The Pharmacy The Pharmacy Technician 4ETechnician 4E

Chapter 17Chapter 17Other EnvironmentsOther Environments

Course OutlineCourse Outline

1.1. Mail Order PharmacyMail Order Pharmacy2.2. Long-Term CareLong-Term Care3.3. Home InfusionHome Infusion

Mail Order PharmacyMail Order Pharmacy

Chronic condition Chronic condition Continuing condition that requires ongoing Continuing condition that requires ongoing

treatment for a prolonged period.treatment for a prolonged period. Maintenance medication Maintenance medication

Medication that is required on a continuing basis Medication that is required on a continuing basis for the treatment of a chronic condition.for the treatment of a chronic condition.

Acute condition Acute condition Sudden condition requiring immediate treatment.Sudden condition requiring immediate treatment.

Mail Order PharmacyMail Order Pharmacy

Type of pharmacy that Type of pharmacy that mails or delivers medicationsmails or delivers medications.. Requires a delivery time of at Requires a delivery time of at least 24–48 hoursleast 24–48 hours.. Used for maintenance medication.Used for maintenance medication. Serves Serves broad geographic areasbroad geographic areas.. Process a high volume prescription which allows Process a high volume prescription which allows deep deep

discounts. discounts. Dispense a 3 month Dispense a 3 month supply at time..supply at time.. Most third party insurers force their clients to use mail Most third party insurers force their clients to use mail

order pharmacy for maintenance medications. order pharmacy for maintenance medications.

Online DrugstoresOnline Drugstores Online drugstores are a type of mail order pharmacy Online drugstores are a type of mail order pharmacy

that that use the Internet to advertise use the Internet to advertise and take orders and take orders for drugs which are then mailed to the customer.for drugs which are then mailed to the customer.

Drugs cost less in Canada and U.S. Drugs cost less in Canada and U.S. Cross-border Cross-border regulations allow Canadian pharmacies to fill regulations allow Canadian pharmacies to fill individual prescriptions from U.S. consumers for individual prescriptions from U.S. consumers for small amounts of drugs. small amounts of drugs.

Canadian online drugstore industry has grown Canadian online drugstore industry has grown rapidly, and has been the subject of much consumer rapidly, and has been the subject of much consumer and political debate.and political debate.

Long-term Care FacilityLong-term Care Facility Long-term Care FacilityLong-term Care Facility

An institution that provides care for An institution that provides care for geriatricgeriatric and and disabled disabled patients.patients. Includes adults who suffer from chronic (long-lasting) Includes adults who suffer from chronic (long-lasting) or debilitating illnesses as stroke or Alzheimer’s disease. or debilitating illnesses as stroke or Alzheimer’s disease.

Nursing Homes Nursing Homes Most long-term care facilities are nursing homes that Most long-term care facilities are nursing homes that provide daily nursing care.provide daily nursing care.Patients in this setting are generally referred to as Patients in this setting are generally referred to as residents.residents.

Institutional PharmacyInstitutional Pharmacy Skilled-care facilities (SCF) Skilled-care facilities (SCF)

Limited to patients requiring more round-the-clock Limited to patients requiring more round-the-clock nursing care (such as IV infusions) or recovery after nursing care (such as IV infusions) or recovery after a recent hospitalization.a recent hospitalization.

Most patients are discharged from SCF to home Most patients are discharged from SCF to home when they have adequately recovered.when they have adequately recovered.

Other long-term care facilities Other long-term care facilities Include patients with acute or chronic psychiatric Include patients with acute or chronic psychiatric

disorders or rehabilitation facilities for those with disorders or rehabilitation facilities for those with serious traumatic brain or spinal cord injuries.serious traumatic brain or spinal cord injuries.

Long-Term Care PharmacistsLong-Term Care Pharmacists

Distributive pharmacistDistributive pharmacist Ensures long-term care patients receive the Ensures long-term care patients receive the

correct medications ordered.correct medications ordered. Consultant pharmacist Consultant pharmacist

Develops and maintains an individual Develops and maintains an individual pharmaceutical plan for each long-term care pharmaceutical plan for each long-term care patient.patient.

Licensed pharmacists’ RoleLicensed pharmacists’ Role Some long-term care facilities have an Some long-term care facilities have an “in-house” “in-house” pharmacy pharmacy

while others contract with a community pharmacy or allow each while others contract with a community pharmacy or allow each resident to choose his or her pharmacy.resident to choose his or her pharmacy.

Licensed pharmacists’ RoleLicensed pharmacists’ Role Establish record-keeping systems related to controlled Establish record-keeping systems related to controlled

substances.substances. Review drug regimens.Review drug regimens. Monitor repackaging and storage of pharmaceuticals. Monitor repackaging and storage of pharmaceuticals. Ensure that medications are uncontaminated and have not Ensure that medications are uncontaminated and have not

expired.expired. Note medication errors and adverse reactions or interactions. Note medication errors and adverse reactions or interactions. Educate residents on drug therapies and self-medication. Educate residents on drug therapies and self-medication. Provide medications to outpatients or residents on weekend Provide medications to outpatients or residents on weekend

leave.leave.

A Pharmacy Technician’s RoleA Pharmacy Technician’s Role Log prescriptions and refill orders via computer.Log prescriptions and refill orders via computer. Prepare billings.Prepare billings. Maintain drug boxes or trays for emergencies.Maintain drug boxes or trays for emergencies. Package and label medications.Package and label medications. Deliver medications to the nursing home.Deliver medications to the nursing home. Maintain records, retrieve and organize patient charts.Maintain records, retrieve and organize patient charts. Conduct inspections of drugs in the inventory and in Conduct inspections of drugs in the inventory and in

the nursing stations.the nursing stations. Repackage drugs in unit doses labeled for each Repackage drugs in unit doses labeled for each

patient. patient.

Long-Term Care PharmacyLong-Term Care Pharmacy In-house pharmacies may provide In-house pharmacies may provide a 7-day supply of a 7-day supply of

medication in “blister packsmedication in “blister packs.” .” Community pharmacies fill medication carts or trays Community pharmacies fill medication carts or trays

with a with a 30-day supply 30-day supply of medication.of medication. Medication orders rarely change in this Medication orders rarely change in this

environment.environment.

Home Infusion PharmacyHome Infusion Pharmacy A pharmacy that dispenses, prepares, and delivers A pharmacy that dispenses, prepares, and delivers drugs and medical suppliesdrugs and medical supplies directly to the home of the directly to the home of the patient.patient. Spiraling hospitalization costs, regulatory changes, Spiraling hospitalization costs, regulatory changes, and advances in parenteral therapies have created an and advances in parenteral therapies have created an explosion in this field. explosion in this field. The home healthcare market continues to grow The home healthcare market continues to grow because of our aging society and as an alternative to the because of our aging society and as an alternative to the higher cost of hospitalizations. higher cost of hospitalizations.

Many hospitalized patients are discharged as soon Many hospitalized patients are discharged as soon as possible to continue their recovery at home with as possible to continue their recovery at home with IV solutions.IV solutions.

Home Infusion PharmacyHome Infusion Pharmacy Pharmacists and pharmacy technicians working in Pharmacists and pharmacy technicians working in

home healthcare.home healthcare. Provide educational materials.Provide educational materials. Carry out traditional compounding and delivery Carry out traditional compounding and delivery

functions.functions. Prepare and provide infusions and infusion Prepare and provide infusions and infusion

equipment.equipment. Might be available for emergencies on a 24-Might be available for emergencies on a 24-

hour basis.hour basis.

Primary Home InfusionPrimary Home InfusionCont.Cont.

The primary therapies provided by home infusionThe primary therapies provided by home infusionservice include:service include: Antibiotic TherapyAntibiotic Therapy

Common home infusion service used in treating AIDS Common home infusion service used in treating AIDS related and other infections.related and other infections.

Parenteral NutritionParenteral Nutrition Required for patients with various intestinal disorders.Required for patients with various intestinal disorders.

Pain ManagementPain Management Applies to the infusion of narcotics for patients with painful Applies to the infusion of narcotics for patients with painful

terminal illnesses or other types of severe chronic pain.terminal illnesses or other types of severe chronic pain. ChemotherapyChemotherapy

Provided in the home, generally in conjunction with an Provided in the home, generally in conjunction with an oncology program at a hospital or clinic.oncology program at a hospital or clinic.

Home Care TeamHome Care TeamThe team that provides home health care includes the The team that provides home health care includes the following:following: Physician Physician

Orders the infusion therapy.Orders the infusion therapy. Registered Nurse Registered Nurse

Responsible for coordinating and monitoring the care plan and the home Responsible for coordinating and monitoring the care plan and the home care team, and for educating the patient.care team, and for educating the patient.

PharmacistPharmacist Works with the supervising nurse to develop a pharmaceutical care plan Works with the supervising nurse to develop a pharmaceutical care plan

which includes selection of the infusion device, identification of potential which includes selection of the infusion device, identification of potential adverse reactions and interventions, and monitoring practices.adverse reactions and interventions, and monitoring practices.

Pharmacy Technician Pharmacy Technician The technician works under the pharmacist's supervision and may be involved with The technician works under the pharmacist's supervision and may be involved with

compounding, labeling, delivery, and other non-consulting activities.compounding, labeling, delivery, and other non-consulting activities. Home Care Aide Home Care Aide

Aides are non-professional staff employed by the home care agency who work under Aides are non-professional staff employed by the home care agency who work under the supervision of the registered nurse. They assist in various aspects of a patient's the supervision of the registered nurse. They assist in various aspects of a patient's care, but generally not in medication therapy.care, but generally not in medication therapy.

Home Care TeamHome Care TeamCont.Cont.

Pharmacy Technician Pharmacy Technician Works under the pharmacist's supervision.Works under the pharmacist's supervision. May be involved with compounding, labeling, delivery, and May be involved with compounding, labeling, delivery, and

other non-consulting activities.other non-consulting activities. Home Care AideHome Care Aide

Non-professional staff employed by the home care agency.Non-professional staff employed by the home care agency. Work under the supervision of the registered nurse. Work under the supervision of the registered nurse. Assist in various aspects of a patient's care, but generally Assist in various aspects of a patient's care, but generally

not in medication therapy.not in medication therapy.

Managed CareManaged Care•A type of health insurance system that emphasizes A type of health insurance system that emphasizes keeping the patient healthy of diseases controlled to keeping the patient healthy of diseases controlled to reduce healthcare costs.reduce healthcare costs.•A relatively new form of healthcare that has grown A relatively new form of healthcare that has grown dramatically over the past 35 years.dramatically over the past 35 years.

• One of the first managed-care organizations One of the first managed-care organizations was Kaiser Permanente.was Kaiser Permanente.

Managed CareManaged CareCont.Cont.

• Health maintenance organization (HMO) is Health maintenance organization (HMO) is another name for managed care.another name for managed care.

Most HMOs are centralized primary-care clinics.Most HMOs are centralized primary-care clinics. Serve patients with pharmacy, x-ray, and Serve patients with pharmacy, x-ray, and

laboratory departments.laboratory departments. Similar to a hospital, HMO’s usually have an Similar to a hospital, HMO’s usually have an

approved drug list or approved drug list or formularyformulary that has been that has been recommended by a drug information pharmacist recommended by a drug information pharmacist and approved by the medical staff.and approved by the medical staff.

Managed CareManaged CareCont.Cont.

After the patient sees the physician, the patient may After the patient sees the physician, the patient may go to the go to the HMO pharmacyHMO pharmacy to fill a prescription. to fill a prescription.

Patients needing refills may call an automated Patients needing refills may call an automated telephone number to expedite processing and reduce telephone number to expedite processing and reduce waiting times.waiting times. This “time savings” also allows the pharmacist to This “time savings” also allows the pharmacist to

spend more time reviewing the computerized spend more time reviewing the computerized medication profile and counseling the patient.medication profile and counseling the patient.

Managed CareManaged CareCont.Cont.

The pharmacy technician in managed care performs The pharmacy technician in managed care performs similar functions to those in the community pharmacy.similar functions to those in the community pharmacy. Insurance billing and cashiering are minimal.Insurance billing and cashiering are minimal.

Clinical pharmacists may work closely with the primary-Clinical pharmacists may work closely with the primary-care physicians to better control chronic disease.care physicians to better control chronic disease. EducatingEducating MonitoringMonitoring Adjusting doses of medications per physician-Adjusting doses of medications per physician-

approved protocols.approved protocols.

Terms to RememberTerms to Remember

1. Acute condition1. Acute condition2. Antibiotic therapy2. Antibiotic therapy3. Automated dispensing system3. Automated dispensing system4. Chronic condition 4. Chronic condition 5. Consultant pharmacist 5. Consultant pharmacist 6. Distributive pharmacist 6. Distributive pharmacist 7. Home care agencies 7. Home care agencies 8. Maintenance medication8. Maintenance medication