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Wisconsin Dialysis Inc. (WDI) Operating Procedures (15.5)

Wisconsin Dialysis Inc. (WDI) Operating Procedures (15.5) - Policies, Clinical, UWHC Clinical, Department Specific, Pharmacy, Clinics

15.5





Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 1
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


I. PURPOSE: To establish methods for Wisconsin Dialysis Inc. (WDI) to obtain
medications from UW Hospital & Clinics (UWHC).

II. POLICY: UWHC will provide medications to WDI for the treatment of patients.

III. ATTACHMENTS:
a. 15.5a WDI East Prescription Stock List
b. 15.5b WDI Fitchburg Prescription Stock List
c. 15.5c WDI Contact List
d. 15.5d WDI Prescription Order Form
e. 15.5e WDI Home Prescription Order Form
f. 15.5g WDI OPP log form
g. 15.5h Ordering Medications from Metro Medical for WDI

IV. PROCEDURE:
A. Unit dose injectables prepared by SPA
1. UWHC sterile products area (SPA) will prepare and provide syringes in unit-
dose packaging.
2. Medications will be ordered as needed by the WDI technician for delivery on
scheduled delivery day.
B. AcuDose® cabinet
1. WDI will utilize AcuDose® cabinets to store a minimum 7-day supply of
medications.
2. Initial stocking of medications will be charged to UWHC, utilizing account
1396061.
3. All restocking of medication will be charged to WDI (Fitchburg account
9840650 and East account 9840660) and will be handled as a cost transfer
from UWHC inpatient pharmacy or from UWHC pharmacy stockroom.
4. All invoices for the AcuDose® cabinet related to the technology (non-
inventory) will be charged to WDI cost center.
C. Non-stock medications and stock-outs
1. Non-stock or stock-out requests may be obtained via fax to the Central
Pharmacy (fax # 262-2584) using the “WDI Prescription Order Form” (see
attached).
a. Stock-out requests
i. If WDI stocks are depleted, the requestor will only need to
complete the medication, strength, and quantity needed.
ii. The notation “STOCK-OUT” will be recorded in the space
provided for patient name.
b. Non-stock requests
i. For non-stock requests, the requestor will complete the
prescription order form including the patient’s name,





Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 2
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


medication, strength, quantity (order a seven-day supply),
indications, directions and stop date if known.
ii. The ordering physician must sign the prescription.
 A nurse may sign the order form for verbal orders by
noting “ VO per ___ “, then printing the name of the
physician who gave the order, and then signing the
nurse’s name.
iii. Medications not stocked by UWHC Pharmacy (non-
formulary medications)
 If a medication is ordered that is not stocked by UWHC
pharmacy, the Central Pharmacist will inform WDI of
the status of the medication and offer to substitute an
alternate product that is available on the formulary.
 If no alternate item is acceptable, then the Central
Pharmacist will complete a special order form and
determine from WDI staff the urgency of need.
 If the medication is urgently needed, the Central
Pharmacist will either borrow the medication or
implement an emergency acquisition from the
wholesaler. How product was obtained will be noted
on the WDI order form.
 If the need is non-urgent, the item will be purchased on
the next business day to be delivered to WDI when
received from the wholesaler.
c. The Central Pharmacy will fill the request and send to WDI.
i. A Central Pharmacy technician, upon receiving the fax order
from WDI, will obtain the requested medications and
complete the following:
 Photocopy the order form.
 Place the product and both copies of the order, for the
Central pharmacist to check.
ii. The Central Pharmacist will verify that the product picked
matches the product ordered and will initial the order form
indicating that the product was verified and dispensed.
 The order form will be placed in the charge bin in the
SPA.
iii. When the product has been checked and is ready for delivery
to WDI, the Central Pharmacy technician will arrange for
delivery by taxi or WDI technician.
d. The WDI Nurse will receive the medication and lock it in a secure
storage drawer or cabinet.





Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 3
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


i. The copy of the order that is sent with the product will be
reviewed by the nurse to verify that the appropriate product
was sent.
ii. After review by the nurse, the document will be placed in the
WDI pharmacy binder.
e. The WDI technician will review the SPA charge bin for WDI
prescription forms daily and complete the following:
i. Make a copy of the order form and keep it in a “non-stock”
folder.
ii. Key the cost of the medication as a “customer to customer”
transfer, crediting the SPA (1365010) and charging WDI
(9840650)
iii. Print a receipt to be delivered with product to WDI.
f. The WDI technician will refill all non-stock items when needed.
i. If non-formulary medication needs to be ordered, the WDI
technician will request the purchasing agent to order,
indicating patient name, item and quantity to re-order.
D. Pharmacy technician services
1. The WDI technician will restock all WDI medications during scheduled
delivery days (Monday, Wednesday and Friday for Fitchburg and
Wednesdays for East).
2. WDI Technician will order all drugs for WDI using EMM system daily.
3. Stockroom Technicians will fill WDI order by 8AM every day.
a. Items from inventory will be issued by SR Technician.
b. Items from CUD will be picked by SR Technician.
c. Special Order items will be ordered from McKesson.
4. Stockroom Technician will make sure that the item and quantities being sent
to WDI match the paperwork.
a. A receipt will be provided for all issues from stockroom and dispenses
from CUD.
b. A copy of the PO for any special orders will accompany the special order
item.
c. The stockroom technician will verify that each item that will be sent to
WDI is accounted for on either the receipt or copy of the PO.
d. The stockroom technician will sign the paperwork that leaves with the
product as documentation that paperwork has been verified.
5. The WDI technicians will double check that products and paperwork are
correct with the WDI staff member.
a. Both WDI pharmacy technician and WDI staff member will sign
paperwork verifying that all paperwork is correct.
b. A copy of signed paperwork will be left with WDI and the original will
be maintained on file at UWHC with Purchasing Coordinator.





Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 4
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


c. The WDI technician will check inventories for expired medications on a
monthly basis.
i. Any medications that are expired will be replaced.
ii. No credit to WDI will be made for medications that have expired.
E. The WDI technician will complete monthly MedKeeper regulatory inspection
documentation. Transportation costs (fleet car) for the daily technician visits will be
billed to UWHC using the UWHC Pharmacy-WDI cost center account 1396.
F. Medication charging to WDI
1. Stock medications initially placed in the AcuDose® cabinet will be charged
to UWHC account 1396 and thus will not be billed to WDI.
2. Initial drugs placed in other inventory locations as well as non-stock
medications placed in the Acudose® cabinet will be charged to WDI
account.
3. All restocking of medications (cabinet as well as non-cabinet locations) will
be billed to WDI account.
4. Any medication with at least 3 months dating may be returned to UWHC.
G. Billing for medications
1. WDI will be billed for the UWHC acquisition cost of the medications.
2. A monthly invoice will be provided to WDI for the direct cost of the drugs
utilized that month.
3. WDI will be billed for a management fee on a monthly basis, and this will be
applied to the Overhead Charges Non-hospital (Expense Class 5993) in cost
center 1396.
H. Additions to stock medications
1. Requests to add a new stock medication will be initiated by WDI by
contacting the WDI pharmacist.
2. If the request is to add a medication not included on the UWHC formulary,
the medication will be initially stocked as a special order (See Policy 3.0).
The WDI pharmacist will also request a UWHC P&T committee review of
therapeutic and economic issues related to the medication. The review will
be returned to the WDI administration and pharmacist for final decision
regarding whether to permanently add the medication to WDI stock.
I. Prescription Services for WDI
1. Prescription services for WDI patients may be obtained by faxing a WDI
prescription order form to an appropriate UWHC Pharmacy.
2. In addition to the WDI prescription order form, a copy of the patient’s
insurance card must be faxed.
3. Co-payments, if required, will be paid through a Visa or Master Card credit
card.
a. Credit card number and expiration must be phoned in to the UWHC
Outpatient Pharmacy at 263-1280 and entered directly by the OPP staff
into a secure credit card storage system.





Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 5
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


4. Prescriptions may be mailed directly to the patient’s home, or delivered to
WDI.
a. Prescriptions for either mail or delivery to WDI will be placed with
UWHC mail order pharmacy.
b. When possible, requests will provide 48 hour notice for prescription
filling.
c. Prescriptions received at UWHC pharmacy by 12 noon, will be delivered
to WDI by 11 AM the following day.
d. Prescriptions received after noon will be delivered by 11 am two days
later.
e. If taxi delivery is requested, taxi charges will be applied to the credit card
and charged to the patient.
5. Home Dialysis Prescriptions
a. General Information
i. Certain medications that are provided to patients for use while on
dialysis must be billed by the dialysis facility as part of the
dialysis procedure. In order to ensure proper labeling and
dispensing of medications these will be dispensed by UWHC
pharmacies.
ii. The medications that may be dispensed to home dialysis patients
by UWHC pharmacies and billed directly to WDI are those listed
in this policy. Exceptions to this list of medications should be
rare, but may occur.
 Darbepoetin injection
 Epoetin vials
 Heparin 1000 units/ml 10ml vial or 30ml vial
 Alteplase 2mg vial
 Lidocaine 1% 20ml vial
 Iron sucrose 100mg vial
 Sterile water 10ml vial
 Vancomycin 1000mg vial or 500mg vial
 Tobramycin 80 mg vial
 Cefazolin 1000mg vial
 Cefepime 1000mg vial
 Ceftazadime 1000mg vial
 Oral iron supplements
 Doxercalciferol
 Paricalcitol
 Calcitriol
b. Prescription ordering
i. A prescription order form will be faxed to the dispensing pharmacy
by a home dialysis nurse or by the prescriber.





Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 6
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


ii. Prescriptions that will be picked up by the patient will be faxed
preferably to UWHC Outpatient Pharmacy (OPP), but may be
called into another UWHC pharmacy based on patient preference.
iii. Prescriptions for delivery to WDI will be faxed to the Outpatient
Pharmacy.
iv. Prescriptions for mail order will be faxed to the UW East Clinic
Pharmacy.
c. Delivery of Medications to Patients
i. Patients coming for a scheduled clinic visit may have prescriptions
delivered directly to WDI prior to their appointment
 Prescriptions should be provided to Outpatient
pharmacy 24 to 48 hours prior to the requested delivery
time and date.
 The WDI technician will deliver prescriptions to WDI
either the day prior to the appointment or the day of the
appointment prior to the patient’s scheduled
appointment time.
ii. Patients may pick up prescriptions at a UWHC pharmacy.
iii. Prescriptions may be mailed to the patient
 Patients who would like prescriptions mailed to them
will need to sign up for the UW Mail Order pharmacy
program through UW East Pharmacy
 Patient will pay for the mail fee if applicable.
- If four or more medications are mailed, there is
no mail fee.
- If less than 4 medications are mailed, there is a
mail fee.
- If overnight delivery is requested there is an
overnight mail fee.
d. Pharmacist / Physician Medication Counseling
i. A delivery log will be kept by Outpatient pharmacy and by WDI
for medications delivered to WDI.
ii. Patients who have medications delivered to WDI may be
counseled by the physician during their clinic visit. This will be
documented by WDI on the delivery log.
iii. The WDI delivery log will be faxed to OPP on a regular basis to
document medication counseling was done.
iv. Patients who pick up prescriptions at a UWHC pharmacy will be
counseled by the pharmacist at the time of pick-up.
v. Patients who have medications delivered to WDI who do not
receive physician counseling at the clinic will need to be counseled
by a pharmacist.





Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 7
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


 If a pharmacist is present at WDI, they will counsel the patient
 If a pharmacist is not present, the patient must be counseled
over the phone by an OPP pharmacist prior to receiving their
medication. This can be facilitated by the dialysis nurse.
e. Billing of Medications
i. UWHC pharmacies will bill WDI for the cost of the medication
plus a dispensing fee using Payer Plan “WDI”.
ii. WDI will bill the patient’s insurance as part of the dialysis billing.
J. Schedule II-V controlled substances
1. UWHC will not supply schedule II-V controlled substances to WDI.
2. If a schedule II-V controlled substance is needed, the patient or family will
supply from home.
K. AcuDose® downtime procedure
1. If technical problems develop the nurse will call the AcuDose® Help
Desk. The Help Desk will resolve most issues.
2. If the help desk is unable to get the cabinet working in a reasonable
timeframe, the R.N. will coordinate the downtime procedure if necessary
and will contact Mary Demski as needed.
3. If after 60 minutes, an acceptable timeframe cannot be provided as to
when cabinet activity will be restored, the Acudose cabinet will then be
placed on Manual Override and the RN will request that an AcuDose
service representative be paged and sent to WDI.
4. AcuDose keys, which are maintained at WDI, are used to place cabinets
on Manual Override. The cabinet has 1 set of keys, both keys are needed
to place a cabinet on Manual Override and open the drawers.
5. The RN will utilize the downtime dispensing form to document dispensing
of all medications removed from the Acudose cabinet during the
downtime.
6. When the cabinet has been restored to service the RN will close all
drawers, lock the cabinet and return the keys. All dispenses recorded on
the downtime dispensing form will then be entered into the cabinet and the
form provided to the WDI pharmacy technician.







Effective Date:

November 2003
Pharmacy Policy Manual
Chapter: Clinics

Chapter:

Policy #: 15.5


Revision 8/16

Page 8
of 8

Title: Wisconsin Dialysis Inc
(WDI) Operating Procedures


L. Metro Medical Order
1. Some medications used by WDI may be ordered from Metro Medical.
2. See 15.5h “Ordering Medications from Metro Medical for WDI” for
details on the ordering systems for Metro Medical.




Approved By: ____________________________
Director of Pharmacy Services

Date: ____________