Department of Pharmacy Policies & Procedures

Number: 5:26

Effective Date: October, 2005

Revisions: 10/08

Reviewed: 11/09

Approval:  Outpatient Administration/ P&T Committee

Subject: PROCESSING AND DISPENSING MEDICATIONS TO PATIENTS IN THE OUTPATIENT CLINICS.

 

A. Policy

All orders written for patients in the UAMS outpatient clinics which concern drug therapy will be processed and dispensed directly by the Outpatient Pharmacy unless the medication is approved to be kept as floorstock.

 

All medication orders will be reviewed by a pharmacist before administration unless the preparation and administration is under the complete supervision of a physician, except in emergent situations.  Controlled substances will not be floor stocked unless all the regulatory requirements are met, i.e. perpetual inventory, double locked with limited access, twice daily inventories, etc.

 

B. General Procedures

1.      All orders for drugs originate with the Physician's Order which is written in the patient's medical record or entered in the outpatient electronic medical record.

2.      For orders that are to be dispensed directly by the Outpatient Pharmacy:

  1. A copy of the Physician's Order is faxed to the pharmacy by clinic staff or is automatically printed in the pharmacy if  the outpatient electronic medical record is used.  Handwritten orders may also be delivered directly to the Outpatient Pharmacy.  If the order is handwritten, the physician will be contacted if the order cannot be easily understood.
  2. A pharmacist reviews the order for the following:

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

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

                                                          iii.      The order is screened for clarity, appropriateness, dose, therapeutic duplications, drug-drug interactions, allergies, unapproved abbreviations and formulary status.

                                                           iv.      If an order is incomplete, illegible, unclear or questionable due to problems identified in section ii or iii the pharmacist will contact the physician to clarify or change the order.

  1. The order is entered into the patient profile of the pharmacy computer system and dispensed to the patient, or their caregiver.  In more emergent situations the medication may be dispensed prior to entering the order in the patient profile.  Drugs that are on the approved list may be sent to the appropriate clinic via pneumatic tube.

3.        For orders that will be dispensed using floorstock

  1. Drugs must be approved by the pharmacy before they will be permitted to be dispensed as floor stock.  The criteria that will be used for approval includes such things as:

                                                              i.      Patient and employee safety

                                                            ii.      Need for timely administration of the medication

                                                          iii.      Proper storage requirements

                                                           iv.      Clinic has ability to consistently, correctly charge for medication.

                                                             v.      Physician involvement in medication process

 

    1. At time of need, the medication is removed from automated dispensing machine (i.e. Omnicell) or other secured area in the clinic that has been designated for use for floor stock medications.

 

    1. Prior to administration the physician order will be screened as described in section 2.b.iii.

 

    1. If it is required that the medication be mixed, reconstituted, drawn out of a vial or otherwise prepared prior to administration, the preparation will be performed by a physician or by a nurse who is assisting the physician with the procedure, and who is under the  direct supervision of the physician.  Doses will not be prepared in advance of the procedure.

 

    1. Charging for the medications will be done via automated dispensing machine or encounter form and will be the responsibility of clinic personnel.

 

    1. Floor stocked influenza vaccine (flu shots) will be administered according to the following procedure.

 

                                                              i.      Each fall, prior to the clinic receiving their allotment of influenza vaccine from the outpatient pharmacy, the clinic managers will develop a standing order for their clinic(s) that includes the name of each physician who will be practicing in the clinic during the time that flu shots are normally administered.  Each physician will sign the standing order authorizing nursing staff to administer a flu shot to any patient in that clinic who requests a shot. 

                                                            ii.      The nurse will adhere to the clinic protocols concerning the administration of flu shots and will screen for allergies or past reactions to influenza vaccine or its contents.  Administration of the flu shot will be documented in the patient’s chart.