Orientation to Pharmacy

1. Orientation to Pharmacy What you need to Know About Health Sciences North

2. Overview • Health Sciences North • Pharmacist Rotations • Medication Orders & Pharmacy Communication Forms • HSN Formulary • The Robot ‘Picksy’ & PickRings • Pyxis • Medication Administration • MAR: Medication Administration Record • Patient Charts • MEDITECH

3. Health Sciences North • Main Pharmacy: 3rd Floor Centre Tower • Pharmacist (ext. 5511) • 8:00 -21:00 • Pharmacy technician on-site • 24 hours daily • Pharmacist on-call 24 hours (ext. 3196)

4. Pharmacist Rotations L1: Desk A: Emergency Department B: ICU C: Oncology D: E: Evening G: M: N: R: S: 4th & 5th Floor South Tower X: Cardiology

5. Medication Orders • Orders can be written by: • Physician: MD or Medical Resident with privileges • Clinical Clerk : 3rdor 4th year medical student , co-signedby physician • RN Extended Class/Nurse Practitioner • Physician Assistant (PA) under a medical directive , which must be written in the order • 2ndyear PA students, co-signed by physician • Complete orders include: • Patient identification • Name & SH/SI # • Date & time • Clear legible directives • Signature of ordering provider

6. Medication Orders • Medication Order sheets consist of • 3 sections per page • 1 white page that remains in the patient chart • 1 yellow carbon copy page that is processed by pharmacy • Orders may be handed to a pharmacist if on the floor or tubed to the pharmacy to be reviewed at the desk

7. Pharmacy Communication Forms • Pharmacy completes a Pharmacy Communication form when suggesting a change in drug therapy • e.g., Initiate, Discontinue, Change • Yellow carbon copy is processed by pharmacy after MD has reviewed suggestion

8. HSN Formulary • Medications on the HSN Formulary are found using Lexicomp • Open Internet Explorer > HSN Intranet > Click ‘LexiComp’ • If available the drug will be listed & automatic substitutions as well

9. The Robot ‘Picksy’ & PickRings Many Medication Orders that are processed by pharmacy & entered into MEDITECH are assembled by the robot onto plastic PickRings Picksy, the robot, is located across the hall from the main pharmacy

10. The Robot ‘Picksy’ & PickRings PickRings help organizemedication administration & prevent omitted or extra dose errors Medications on the PickRing are organized by administration time & are listed in alphabeticalorder by generic name PickRings contain patient medications for a 24 hour period

11. Pyxis • Pyxis units are used when medications are: • missing from PickRings • dropped or wasted • new orders/first dose • Depending on when the patient arrives to the floor & the bin delivery time, there may not be a PickRing until next delivery time (bins exchanged every 24 hours at specified time for each floor) • STAT orders • narcotics • benzodiazepines • Pharmacy will send medications not stocked in Pyxis

12. Medication Administration • Medications are given to patients by the nurse preparing the medication • The nurse administering the medication must confirm • patient is wearing a current armband • the armband’s patient account number (SI#) & full name matches the information listed on Medication Administration Record (MAR) prior to administering the medication

13. Medication Administration • As soon as possible after medication administration, the Medication Administration Record (MAR) should be signed • If medication refused/held/not available, reason for omission recorded in MAR • An asterisk (*) beside an entry in the MAR directs reader to interdisciplinary note for more detailed information • The MAR is a useful tool • e.g., Dosing of sliding scale insulin can be found in the MAR

14. Patient Charts Sections: Orders: Physician Order Sheets, Admission Medication Order Record (AMOR) Medication: Medication Administration Record (MAR) (if not in separate binder) Miscellaneous: Long-term care MAR, community pharmacy list

15. MEDITECH • MEDITECH is the computer program used at HSN for electronic patient records • MEDITECH contains: • Patient Demographics • Location in Hospital • Reason for Visit • Allergies • Current Medication Orders • Laboratory Results • Microbiology Results • Imaging Reports • Notes & Other Reports • etc.

16. MEDITECH • To access information on MEDITECH: • Login • Pharmacy > Pharmacist Desktop • Rounding: allows you to view patients in a specific unit • My List: allows you to add patients for quick access • Add > Last name, First name (only partial name needed) • Once a patient is selected, can choose: • Patient Profile: demographics, location, allergies, current orders, etc. • EMR: lab results, MD notes, etc. • Interventions: to document

17. MEDITECH Drug Name Dose, Route, Frequency Active, Hold, Discontinued Start Date Stop Date NOTE: This is more of an accounting system, to be sure if patient is receiving medication refer to the MAR

18. Welcome to Health Sciences North