Pharmacy Department Overview & Prescription Regulations

House Staff Orientation 2015

University of Utah Hospitals and Clinics

Salt Lake City, UT

Overview

• University of Utah Hospitals & Clinics overview

• Department of Pharmacy Services overview

• Pharmacy patient care services

• Prescription Regulations

• Tips for your success

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University of Utah Hospitals & Clinics

• Four Hospitals:– University Hospital– Huntsman Cancer Hospital– University Orthopedic Center– University Neuropsychiatric Institute

• Ten Community Health Centers• Several Specialty Centers

– Moran Eye Center– Cardiovascular Center– Utah Diabetes Center– Clinical Neurosciences Center

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University of Utah Hospitals & Clinics

• Four Hospitals:– University Hospital– Huntsman Cancer Hospital– University Orthopedic Center– University Neuropsychiatric Institute

• Ten Community Health Centers• Several Specialty Centers

– Moran Eye Center– Cardiovascular Center– Utah Diabetes Center– Clinical Neurosciences Center

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UUHC Pharmacy Services are

prevalent in nearly every UUHC

location. Do not hesitate to ask for

help!

UUHC Pharmacy Services• Outpatient Pharmacy Services

– 14 retail pharmacies • Discharge medication reconciliation and bedside prescription services• Accepts most major prescription plans• Competitive pricing

– $4 pricing on many commonly used medications– https://pulse.utah.edu/site/dirc/Pages/4-dollar-drug-list.aspx– Possible to fill for a 90 day supply

• Mail order available• Accepts e-prescriptions, except C-II medications

– Patient Assistance Program– Thrombosis Consult Service– Pharmacists in specialty clinics– Medication therapy management (MTM) in many locations– Medicare Part D enrollment assistance

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UUHC Pharmacy Services• Infusion Pharmacy Services

– Three ambulatory infusion centers throughout the valley that provide services 7 days a week

• University Hospital• South Jordan• Huntsman (primarily oncology infusions)

– University Home Infusion Pharmacy • Focuses on home intravenous therapy on patients discharged from UUHC

facilities– Total parenteral nutrition– Anti-infective agents

• Service provides comprehensive insurance reviews and works with medical team to determine most appropriate medication based on vascular access

• Service available 24/7: 801-587-8600

UUHC Pharmacy Services• Inpatient Pharmacy Services

– Centralized operations: 24/7• Drug distribution• Medication preparation

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UUHC Pharmacy Services• Inpatient Pharmacy Services (continued)

– Decentralized clinical services on nearly all inpatient units 7 days a week, generally from 0700-1500 (some areas have staff until 2300)

• Pharmacist rounding and consults• Drug information• Formulary recommendations• Medication monitoring• Medication policy guidance• Epic navigation assistance• Home medication reconciliation

Medication Reconciliation

Pharmacy staff will review within 24 hours of admission

Prescription Regulations• First year residents (unlicensed)

– Permitted to write for inpatients of affiliated hospitals: includes controlled and non-controlled substances

– No outpatient prescription writing permitted

• Second year residents and older (licensed, DEA and NPI)– Permitted to write for controlled and non-controlled

substances for both inpatients and outpatients– Prescriptions can be filled in any Utah pharmacy

Prescription Requirements• Prescriber’s name, address, telephone, NPI• Patient’s name and address• Name of medication, strength, dose, quantity, route and

directions for use• Prescriber’s signature, printed prescriber’s name, contact

number• Date prescription written• # of refills• ****For controlled substances*****

– Patient’s date of birth– Prescriber’s DEA

• ****Remember, C-II’s have to be written and cannot be processed electronically

Other Relevant Rules• Providers MAY NOT write controlled substance

prescriptions for personal use or for family members• Medicaid patients:

– Providers must be registered as a “limited provider”– If not registered, an attending who is registered must sign

the prescription– GME Office handles this process

• Medicare patients:– Providers must be registered for Provider Enrollment,

Chain and Ownership System (PECOS)– GME Office handles this process

Tips for Your Success• Know your pharmacist – some is there to help you all hours of

the day• Use Epic – tips

– Order sets– Understand phase of care (tip sheets)– Limit use of comment fields– Watch for therapeutic duplication– All PRN orders must have specific instructions (mild, moderate, severe

pain) and you may not have 2 meds ordered with the same indication. – Preference list has formulary status

• Medication reconciliation of home medications– If possible, wait for the pharmacist to complete the medication

reconciliation– DO NOT just reorder medications from the clinic list!

Tips for Your Success• Know the on-line tools

– On-line formulary– Pharmacy & Therapeutics Committee approved guidelines,

restrictions, and policies• Therapeutic interchanges• IV to PO policy• Restricted medication policy

– https://pulse.utah.edu/policies/Lists/Policies/DispForm.aspx?ID=2313– Medications that require medical director approval (Smartweb – Medical

Director)» Outpatient only list» Factor VII (NovoSeven® RT)» Immune Globulin (IVIG)» Other high cost or high impact medications (REMS)

– Restricted anti-infectives (Smartweb – Stewardship or ID Pharmacist)» Caspofungin (Cancidas®)» Daptomycin (Cubicin®)» Linezolid (Zyvox®)

Tips for Your Success• Know the on-line tools (continued)

– Restricted medication policy• https://pulse.utah.edu/policies/Lists/Policies/DispForm.aspx?ID=2313• Medications that require medical director approval (Smartweb – Medical

Director)– Outpatient only list– Factor VII (NovoSeven® RT)– Immune Globulin (IVIG)– Bivalirudin (Angiomax®)– Dofetilide (Tykosyn®) – Inhaled nitric oxide (INOmax®) – Dalteparin (Fragmin®)– Other high cost or high impact medications (REMS)

• Restricted anti-infectives (Smartweb – Stewardship or ID Pharmacist)– Caspofungin (Cancidas®)– Daptomycin (Cubicin®)– Linezolid (Zyvox®)

Tips for Your Success• Use Pulse for assistance – there is a wealth of information on

the internal website to assist with your prescribing questions• Let us help with the discharge process

– Call us early and if possible, engage us days in advance of discharge– Many medications require prior authorization – We want to ensure that the patient has access to the medication and

will obtain it upon discharge

• Ask us for help!– Pharmacists should be available in most patient care areas or via

Smartweb– If you need help off-hours, call the University Hospital Central

Pharmacy at 801-585-2330