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Administrator
Posts: 578
Registered: ‎02-22-2010
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Joint Commission 2012 Update Webinar

[ Edited ]

Thanks for joining our webinar with Darryl Rich, who reviewed The Joint Commission standards on medication management for 2012.

View the on-demand recording.

Have a question for Darryl? Post it here and he will be answering your questions until November 23, 2011. Please keep all questions related to the presentation.

Regular Visitor
Posts: 2
Registered: ‎03-03-2010
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Re: Joint Commission 2012 Update Webinar

I would like some clarification on nurse access after hours. We have a small room with medications that are in bins that nurses can access and sign out after hours. It is not licensed as part of the pharmacy. Did I hear you say that this is not allowed (except in certain states)? We do not currently have dispensing cabinets.

Jan Rozenboom
Occasional Visitor
Posts: 4
Registered: ‎11-16-2011
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Re: Joint Commission 2012 Update Webinar

Famotidine IV is prepared as an IV push here. Nurses remove a 2ml (10mg/mL) vial from Pyxis. They draw up 2mL in a 10mL syringe. They then obtain a 10mL vial of NS, and qs to 10mL in the syringe with the famotidine. They then inject over 2 minutes. Is this considered nurse mixing? Could we be cited for this practice? If it is not nurse mixing, what separates this process from nurse mixing of IV's? Thanks

Occasional Visitor
Posts: 4
Registered: ‎11-16-2011
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Re: Joint Commission 2012 Update Webinar

In regards to contrast media (Readi Cat) handed out by the radiology secretary. Would this process past muster with JC. An order for the contrast is sent to pharmacy. The pharmacy reviews the order. The product is labeled with appropriate information (patient name, directions etc). The labeled contrast is then returned to the radiology department. The radiology secretary hands out to patient when they return to pick it up. (There is no outpatient pharmacy here to hand out the medication.). If this is not sufficient, can you comment on a process that would be? Thanks

Administrator
Posts: 578
Registered: ‎02-22-2010
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Re: Joint Commission 2012 Update Webinar

[ Edited ]

Here are some questions from our live presentation:

Q: Could you please clarify the requirement for review of contrast meds by pharmacy?  Sounds like these orders can be exempt from pharmacy review?  So, if radiology has protocols that they follow for dosing (reviewed by radiology alone not by P&T) that a radiology tech could administer contrast without pharmacy review? 

Q: Can you store a multidose vial in a patient care area, eg: in OR suite if it used as a single use vial (1 vial for one patient)?

Q: You stated dispensing cabinets are not considered "mobile".  At least one brand of automation provides their dispensing cabinets on wheels.  Would these be considered mobile and/or need to be in a locked room if not constantly supervised?  If considered mobile would tethering them to a floor/wall be considered sufficiently secure?

Q:If a MDV is used as a single dose vial during a procedure and thrown away after procedure, does it require and expiration date?

Q: What are the standards if we are using a compounding facility to outsource our IV preparations? They often give room temp expiration dating.

Q: Isovue 370 500mL IV bottles are used here. The PI states "The transferring ISOVUE from the pharmacy bulk package should be performed in a suitable work area, such as a laminar flow hood, utilizing aseptic technique." Specifically, how can this be accomplished? Bracco offers professional information stating a laminar flow hood is not required. Looking for a specific process to get this done.

Q: Is there any requirement for RPh to review (retrospective) contrast orders for compliance to policies?

Q: Surgeon wants to have anesthesia administer Ibuprofen IV (which comes 800mg vial and needs to be diluted in 250 ml Saline) during surgery.  Does the pharmacist have to mix that IV or can the MD?

Q: If a medication like eye drops or nasal spray is administered in a clinic, can the physician give that medication to administer at home?  Or are they required to dispose of those remaining drops/solution and write a separate prescription for patient to use at home?  If they can give it directly to the patient, are there labeling requirements?

Q: In emergency situations can a RN mix an IV admixture greater than 50mL? If yes, what is considered an emergency situation?

Q: Anesthesiologist use MDV in patient care areas.  These are stored in the anesthesia stations.  Is this considered non-compliant practice?

Q: I would like to reach out to you to ask you about prn pain meds and frequency. For example: Percocet 1 PO q4hprn mild pain , Percocet #2 tabs PO mod pain, and Morphine 2mg IV q4hprn severe pain.  Are you allowing nursing to administer eg the Percocet 1 PO (from the q4hprn mild pain order) at 8AM, wait one hour to evaluate pain level. If patient is still in pain then administer Percocet #2 tabs (from the q4hprn moderate pain order) at 9AM. Evaluate patient pain level again in 1 hour. If patient still in pain allow  Morphine 2mg IV (from the q4hprn severe pain order) to be administered? I am recommending, when a patient is needing additional pain relief for nursing to call the physician and obtain a breakthrough pain order or a onetime pain med order and stay with the prescribed frequency of the chosen medication.

Can you let me know what your recommendations are?

Occasional Visitor
Posts: 4
Registered: ‎11-16-2011
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Re: Joint Commission 2012 Update Webinar

Looking to clarify the use of contrast media in CT. In your talk, you alluded to the use of contrast media in these areas as patient specific. In other words, a 500mL bottle to be used for multiple patients would not be acceptable. Is that correct? In order to accomplish this, a new bottle of contrast media and a new bag of NS would need to be hung for each patient. A new transfer set would be required and new Medrad Syringes for the pump would be necessary. The CT scanning injection device is mobile. In order to accomplish the process of spiking the bottle and attaching it to the mobile CT infusion device in an aseptic environment (laminar flow hood) the device would need to constantly be moved in an out of the hood. Can you suggest a process to accomplish this feat. Have you come across an institution that performs this process flawlessly? I would be interested in duplicating a substantiated process. Thanks rxdave9@aol.com

Frequent Visitor
Posts: 3
Registered: ‎11-16-2011
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Re: Joint Commission 2012 Update Webinar

[ Edited ]

1. Is it ok to have insulin multi-dose vials in the refrigerator of ER and PACU? The fridge is attached to the Pyxis machine inside the med room.

 

2. Do medications administered in the ER needs to be reviewed by the pharmacist, even if the physician is readily available?

 

3. When you said that we needed a list of high alert and hazardous medications, do you mean that the list needs to be posted throughout the hospital?

 

Expert
Posts: 78
Registered: ‎06-02-2010
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Re: Joint Commission 2012 Update Webinar


JanR wrote:

I would like some clarification on nurse access after hours. We have a small room with medications that are in bins that nurses can access and sign out after hours. It is not licensed as part of the pharmacy. Did I hear you say that this is not allowed (except in certain states)? We do not currently have dispensing cabinets.


Answer: As long as the small room with medications is not part of the licensed pharmacy, it is acceptable for nursing access after hours.  This is just another version of a night cabinet.  It is the licensed pharmacy which must be locked after-hours, that nurses or physicians cannot access.

Expert
Posts: 78
Registered: ‎06-02-2010
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Re: Joint Commission 2012 Update Webinar


rxdave9 wrote:

Famotidine IV is prepared as an IV push here. Nurses remove a 2ml (10mg/mL) vial from Pyxis. They draw up 2mL in a 10mL syringe. They then obtain a 10mL vial of NS, and qs to 10mL in the syringe with the famotidine. They then inject over 2 minutes. Is this considered nurse mixing? Could we be cited for this practice? If it is not nurse mixing, what separates this process from nurse mixing of IV's? Thanks


ANSWER: No this does not require that the pharmacy prepare and it is allowed for nurse to prepare syringes this way.  However, nurses could be cited for a variety of other reasons, such as lack of aseptic technique (MM.05.01.07, EP 2), not labeling the syringe (if required), etc. 

Expert
Posts: 78
Registered: ‎06-02-2010
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Re: Joint Commission 2012 Update Webinar


rxdave9 wrote:

In regards to contrast media (Readi Cat) handed out by the radiology secretary. Would this process past muster with JC. An order for the contrast is sent to pharmacy. The pharmacy reviews the order. The product is labeled with appropriate information (patient name, directions etc). The labeled contrast is then returned to the radiology department. The radiology secretary hands out to patient when they return to pick it up. (There is no outpatient pharmacy here to hand out the medication.). If this is not sufficient, can you comment on a process that would be? Thanks

 


ANSWER: This is acceptable as long as the State Board of Pharmacy allows the radiology secretary to act as an agent of the physician (radiologist).  I recommend you get a written ruling from the Board that you can show surveyors, if questioned.   Some states may require the radiology technician to dispense.