Navmed P-117 Ch 21: Pharmacy

Telephone or oral prescriptions will not be accepted except for emergency situations or under extraordinary circumstances, directly from an authorized prescriber.  Telephone and oral prescriptions shall be immediately reduced to writing and read back to the provider for verification.

• True

• False

Products containing pseudoephedrine or other over-the-counter (OTC) medications with FDA restrictions shall not be dispensed as an OTC.  MTFs will only dispense pseudoephedrine-containing products as a prescription item.  \

• True

• False

When a pharmacy receives a prescription refill request for a controlled medication listed in DEA Schedule II but there are no further refills authorized, the pharmacist may choose to fill the prescription with a 72 hour supply if the medicine is for __________ (one word) control.

Deploying service members may receive up to a __________(word or numbers) day supply of DEA Schedule II medication. 

All new and refill prescriptions will be dispensed to include a printed Patient Education Monograph from CHCS along with any FDA-approved Medication Guide to distribute the effects statement.  Pharmacies may also in addition to not in lieu of; distribute the side effects statement on a sticker attached to the unit package, vial, or container of the drug product or on a preprinted pharmacy vial cap.

• True

• False

__________(one word) checks will be made by the pharmacy of all nursing care units or other areas where medications are dispensed, administered, or stored?

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Pharmaceutical inventory will be managed to ensure the stock levels of pharmaceuticals on-hand are not excessive (in general, not to exceed a 30-day supply). Annually, at a minimum, MTFs will establish drug inventory par or stock levels that reflect the level of care, prescription workload, and mission MTFs shall conduct an annual inventory of all drugs stocked in the pharmacy however, should resource constraints be an impediment, MTFs may choose to perform a monthly sampling and/or a risk based approach until a perpetual inventory system is implemented. Pharmacies will segregate duties for ordering, receiving, and inventorying medications to the maximum possible extent.

• True

• False

When only a month and year of expiration are provided for a drug, the drug may be used until the __________ (one word) day of that month.

No authorized provider shall prescribe or furnish a DEA controlled substance for themselves or members of their immediate family.

• True

• False

Prescriptions from MTF and DoD authorized providers for formulary drugs will be honored.  Authorized prescribers may include:      - Medical Corps officers      - Dental Corps officers      - Optometrists      - Physician Assistants      - Pharmacists      - Independent Duty Corpsmen      - Physical Therapists      - Veterinarians (when prescribing medications for military working animals)

• True

• False

The primary means of inpatient drug distribution in fixed inpatient treatment facilities will be the unit-dose system or automated medication dispensing systems, which shall include the pharmacist interpreting the physician's orders and monitoring inpatient medication needs.

• True

• False

The pharmacy is responsible for labeling medications.  All medications issued in bulk containers to nursing care units or clinics, not dispensed in the original container, shall be labeled by the pharmacy with the date of issue, generic and trade name, strength, quantity, beyond use date, name of the manufacturer, and lot number or appropriate code to identify the drugs.  A repackaging beyond use date will comply with current USP requirements  not to exceed 1 year or the actual manufacturer's expiration date, whichever is less, will be added to drugs distributed in other than the original manufacturer package.

• True

• False

A log or electronic record of all medications placed in storage counting cells (e.g. Baker Cells, Drug-o-Matic) will be maintained to include initials of the pharmacist or senior technician checking the filled cell, manufacturer. lot number, and expiration date.

• True

• False

A prescription for a non-controlled medication shall be filled within 1 year of the date originally written.  These prescriptions may be refilled, if authorized by the prescriber, up to 12 months from the date originally written. 

• True

• False

When CHCS is down, only prescriptions written by civilian and MTF providers for urgent medications (i.e., antibiotics and pain medications) may be filled unless an adequate downtime system is available that offers complete patient medication profile information.  All pharmacy services may be ceased at the direction of the MTF CO until system is operational at the recommendation of the pharmacist as deemed necessary for safe and effective patient care.

• True

• False

Prescriptions written by civilian practitioners other than those employed by the DoD may be filled for authorized beneficiaries provided that the item is on the MTF formulary and a pharmacist verfies the prescription per current regulations.

• True

• False

Prescription medications for oral use by outpatients will normally be dispensed in child resistant containers unless the patient or prescribing practitioner requests conventional (non-child resistant closures).  These requests for non-child proof containers shall be authorized by a notation in CHCS for the individual prescriptions or in the pharmacy comment section.  If CHCS is not available, then these prescriptions shall be authorized by the patient's signature and such documentation shall remain on file within the MTF.

• True

• False

Products containing pseudoephedrine or other over-the-counter (OTC) medications with FDA restrictions shall not be dispensed as an OTC.  MTFs will only dispense pseudoephedrine-containing products as a prescription item. 

• True

• False

Multiple dose vials (MDVs) containing parenteral medications may be reused if the following procedures are followed to eliminate the risk of infection:      (a)  Use strict aseptic technique.      (b)  Upon reconstitution, date an MDV that requires addition of a diluent, label with a beyond-use date, store, and discard using the manufacturer's stability data, not to exceed the current reference standard as stated in USP 797.       (c)  Date any open or entered (e.g. needle punctured) MDV, which does not require addition of a diluent and discard according to the current standard as stated in USP 797.  The beyond-use date for MDVs with an anti-microbial preservative is 28 days, unless otherwise specified by the manufacturer.  Opened or needle punctured single dose containers shall be used within 1 hour and any remaining contents discarded.   Date and time for single dose must be marked upon opening or puncture.      (d)  Discard contaminated vials immediately upon detection.

• True

• False

Key elements of a unit-dose system are:      a.  Medications are contained in and administered from single-unit or unit-dose packages.      b.  Medications are dispensed in ready-to-administer form to the maximum extent possible.      c.  For most medications, not more than a 24-hour supply of doses is provided to or available at the patient care area at any time, unless an automated dispensing system is in place.      d.  A patient medication profile is concurrently maintained by the pharmacy for each patient.      e.  Minimize the use of floor stock medications.

• True

• False

Acceptance of pharmaceutical samples from sales representatives for dispensing to patients is prohibited.  Should a practitioner desire to evaluate a pharmaceutical, the practitioner's department head will request a review by the Pharmacy and Therapeutics (P&T) Committee.  If approved by the P&T Committee:      (a)  Parameters will be established to allow evaluation      (b)  The product will be purchased via established protocols      (c)  After a reasonable evaluation period, the P&T Committee must determine if the product warrants formulary status

• True

• False

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• True

• False

Pharmaceutical inventory will be managed to ensure the stock levels of pharmaceuticals on-hand are not excessive (in general, not to exceed a 30 day supply), based on historic utilization patterns, potential urgency of medication use, administrative costs, in addition to considering the limits of the supply system.

• True

• False

Prescription medications for oral use by outpatients will normally be dispensed in child resistant containers unless the patient or prescribing practitioner requests conventional (non-child resistant closures).  These requests for non-child proof containers shall be authorized by a notation in CHCS for the individual prescriptions or in the pharmacy comment section.  If CHCS is not available, then these prescriptions shall be authorized by the patient's signature and such documentation shall remain on file within the MTF. 

• True

• False

MTF pharmacies will not provide medications intended for the purpose of home intravenous infusion. 

• True

• False

All medications issued in bulk containers to nursing care units or clinics, not dispensed in the original container, shall be labeled by the pharmacy with which of the following pieces of information?

• Date of issue

• Generic and trade name

• Strength and quantity

• Beyond use date

• All of the above

Personal medications brought to a hospital by a patient that were kept by nursing staff shall be destroyed 15 days after discharge.

• True

• False

Only items which have been licensed and approved by the Food and Drug Administration (FDA) for sale in the United States are authorized for use in CONUS MTFs.  Executive order 13139 and 10 USC 1107 prohibits the use of non-FDA approved drugs on service members, whether CONUS or OCONUS, unless the member signs a consent form or the President waives the requirement for member consent.

• True

• False

Each parent MTF, with an organic pharmacy department, shall establish a Pharmacy and Therapeutics (P&T) Committee to advise the CO on the selection and use of drugs in the facility.  The P&T Committee is a function of the medical staff and will meet at least quarterly. 

• True

• False

Pharmacies will fill all valid non-controlled prescriptions that are presented, regardless of the geographic location of the beneficiary or prescriber, providing the medication is on the MTF formulary, and the prescription conforms to applicable laws and regulations.

• True

• False

Non-FDA approved medications such as neutraceuticals, homeopathic, and therapeutic dietary supplements are not a TRICARE-covered benefit, therefore, not dispensed by the pharmacy department.  These agents are not subject to FDA regulation regarding good manufacturing processes which presents legal risks to the MTF.

• True

• False

Monthly checks will be made by the pharmacy of all nursing care units or other areas where medications are dispensed, administered, or stored, to verify that at the minimum:      (a) Drugs for external use and disinfectants have been stored separately from internal and injectable medications      (b) Drugs are not overstocked      (c) Drugs are stored following current established standards      (d) Once discovered, outdated or unusable drugs should be segregated and returned to the pharmacy immediately      (e) There is an adequate and proper supply of P&T Committee-approved emergency drugs      (f) All drugs in the area are properly labeled NAVMED P-117, Article 21-6, Paragraph (2)

• True

• False

Substances listed on DEA Schedule II  are considered to be drugs with an acceptable medical use and a very high abuse potential.

• True

• False

Which chapter of the MANMED deals with Pharmacy?

• Chapter 14

• Chapter 19

• Chapter 21

• Chapter 23

Patient's age or date of birth is required to be on every outpatient prescription.  If the child is 12 years old or younger, the age must also be included.  The pharmacy may record the child's age or weight on the prescription if it was omitted.  

• True

• False

Caustic substances such as acetic acid and concentrated hydrochloric acid shall be submitted and approved by the MTF CO prior to being issued to nursing care units, clinics, or outpatients.  They shall be stored in separate lockers and contents shall be clearly marked.

• True

• False

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• True

• False

All prescriptions originally filled at one DoD MTF may be refilled at another as long as the pharmacy takes into account the type of medication and the method used for recording refills.  MTFs with pharmacy data processing systems that do not access the same prescription records electronically will notify the original facility of transfer of remaining refills, thus voiding any remaining refills at the original MTF.  An electronic record will be made of the the prescription such as "Transferred to (name of MTF)" with date of transfer.

• True

• False

Prior to releasing sensitive patient information, all requests shall be approved through the command legal office or appropriate authority.  A police officer, agent of the Naval Criminal Investigative Service (NCIS), agent of the CO, or any agent of higher authority may remove an original prescription from the pharmacy's files for the purpose of an investigation.  Whenever this occurs, a photocopy of the original prescription and a receipt from the agent or police officer shall be kept in the pharmacy's files. 

• True

• False

Individuals receiving outpatient medications for beneficiaries other than themselves or their minor children should provide reasonable proof of patient consent such as an authorization letter and front and back photocopy of patient's ID for the release of medical information and prescriptions. Expired IDs will be confiscated via local MTF policy.

• True

• False

DEA Schedule II medications must be refilled within 30 days of the prescription being written.  They may not be refilled, except for a 72-hour supply of anti-seizure medication.  Deploying service members on Schedule II medications may receive up to a 90-day supply.

• True

• False

Alcoholic beverages shall not be stocked or dispensed from Navy MTFs.

• True

• False

The patient's weight is required on the prescription when the patient is under 12 years of age.

• True

• False

Facilities will minimize the potential for the dispensing of expired drugs through effective inventory management, identification of expired drugs, prompt removal of expired drugs, and tracking of expired drugs.      (a)  When only a month and year of expiration are provided for a drug, the drug may be used until the last day of that month.      (b)  Pharamaceutical inventory will be inspected at least monthly.      (c)  Pharmaceuticals that will expire first shall be placed in a position to be used first.      (d)  During the monthly inspections, pharmaceutical items that will expire within 30 days will be removed from inventory, isolated, and securely stored in an area away from in-date pharmaceuticals.  Special consideration should be given to medications normally dispensed in 90-day supply or greater.

• True

• False

When only a month and year of expiration are provided for a drug, the drug may be used until the last day of that month.

• True

• False

Products containing pseudoephedrine or other over-the-counter (OTC) medications with FDA restrictions shall not be dispensed as an OTC.  MTFs will only dispense pseudoephedrine-containing products as a prescription item. 

• True

• False

Nursing personnel shall collect all medications brought to the hospital by patients admitted to nursing care units.  When possible, these drugs will be given to a member of the patient's family to return to the patient's home for safekeeping.  Medications collected in this manner will not be retained by the patient, unless an order is written by the practitioner responsible for the patient that the patient may use his or her own medication following local MTF policy (e.g., "Keep personal medications at bedside").  If this is not possible, all medications will be identified, inventoried, and secured until the patient is discharged.  Any medications remaining 15 days after date of discharge shall be destroyed.

• True

• False