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Pharmacy, Dietary, Maintenance, Board, ED, and Policies

Presented by Sue Dill Calloway
Duration - 120 Minutes

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Description

At the conclusion of part two, participants should be able to:

  • Explain the responsibilities of the pharmacists that include developing, supervising, and coordinating activities of the pharmacy.
  • Describe the requirements for CAH to monitor and inspect to ensure that outdated drugs are not available for patient use.
  • Recall the requirements for  security and storage of medications, medication carts, and anesthesia carts, 
  • Discuss the requirement to have a list of do not use abbreviations and a review of sound-alike/look-alike drugs. 

Speaker

Speaker Image

Sue Dill Calloway, RN, MSN, JD, is the president of Patient Safety and Healthcare Consulting and Education company with a focus on medical-legal education especially Joint Commission and the CMS hospital CoPs regulatory compliance. She also lectures on legal, risk management, and patient safety issues. She was a director for risk... Read more

Agenda

  • Physical Plant and Environment
  • Disposal of trash
  • Storage of drugs
  • Physical environment
  • Construction and equipment
  • Maintenance
  • Emergency Procedures-moved to new appendix Z
  • Life Safety from Fire
  • LSC waivers
  • Fire inspections 
  • Board section
  • Staffing
  • Physician responsibilities
  • Physician supervision
  • Transfer of patient
  • Patient admissions
  • Patient care policies
  • Medical management

Regulations and Interpretive Guidelines for CAHs

  • Direct Services
  • Services Provided through Agreements or Arrangements
  • Drug and biologicals
    • Security of medication, qualifications of pharmacy director, proper environmental conditions, P&P to monitor all carts, compounding, blue box advisories, Drug Quality and Security Act, standards of care, dispensing medications, list of high alert medications, labeling, the definition of a medication error, adverse event, indicator or trigger drugs

Pharmacy

  • Inspections/staff interviews
  • Dispensing of drugs
  • Pharmacist responsibilities
  • Staffing in pharmacy
  • Pharmacy policies and procedures 
  • Medication therapy monitoring
  • Pharmacy USP 797 regulations
  • Emergency medicine kits
  • Drug storage
  • Nursing med carts/anesthesia carts
  • Outdated drugs
  • Survey of pharmacy
  • Reporting ADR and medication errors
  • Near misses/good catches
  • High alert medication
  • Definition of medication error required
  • Trigger/indicator drugs
  • Monitoring medication errors
  • Medication alerts
  • Standard of care for medications
  • Websites and additional resources
  • Required pharmacy P&P
  • Do not use abbreviations
  • Sound-alike/look-alike drugs
  • Non-punitive policies

Dietary and Nutrition Services

  • Final change
  • Dietary policies
  • C&P to order diet
  • Meeting patient needs, diet order, follow recognized dietary practices
  • Dietary compliance
  • Qualified dietician
  • Dietary support staff
  • Assessment of patients and order