Department of Pharmacy Policies & Procedures

Number: 4:10

Effective Date: September 2009

Revisions:

Approval: 09/2009

Subject: COMPUTER DOWNTIME

A. POLICY

The following guidelines and procedures have been developed in the event of planned computer-related down time.

B. PROCEDURES

1. Profiles/Cart Fills/Deliveries - print the following prior to the planned downtime. At a minimum, print those reports that are expected to fall within the planned downtime period. Refer to the spreadsheet document “Sunrise Fill Processes” for detailed information regarding cart fill and IVPB and LVP filling report times.

a) Patient profiles from MAR (from Webchart) – instructions for downloading the Downtime – Medication Administration Record from Webchart are located in the downtime tote. Allow approximately 1 to 1.5 hours to print. Organize profiles by unit to facilitate order review.

b) Cart Fill Reports

i) General

ii) Nursery

iii) Overnight Recovery/Short Stay Units

c) Cart Fill Catchup Reports (if applicable)

i) General

ii) Nursery

d) IVPB Filling Reports

i) IVPB

ii) Adult Extempo

iii) Nursery Oral Syringe

iv) Nursery IV Syringe

e) LVP Filling Reports

i) LVP

2. Pyxis - put Pyxis on Critical Override during the planned down time. Existing orders will still appear on the patient's Pyxis profile; however, during the downtime, no new orders will cross over to Pyxis. Critical Override allows nurses to obtain drugs for new orders. Communication of critical override status should be communicated to the nursing staff by e-mailing the nursing directors so that they may disseminate the information to the nursing staff.

3. New orders – will be faxed to pharmacy

a) Pharmacists will process new orders manually

i) Review for duplicate/allergy, etc. using the printed profiles.

ii) Paperclip new orders to the printed profile – organize those profiles with new orders alphabetically to maintain organization.

iii) Note doses and quantity of items dispensed on the order.

iv) Pyxis inventory can be reviewed on the Pyxis console.

b) Handwrite labels –downtime labels are located in the downtime tote. Downtime labels are also located on the pharmacy “G” drive at G:\Shared\Labels\Prebuilt Labels\Downtime Labels. This file may also be accessed locally on the C drive of the A2 computer at C:\Shared\Labels\Prebuilt Labels\Downtime Labels. If the network is down and should additional labels be needed, a downtime label printer is directly connected to the A2 computer. Otherwise, these labels can be printed from any pharmacist computer in the dispensing area and IV Room.

i) IVs - use preprinted IV labels to facilitate appropriate label format

(1) Prebuilt labels for electrolyte replacements, IVPBs, and standard drips

(2) Blank labels for electrolyte replacements, IVPBs, standard drips and other IV products that are not prebuilt

(3) Immediately prior to the planned down time, look through certain units for difficult labels, reprint (Neonatal ICU, Medical/Neuro ICU, TSICU/CVICU, BMT, Hem/Onc)

ii) Meds – label baggie using blank medication labels (located in downtime label tote)

c) Replacement doses – nursing will fax a Pharmacy Miscellaneous charge ticket with a patient label affixed and the quantity and medication needing replaced written on the ticket. However, the only items that should be charged are those items considered “multi-dose” that are not located in the units Pyxis.

4. When Downtime Ends:

a) Once the computer systems are back up and orders are in, Pyxis will be taken off Critical Override.

b) Once the hospital computer system is back up, nursing is responsible for backloading those new orders from the downtime period.

c) Multi-dose items not loaded into a unit’s Pyxis that are dispensed during downtime should be debited to the patient using the specialty charge function within the pharmacy computer system. The same should be done for all items dispensed to “Bill on Dispense” locations.

5. Quality Assurance/Medication Error Prevention

a) Cart Fill – pharmacy should reconcile against all new orders.

b) IVPB Filling Lists (IVPB, extemporaneous preparations, nursery syringes) – pharmacy should reconcile against the new orders.

6. Worst Case Scenario: Issues/Concerns

a) The following activities must be planned for if the system does not come back up for an extended time:

i) Future cart fill, IVPB filling, and LVP filling reports

(1) Should be generated by reviewing the downtime cart fill reports available from Webchart (instructions for downloading available from downtime tote) plus the new orders that have been clipped to the patient’s profile.

(2) Preprinted labels may be used if available; otherwise handwritten labels will be required.

ii) Identify additional staff for varying degrees of downtime timeframes (for order input, handwriting batches, etc.)

	Sunrise Fill Processes (by Type)
Cart Fill Reports		Report Time	Catch-up List	Fill Period	Reprint Available	Early Call Available
General		0600	1130, 1330	1430 - 1429	0600 -1430	1430 - 0600
	(Pharmacy A1, A2, B1, B2)
Nursery-General		1500	0200	0400 - 0359	1500 - 0400	0400 - 1500
	(Nursery B2+F5M)
Overnight Recovery (ONR)		2300	N/A	0400-0359	2300-0400	0400-2300
Short Stay Units
IVPB Filling Reports		Report Time	Catch-up List	Fill Period	Reprint Available	Early Call Available
IVPB (11AM)		0500	N/A	1159 - 1728	0500 - 1159	0459 - 0500
	(IVPB - A1, A2, B1, B2, 7A)
IVPB (7PM)		1300	N/A	1729 - 0458	1300 - 1729	1159 - 1300
	(IVPB - A1, A2, B1, B2)
IVPB (4AM)		1730	N/A	0459 - 1158	1730 -0459	1729 - 1730
	(IVPB - A1, A2, B1, B2)
Adult Extempo		0700	N/A	1430-1429	0700 - 1430	1430 - 0700
	(Extemp Syringe - A1, A2, B1, B2)
Nursery Oral Syringe		1500	N/A	0400-0359	1500 - 0400	0400 -1500
	(NEO Oral Extemp - B2)
Nursery IV Syringe		2000	N/A	0400-0359	2000 - 0400	0400 - 2000
	(NEO IV Extemp - B2)
LVP Filling Reports		Report Time	Catch-up List	Fill Period	Reprint Available	Early Call Available
LVP		2000	N/A	0459 - 0458	2000 - 0459	0459 -2000
	(LVP - A1, A2, B1, B2)

	Sunrise Fill Processes (by Time)
Cart Fill Reports		Report Time	Catch-up List	Fill Period	Reprint Available	Early Call Available
IVPB (11AM)		0500	N/A	1159 - 1728	0500 - 1159	0459 - 0500
	(IVPB - A1, A2, B1, B2, 7A)
General		0600	1130, 1330	1430 - 1429	0600 -1430	1430 - 0600
	(Pharmacy A1, A2, B1, B2)
Adult Extempo		0700	N/A	1430-1429	0700 - 1430	1430 - 0700
	(Extemp Syringe - A1, A2, B1, B2)
IVPB (7PM)		1300	N/A	1729 - 0458	1300 - 1729	1159 - 1300
	(IVPB - A1, A2, B1, B2)
Nursery-General		1500	0200	0400 - 0359	1500 - 0400	0400 - 1500
(Nursery B2+F5M)
Nursery Oral Syringe		1500	N/A	0400-0359	1500 - 0400	0400 -1500
	(NEO Oral Extemp - B2)
IVPB (4AM)		1730	N/A	0459 - 1158	1730 -0459	1729 - 1730
	(IVPB - A1, A2, B1, B2)
Nursery IV Syringe		2000	N/A	0400-0359	2000 - 0400	0400 - 2000
	(NEO IV Extemp - B2)
LVP		2000	N/A	0459 - 0458	2000 - 0459	0459 -2000
	(LVP - A1, A2, B1, B2)
Overnight Recovery (ONR)		2300	N/A	0400-0359	2300-0400	0400-2300
	Short Stay Units