Pharmacy

From Guide to YKHC Medical Practices

Pharmacy verifies every order and presciption you place. They often catch mistakes. Please, be nice to them when they call you!

Introduction

Our pharmacists are a great resource. Always feel free to ask the pharmacists questions. They are always willing to look up things.

We do have a limited formulary and all formulary items are designated with a green circle, a yellow triangle, or a red square in PowerChart/FirstNet.

Pharmacy Indicators.png

These symbols cannot be seen within the Dynamic Documentation workflows however, if medications are selected from PowerPlans or folders, they will be on formulary. The pharmacists will call you if you order something not on the formulary. If you want to order a non-formulary item you can use a Non-Formulary Request form and the pharmacist will determine if the non-formulary item is allowed.

Pharmacy also manages Coumadin patients and does their INRs in the pharmacy in Bethel or village clinic coordinating with the local Health Aide.

Outpatient pharmacists are also available for comprehensive medication review, dosing consultations, pain management, poly-pharmacy review for elders, and prior authorizations.

Pharmacy Roles

Clinic Pharmacist

  • Monday-Friday 8:30am-5:30pm, closed holidays
  • Clinic A, B, and C pharmacist roles are available in tigertext

Clinic pharmacists are physically located in the ambulatory clinics and are readily available to help answer medication related questions for providers and patients. One of their main responsibilities is to manage the thousands of refill requests that come through the pharmacy each month. A clinic pharmacist receives the refill requests, evaluates whether the patient and their prescription meet the criteria defined in the Pharmacy Refill Protocol, and if they do, the pharmacist is able to renew the prescription on the providers behalf without the request even being sent to the provider. When the prescription/patient do not meet the refill protocol requirements the pharmacist will propose the medication to the provider for approval. If the refill request is for a controlled substance, a message will be sent to the provider in message center with the details about the request.

Clinic pharmacists are also responsible for anticoagulation monitoring for our patients on Coumadin. They are available for completing Drug Utilization Reviews in order to make recommendations about maximizing therapy and minimizing drug interactions, as well as patient counseling upon request by a provider. Clinic pharmacists also spend a significant amount of time gathering information to submit to insurance companies for prior authorizations.

MAT Pharmacist

The MAT Pharmacist works closely with the MAT (Medical Assistance Team) program to assist with initiation and ongoing treatment of patients with substance use disorders. This person also has responsibilities related to the pain committee and facilitates regular pain committee meetings, pill audits, and urine drug screens when necessary.

Outpatient Pharmacist

  • Monday-Friday 9am-7pm , closed holidays
  • Outpatient Pharmacy 1 and Outpatient Pharmacy 2 pharmacist roles are available in tigertext

Outpatient pharmacists are responsible for traditional “pharmacy” jobs associated with filling prescriptions. There are typically 5 outpatient pharmacists scheduled each day. Two of the five are responsible for data entry, two are responsible for verification/checking of completed prescriptions, and the fifth pharmacist does most of the counseling and floats between data entry and checking depending on the need. Data entry for each prescription is done by a pharmacist who has access to the patient chart. A clinical review is done by the data entry pharmacist who evaluates the prescription for appropriate therapy, dose, frequency, duration, etc. Once the prescription has been entered by a pharmacist, the prescription is filled by a technician and then checked by a second pharmacist. This pharmacist is also doing a clinical check, but they are also checking the final product to make sure that what has been prepared for the patient matches what was prescribed. Once a new prescription has been verified, patients will be called to a counseling room to speak with the counseling pharmacist who will tell them about their medication, expected or possible side effects, how and when to take it and any potential drug interactions. The multi pharmacist involvement is by design to decrease errors and ensure that our patients get the very best care.

“Outpatient pharmacy” is where prescriptions are filled. In Cerner, there are two different pharmacies. There is a YKHC Pharmacy and a YKHC Clinic Dispensed Pharmacy. Sometimes there is confusion about which of them should be chosen by the ordering provider. There are always exceptions to every rule, but in general, if it is something that should be filled by the pharmacy and given/mailed to the patient, it should be sent to YKHC Pharmacy. If the prescription is documentation of something that a patient received in a village clinic or the Emergency Room (to take home with them), then the prescription should be sent to the Clinic Dispensed Pharmacy.

Village Ops Pharmacist

  • Monday-Friday 8:30am-5:30pm, closed holidays
  • Village Ops pharmacist available in tigertext

Village Ops pharmacist is a newer position within the department. It is a pharmacist who is specifically responsible for prescriptions that are sent to the Clinic Dispensed Pharmacy. The Village Ops pharmacist receives and reviews the prescriptions written pursuant to health aide, SRC provider, or village travel visits, as well as prescriptions written in the emergency room overnight (that were removed from the pickpoint). They are a great, dedicated resource for providers in villages and for health aides and SRC providers.

Inpatient Pharmacist

  • 7 days a week 7 am-7 pm
  • Pharmacist on-call 24 hours a day
  • Inpatient Pharmacy on-call pharmacist role available in tigertext
  • Inpatient Pharmacy will respond to Code Blues, intubations, C-sections, or other critical patients during business hours if their presence is requested. They are available for consults outside of regular hours, and will come in when the situation meets these criteria
    • medications only stocked in pharmacy (e.g. hypertonic 3% saline, altaplase)
    • certain level of trauma
    • mass casualties

Inpatient Pharmacists are responsible for care of patients in the inpatient units (Adult, Peds, and OB), as well as patients in the Emergency room and in the OR. All orders are verified by a pharmacist and the majority of orders are available in an automated dispensing cabinet (Pyxis) on each unit. But, when the ordered medication is not available on the unit, or is an injectable medication that needs to be compounded by the pharmacy, the medication will be prepared in the pharmacy and will be delivered to the unit for administration to the patient. Inpatient pharmacists are trained to participate in rapid sequence intubations when requested and assist with Codes. Inpatient pharmacists attend multidisciplinary rounds on admitted patients and make therapy recommendations when appropriate. Inpatient pharmacists play a vital role in antibiotic stewardship in the inpatient setting, and are great resources for drug questions of all kinds.

Scope of Services

Pharmacy services are patient-centered and are directed toward optimal patient care outcomes, health promotion, and disease prevention. Pharmacy services purpose is to assure efficacious, safe, and cost- effective drug therapy and appropriate outcomes in the use of drugs and medicines in the communities served.

Outpatient Services: Medical history review, interviewing patients for medication history, filling of prescriptions, patient counseling/education including food/nutrient interactions, cytotoxic IV preparation, distribution of medications to village and subregional clinics, drug information.

Inpatient Services: Preparation of sterile products (IV admixtures, piggybacks, syringes), medication histories, monitoring of drug therapy, drug information, discharge counseling/education on medications including food/nutrient interactions.

Drug Information/Education: Provided by a licensed pharmacist for patients and health care providers.

Personnel/Administration & Management: Recruitment and retention, staff development, development of department budget, maintains appropriate records for controlled substances, personnel management, scheduling, planning.

Supply and Distribution: Procurement of needed supplies from various vendors; distribution of medications to nursing units and clinics, vaccines to villages and clinics, prepackaging of medications and monitoring drug recalls, inventory management, cost accounting.

QC/QA/QI: Maintain Drug Utilization Reviews, Pharmacy and Therapeutics Committee, Drug Utilization Evaluations, Quality Controls, Adverse Drug Reactions, Non-Formulary requests, Clinical Guidelines, Staff Competencies/Training, and other Quality Improvement activities.

Mechanism Used to Meet Patient Care Needs

The Pharmacy maintains a QC/QA/QI plan which includes drug utilization review, drug utilization evaluations, adverse drug reaction monitoring, non-formulary request monitoring, clinical guideline monitoring/development, competency evaluations, pharmacist/DEA/FDA license monitoring, pharmacists dispensing review, chemotherapy dispensing review, Pharmacy & Therapeutics Committee activities, and various other quality control (patient waiting times, assessment of patient understanding of counseling, etc.) and quality improvement activities as determined. The Pharmacy also maintains workload indicators that are used to determine the application of existing resources and for strategic planning.

How the Unit is Staffed to Meet Patient Care Needs

The Pharmacy is staffed with 45 pharmacy employees. Pharmacists account for 20 FTE's, Technicians account for 20 FTE's, and other support staff for 5 FTE's. Competency of staff is determined as new staff goes through orientation and the initial 3- month probationary period, in addition, each employee has an annual competency evaluation in conjunction with their performance appraisal. Workload indicators are continually monitored for adjustments in staffing (location, hours, FTE's, etc.).

Process Used for Acting on Both Positive and Negative Variances

The Pharmacy Department monitors workload activities and builds staffing schedules to accommodate the provision of care. Training and leave requirements are adjusted in order to assure the proper provision of care. Recruiting activities are on going and pharmacy intern(s) and TDY(s) fill any gaps in staffing.

Formularies

Formularies at YKHC are managed by Pharmacy through the P&T Committee.

Follow this link to see links to pdf files of YKHC formularies for the main hospital, sub-regional clinics, and village clinics. A link to the Lifemed medevac formulary is also included.

Non-Formulary Medication Requests

POLICY: Non-Formulary Medication Requests (links to MCN)

Requests for non-Formulary Medication are made when an alternate medication already on the YKHC formulary is not appropriate for patient care.

Any provider can request a medication be obtained as non-formulary by filling out [this form]. It is reviewed and approved/rejected by the pharmacy director. To maximize the chances of the drug being approved, include as much information as possible, including other regimens that have been tried, history of intolerances, reasons why formulary options are not appropriate, etc.

If three or more patients are on a non-formulary drug, it will be brought to P&T to vote on adding it to the formulary.

Click here for a fillable request form located in Policy Manager.

Pharmacy Things to Know

Click above to see a list of pharmacy clinical pearls for providers.

category:Ancillary Services