January 2012

Inpatient Pharmacy Order Processing

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Learning Objectives

• Explain the difference between inpatient and outpatient medication orders

• Explain why inpatient and outpatient medication orders must be different

• Discuss best practices in inpatient pharmacy

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Inpatient versus Outpatient

• Differences between inpatient and outpatient patients:• Outpatients take their meds and leave:• They receive multiple days’ supplies• Then they ask for refills

• Inpatients are residents of the facility:• Medications are administered by nursing• Nursing normally has access to meds needed for one

day• Many more controls and higher risk of errors

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Inpatient versus Outpatient

• Outpatient orders are converted to prescriptions: • Set days supply with refills• Patients are in control• See provider when it’s time to renew• Ask for refills

• Inpatient orders contain no days supply:• Are open ended but may automatically discontinue if

policies require• Are printed on nursing MAR so accuracy and clarity are

crucial• Utilize a team approach to assure patient safety

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RPMS Inpatient Order Processing

• Two menus: IV and Unit Dose• IV can also be used for Outpatient IVs• Unit Dose has same core functionality• The difference is in the reports available• Both menus will be used because they use

different reports to manage workload

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IV Menu CRL Change Report/Label Devices (IV) CIR Change to Another IV Room (IV) Drug Inquiry (IV) IOE Inpatient Order Entry IPF Inpatient Profile Barcode ID - Return and Destroy (IV) Label Menu (IV) ... Manufacturing List (IV) Order Entry (IV) Profile (IV) REPorts (IV) ... RETurns and Destroyed Entry (IV) SUPervisor's Menu (IV) ... SUSpense Functions (IV) ... Update Daily Ward List (IV) Ward List (IV)

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Example (not a real patient)Select PATIENT: ABEL,DEVIN JOE M ** SENSITIVE ** WW 194173 Patient Information Jul 27, 2011 17:12:31 Page: 1 of 1ABEL,DEVIN JOE Ward: MEDICAL HRN: 194173 Room-Bed: 3305-2 Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________) Sex: MALE Admitted: 06/11/09 Dx: 296.32 Last transferred: ********

Allergies/Reactions: No Allergy Assessment Inpatient Narrative:Outpatient Narrative:Enter ?? for more actionsPU Patient Record Update NO New Order EntryDA Detailed Allergy/ADR List IN Intervention MenuVP View Profile

Select Action: View Profile// View Profile

SHORT, LONG, or NO Profile? SHORT//

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NO ORDERS FOUND FOR SHORT PROFILE.Enter RETURN to continue or '^' to exit: Patient Information Jul 27, 2011 17:17:55 Page: 1 of 1ABEL,DEVIN JOE Ward: MEDICAL HRN: 194173 Room-Bed: 3305-2 Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________) Sex: MALE Admitted: 06/11/09 Dx: 296.32 Last transferred: ********

Allergies/Reactions: No Allergy Assessment Inpatient Narrative:Outpatient Narrative:

Enter ?? for more actionsPU Patient Record Update NO New Order EntryDA Detailed Allergy/ADR List IN Intervention MenuVP (View Profile)Select Action: Quit// NO

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Select DRUG: LISINOPRIL 10MG TAB U/D CV800 ...OK? Yes// (Yes) Available Dosage(s) 1. 10MG 2. 20MG

Select from list of Available Dosages or Enter Free Text Dose: 1 10MG You entered 10MG is this correct? Yes// YESMED ROUTE: ORAL// POSCHEDULE TYPE: CONTINUOUS// CONTINUOUSSCHEDULE: QDAY// 0900 [ENTER]ADMIN TIMES: 0900// 0900SPECIAL INSTRUCTIONS:START DATE/TIME: JUL 27,2011@09:00// JUL 27,2011@09:00STOP DATE/TIME: NOV 4,2011@23:59// NOV 4,2011@23:59PROVIDER: JACOBSEN,JACOB//SELF MED:

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ACTIVE UNIT DOSE Jul 27, 2011 17:23:37 Page: 1 of 2ABEL,DEVIN JOE Ward: MEDICAL HRN: 194173 Room-Bed: 3305-2 Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________)

(1)Orderable Item: LISINOPRIL TAB <DIN> Instructions: (2)Dosage Ordered: 10MG (3)Start: 07/27/11 09:00 (4) Med Route: ORAL (5) Stop: 11/04/11 23:59 (6) Schedule Type: CONTINUOUS (8) Schedule: QDAY (9) Admin Times: 0900 (10) Provider: JACOBSEN,JACOB DURATION: (11) Special Instructions: (12) Dispense Drug U/D Inactive Date CM-LISINOPRIL 10MG TAB U/D 1

+ Enter ?? for more actionsED Edit AC ACCEPTSelect Item(s): Next Screen//

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ACTIVE UNIT DOSE Jul 27, 2011 17:29:14 Page: 2 of 2ABEL,DEVIN JOE Ward: MEDICAL HRN: 194173 Room-Bed: 3305-2 Ht(cm): ______ (________) DOB: 06/14/79 (32) Wt(kg): ______ (________)+ (7)Self Med: NO

Entry By: ALLEN,MICHAEL Entry Date: 07/27/11 17:23

(13) Comments:

ORDER NOT VERIFIED

Enter ?? for more actionsED Edit AC ACCEPTSelect Item(s): Edit// AC

NATURE OF ORDER: WRITTEN// ...transcribing this active order.....Pre-Exchange DOSES: Select DRUG: Select IV TYPE: PIGGYBACK.Select ADDITIVE: CEFTRIAXON CefTRIAXone(The units of strength for this additive are in GM)Strength: 1 GMSelect ADDITIVE:

Nature of order: Verbal, Telephone – Self ExplanatoryService Correction – If something needed fixing on the order*Written – When working from a signed sheet of ordersPolicy – When working from protocols (covered by policy)

* Counts against provider for Meaningful Use

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Select SOLUTION: SODIUM CHLORIDE 0.9% INJ. 100 MLINFUSION RATE: 30 INFUSE OVER 30 MIN.MED ROUTE: IV//SCHEDULE: Q24H 1200ADMINISTRATION TIMES: 1200//REMARKS:OTHER PRINT INFO:START DATE/TIME: JUL 27,2011@12:00// (JUL 27, 2011@12:00)STOP DATE/TIME: AUG 6,2011@23:59//PROVIDER: JACOBSEN,JACOB//Orderable Item: CEFTRIAXONE INJ,SOLNGive: IV Q24H

112584[1]194173 MEDICALSURGICAL 07/27/11ABEL,DEVIN JOE 3305-2

CefTRIAXone 1 GMSODIUM CHLORIDE 0.9% INJ. 100 ML

Dose due at: ________INFUSE OVER 30 MIN.Q24H1200RETURN TO IV ROOM IN 24 HOURS MADE BY _____ TIME____1[1]

Start date: JUL 27,2011 12:00 Stop date: AUG 6,2011 23:59

Is this O.K.: YES// YESNATURE OF ORDER: WRITTEN//

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Dose due at: ________INFUSE OVER 30 MIN.Q24H1200RETURN TO IV ROOM IN 24 HOURS MADE BY _____ TIME____1[1]

Start date: JUL 27,2011 12:00 Stop date: AUG 6,2011 23:59

Is this O.K.: YES// YESNATURE OF ORDER: WRITTEN// W

1 Label needed for dose due at ...

07/27/11 1200 :

Next delivery time is 1100 ***

Action (PB) P// PRINT

112584V1180[1] 194173 MEDICALSURGICAL 07/27/11ABEL,DEVIN JOE 3305-2

CefTRIAXone 1 GMSODIUM CHLORIDE 0.9% INJ. 100 ML

Dose due at: ________INFUSE OVER 30 MIN.Q24H1200RETURN TO IV ROOM IN 24 HOURS MADE BY _____ TIME____1180[1200]

Questions?

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