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20 Cards in this Set
- Front
- Back
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OBRA - 90
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First federal law regulating pharmacy practice standards
Primary goal to save money Requires that states must actually establish the standards in order to receive federal funds for medicaid |
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How did most states choose to promulgate?
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Via the pharmacy practice act
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What did OBRA establish?
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Two types of DUR program - Retrospective review and prospective DUR
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Retrospective DUR
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Each state must establish a DUR board composed of physicians and pharmacists to oversee retrospective DUR
- Reviews medication use data, and recommends/establishes education programs for providers who are not meeting target criteria |
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Prospective DUR
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Evaluates prescribed drug therapy before the Rx is dispensed/active resolution of problems at point of dispensing
DUR board can examine data to determine if drug use problems are being resolved or continuing |
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What are the three components of prospective DUR?
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Screening
Counseling Patient profile |
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OBRA lists 7 general categories of potential problems which should be screened. What are they?
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Therapeutic duplication
Drug-disease contraindications Drug - Drug interactions Drug - Allergy interactions Incorrect Drug dosages Incorrect duration of treatment Clinical abuse or misuse |
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If a pharmacist fails to screen for potential problems, the pharmacist can be held liable for this
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Negligence per se
To determine this, pharmacist action is compared to those of an ordinary, reasonable, prudent pharmacist (ORPP) |
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A pharmacist is not normally expected to:
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Conduct drug information searches in order to screen for problems
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Are computer programs required by OBRA 90 in screening patients?
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Not required by OBRA 90
If the computer program fails, the pharmacist can be liable |
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When the physician tells the pharmacist to dispense as written, even if the risks are high
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Then the pharmacist must make a decision based on the situation, and if they choose to dispense, the patient must be counseled regarding the risks.
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Counseling
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Offer to counsel is required
OBRA 90 allows pharmacist to determine the content based on professional judgement Offer to counsel may be made by ancillary personnel or other means, but pharmacist must actually counsel Patient has the right to waive counseling |
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Counseling suggested info
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Name/description of medication
Dosage form and amount Route of administration Duration of therapy Special directions and precautions for preparation, administration, and use |
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Continued
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Common severe side effects, adverse effects, interactions or contraindications
Techniques for self monitoring Refill information Action to be taken if dose is missed |
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Side effects to counsel on
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Very likely, self limiting
Very likely, significant Not likely, significant |
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Components of Pro-DUR
Patient profile --> |
Requires pharmacy to obtain, record and maintain a record of specified information about the patient, and review it prior to dispensing
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Patient profile -->
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Must make reasonable effort to obtain:
Name, address, and telephone number Age and gender Allergies, Drug interactions Current list of Rx and OTC's Any relevant devices Disease states ***Must also document when a patient refuses to provide information for the patient profile*** |
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What must be documented?
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Refusal to accept counseling (Name or initials of pharmacist, and a notation on the Rx, patient profile or electronic records) or a document signed by the patient or caregiver
Excessive waivers indicates an unacceptable standard of practice |
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Documentation
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Pharmacist need to document a comment when:
screening uncovers a problem patient requires unique counseling or information pharmacist notices something out of the ordinary about a patients behavior or drug therapy |
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Risk management
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Use open-ended questions (How did your doctor tell you to take this medication?, Not do you know how to take this medication?)
Show medication to patient to ensure correct medication is being dispensed |
