune globulin (IVIG)
Meperidine (Demerol®, generic)
Levalbuterol (Xopenex®)
House Staff Orientation
16
Formulary Restrictions
Outpatient Only Medications:
Medications used to manage chronic
diseases- not related to patient’s
admission
Examples: Natalizumab (Tysabri®), Infliximab
(Remicade®), Ibandronate (Boniva®), Zoledronic
acid (Reclast®), Adalimumab (Humira®)
Any exceptions
 Require the medical director’s approval
House Staff Orientation
17
Antibiotic Stewardship
 ID Pharmacists
 Some antimicrobials require ID approval:
 Caspofungin
 Daptomycin
 Linezolid
Non formulary agents
Compounded irrigations
Search for “Stewardship” on Intercomm
House Staff Orientation
18
House Staff Orientation
19
House Staff Orientation
20
Investigational Drug Studies
 Medication management for over 300
studies
 Randomization
 Product preparation
 Regulatory compliance
 Study monitor meetings
House Staff Orientation
21
Summary
 Ask for Help – Pharmacists should be
available in most patient care areas or via
phone (SmartWeb)
House Staff Orientation
22
Questions
Medication
management
policies
Collaboration
Patient focus
House Staff Orientation
23