Department of Pharmacy Policies & Procedures

Number: 5:01.3

Effective Date: September 1987

Revisions: 3/99; 4/00; 1/06; 10/08; 7/09; 11/09

Approval: March 1999

Subject: PROCESSING AND DISPENSING DRUG ORDERS

A. Policy

All orders written for patients in the hospital which concern drug therapy will be processed and dispensed by Pharmacy Services. All medication orders will be reviewed by a pharmacist before administration except in emergent situations.

B. General Procedures

1. All orders for prescription medications originate with the Physician's Order, which is written in the patient's medical record or entered in the computerized practitioner order entry (CPOE) system.

2. A copy of the Physician's Order is faxed to the pharmacy by nursing unit staff or entered into the CPOE system and into the pharmacy verification queue.  If the order is handwritten, the physician will be contacted if the order cannot be readily understood.

a. Any new order shall be transmitted by fax or the CPOE system to the pharmacy

b. The Patient Service Coordinator shall indicate in the left margin that the order has been faxed. This may be accomplished by using a "Faxed" stamp or handwriting the word "faxed" at the bottom of the order.

c. All fax machines should be adjusted to "high resolution" for sending a fax to the pharmacy.

3. A pharmacist reviews the order for the following,

a. The order must have a written or electronic signature by a housestaff or faculty physician. Orders written or entered by a medical student, acting intern, or other non-physician personnel must be countersigned by either a housestaff or faculty physician.

b. The order must be complete to include name of medication, dosage, route of administration, frequency and reason for use if "prn".

c. The order is screened for clarity, appropriateness, dose, any pertinent lab values, therapeutic duplications, food-drug interactions, drug-drug interactions, allergies, formulary status, and any other contraindications.

d. If an order is incomplete, illegible, unclear or questionable due to problems identified in (c), the pharmacist will contact the physician to clarify or change the order. These include any off-labeled uses or indications.

e. The order is entered into the computer patient profile or is verified if entered on the CPOE system.

4. The fax sheet is initialed by the pharmacist who profiles the order. If this is accomplished by a pharmacy student, the work must be checked by a pharmacist, who then initials the order and verifies the computer profile.

5. A written order copy with no medication orders will be initialed by an editing pharmacist.

6. After all medication orders have been profiled, the order copy is filed. Orders entered into the CPOE system are not filed as they are stored electronically.

7. When the patient is discharged, the patient's folder is pulled and the order copies are destroyed.

C.  DRUGS NOT STOCKED IN THE AUTOMATED DISPENSING MACHINE  

For any drug not stocked in the Pyxis Medstation, the procedure is as follows:

1. The pharmacy technician pulls all labels from the printer.

2. The pharmacy technician picks the medication from the "picking area".

3. The pharmacy technician places the medication in a plastic bag and puts the label on the bag.

4. The pharmacist checks the medication against the bag label. If the order is filled correctly, the pharmacist initials the bottom right of the label.

5. The technician sorts all completed orders by nursing stations and delivers it to the appropriate nursing unit, usually via the pneumatic tube system. Medications for the next 24 hour period are placed in the medication exchange bins from the cart fill update reports. If the medication is ordered after the last cart fill update report prints, the quantity to dispense will default to an amount sufficient until 1430 the next day.

6. Drugs stocked in the Pyxis Medstation are available for use on the patient as soon as the pharmacy computer profile updates the Pyxis profile or through the override function for certain emergency use situations.

D.    DRUGS WHICH MAY NOT BE SENT IN THE PNEUMATIC TUBE

When delivering drugs to the patient care units, the following medications cannot be tubed. They must be delivered by pharmacy or picked up by unit personnel.

Any  Investigational/non-formulary med where shaking is not advised	Drotrecogin alfa^2,4
	Epoetin^2
Any IV in a glass bottle^3	Eptifibatide^2,4
Any of the "-mab" drugs^2,4	Filgrastim (G-CSF)^2
Albumin containing IV/TPN^2	Immunoglobulin products^2,4
Aldesleukin^2	Interferon products^2
Alprostadil^2	Lepirudin^2,4
Alteplase^2 (thawed)	Muromonab CD3^2,4
Antithymocyte Globulin^2,4(either)	Nesiritide^2
Argatroban^2,4	Nitrolingual Spray^5
Asparaginase^2	Oprelvekin^2
Beractant^2,4	Sargramostim (GM-CSF)^2
Bortezomib^4(see note)	Streptokinase^2,4
Botulin Toxin A+B^2,4	Tenecteplace^2,4
Cytogam^2,4	Urofollitropin^2
Dalfopristin-Quinupristin^2	Urokinase^2
Darbepoetin^2

Table 1: Reasoning for Exclusions

1.  Product exceeds pneumatic tube weight and/or size limits

2.  Possible alteration of active ingredient (i.e. protein denaturation)

3.  Breakage (i.e. glass bottle)

4.  Substantial monetary or labor loss if the medication is "lost" during the transport process

5.  Explosive or flammable substances

Note:  Items only excluded for reason 4 may be tubed by secure transaction in emergency situations