Objectives for Drug Distribution Rotation

1. The resident will carry out the following functions involved in medication order review:

1. Receiving medication orders
2. Prioritizing medications orders including procedure for stat orders.
3. Assessing for the 5 R’s – right drug, right dose, right patient, right schedule and right formulation.
4. Assessing for renal dose adjustment, drug allergies, duplications and interactions.
5. Entering medication orders
6. Verifying medication orders
7. Filling medication orders
8. Common problem-solving scenarios such as non-formulary requests, patient’s own orders, therapeutic substitutions, missing dose requests and order clarification.

Documentation of the following activities will be evidenced in procedural logs on One45.com:

1. Non-formulary orders clarification- x 3

2. Patient’s Own Medication x 3

3.   Therapeutic Substitution x 2

4.   ADR/allergy clarification x 3

5.   Medication Incident reporting x 2

6.   “Problem Order” clarification x 5

2. The resident will become familiar with concepts of wardstock management by conducting one medication storage room audit with a nursing representative and reflecting on what they learned.

5. The resident will compare and contrast an automated dispensing system and a manual wardstock system by participating in a top-up of the Accudose system and participating in a manual top-up of wardstock on a patient care ward. The resident will formulate 3 advantages and disadvantages of each system. These concepts will be discussed and summarized in discussion with preceptor and can be included in their learning portfolio.

AcuDose Wardstock

Advantages
–    Safer for patients → smaller chance of medication error compared to manual wardstock
–    Automated → easier for pharmacy to top-up cabinets (technician can automatically scan the bar codes in        the med carousel)
–    Easier for pharmacy to keep track of stock and less potential for “stashes” to develop on the ward

Disadvantages
–    More expensive than manual ward stock
–    Requires more training for pharmacy and nursing staff
–    Potential for technical difficulties/malfunctions (ie. power outage, passwords not working, discrepancies), which may delay medication administration.
–    Requires daily “top up” from pharmacy
–    Only one nurse can access AcuDose at a time.

Manual Wardstock

Advantages
–    Cheaper than purchasing AcuDose machines
–    Less training involved for pharmacy and nursing stuff
–    No potential for technical difficulties/malfunctions (as with AcuDose)
–    Does not require pharmacy to top up every day

Disadvantages
–    Less safe for patients→ more potential for medication errors
–    Harder for pharmacy to keep track of stock and more potential for “stashes” to develop on the ward
–    Must have large inventory quantities for since there is only a weekly top up.
–    Technician must physically check inventory on the ward, return to pharmacy to pick ward stock, then return to ward to restock.

6. The resident will become familiar with nursing administration procedures at each site by observing nursing staff administer medications to patients for at least 2 medications times and documenting the following:

1) Medication Administration Record-how it is produced; how changes are made; how meds are signed of

7. The resident will formulate a Medication Flow Chart for unit dose and traditional dose distribution system starting with the time that the order is written, documenting each step along the way, and finishing when the patient receives the medication. This flow chart should include process for initial doses, and refilled doses. The resident is to note potential for error at each step, and possible solutions/procedures to avoid errors.

See chart attached → flowchart

Notes: Objectives higlighted in green are objectives that I have received credit for prior learning based on my experience as a grade I pharmacist at RJH.

Reflections

June 26th: VGH and Aberdeen