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1229 Cards in this Set

  • Front
  • Back
a.d.
right ear
a.s.
left ear
a.u.
each ear
i.m., IM
intramuscular
inj.
injection
i.v., IV
intravenous
IVPB
intravenous piggyback
n.p.o
nothing by mouth
o.d.
right eye
o.s.
left eye
o.u
each eye
p.o
by mouth
pr
per rectum
pv
per vagina
sl
sublingual
sq or sc
subcutaneous
top
topical
aq
water
aqua.dist
distilled water
caps
capsules
DW
distilled water
elix
elixir
liq.
liquid
MDI
Metered dose inhaler
NS
normal saline
supp.
suppository
syr.
syrup
tab.
tablet
ung.
ointment
a.c
before food, before meals
a.m
morning
a.t.c
around the clock
b.i.d, bid
twice a day
h
hour, at the hour
h.s
at bedtime (hour of sslep)
p.c
after food, after meals
p.r.n, prn
as needed
q.i.d, qid
four times a day
q
each , every
q.d
every day
q.h
every hour
q.h
every hour
q.o.d
every other day
stat.
immediately
t.i.d, tid
three times a day
a.a or aa
of eac
ad
add quantity up to
cc
cubic centimeter (mL)
dil
dilute
div
divide
f, fl.
fluid
g., G, gm
gram
gr
grain
gtt(s)
drop (s)
L
liter
mcg
microgram
mEq
milliequivalent
mg
milligram
mL
milliliter
oz
ounce
q.s
sufficient quantity
qsad
add sufficient quantity to make
ss
one-half
tb sp.
tablespoon
tsp.
teaspoon
u
unit
a.
before
ad
as directed
AAA
apply to affected area
ad lib.
at preasure
agit
shake, stir
amp.
ampule
aur.
ear
aurist
ear drops
brach.
the arm
BP
blood pressure
BSA
body surface area
c
with
collun
nose wash
collut
a mouthwash
collyr
an eyewash
comp.
compound
c.c.
with food, with meals
d.
right
disp.
dispense
emuls.
emulsion
et
and
HA
headachd
I
left
lin.
liniment
lot.
lotion
MR
may repeat
n.
at night
narist.
nasal drops
neb.
a spray
N>F.
National Formulary
non.rep.
do not repeat
NTE
not exeed
occulent.
eye ointment
o.
eye
p.r
per rectum
PTE
prior toexercise
pulv.
powder
s
without
SOB
shortness of breath
sig.
write, label
sol.
solution
tinc.;tr
tincture
ut dict., u.d.
as directed
WF
with food
a
without
ambi
both
ante
before
anti
against
bi
two
brady
slow
chlor
green
chondro
cartilage
circum
around
cirrh
yellow
con
with
contra
against
cyan
blue
dia
across or through
dis
sepeart from or apart
ecto
outside
end
within
epi
upon
erythr
ered
eu
good or normal
exo
outside
hepato
pertaining to the liver
heter
different
homo
same
hyper
above or excessive
hypo
below or deficient
im
not
imun
safe, protected
in
not
infra
below or under
inter
between
intra
within
iso
equal
leuk
white
macro
large
medi
middle
melan
black
meso
middle
meta
beyound, after, changing
ac
pertaining to (Example: hemophiliac)
al
pertaining to (Example: neural)
algia
pain (Example: fibromyalgia)
ar
pertaining to (Example: macular)
ary
pertaining to (Example: apothecary)
asthenia
without strength (Example: myasthenia)
cele
pouching or hernia (Example: blastocele)
eal
pertaining to (Example: perotoneal)
ectasis
expansion or dilation (Example: venectasis)
ectomy
removal (Example: tonsilectomy)
emia
blood (Example: anemia) condition
gram
record (Example: mammogram)
graph
recording instrument (Example: cardiograph)
graphy
recording process (Example: cardiography)
ia
condition of (Example: hernia)
iasis
condition, formation of (Example: psoriasis)
iatry
treatment (Example: podiatry)
ic
pertaining to (Example: aerobic)
icle
small (Example: cuticle)
ism
condition of (Example: metabolism)
itis
inflammation (Example: rhinitis)
ium
tissue (Example: epithelium)
lith
stone, calculus (Example: urolith)
logy
study of (Example: biology)
malacia
softening (Example: chondromalacia)
megaly
enlargement (Example: cardiomegaly)
meter
measuring instrument (Example: barometer)
metry
measuring process (Example: telemetry)
oid
resembling (Example: cuboid)
ole
small (Example: arteriole)
oma
tumor (Example: lymphoma)
opia
vision (Example:presbyopia)
osis
abnormal condition (Example: halatosis)
ous
pertaining to (Example: squamous)
paresis
partial paralysis (Example: hemiparesis)
pathy
disease (Example: myopathy)
penia
decrease (Example: neutropenia)
phagia
swallowing (Example: dysphagia)
phasia
speech (Example: aphasia)
philia
attraction for (Example: hemophilia)
phobia
fear of (Example: acrophobia)
plegia
paralysis, stroke (Example: quadriplegia)
rrhea
discharge (Example: diarrhea)
sclerosis
narrowing, constriction (Example: arteriosclerosis)
scope
examination instrument (Example: stethoscope)
scopy
examination (Example: laryngoscopy)
spasm
involuntary contraction (Example: bronchospasm)
stasis
stop or stand (Example: homeostasis)
tic
pertaining to (Example: otic)
tocia
childbirth, labor (Example: embryotocia)
tomy
incision (Example: labotomy)
toxic
poison (Example: hepatotoxic)
tropic
stimulate (Example: hetrotropic)
ula
small (Example: blastula)
y
condition (Example: itchy)
Hospital pharmacy, though different, contains enough on-the-job similarities that, with some brief training, this portion of the exam should not be difficult. Hospital pharmacies use many of the same medications as those dispensed in retail pharmacies, so your current medication knowledge will serve you well. The differences that do exist between the two environments can be summed up in the four sections discussed below.
The Unit Dose System
A. This is a medication distribution system that hospitals use to issue oral medications to each patient. Each dose of each medication is individually packaged either by the pharmacy or the drug manufacturer. Since hospitals are giving care to the acutely ill, the medication regimens are constantly changing. Therefore, it would be costly and time consuming to dispense medications for more than one or two days at a time.
B. Each unit in the hospital is given two medication carts (also known as medication cassettes) which hold medication drawers (one for each patient). At any given time throughout the day, one cart is on the floor where the nurses have access to the patients’ medications and the other cart is in the pharmacy waiting to be filled for the next day.
                                               
    Unit Dose Carts
C. The technician’s role in the unit dose system is essential. It is the job of the technician to fill all the medication drawers according to a computer printout of what each patient is currently receiving. This position is generally referred to as the "unit dose cart fill technician." Most large hospitals fill their unit dose carts on the graveyard shift when the pharmacy is quiet and relatively free from distractions.
D. There are a few hospitals who have chosen an automated system to fill unit dose carts. However, this involves the purchase of a large, costly, and cumbersome robotic arm that requires a large amount of pharmacy space. It is uncommon to see one of these robots in use, but you should be aware of their existence.
Go To Top
Physician Medication Orders
A. Medication orders in a retail pharmacy are in the form of prescriptions. In a hospital, the medication orders are written on a pre-printed form that prints in duplicate. One sheet stays on the floor with the patient’s chart and one is sent to the pharmacy for processing. Hospital physician medication orders are not just for medications that the patient will receive but also for tests, procedures, and any other instructions to hospital staff concerning the patient's therapy.
B. Medication orders are put into the computer by technicians, just as in retail, when prescription order entry is performed by technicians. In a hospital, the orders are either sent by way of personnel or by pneumatic tube. A pneumatic tube system runs throughout the hospital and travels on a vacuum that pulls the tube to the desired destination – much like the pneumatic tubes used in the drive-through lanes of many banks. Once the orders are received, a technician will enter the orders into the computer. When the orders have been input, a pharmacist will log-on to the computer and check all the order entries against the original orders, then verify all orders electronically. The act of verification is a signal to the computer system that the orders are ready to be filled for the medications requested. Labels are automatically generated and then filled, as in retail.
Go To Top
Hospital Formulary:
A. A formulary is a list of medications that the pharmacy agrees to stock. A hospital formulary is the list of drugs that the hospital pharmacy will have on hand and are approved for use by the hospital. Because of the high cost associated with stocking a large inventory of medications, a hospital will determine which drugs from a particular therapeutic classification it will keep on hand. This decision is based on the cost and the efficacy (effectiveness) of the drug.
B. Example: Let’s look at ABC Community Hospital. Their formulary committee (made up of doctor’s, pharmacists and hospital administrators) is trying to decide which Proton Pump Inhibitor (PPI) they will stock in their pharmacy for use in the hospital. Since there are several PPI’s currently available and all are quite expensive, they must choose only one or two. If they determine that all of the drugs are equally effective, they will research the cost. Once they determine which drug is the most cost effective, they will add that drug to the hospital formulary. Most formulary decisions however, are not made so easily. Committees frequently run into situations where one drug has been proven slightly more effective but costs more to stock than other alternative drugs. The formulary committee must then do a cost-benefit analysis to determine which drug to stock.So, let us suppose that a doctor at the hospital orders a PPI that is other than the one on the formulary. The pharmacy will be allowed to automatically "switch" the order to the PPI that is on the formulary. This switch is called a "therapeutic substitution"*. There are also times when a doctor will order a drug that is not on the formulary but would really like to have it for his/her patient. The doctor will usually have to fill out a "non-formulary request" form. Then the pharmacy will either order the drug from their wholesaler or buy it from another local pharmacy (usually the closest retail location). Then, when the patient goes home, or is no longer on the non-formulary drug, the pharmacy will stop stocking the item.
C. The primary purpose of a hospital formulary is to keep the pharmacy inventory costs down, thus, keeping down the cost of health-care for patients.
*Please note the difference in retail pharmacies. Therapeutic substitutions cannot automatically take place. The pharmacist must consult with the patient and their physician before switching a drug that has been ordered.
Go To Top
Sterile Products
                   
Hospital pharmacy, though different, contains enough on-the-job similarities that, with some brief training, this portion of the exam should not be difficult. Hospital pharmacies use many of the same medications as those dispensed in retail pharmacies, so your current medication knowledge will serve you well. The differences that do exist between the two environments can be summed up in the four sections discussed below.
A. Laminar flow hoods are sterile cabinets that are used to prepare sterile products. There are two types of hoods used:
1. The horizontal flow hood is used to prepare sterile products that are not considered chemotherapeutic or toxic upon contact. Most of the IV preparations for a hospital are prepared in the horizontal hood. The horizontal flow hood is a cabinet with a work area. Air is sucked in through a filter at the bottom of the cabinet and then is blown up the back of the cabinet and forced through a HEPA (high efficiency particulate air) filter. A HEPA filter is a particulate filter that is 99.97% efficient at removing particles 0.3 microns or larger. Once the air is forced through the HEPA filter, it is blown horizontally across the work surface toward the technician. To ensure that all products remain exposed to the HEPA filtered air, the technician must be sure to never move or place one product behind another in a horizontal flow hood. The technician must work at least 6 inches inside the hood. This ensures that the filtered air is protecting the technician's work. When cleaning this type of hood, a technician must start the cleaning process from the back of the hood and work toward the front, cleaning the stainless steel work surface.
2. The other hood is called a vertical flow hood. The vertical flow hood is used to prepare toxic and dangerous substances. This hood works on the same principle as the horizontal hood; however, the HEPA filtered air is blown vertically down from the top of the cabinet. To ensure that all products remain exposed to the HEPA filtered air, the technician must be sure to never move one product over another in a vertical flow hood. The front of the cabinet is enclosed with a space at the bottom large enough for the hands and arms. This configuration along with the vertical airflow, protects the technician from the toxic drugs (usually chemotherapy) he/she is preparing. The technician must also wear a solid front gown and double glove for added protection. As with a horizontal flow hood, when cleaning a vertical flow hood, a technician should start the cleaning process from the back of the hood and work toward the front, cleaning the stainless steel work surface.
**Note: All Laminar Flow Hoods must be cleaned with 70% isopropyl alcohol.
**Note: Certification of laminar flow hoods must occur once a year, to ensure the hoods are functioning properly.
B. Preparation of sterile products is very important to the safety of every patient in the hospital. Hospital pharmacy technicians function under the standards of universal precautions and practice aseptic technique.
The Unit Dose System
A. This is a medication distribution system that hospitals use to issue oral medications to each patient. Each dose of each medication is individually packaged either by the pharmacy or the drug manufacturer. Since hospitals are giving care to the acutely ill, the medication regimens are constantly changing. Therefore, it would be costly and time consuming to dispense medications for more than one or two days at a time.
B. Each unit in the hospital is given two medication carts (also known as medication cassettes) which hold medication drawers (one for each patient). At any given time throughout the day, one cart is on the floor where the nurses have access to the patients’ medications and the other cart is in the pharmacy waiting to be filled for the next day.
                                               
    Unit Dose Carts
1. Universal precautions are a nationally recognized set of standards for the safe handling of drugs and contaminated substances in the hospital. This includes dealing with patients who have communicable diseases. Universal Precautions are a set of standards that hospital personnel follow to ensure their own personal safety. This includes such practices as safe clean-up of potentially infectious body fluids, disposal of needles and contaminated materials, wearing gowns/gloves/masks/etc., and clean-up of toxic or caustic chemical spills (chemotherapy, nitroglycerin, etc.). Universal precautions are used throughout the hospital by all personnel from doctors to housekeeping.
2. Aseptic technique is also a nationally standardized practice. Aseptic technique literally means "without sepsis". Sepsis is typically a bloodborne infection. Therefore, the purpose of using aseptic technique to make an IV for a patient, is sterility. If the patient doesn't get a sterile IV product, they are susceptible to blood-borne infections. Aseptic technique is a standard way of making IV's that ensures sterility. For instance, when making IV's, a technician must work at least six inches inside the flow hood. Also, the way that you move things around inside the hood, always ensuring clean air flow over the IV products, is a part of aseptic technique. An obvious component of aseptic technique is to never sneeze, cough or talk while compounding IV's inside a flow hood (an obvious assault to sterility). Following the standards for aseptic technique ensures that a patient will receive a sterile product.
C. Calculating IV doses is another integral part of hospital pharmacy. Yet, the calculations done in a hospital are by and large the same as those done in a retail setting. The dosage calculation chapter of this manual will show you how to use a technique called cross-multiplication to figure most calculations you come into contact with. This includes figuring doses for IV preparation. It is important to remember that, though this technique is not difficult to learn, it will take some practice. Remember to take notes and then repeatedly practice everything you learn until it comes naturally to you.
C. The technician’s role in the unit dose system is essential. It is the job of the technician to fill all the medication drawers according to a computer printout of what each patient is currently receiving. This position is generally referred to as the "unit dose cart fill technician." Most large hospitals fill their unit dose carts on the graveyard shift when the pharmacy is quiet and relatively free from distractions.
D. There are a few hospitals who have chosen an automated system to fill unit dose carts. However, this involves the purchase of a large, costly, and cumbersome robotic arm that requires a large amount of pharmacy space. It is uncommon to see one of these robots in use, but you should be aware of their existence.
Go To Top
Physician Medication Orders
A. Medication orders in a retail pharmacy are in the form of prescriptions. In a hospital, the medication orders are written on a pre-printed form that prints in duplicate. One sheet stays on the floor with the patient’s chart and one is sent to the pharmacy for processing. Hospital physician medication orders are not just for medications that the patient will receive but also for tests, procedures, and any other instructions to hospital staff concerning the patient's therapy.
B. Medication orders are put into the computer by technicians, just as in retail, when prescription order entry is performed by technicians. In a hospital, the orders are either sent by way of personnel or by pneumatic tube. A pneumatic tube system runs throughout the hospital and travels on a vacuum that pulls the tube to the desired destination – much like the pneumatic tubes used in the drive-through lanes of many banks. Once the orders are received, a technician will enter the orders into the computer. When the orders have been input, a pharmacist will log-on to the computer and check all the order entries against the original orders, then verify all orders electronically. The act of verification is a signal to the computer system that the orders are ready to be filled for the medications requested. Labels are automatically generated and then filled, as in retail.
Go To Top
Hospital Formulary:
A. A formulary is a list of medications that the pharmacy agrees to stock. A hospital formulary is the list of drugs that the hospital pharmacy will have on hand and are approved for use by the hospital. Because of the high cost associated with stocking a large inventory of medications, a hospital will determine which drugs from a particular therapeutic classification it will keep on hand. This decision is based on the cost and the efficacy (effectiveness) of the drug.
B. Example: Let’s look at ABC Community Hospital. Their formulary committee (made up of doctor’s, pharmacists and hospital administrators) is trying to decide which Proton Pump Inhibitor (PPI) they will stock in their pharmacy for use in the hospital. Since there are several PPI’s currently available and all are quite expensive, they must choose only one or two. If they determine that all of the drugs are equally effective, they will research the cost. Once they determine which drug is the most cost effective, they will add that drug to the hospital formulary. Most formulary decisions however, are not made so easily. Committees frequently run into situations where one drug has been proven slightly more effective but costs more to stock than other alternative drugs. The formulary committee must then do a cost-benefit analysis to determine which drug to stock.So, let us suppose that a doctor at the hospital orders a PPI that is other than the one on the formulary. The pharmacy will be allowed to automatically "switch" the order to the PPI that is on the formulary. This switch is called a "therapeutic substitution"*. There are also times when a doctor will order a drug that is not on the formulary but would really like to have it for his/her patient. The doctor will usually have to fill out a "non-formulary request" form. Then the pharmacy will either order the drug from their wholesaler or buy it from another local pharmacy (usually the closest retail location). Then, when the patient goes home, or is no longer on the non-formulary drug, the pharmacy will stop stocking the item.
C. The primary purpose of a hospital formulary is to keep the pharmacy inventory costs down, thus, keeping down the cost of health-care for patients.
*Please note the difference in retail pharmacies. Therapeutic substitutions cannot automatically take place. The pharmacist must consult with the patient and their physician before switching a drug that has been ordered.
Go To Top
Sterile Products
                   
A. Laminar flow hoods are sterile cabinets that are used to prepare sterile products. There are two types of hoods used:
1. The horizontal flow hood is used to prepare sterile products that are not considered chemotherapeutic or toxic upon contact. Most of the IV preparations for a hospital are prepared in the horizontal hood. The horizontal flow hood is a cabinet with a work area. Air is sucked in through a filter at the bottom of the cabinet and then is blown up the back of the cabinet and forced through a HEPA (high efficiency particulate air) filter. A HEPA filter is a particulate filter that is 99.97% efficient at removing particles 0.3 microns or larger. Once the air is forced through the HEPA filter, it is blown horizontally across the work surface toward the technician. To ensure that all products remain exposed to the HEPA filtered air, the technician must be sure to never move or place one product behind another in a horizontal flow hood. The technician must work at least 6 inches inside the hood. This ensures that the filtered air is protecting the technician's work. When cleaning this type of hood, a technician must start the cleaning process from the back of the hood and work toward the front, cleaning the stainless steel work surface.
2. The other hood is called a vertical flow hood. The vertical flow hood is used to prepare toxic and dangerous substances. This hood works on the same principle as the horizontal hood; however, the HEPA filtered air is blown vertically down from the top of the cabinet. To ensure that all products remain exposed to the HEPA filtered air, the technician must be sure to never move one product over another in a vertical flow hood. The front of the cabinet is enclosed with a space at the bottom large enough for the hands and arms. This configuration along with the vertical airflow, protects the technician from the toxic drugs (usually chemotherapy) he/she is preparing. The technician must also wear a solid front gown and double glove for added protection. As with a horizontal flow hood, when cleaning a vertical flow hood, a technician should start the cleaning process from the back of the hood and work toward the front, cleaning the stainless steel work surface.
**Note: All Laminar Flow Hoods must be cleaned with 70% isopropyl alcohol.
Go To Top
IV Compounding
There are many different types of IV’s that are made in hospital and compounding pharmacies. We will describe some of these different types in the paragraphs to follow. All IV’s, no matter how they differ in size or ingredients, have one important thing in common, they must ALL be prepared using aseptic technique. Aseptic technique will vary depending on the type of hood used in the preparation of the IV. There are two types of compounding hoods*, a horizontal flow hood and a vertical flow hood (a.k.a. chemo hood). Aseptic technique, whether employed in a horizontal or vertical flow must accomplish the same goal, product sterility.
Certain steps must be followed to prepare a sterile IV solution. Familiarize yourself with the following checklist. All of these steps apply to both types of hoods.
1. Checklist for IV Compounding
1. Collect all of the supplies needed to compound the IV solution and set them on a counter-top close to the IV hood.
2. Remove all jewelry from hands and arms, then wash your hands thoroughly by scrubbing for at least 30 seconds.
3. Clean the laminar flow hood you will be working in with 70% isopropyl alcohol. Clean the bottom, stainless steel surface from the back of the hood toward the front using sweeping, side-to-side motion.
4. Place only the supplies you need inside the hood, making sure that all sites that will be penetrated with a needle are fully exposed to the air flow.
5. Sterilize all sites that will be punctured with a needle. The best way is to take a 70% isopropyl alcohol pad (making sure to unwrap the pad at least six inches inside the hood) and rub vigorously across the puncture site. Rub in one direction (NOT back and forth), usually from back to front. This is called "friction sterilization".
*For more information about horizontal and vertical flow hoods, please review the section on "IV Hoods" prior to this section.
6. Now, compound the IV solution according to aseptic technique. Observe the following cautions at all times.
A. You must remain at least six inches inside the hood when working!
B. Do not talk, cough or sneeze while working inside the hood.
C. Keep all hand motions as small as possible to avoid air turbulence inside the hood.
D. Do not touch the needle or any part of the plunger in the syringe that is below the plastic "lip" at the top.
**Note: Certification of laminar flow hoods must occur once a year, to ensure the hoods are functioning properly.
B. Preparation of sterile products is very important to the safety of every patient in the hospital. Hospital pharmacy technicians function under the standards of universal precautions and practice aseptic technique.
1. Universal precautions are a nationally recognized set of standards for the safe handling of drugs and contaminated substances in the hospital. This includes dealing with patients who have communicable diseases. Universal Precautions are a set of standards that hospital personnel follow to ensure their own personal safety. This includes such practices as safe clean-up of potentially infectious body fluids, disposal of needles and contaminated materials, wearing gowns/gloves/masks/etc., and clean-up of toxic or caustic chemical spills (chemotherapy, nitroglycerin, etc.). Universal precautions are used throughout the hospital by all personnel from doctors to housekeeping.
2. Aseptic technique is also a nationally standardized practice. Aseptic technique literally means "without sepsis". Sepsis is typically a bloodborne infection. Therefore, the purpose of using aseptic technique to make an IV for a patient, is sterility. If the patient doesn't get a sterile IV product, they are susceptible to blood-borne infections. Aseptic technique is a standard way of making IV's that ensures sterility. For instance, when making IV's, a technician must work at least six inches inside the flow hood. Also, the way that you move things around inside the hood, always ensuring clean air flow over the IV products, is a part of aseptic technique. An obvious component of aseptic technique is to never sneeze, cough or talk while compounding IV's inside a flow hood (an obvious assault to sterility). Following the standards for aseptic technique ensures that a patient will receive a sterile product.
C. Calculating IV doses is another integral part of hospital pharmacy. Yet, the calculations done in a hospital are by and large the same as those done in a retail setting. The dosage calculation chapter of this manual will show you how to use a technique called cross-multiplication to figure most calculations you come into contact with. This includes figuring doses for IV preparation. It is important to remember that, though this technique is not difficult to learn, it will take some practice. Remember to take notes and then repeatedly practice everything you learn until it comes naturally to you.
E. Do not touch the top of any vial you will be puncturing with a needle. This includes the metal ring around the rubber stopper (this area is an example of a "critical area") at the top of the vial.
F. When using a drug from an ampule you MUST use a filter! You may either pull the drug from the ampule with a filter needle or straw, then switch to a regular needle to inject the drug into the IV bag. OR, you may remove the drug from the ampule with a regular needle and then switch to a filter needle to inject the drug into the IV bag. Ampules are drug containers that are completely made from glass. You must "pop" the glass top off from an ampule to access the drug. The danger is that small particles of glass may fall into the liquid inside the ampule as you are popping off the top. Therefore a filter needle must be used.
7. Once the IV is finished and the label is affixed to the bag, a pharmacist must check the product. Leave all vials/ampules that were used, sitting beside the bag so the pharmacist can check to see that the correct drug is in the IV bag. A technician should also leave out the syringes that were used. The plunger should be pulled back to show the amount of drug that was put into the IV bag. This way, a pharmacist can also check to see that the correct dosage was used.
2. Below, find a list of differences in technique between working in horizontal versus a vertical flow hood.
1. Chemotherapy and other hazardous substances are prepared in a vertical flow hood, NOT a horizontal flow hood, for obvious safety reasons (air flows toward the technician in a horizontal flow hood). Non-toxic substances are compounded in a horizontal flow hood (i.e. antibiotics, antacids, cardiac drugs, etc.).
2. When working in a vertical flow hood, a technician must wear special protective clothing that is not required when working in a horizontal hood.
Double gloves (latex gloves and an outer, heavier glove)
Solid front gown that can be pulled down over gloves
Mask
Protective eye-wear (can be optional, but highly recommended)
3. Because of the differences in the direction of air flow, manipulation of the items in the hood must be handled differently to avoid obstructing airflow. In a vertical flow hood, items must be shifted AROUND each other on the horizontal plane of the work surface, and never over the top of one another. In a horizontal flow hood, items must be moved OVER one another, never around each other (never in front of, or behind another object).
4. When the technician is finished making an IV there will be needles and syringes and packaging and used vials/ampules to throw away. If the IV was made in a horizontal hood, all the trash can be thrown in a regular pharmacy trash container (with the exception of the needles, which must be put into a sharps container for disposal). If the IV was made in a vertical flow hood, all trash must be thrown in a specially marked trash receptacle for hazardous waste (this includes the technician’s gloves!).
5. Spills are handled much differently. If non-toxic substances spill in a horizontal hood, the technician can simply wipe them clean with wet paper towels and then re-sterilize the surface with 70% isopropyl alcohol. All trash from the spill (except needles) can be thrown in a regular trash receptacle. If a chemotherapy drug is spilled in a vertical flow hood, it must be cleaned up using a "Chemo Spill Kit" that contains a large absorbent pad and a plastic, sealable bag to dispose of all contaminated items. The sealable bag is then placed in a specially marked trash receptacle for hazardous substances.
C. Common IV Preparations
1. Large Volume IV’s – This term primarily applies to IV’s that are larger than 100 mls. Usually these IV’s are fluid replacing solutions like saline or dextrose. They can be run continuously for long periods of time and will provide an open line for smaller volume piggybacks. The size of the bags range from 150 mls to 3000 mls.
2. Piggybacks – The term "piggyback" can be also be seen abbreviated as "PB" or "IVPB" (intravenous piggyback). A piggyback is a small volume IV, usually 100 mls or less. They are called piggybacks because they are usually given with a large volume IV. The larger IV will be clamped off so that the piggyback, which hangs right beside it, can be run into the patient. A nurse uses Y-tubing to accomplish this. Imagine IV tubing that looks like a "Y" with a large volume IV attached to one of the "arms" and a piggyback attached to the other. There are clamps on the tubing below each of the solutions, so either one can be turned on or off at any time.
3. TPN – The acronym, TPN stands for Total Parenteral (means, "outside the stomach") Nutrition. This is a solution that is used to feed patients who cannot eat food orally or take nutrition through a naso-gastric (NG) tube. A TPN contains sugar that the body will use for fuel, amino acids that the body will use to make proteins. It also contains essential minerals and electrolytes. A TPN may or may not contain fats (which come as a white, milk-like solution). TPN bags are usually infused through a central line.
4. Chemotherapy – These are highly toxic substances that are prepared in a contained environment (a vertical flow hood). Chemotherapy is toxic to human tissue, particularly fast-growing human tissue (like cancerous tumors) so must be handled very carefully.
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IV Compounding
There are many different types of IV’s that are made in hospital and compounding pharmacies. We will describe some of these different types in the paragraphs to follow. All IV’s, no matter how they differ in size or ingredients, have one important thing in common, they must ALL be prepared using aseptic technique. Aseptic technique will vary depending on the type of hood used in the preparation of the IV. There are two types of compounding hoods*, a horizontal flow hood and a vertical flow hood (a.k.a. chemo hood). Aseptic technique, whether employed in a horizontal or vertical flow must accomplish the same goal, product sterility.
Certain steps must be followed to prepare a sterile IV solution. Familiarize yourself with the following checklist. All of these steps apply to both types of hoods.
1. Checklist for IV Compounding
1. Collect all of the supplies needed to compound the IV solution and set them on a counter-top close to the IV hood.
2. Remove all jewelry from hands and arms, then wash your hands thoroughly by scrubbing for at least 30 seconds.
3. Clean the laminar flow hood you will be working in with 70% isopropyl alcohol. Clean the bottom, stainless steel surface from the back of the hood toward the front using sweeping, side-to-side motion.
4. Place only the supplies you need inside the hood, making sure that all sites that will be penetrated with a needle are fully exposed to the air flow.
5. Sterilize all sites that will be punctured with a needle. The best way is to take a 70% isopropyl alcohol pad (making sure to unwrap the pad at least six inches inside the hood) and rub vigorously across the puncture site. Rub in one direction (NOT back and forth), usually from back to front. This is called "friction sterilization".
*For more information about horizontal and vertical flow hoods, please review the section on "IV Hoods" prior to this section.
6. Now, compound the IV solution according to aseptic technique. Observe the following cautions at all times.
A. You must remain at least six inches inside the hood when working!
B. Do not talk, cough or sneeze while working inside the hood.
C. Keep all hand motions as small as possible to avoid air turbulence inside the hood.
D. Do not touch the needle or any part of the plunger in the syringe that is below the plastic "lip" at the top.
E. Do not touch the top of any vial you will be puncturing with a needle. This includes the metal ring around the rubber stopper (this area is an example of a "critical area") at the top of the vial.
F. When using a drug from an ampule you MUST use a filter! You may either pull the drug from the ampule with a filter needle or straw, then switch to a regular needle to inject the drug into the IV bag. OR, you may remove the drug from the ampule with a regular needle and then switch to a filter needle to inject the drug into the IV bag. Ampules are drug containers that are completely made from glass. You must "pop" the glass top off from an ampule to access the drug. The danger is that small particles of glass may fall into the liquid inside the ampule as you are popping off the top. Therefore a filter needle must be used.
7. Once the IV is finished and the label is affixed to the bag, a pharmacist must check the product. Leave all vials/ampules that were used, sitting beside the bag so the pharmacist can check to see that the correct drug is in the IV bag. A technician should also leave out the syringes that were used. The plunger should be pulled back to show the amount of drug that was put into the IV bag. This way, a pharmacist can also check to see that the correct dosage was used.
2. Below, find a list of differences in technique between working in horizontal versus a vertical flow hood.
1. Chemotherapy and other hazardous substances are prepared in a vertical flow hood, NOT a horizontal flow hood, for obvious safety reasons (air flows toward the technician in a horizontal flow hood). Non-toxic substances are compounded in a horizontal flow hood (i.e. antibiotics, antacids, cardiac drugs, etc.).
2. When working in a vertical flow hood, a technician must wear special protective clothing that is not required when working in a horizontal hood.
Double gloves (latex gloves and an outer, heavier glove)
Solid front gown that can be pulled down over gloves
Mask
Protective eye-wear (can be optional, but highly recommended)
3. Because of the differences in the direction of air flow, manipulation of the items in the hood must be handled differently to avoid obstructing airflow. In a vertical flow hood, items must be shifted AROUND each other on the horizontal plane of the work surface, and never over the top of one another. In a horizontal flow hood, items must be moved OVER one another, never around each other (never in front of, or behind another object).
4. When the technician is finished making an IV there will be needles and syringes and packaging and used vials/ampules to throw away. If the IV was made in a horizontal hood, all the trash can be thrown in a regular pharmacy trash container (with the exception of the needles, which must be put into a sharps container for disposal). If the IV was made in a vertical flow hood, all trash must be thrown in a specially marked trash receptacle for hazardous waste (this includes the technician’s gloves!).
5. Spills are handled much differently. If non-toxic substances spill in a horizontal hood, the technician can simply wipe them clean with wet paper towels and then re-sterilize the surface with 70% isopropyl alcohol. All trash from the spill (except needles) can be thrown in a regular trash receptacle. If a chemotherapy drug is spilled in a vertical flow hood, it must be cleaned up using a "Chemo Spill Kit" that contains a large absorbent pad and a plastic, sealable bag to dispose of all contaminated items. The sealable bag is then placed in a specially marked trash receptacle for hazardous substances.
C. Common IV Preparations
1. Large Volume IV’s – This term primarily applies to IV’s that are larger than 100 mls. Usually these IV’s are fluid replacing solutions like saline or dextrose. They can be run continuously for long periods of time and will provide an open line for smaller volume piggybacks. The size of the bags range from 150 mls to 3000 mls.
2. Piggybacks – The term "piggyback" can be also be seen abbreviated as "PB" or "IVPB" (intravenous piggyback). A piggyback is a small volume IV, usually 100 mls or less. They are called piggybacks because they are usually given with a large volume IV. The larger IV will be clamped off so that the piggyback, which hangs right beside it, can be run into the patient. A nurse uses Y-tubing to accomplish this. Imagine IV tubing that looks like a "Y" with a large volume IV attached to one of the "arms" and a piggyback attached to the other. There are clamps on the tubing below each of the solutions, so either one can be turned on or off at any time.
3. TPN – The acronym, TPN stands for Total Parenteral (means, "outside the stomach") Nutrition. This is a solution that is used to feed patients who cannot eat food orally or take nutrition through a naso-gastric (NG) tube. A TPN contains sugar that the body will use for fuel, amino acids that the body will use to make proteins. It also contains essential minerals and electrolytes. A TPN may or may not contain fats (which come as a white, milk-like solution). TPN bags are usually infused through a central line.
4. Chemotherapy – These are highly toxic substances that are prepared in a contained environment (a vertical flow hood). Chemotherapy is toxic to human tissue, particularly fast-growing human tissue (like cancerous tumors) so must be handled very carefully.
Hospital pharmacy, though different, contains enough on-the-job similarities that, with some brief training, this portion of the exam should not be difficult. Hospital pharmacies use many of the same medications as those dispensed in retail pharmacies, so your current medication knowledge will serve you well. The differences that do exist between the two environments can be summed up in the four sections discussed below.
The Unit Dose System
A. This is a medication distribution system that hospitals use to issue oral medications to each patient. Each dose of each medication is individually packaged either by the pharmacy or the drug manufacturer. Since hospitals are giving care to the acutely ill, the medication regimens are constantly changing. Therefore, it would be costly and time consuming to dispense medications for more than one or two days at a time.
B. Each unit in the hospital is given two medication carts (also known as medication cassettes) which hold medication drawers (one for each patient). At any given time throughout the day, one cart is on the floor where the nurses have access to the patients’ medications and the other cart is in the pharmacy waiting to be filled for the next day.
                                               
    Unit Dose Carts
C. The technician’s role in the unit dose system is essential. It is the job of the technician to fill all the medication drawers according to a computer printout of what each patient is currently receiving. This position is generally referred to as the "unit dose cart fill technician." Most large hospitals fill their unit dose carts on the graveyard shift when the pharmacy is quiet and relatively free from distractions.
D. There are a few hospitals who have chosen an automated system to fill unit dose carts. However, this involves the purchase of a large, costly, and cumbersome robotic arm that requires a large amount of pharmacy space. It is uncommon to see one of these robots in use, but you should be aware of their existence.
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Physician Medication Orders
A. Medication orders in a retail pharmacy are in the form of prescriptions. In a hospital, the medication orders are written on a pre-printed form that prints in duplicate. One sheet stays on the floor with the patient’s chart and one is sent to the pharmacy for processing. Hospital physician medication orders are not just for medications that the patient will receive but also for tests, procedures, and any other instructions to hospital staff concerning the patient's therapy.
B. Medication orders are put into the computer by technicians, just as in retail, when prescription order entry is performed by technicians. In a hospital, the orders are either sent by way of personnel or by pneumatic tube. A pneumatic tube system runs throughout the hospital and travels on a vacuum that pulls the tube to the desired destination – much like the pneumatic tubes used in the drive-through lanes of many banks. Once the orders are received, a technician will enter the orders into the computer. When the orders have been input, a pharmacist will log-on to the computer and check all the order entries against the original orders, then verify all orders electronically. The act of verification is a signal to the computer system that the orders are ready to be filled for the medications requested. Labels are automatically generated and then filled, as in retail.
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Hospital Formulary:
A. A formulary is a list of medications that the pharmacy agrees to stock. A hospital formulary is the list of drugs that the hospital pharmacy will have on hand and are approved for use by the hospital. Because of the high cost associated with stocking a large inventory of medications, a hospital will determine which drugs from a particular therapeutic classification it will keep on hand. This decision is based on the cost and the efficacy (effectiveness) of the drug.
B. Example: Let’s look at ABC Community Hospital. Their formulary committee (made up of doctor’s, pharmacists and hospital administrators) is trying to decide which Proton Pump Inhibitor (PPI) they will stock in their pharmacy for use in the hospital. Since there are several PPI’s currently available and all are quite expensive, they must choose only one or two. If they determine that all of the drugs are equally effective, they will research the cost. Once they determine which drug is the most cost effective, they will add that drug to the hospital formulary. Most formulary decisions however, are not made so easily. Committees frequently run into situations where one drug has been proven slightly more effective but costs more to stock than other alternative drugs. The formulary committee must then do a cost-benefit analysis to determine which drug to stock.So, let us suppose that a doctor at the hospital orders a PPI that is other than the one on the formulary. The pharmacy will be allowed to automatically "switch" the order to the PPI that is on the formulary. This switch is called a "therapeutic substitution"*. There are also times when a doctor will order a drug that is not on the formulary but would really like to have it for his/her patient. The doctor will usually have to fill out a "non-formulary request" form. Then the pharmacy will either order the drug from their wholesaler or buy it from another local pharmacy (usually the closest retail location). Then, when the patient goes home, or is no longer on the non-formulary drug, the pharmacy will stop stocking the item.
C. The primary purpose of a hospital formulary is to keep the pharmacy inventory costs down, thus, keeping down the cost of health-care for patients.
*Please note the difference in retail pharmacies. Therapeutic substitutions cannot automatically take place. The pharmacist must consult with the patient and their physician before switching a drug that has been ordered.
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Sterile Products
                   
A. Laminar flow hoods are sterile cabinets that are used to prepare sterile products. There are two types of hoods used:
1. The horizontal flow hood is used to prepare sterile products that are not considered chemotherapeutic or toxic upon contact. Most of the IV preparations for a hospital are prepared in the horizontal hood. The horizontal flow hood is a cabinet with a work area. Air is sucked in through a filter at the bottom of the cabinet and then is blown up the back of the cabinet and forced through a HEPA (high efficiency particulate air) filter. A HEPA filter is a particulate filter that is 99.97% efficient at removing particles 0.3 microns or larger. Once the air is forced through the HEPA filter, it is blown horizontally across the work surface toward the technician. To ensure that all products remain exposed to the HEPA filtered air, the technician must be sure to never move or place one product behind another in a horizontal flow hood. The technician must work at least 6 inches inside the hood. This ensures that the filtered air is protecting the technician's work. When cleaning this type of hood, a technician must start the cleaning process from the back of the hood and work toward the front, cleaning the stainless steel work surface.
2. The other hood is called a vertical flow hood. The vertical flow hood is used to prepare toxic and dangerous substances. This hood works on the same principle as the horizontal hood; however, the HEPA filtered air is blown vertically down from the top of the cabinet. To ensure that all products remain exposed to the HEPA filtered air, the technician must be sure to never move one product over another in a vertical flow hood. The front of the cabinet is enclosed with a space at the bottom large enough for the hands and arms. This configuration along with the vertical airflow, protects the technician from the toxic drugs (usually chemotherapy) he/she is preparing. The technician must also wear a solid front gown and double glove for added protection. As with a horizontal flow hood, when cleaning a vertical flow hood, a technician should start the cleaning process from the back of the hood and work toward the front, cleaning the stainless steel work surface.
**Note: All Laminar Flow Hoods must be cleaned with 70% isopropyl alcohol.
**Note: Certification of laminar flow hoods must occur once a year, to ensure the hoods are functioning properly.
B. Preparation of sterile products is very important to the safety of every patient in the hospital. Hospital pharmacy technicians function under the standards of universal precautions and practice aseptic technique.
Hospital pharmacy, though different, contains enough on-the-job similarities that, with some brief training, this portion of the exam should not be difficult. Hospital pharmacies use many of the same medications as those dispensed in retail pharmacies, so your current medication knowledge will serve you well. The differences that do exist between the two environments can be summed up in the four sections discussed below.
1. Universal precautions are a nationally recognized set of standards for the safe handling of drugs and contaminated substances in the hospital. This includes dealing with patients who have communicable diseases. Universal Precautions are a set of standards that hospital personnel follow to ensure their own personal safety. This includes such practices as safe clean-up of potentially infectious body fluids, disposal of needles and contaminated materials, wearing gowns/gloves/masks/etc., and clean-up of toxic or caustic chemical spills (chemotherapy, nitroglycerin, etc.). Universal precautions are used throughout the hospital by all personnel from doctors to housekeeping.
The Unit Dose System
2. Aseptic technique is also a nationally standardized practice. Aseptic technique literally means "without sepsis". Sepsis is typically a bloodborne infection. Therefore, the purpose of using aseptic technique to make an IV for a patient, is sterility. If the patient doesn't get a sterile IV product, they are susceptible to blood-borne infections. Aseptic technique is a standard way of making IV's that ensures sterility. For instance, when making IV's, a technician must work at least six inches inside the flow hood. Also, the way that you move things around inside the hood, always ensuring clean air flow over the IV products, is a part of aseptic technique. An obvious component of aseptic technique is to never sneeze, cough or talk while compounding IV's inside a flow hood (an obvious assault to sterility). Following the standards for aseptic technique ensures that a patient will receive a sterile product.
A. This is a medication distribution system that hospitals use to issue oral medications to each patient. Each dose of each medication is individually packaged either by the pharmacy or the drug manufacturer. Since hospitals are giving care to the acutely ill, the medication regimens are constantly changing. Therefore, it would be costly and time consuming to dispense medications for more than one or two days at a time.
C. Calculating IV doses is another integral part of hospital pharmacy. Yet, the calculations done in a hospital are by and large the same as those done in a retail setting. The dosage calculation chapter of this manual will show you how to use a technique called cross-multiplication to figure most calculations you come into contact with. This includes figuring doses for IV preparation. It is important to remember that, though this technique is not difficult to learn, it will take some practice. Remember to take notes and then repeatedly practice everything you learn until it comes naturally to you.
B. Each unit in the hospital is given two medication carts (also known as medication cassettes) which hold medication drawers (one for each patient). At any given time throughout the day, one cart is on the floor where the nurses have access to the patients’ medications and the other cart is in the pharmacy waiting to be filled for the next day.
                                               
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    Unit Dose Carts
IV Compounding
There are many different types of IV’s that are made in hospital and compounding pharmacies. We will describe some of these different types in the paragraphs to follow. All IV’s, no matter how they differ in size or ingredients, have one important thing in common, they must ALL be prepared using aseptic technique. Aseptic technique will vary depending on the type of hood used in the preparation of the IV. There are two types of compounding hoods*, a horizontal flow hood and a vertical flow hood (a.k.a. chemo hood). Aseptic technique, whether employed in a horizontal or vertical flow must accomplish the same goal, product sterility.
Certain steps must be followed to prepare a sterile IV solution. Familiarize yourself with the following checklist. All of these steps apply to both types of hoods.
1. Checklist for IV Compounding
1. Collect all of the supplies needed to compound the IV solution and set them on a counter-top close to the IV hood.
2. Remove all jewelry from hands and arms, then wash your hands thoroughly by scrubbing for at least 30 seconds.
3. Clean the laminar flow hood you will be working in with 70% isopropyl alcohol. Clean the bottom, stainless steel surface from the back of the hood toward the front using sweeping, side-to-side motion.
C. The technician’s role in the unit dose system is essential. It is the job of the technician to fill all the medication drawers according to a computer printout of what each patient is currently receiving. This position is generally referred to as the "unit dose cart fill technician." Most large hospitals fill their unit dose carts on the graveyard shift when the pharmacy is quiet and relatively free from distractions.
4. Place only the supplies you need inside the hood, making sure that all sites that will be penetrated with a needle are fully exposed to the air flow.
5. Sterilize all sites that will be punctured with a needle. The best way is to take a 70% isopropyl alcohol pad (making sure to unwrap the pad at least six inches inside the hood) and rub vigorously across the puncture site. Rub in one direction (NOT back and forth), usually from back to front. This is called "friction sterilization".
*For more information about horizontal and vertical flow hoods, please review the section on "IV Hoods" prior to this section.
D. There are a few hospitals who have chosen an automated system to fill unit dose carts. However, this involves the purchase of a large, costly, and cumbersome robotic arm that requires a large amount of pharmacy space. It is uncommon to see one of these robots in use, but you should be aware of their existence.
6. Now, compound the IV solution according to aseptic technique. Observe the following cautions at all times.
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Physician Medication Orders
A. Medication orders in a retail pharmacy are in the form of prescriptions. In a hospital, the medication orders are written on a pre-printed form that prints in duplicate. One sheet stays on the floor with the patient’s chart and one is sent to the pharmacy for processing. Hospital physician medication orders are not just for medications that the patient will receive but also for tests, procedures, and any other instructions to hospital staff concerning the patient's therapy.
A. You must remain at least six inches inside the hood when working!
B. Medication orders are put into the computer by technicians, just as in retail, when prescription order entry is performed by technicians. In a hospital, the orders are either sent by way of personnel or by pneumatic tube. A pneumatic tube system runs throughout the hospital and travels on a vacuum that pulls the tube to the desired destination – much like the pneumatic tubes used in the drive-through lanes of many banks. Once the orders are received, a technician will enter the orders into the computer. When the orders have been input, a pharmacist will log-on to the computer and check all the order entries against the original orders, then verify all orders electronically. The act of verification is a signal to the computer system that the orders are ready to be filled for the medications requested. Labels are automatically generated and then filled, as in retail.
B. Do not talk, cough or sneeze while working inside the hood.
C. Keep all hand motions as small as possible to avoid air turbulence inside the hood.
D. Do not touch the needle or any part of the plunger in the syringe that is below the plastic "lip" at the top.
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Hospital Formulary:
Hospital pharmacy, though different, contains enough on-the-job similarities that, with some brief training, this portion of the exam should not be difficult. Hospital pharmacies use many of the same medications as those dispensed in retail pharmacies, so your current medication knowledge will serve you well. The differences that do exist between the two environments can be summed up in the four sections discussed below.
A. A formulary is a list of medications that the pharmacy agrees to stock. A hospital formulary is the list of drugs that the hospital pharmacy will have on hand and are approved for use by the hospital. Because of the high cost associated with stocking a large inventory of medications, a hospital will determine which drugs from a particular therapeutic classification it will keep on hand. This decision is based on the cost and the efficacy (effectiveness) of the drug.
B. Example: Let’s look at ABC Community Hospital. Their formulary committee (made up of doctor’s, pharmacists and hospital administrators) is trying to decide which Proton Pump Inhibitor (PPI) they will stock in their pharmacy for use in the hospital. Since there are several PPI’s currently available and all are quite expensive, they must choose only one or two. If they determine that all of the drugs are equally effective, they will research the cost. Once they determine which drug is the most cost effective, they will add that drug to the hospital formulary. Most formulary decisions however, are not made so easily. Committees frequently run into situations where one drug has been proven slightly more effective but costs more to stock than other alternative drugs. The formulary committee must then do a cost-benefit analysis to determine which drug to stock.So, let us suppose that a doctor at the hospital orders a PPI that is other than the one on the formulary. The pharmacy will be allowed to automatically "switch" the order to the PPI that is on the formulary. This switch is called a "therapeutic substitution"*. There are also times when a doctor will order a drug that is not on the formulary but would really like to have it for his/her patient. The doctor will usually have to fill out a "non-formulary request" form. Then the pharmacy will either order the drug from their wholesaler or buy it from another local pharmacy (usually the closest retail location). Then, when the patient goes home, or is no longer on the non-formulary drug, the pharmacy will stop stocking the item.
The Unit Dose System
A. This is a medication distribution system that hospitals use to issue oral medications to each patient. Each dose of each medication is individually packaged either by the pharmacy or the drug manufacturer. Since hospitals are giving care to the acutely ill, the medication regimens are constantly changing. Therefore, it would be costly and time consuming to dispense medications for more than one or two days at a time.
C. The primary purpose of a hospital formulary is to keep the pharmacy inventory costs down, thus, keeping down the cost of health-care for patients.
*Please note the difference in retail pharmacies. Therapeutic substitutions cannot automatically take place. The pharmacist must consult with the patient and their physician before switching a drug that has been ordered.
B. Each unit in the hospital is given two medication carts (also known as medication cassettes) which hold medication drawers (one for each patient). At any given time throughout the day, one cart is on the floor where the nurses have access to the patients’ medications and the other cart is in the pharmacy waiting to be filled for the next day.
                                               
    Unit Dose Carts
E. Do not touch the top of any vial you will be puncturing with a needle. This includes the metal ring around the rubber stopper (this area is an example of a "critical area") at the top of the vial.
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F. When using a drug from an ampule you MUST use a filter! You may either pull the drug from the ampule with a filter needle or straw, then switch to a regular needle to inject the drug into the IV bag. OR, you may remove the drug from the ampule with a regular needle and then switch to a filter needle to inject the drug into the IV bag. Ampules are drug containers that are completely made from glass. You must "pop" the glass top off from an ampule to access the drug. The danger is that small particles of glass may fall into the liquid inside the ampule as you are popping off the top. Therefore a filter needle must be used.
Sterile Products
                   
7. Once the IV is finished and the label is affixed to the bag, a pharmacist must check the product. Leave all vials/ampules that were used, sitting beside the bag so the pharmacist can check to see that the correct drug is in the IV bag. A technician should also leave out the syringes that were used. The plunger should be pulled back to show the amount of drug that was put into the IV bag. This way, a pharmacist can also check to see that the correct dosage was used.
2. Below, find a list of differences in technique between working in horizontal versus a vertical flow hood. </