Chapter 4 Pharmacy and Therapeutics Committee 2

Inpatient Prescribing a. Routine Drug Orders A physician’s medication order written on a patient order form is seemed a legal prescription. A legible copy of the medication order must be forwarded to the Pharmacy. Orders written by medical students must be countersigned by a member of the medical staff. Quantitates of drugs to be dispensed need not be specified since the pharmacist will determine optimum amounts keeping with greatest economy to the patient and efficiency in handling and storage by the nurse and pharmacy staff. b. I. V Orders Orders for intravenous medications must be written in the same manner as routine drugs and must include the following information: i. The exact quantity of the drug (s) which must be added; ii. The exact volume and name of the infusate solution; iii. Specific directions for administration such as IV drip, IV bolus, IV push, etc. iv. Specific times to hang infusate solution and drip rate and v. Specific directions for continuing or discontinuing any IV medications c. Total Parenteral Nutrition (TPN) TPN has been designated to serve as nutritional infusion providing essential amino acids, carbohydrates, and electrolytes for patients incapable of ingesting, digesting or absorbing food substances given by mouth. Since a standard hyperalimentation solution must always be prepared extemporaneously, the pharmacy department shall be responsible for the preparation of these solutions. d. Self-Medication Only Nitroglycerin and Antacids may be left to the patient’s bedside for self- administration if so ordered by the physician. The quantity of nitroglycerin is limited to 10 tablets which must be counted by the nurse at the conclusion of each shift and charted in the patient’s medical record. Antacids must be recorded and replenished in the same manner. e. Automatic Stop Orders Applies to instances when the physician did not specify the exact number of doses or duration of therapy (open ended drug order). The automatic stop order policy serves as a protection against indiscriminate and indefinite open ended drug orders that can be harmful to the patient and at the same time ensures continuous therapy if so desired by the physician. Automatic stop order requirements for medications are: 1. 24 hours for controlled drugs 2. 7 days for all other drugs f. A new medication order must be written by the physician if a change is wanted in route of administration or in dosage. g. Discharge Prescription A separate prescription is required for each medication which the patient is to take home. Discharge prescriptions must be received in the pharmacy prior to discharge, so that they may be processed and returned to the nursing station. Delays may result in the patient having to wait which is not consistent with food patient care. h. Emergency (STAT orders) Bonafide emergency orders should be rare and in most cases obtained from the nursing station emergency drug supplies. When necessary, these orders should be transmitted in writing on the pharmacy copy of the patient order form. This procedure prevents unnecessary delay and confusion which results from hurried verbal transmission orders. If it is necessary to phone the pharmacy of emergency drugs, calls should be placed either by the physician or the nurse in order to avoid delays and error. DRUG UTILIZATION REVIEW Drug utilization has been defined as the prescribing, dispensing, administering and ingesting of prescription drugs. Within the hospital, the Pharmacy and Therapeutic Committee provides the institutional authority for the formulary system of drug use control as well as the mechanism for the continuing education of physicians, nurses and pharmacists. Thus, some constitutions have initiated patient drug utilization profiles and medication history taking as part of their clinical pharmacy programs thereby enabling the pharmacists to monitor drug utilization within the hospital. Medication histories are taken by pharmacists of every patient administered to the hospital or seen in the ambulatory care section. These may be accomplished by personal interview or via computerized questionnaire specifically designed for the purpose. In addition to personal identification and general diagnosis, the following information is elicited: 1. Medications being taken at the time of admission 2. Medications taken during the recent past ( Including antibiotics) 3. Home remedies (OTC drugs) used 4. Drug allergies 5. Laboratory tests performed out of the hospital during which diagnostic agents were ingested 6. Idiosyncrasy towards food products The Patient drug profile is developed by the pharmacists for the following purposes: 1. To help improve the prescribing practices by promoting the safe and rational use of drugs 2. To detect and help prevent potential drug interactions 3. To help detect and prevent adverse drug reactions in sensitive patients 4. To detect and prevent IV additive incompatibilities 5. To detect drug induced laboratory test abnormalities 6. To detect possible drug induced diseases 7. To help detect and prevent potential drug toxicities When the Patient Medication Profile, Patient history, and Laboratory Procedure Profile are compared, the pharmacist is in excellent position to monitor proper drug utilization.