TABLE OF CONTENTS
- Entry SOP’s for Corrections:
- Batches
- Final checks by Certified Technician and or Pharmacist
- ARxium/FastPak Operations
Entry SOP’s for Corrections:
1. Patient Information:
- Search for new inmate using first 4 letters of last name, comma, first 2 letters of first name
- Because inmates often have aliases, using the “advanced search” by PHIN is should be performed as well before entering any new inmate into the system.
Adding a New Patient if Not Found:
- Enter the complete full last and first name adding the facility code after the first name in brackets; example below (pictured): Zachary Benjamin (MRCC)
- Add the birthdate in day/month/year format in the Kroll field; select gender; select address as facility address. A postal code must be entered (any entry is fine).
- For “plan”, choose “COR” in the drop-down menu; ID is PHIN number
- Three of the facilities use the “Groups” section due to large sizes of the batches: HCC, WCC and MRCC. It is very important to ensure that the facility code is entered for the HCC, WCC and MRCC inmate, or else the inmate will not be captured in the batch. MRCC has two groups based upon wards; HCC has 3 groups based upon wards (see special list); WCC has two groups based upon the last name of the inmate.
- Under the “General” tab select Corrections Pricing
- Under the “Nursing Home” tab, select the applicable facility code and ward in the drop-down menus
- In the “Cycle” drop-down menu, choose the facility code
- In the “Room” field, enter the inmate’s date of birth in the following format: YY/MM/DD in order for the DOB to print properly on the pouches.
- AR profile - link to existing AR using existing facility code (must save the file first)
2. Drug:
- Select correct drug, being careful to select the correct generic brand and pack size being used; the drug must be “active”
3. Doctor:
- Select correct doctor (double check)
4. NH Rx Information Screen:
- Automatically pops up after Doctor selected
- Double check that “Batch Fill” is selected if drug is to be included in batch pouches, if not uncheck the box for short term, insulin, inhalers, creams, etc.
Select Med Type
- A – self meds (everything that is not in B list and drugs that may be kept by patient)
(some variation here depending on facility, see separate lists)
- B – non-self meds (drugs that must be kept at nursing station)
- D - (short term)
- I - (dose change)
- M - (Methadone)
- O - (non-blister drugs)
- W - (prn)
- Fill in Administration stop date if there is one
- Select Pass Times and fill in dose on calendar, use drop down for all the pass time selections.
- Make sure to select “Refills” and use unlimited unless a specific End Date is needed.
5. Scan hard copy prescription into file
- Place hard copy paper into scanner
- On right side of screen go to “add Rx Image”
6. Fill in Sig Code
7. Fill in Quantity
8. Days Supply, always use 7
9. Next Quantity Supply (bottom left hand side of screen)
- Put in correct quantity for next 7 days
10. Press F12 to adjudicate and fill prescription
- Respond to any extra charges (okay) and codes (MY,MZ, ME1 need a response)
- Note that these prescriptions are only sent to DPIN for “DU” purposes not for payment purposes, “DU” means therapeutic review only.
11. MAR Sheet
- With the patient’s screen open select Reports tab
- Select “Plain Paper MAR" when required for the pharmacists to do a review of the patient’s file
- Select “Print MAR” for new patients to a facility.
12. Sending Order to FastPak machines
- Select “NH” tab at top of menu
- Select “Package” and choose facility
- Choose correct starting date, first time do not have to enter (unless it is for a same day start, then need to put first dose time)
- Choose number of days, end date is auto calculated
- Add patient and check for home in case of duplicate names, select
- Under tab 2 have to select A and B strip separately, one at a time
- Under tab 3 package batch
- Under Packager select which machine (will default to Machine 2)
- Preview
- Select “YES” to send data, shows automated report which is only needed for whole batch run, close that screen
- May have to do a second time if A and B strips involved
Batches
- Scheduled batches have to be reviewed and cleared before they can be processed.
- Under Utilities tab select view batches
-Pharmacy Assistant needs to sign in and select correct facility batch
- Each line needs to be highlighted and select option to correct review
- Select Modify Rx, make corrections and hit F12 to save and send order to second session. Note: Two Kroll sessions must be open.
-Examples of corrections that may need to be made are adding refills, responding to certain codes, MY and MZ; mostly they are co-pay overrides from DPIN.
- After review of batches is done and cleared, select NH tab
- Select Package > Facility
Tab “Selection”
- Select start day, # of days, Facility NOTE: Make sure box is checked “Show only meds filled”
- Add “PATIENT GROUP” (HCG1, etc)
Tab “Selection 2”
- Make sure “ Show only” is selected
- Select Batch typed A or B
Note: Some facilities have 2 or 3 groups as well each with a Batch A and B, all have to be run one at a time.
Tab – “Packager Batch”
- Select FastPack EXP or EXP2 (1st or 2nd machine)
- When completed, select Preview > YES (to complete sending batch)
- The AutoMed report comes up and is then printed; this report goes to pharmacy clerk processing the batch on the FastPak machine; the facility and packager is identified for the pharmacy clerk on the report
A report can then generated which shows all ODT drugs and Accutane prescriptions that are included in that batch, this report goes with the batch once processed and reviewed by checking technician and or pharmacist (all cut-in’s)
Narcotics processed by the batch
All Narcotic and Controlled drugs processed in the batch are tray-dropped only, and never included in a canister
- A report is generated which shows all narcotics in a batch
- Reports > All > Rx for Drug/Doctor Groups
- Select Today’s Date, Facility, Drug Schedule G and N
- Report is generated to excel spreadsheet (Save CSV)
- This reports sorts out each “N (narcotic) or G (controlled)” drug which is being dispensed in that batc. The pharmacy technician enters these amounts into perpetual narcotic log sheets for that drug and attaches this report to the perpetual log record
- The exact amount of each drug is counted out for each prescription noted on the report and is given to the FastPak operator when processing that batch. The remaining amount of N or G drug is then back counted and checked against the quantity on-hand recorded in the perpetual log. If the quantity matches, it is recorded with a checkmark. Any discrepancies are reported to the Pharmacy Manager for review and resolution.
- The FastPak clerk must manually tray drop each N and G drug. This tray drop is also checked by a Certified Technician and or Pharmacist.
Transfers and Releases
Note: For each internal transfer, facility transfer and or release the batch situation must be assessed - is the batch strip still onsite and needs pulling? When is the next batch due to be run? Will the patients go to a different facility and therefore does a short term supply need to be run? It will be different for each request and this must be assessed first before the proper course of action is done
Internal Transfer
- Select Patient and change “Ward” under NH tab
- For HCC and MRCC internal transfers, you will also have to change the “Group”
- Under “Comments” note transfer date
Facility Transfer
- Select Patient and change all relevant information like name (Code) and address
- Under NH change all relevant information
- Save and answer YES to transfer
- Answer Yes to transfer
- Under Comments record Transfer and Date
- NEXT: must modify facility AR Prolfile for transfers to a new facility
- Must select patient and insert into new AR profile account
- Must copy forward every prescription when doing a transfer to make sure it is being billed to the new AR profile.
Holds
- usually done when patient goes to hospital
- Select Patient and Modify each drug to remove “Batch fill” box checkmark and “Unit Dose” checkmark.
- Save changes
- Also note under Comments and use ALERT function
- Reverse process once patient comes back to facility
Releases
- Select Patient and inactive all drugs
- Highlight each drug and select Inactivate Rx on main screen
- Update Discharge Date and click on inactive box (ie: “unclick” the active box)
- Under Comments note release and date
- Save all changes
Final checks by Certified Technician and or Pharmacist
New Orders, changes: (Pharmacist only)
- After processing by FastPak, the strips are placed into black baskets by facility along with prescription and Mar Sheet.
- Pharmacist then checks the new order and MAR sheet against the prescription including therapeutic review and signs the transaction copy.
- If the prescription is being shipped out immediately it is placed in the red baskets according to facility for same day shipping.
- If the prescription is not needed until next batch shipment it is placed in the blue baskets according to facility.
- Sometimes the prescription (one longer strip) must divided into two portions; one portion of the strip is needed immediately as a stat order to finish of the current week’s batch, and the remainder that will be shipped with the next weekly batch.
- The prescription and transaction copy are attached together and placed in a basket for filling at a later date.
- If the prescription is a narcotic prescription,it is placed on the top filing area (narcotics filed separately).
Add-Ons or Replacement Medications
- When a medication has been changed please ensure that an “Add-on” strip is run if appropriate, or “Replacement” sticker has been added to the patient’s medication strip as needed.
- There are also stickers for “Release Meds” for when an inmate is released.
- There are “New Strip. Please return old meds” stickers for a replacement strip
- There are “Altered by Pharmacy” stickers for when a strip been manually altered (ex: a drug removed).
Batch checking: (Certified Technician and/or Pharmacist)
- Once the batch is processed by the pharmacy clerk at the FastPak machine it is placed into a large basket along with the AutoMed report generated by the batch for that facility and or group at the facility.
- A shipping report is generated for the specific group and or facility that is being checked.
Reports > All > Shipping Report
Select Home and Ward if applicable
- A Report generating all the MARs for that Facility (Ward) is exported to a PDF for use in checking the batch by the certified technicians/pharmacist.
Reports > All > Print Plain Mar > Select Home > export to PDF
Once the “Shipping Report” and “Patient MARs” are on the computer desktop, the A and B batch can be checked for each patient.
- Each strip is checked for proper drug, dose and quantity for each strip pouch
- If applicable, both the A and B strips are banded together and placed in the proper “Ward Bin” in preparation for shipping.
- Any error must be logged in the internal error report and placed in a separate bin for corrections at a later time.
- All issues are recorded on the Shipping Report for future reference
- Once any missed “cut in’s” and/or “fixes” are completed the strips are given back to checking personnel for a final check before placing in appropriate ward bins.
- Once an entire batch for a facility (or group within a facility) is completely checked, the “AutoMed” report that comes in the basket is signed by the checking personnel and filed for regulatory purposes.
Dose Changes
Dose Increases
- If there is only one change, create an “add on” strip to go with the existing facility strip, matching the number of days left on the facility strip
- Unselect “Batch Fill”
- Select Med Type I - Dose Increase
- Run strip to FastPak
- If there are multiple changes, send a new strip matching the number of days of the strip at the facility, and bill for the whole new strip
Dose Decreases
- For dose reductions, re-run entire A or B strip bill for whole strip.
Note: Data Entry Pharmacy Assistants must first assess if the strips have left Providen (check Master Schedule), if so they may be pulled from the order.
If the strip has left Providen the Data Entry Pharmacy Assistant must then assess how many days left to match up to the previous strip and make changes for the next batch as well.
- Discontinued Medications
- When a medication is inactivated for any reason (such as a dose change) the “inactive label” must be printed and included with the new order to show that the previous prescription has been discontinued.
ARxium/FastPak Operations
- Prescriptions orders are sent from Kroll to the ARxium/FastPak as either batches or new orders.
- Orders are processed by hitting dispense button on the ARxium touchscreen
- Orders are then completed by the FastPak machine and come out as labelled pouches:
Tray Drops
- When drugs are not in any of the canisters the machine will stop, the tray will come out and screen will show the drugs needing to be manually dropped.
- Initially a report is generated when doing a batch which shows which prescriptions will need a tray drop; it identifies the drug, DIN number and amount needed.
- The FastPak operator pulls all the stock bottles needed and matches drug and DIN number with the report. The medications are then checked against the list by a Certified Technician and/or Pharmacist who initials each drug/DIN number on the tray drop list, as well as initialing the last page of the report.
- The tray will automatically open when a tray drops is needed
- The screen will show which drug is needed with the lit-up tray cells as below.
- The FastPak operator selects the correct drug (be aware of quantity to drop!) and fills the trays as needed to complete the batch.
- All narcotics must be tray dropped (there are no cells for the narcotics)
- Exact amounts for the total batch are prepared in vials for the FastPak operator by a Certified Technician/Pharmacist.
Refilling Empty Canisters
- When a canister is empty, the computer screen identifies which canister needs filling
- The ARxuim machine will light up to identify the drawer with the empty cannister.
Select the required drug from stock and then using the bar code scanner matches the bar code to the canister and from the bottle.
FastPak operator then adds tablets to the empty cannister on the scale which calculates tablet/capsule amount based upon weight
The FastPak machine will stop when it runs out of pouch paper, another roll then needs to be added and carefully attached together or the machine will jam.
When individual orders are completed they are placed with the matching prescription order that the Kroll technician has placed in the basked beside the FastPak machine it was sent too. The prescription and completed strip are placed into the appropriate facility black basket for checking by a pharmacist.
When a batch is started the beginning strip is taped to the outside of a checking basket. When completed, a batch tracking document is filled out by the FastPak operator and taped to the side of the basket. This basket is then sent for checking.
Misc. Notes:
- These pouches are programmed to only package four different drugs per pouch.
- All ODT medication pouches are empty and must be cut in manually after strip is run.
- Some drugs can be packaged with other drugs and thus are programmed to go alone in a separate pouch from other medications: ex. Arthrotec, narcotics
- PRN batches use a smaller pouch
Administration:
- Monthly reviews of molecule use should be done with FastPak operators.
- Reports can be generated with molecule usage and tray drop usage.
- Analysis needs to be done on which canisters need to be changed and which molecules can be added using “smart” canisters which can be easily swapped.
- A schedule needs to be reviewed which will indicate to the Kroll technicians the slot or window for each home batch and new orders to be processed on which machine.
19. Ward Stock
Each facility sends in ward stock requests on a requisition or Rx order form.
Each facility has a patient call “Ward Stock” and these are filled as prescriptions on this profile.
Large orders of acetaminophen and ibuprofen are processed on the FastPak machines. The FastPak operator must be notified of this as all ward stock and “PRN” drugs are dispensed in smaller pouches and are labelled differently.
None of the facilities has a set list of ward stock drugs at this time.
Vials, ointment jars, etc. are also billed and sent as Ward Stock prescriptions
Some of the larger facilities order the same amounts each week and one of the technicians prepares many of the larger orders in advance.
20. Monthly Mar Sheets
Every month each facility is sent the current MAR for each patient in that facility.
During the last week of the month the facilities are contacted about when they want to receive the MAR sheets as they are checked by the nurses for accuracy and need time for this function.
21. Shipping Procedures
A PDF of each facility shipping label is on file and multiple labels are in an envelope in each facility shipping basket for the shipper to use.
A shipping report is prepared only for the smaller facilities and is included in their shipments, Kroll technician prepares for each facility that requests it.
- Reports > All > Shipping Reports
Shipping reports are sent to BCC/TPCC/WRC only, HCC, WCC/MYC and MRCC do not require them.
All out of town facilities are shipped via Gardewine, the rest are all shipped via Red River according to the weekly and daily schedules above.
Currently Gardewine signs two paper shipping waybills and one is kept at Providen, Red River shipments are all signed by the driver and tracked in a book kept at Providen. Gardewine and Red River track who signs for the shipments at the facilities.
The shipper collects the pouch rolls, uses a pin to remove extra air in each pouch and rolls the strips and bands A and B together in preparation for shipping. This is done each morning before batches are due and early afternoon before daily orders are due.
All strips are placed in an appropriate box with shipping report if applicable, taped up and labelled.
22. Patient List Management
Every Monday a current patient list is sent to TPCC, MYC, BCC and WCC to confirm any releases or transfers that might have been missed.
23. Compounds
Products that need to be compounded should be ordered from The Compounding Pharmacy of Manitoba,(CPM)
CPM has a special order form that is faxed.
Attach the CPM receipts to the faxed order form once the compound arrives.
24. A and B Strips
Some facilities have the medication separated into separate strips
- A strip (Self-Meds) being medications the patient can take to the bedside with them
- B strip (Non-Self-Meds) being medications medications that must be kept at the nursing station only