pharmacy automation

Pharmacy Informatics Workgroup

Pharmacy Informatics Workgroup 1

PHARMACY AUTOMATION

GUIDANCE FOR THE CONTROLLED SUBSTANCE COORDINATOR

Part 1: The Inspection Process


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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.


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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


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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.


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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.


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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.


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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


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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


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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


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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


Pharmacy Informatics Workgroup 1

1

Delbert Siegmund, Pharm.D.

Chief of PharmacyDanville VAMC


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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.


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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


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CPRS Screenshot of Meds Tab


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CPRS Screenshot of Inpatient Medication Details

Scroll Down


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CPRS Screenshot of Inpatient Medication Details cont.


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CPRS Screenshot of Inpatient Medication

Details (IV example)


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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


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BCMA Medication Admin History Report


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BCMA Reports available in CPRS – Reports Tab


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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.


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Verification of Orders in Outpatient Areas

Outpatient CPRS prescription (ex Methadone maintenance)

OR Report (Same Day Surgery) Case Note (Cardiac Cath Lab,

Colonoscopy Suite)


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Jennifer Howard, Pharm.D.Director, Pharmacy Informatics

San Diego VAMC


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Methadone Maintenance Unit

AMS Avatar System

Verify opening amount, amount dispensed, quantity on hand.

Verify 5 orders as previously outlined


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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


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Automation Specific Discrepancy Reports

AcuDose Rx: Discrepancy by Station, Open Discrepancy By Station

MedSelect: Top 25 discrepancies Omnicell: Pharmacy Discrepancy

Report Pandora: Discrepancy Report Pyxis: All Discrepancies


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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


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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


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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


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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


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Inspecting the Pharmacy Narcotic Vault

Pyxis CII Safe

Omnicell Secure Vault


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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


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Outpatient Robotic Prescription Fill

Fast Fill Baker Cells ScriptPro


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Questions??? Marian Daum - Coatesville VAMC

Delbert Siegmund - Danville VAMC

Jennifer Howard - San Diego VAMC

Dionne Roney - Charleston VAMC

Jolene Hallcroft - Sheridan VAMC

pharmacy automation

Documents

pharmacy inventory

overall inspection process

inspection processrequirements

secure storage

vha handbook

nursing unit

omnicell secure vault

days worth of adc