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PHARMACY AUTOMATION

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  1. PHARMACY AUTOMATION GUIDANCE FOR THE CONTROLLED SUBSTANCE COORDINATOR Part 1: The Inspection Process

  2. OBJECTIVES • Understand the VHA Handbook 1108.2 requirements that relate to automation • Understand what reports should be requested from the pharmacy prior to performing a routine unit inspection • Understand what reports should be reviewed as part of the overall inspection process.

  3. The Inspection Process • Requirements from VHA Handbook 1108.2 • Inspectors should have a password that permits access to the automated dispensing cabinets (ADC) only when accompanied by an authorized user • Inspectors must verify source data including a spot check of ADC removals • Report any unresolved discrepancies to the controlled substance coordinator for further investigation • Review resolved discrepancies for trending purposes • Review at least one day’s worth of ADC restocking

  4. Inspecting an Automated Dispensing Cabinet • Written instructions on accessing the automated dispensing cabinet in use in your facility to perform a narcotic inspection is a handbook requirement.

  5. Strategies for the Inspection Process • Temporary Password Set Up • When setting up passwords for the facility inspectors, they may be set up with a temporary password. • The password can be set up to expire within a selected amount of time.

  6. Strategies for the Inspection Process • Permanent Password Set Up • The facility controlled substance inspectors may be set up with a permanent password that only allows the user to act as a witness. • This password will expire every 90 days similar to other passwords.

  7. Conducting the Inspection • Area personnel should sign into the automated dispensing cabinet • The controlled substance inspector should sign on as a witness • Access the controlled substances stored in the cabinet. • Count the items in each drawer or pocket • Look for any discrepancy in count

  8. Reports to Request for Inspection • Inspectors must verify source data including a spot check of ADC removals • The handbook requires that the inspectors verify provider orders in the inpatient or clinical setting • Request one day of activity for busy areas or a week to a month of activity for areas that use few controlled substances

  9. Other Reports to Use in the Inspection of Specialty Areas • Specialty areas such as Operating Rooms, Cardiac Cath Labs or Colonoscopy Suites may require other reports to verify documentation of administration • OR Reports • Case Reports • Waste/Return Reports

  10. Automation Specific Controlled Substance Activity Reports • AcuDose Rx: Controlled Substance Dispense Report • MedSelect: Controlled Substance Inventory Summary • Omnicell: Transactions by Date or Specific Criteria Report • Pandora: Med Usage Report/All Station Events • Pyxis: All Station Events

  11. Delbert Siegmund, Pharm.D. Chief of Pharmacy Danville VAMC

  12. Verifying Inpatient Orders in CPRS • Verify five randomly selected patients to make sure that there is an administration to a patient recorded for the dose(s) removed. • If your machine allows the addition of emergency or temporary cases, check to see that they are reconciled with the patient’s permanent records.

  13. Verifying Inpatient Orders in CPRS • Access the patient and go to the “meds” or “orders” tab and find the order for the medication. • Double click on the order and scroll to the bottom of the “inpatient medication details” box. • Look for the date and time of the administration for the episode on your report

  14. CPRS Screenshot of Meds Tab

  15. CPRS Screenshot of Inpatient Medication Details Scroll Down

  16. CPRS Screenshot of Inpatient Medication Details cont.

  17. CPRS Screenshot of Inpatient Medication Details (IV example)

  18. BCMA Administration Reports • Available in BCMA under “Med Administration History” • Can also access “Med Administration Log” if the episode is recent • Both reports are available in CPRS on the “Reports” tab

  19. BCMA Medication Admin History Report

  20. BCMA Reports available in CPRS – Reports Tab

  21. Verification of Orders in Outpatient Areas • Outpatient Units • Colonoscopy Suite • Same Day Surgery • Cardiac Catheterization Suite • Work with HAS and Pharmacy to have clinic stop added to the unit • Area personnel should not have to add patients on a routine basis.

  22. Verification of Orders in Outpatient Areas • Outpatient CPRS prescription (ex Methadone maintenance) • OR Report (Same Day Surgery) • Case Note (Cardiac Cath Lab, Colonoscopy Suite)

  23. Jennifer Howard, Pharm.D. Director, Pharmacy Informatics San Diego VAMC

  24. Methadone Maintenance Unit • AMS • Avatar System • Verify opening amount, amount dispensed, quantity on hand. • Verify 5 orders as previously outlined

  25. Review Discrepancies • Ideally, you should also look at both unresolved and resolved discrepancy reports • Report any unresolved discrepancies to the controlled substance coordinator for further investigation • Review resolved discrepancies for trending purposes

  26. Automation Specific Discrepancy Reports • AcuDoseRx: Discrepancy by Station, Open Discrepancy By Station • MedSelect: Top 25 discrepancies • Omnicell: Pharmacy Discrepancy Report • Pandora: Discrepancy Report • Pyxis: All Discrepancies

  27. Verification of Restock • The handbook requires that the at least one days worth of restocking be verified as part of the inspection process. • A report of restocks will need to be generated from the Pharmacy narcotic vault. • This report may come from Vista, Pyxis CII Safe or Omnicell Secure Vault

  28. Automation Specific Restock Reports • AcuDose Rx: Loading and Unloading Report • MedSelect: Restock Summary • Omnicell: Transactions by Date or End of Cycle Report (if site has Secure Vault) • Pandora: Narc Vault Reconciliation Report • Pyxis: Med Refill Activities

  29. End of Shift Count • End of Shift Count or Weekly Count • Not a handbook requirement • May be required by local policy • End of shift discrepancy report • Best Practice

  30. Inspecting the Pharmacy Narcotic Vault • Automation that may be present in the vault • Pyxis CII Safe or Omnicell Secure Vault • Fast Fill • Scriptpro SP50 • Baker Cells

  31. Inspecting the Pharmacy Narcotic Vault • Pyxis CII Safe • Omnicell Secure Vault

  32. Inspecting the Narcotic Vault • Pharmacy Dispense without (VA FORM 10-2638) • LORAZEPAM 0.5MG TAB,UD • Select NAOU: xx • QUANTITY DISPENSED (TAB/25): 25// 25 • JAN 01, 2001@08:21:51 DISP OMNICELL XX • -25

  33. Outpatient Robotic Prescription Fill • Fast Fill • Baker Cells • ScriptPro

  34. Questions??? • Marian Daum - Coatesville VAMC • Delbert Siegmund - Danville VAMC • Jennifer Howard - San Diego VAMC • Dionne Roney - Charleston VAMC • Jolene Hallcroft - Sheridan VAMC