Professional Documents
Culture Documents
Allergy Documentation
Nurse/Pharmacy
Note: Allergy documentation is an interdisciplinary workflow and is recorded on multiple patient documentations Ex. Physician orders, allergy sheet, MAR etc
Technicians
Copy of allergy sheet is sent to technicians or written on med rec. form Tech enters allergy information into SoftRx
Technicians
Add medication to shelf inventory using FIFO process Continue with secondary task
YES
Tray Fills
Technicians
Split one type of pill manually using pill splitter Clean pill splitter and trays
Fill tray to designated Automed tray where custom lights provide a prompt or other manual tray Call designated inspector to verify in trays
Remove lower (multi dose or unit dose) unit from machine when prompted Pull unit to clear a path for replacement unit
Pull replacement unit into alignment with Auto Med machine, place into machine, close doors
Physician (MD)
Date specified?
NO
Drug will fall off the MAR and moves to the drug history in Soft Rx system
Pharmacy (Rx)/System
Note: o o
Physician (MD)
YES
NO
Pharmacy (Rx)
Tech can put comment in patient SoftRx file saying auto-substituted Not Auto Sub drug
Technicians
Note:
- If patient is going home then can put reference order of what the patient was originally on this order is not active and wont go on the MAR just in patient profile as a reference when patient is discharged - Currently no automatic auto subs in SoftRx (all manual process)
Tech 1
SCC fill report for unit to identify SMP patients per unit
Pharmacy tech modifies existing prescriptions that can be part of SMP program Pharmacy tech fills blister pack per schedule, leaving packs open
Pharmacist
AutoMed
Tech 1
Tech refers to specific cart fill schedule Meds put in bin for patient
Tech verifies each unit dose package for duplicates, crushed pills etc PRN and non-auto med drugs are checked
Tech 2
Load orders into cassette. Follow cart fill process Left over meds? No Reorganize trays as necessary.
Walk with cart to elevator, then to units medication area Swap bins from existing cassette with new bins.
Tech will move all non-auto multidose items (drops, creams) into new bin at time of exchange Yes
Tech 1
MD/RN
Tech 1
Order brought down or tech picks up order from pharmacy bin on unit Discontinued label prints out and is attached to prescription Enter new order in system Label prints out Picks meds
Not Approved
Tech 2
Checks meds
Approved
Pharmacist
Prior to cassette exchange tech will check for left over meds Yes Meds are dumped out
Tech
No
Tech will move all non-auto multidose items (drops, creams) into new bin at time of exchange
Tech will pick up all forms in pharmacy bin on unit Shortage of drug in Pharmacy? Keep label on want list book Print an extra label Yes after entering into system Try and source drug from sites if no Fill whatever amount of drug they have present Place purchase order for drug needed
Tech
Label prints
Fill Med
No
RN
Pharmacist
RN
RN fills narcotic requisition form (sometime will call or fill MAR req form)
Tech 1
Tech enters information from form into system Narcotic report is printed by unit/cart Narcotic is bagged and takes to unit
Tech 2
Tech checks & signs narcotic meds that have been filled
RN
RN will subtract amount taken from Narcotic Admin Sheet RN will sign the Narcotic Admin Sheet
Tech
Tech and nurse will identify narcotics to be removed from cart based on usage Tech witnesses signature Narcotics are taken down to Pharmacy Return entered into SCC by unit/ cart Returned to stock if expiry allows and added to perpetual count
Tech
Report will print in pharmacy from the med select which narcotics to fill Narcotic drawer will open
Tech will fill & charge narcotics in unit dose packs to the app. Med Select Both techs will take the unit dose narcotics to med select machine Tech 1 will enter drugs into Med select and scan barcode
Tech 2
Tech 2 will load Med Select coils with correct narc and close. Logs off Med Select
If RN has to give a narcotic the process will work the same as getting a medication from the Night Cupboard
MD
Rx
Nurse hand-delivers an order Pharmacist proposes changes Physician contacted for verification or physician changes
Tech 1
Tech 1
2nd pharmacy tech verifies paper entry on separate computer login for authentication and label prints
Physician (MD)
MD writes med to be discontinued on physician order sheet Copy of physician order sheet goes in Rx bin on unit
Nurse pulls d/c med is pulled and put in pharmacy bin on unit for pick up
Tech 1
Tech will pick up all items in Rx bin when on unit Discontinued label will print out Tech will affix label on order
Tech 2
Tech 2 will verify that tech 1 properly discontinued order and sign
Pharmacist
RN will put unit dose med in Rx bin on unit along with d/c physician order sheet Unit dose
Med being discontinued is unit or multi dose Will circle the med being discontinued and put a line through it Med will be pulled out of the package and discarded at time of administration Discontinued physician order sheet will go in Rx bin on unit
Nurse (RN/RPN)
Multi dose
Tech
Other
Pharmacy
Physician (MD)
Physician (MD)
MD will review the discharge med rec with the pharmacist and drug profile Order pulled MD signs
MD/RPh checks discontinues & discharged and modifies drug order according on physician order sheet
Pharmacist
Pharmacist will initiate a discharge med reconciliation form Med rec form finalized by pharmacist Signed form becomes the list of new orders
Tech
Patient/Family
IS THIS FLOW RIGHT?? Doesnt make sense according to corrections made by team
Bickle
11:30 am
UC
HC
1:30 am
UC
9:15 am
HC
Private Courier
Bickle
2:00 pm
LC (Thursday only)