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Virtual Colonoscopy Prep Kit (15.7)

Virtual Colonoscopy Prep Kit (15.7) - Policies, Clinical, UWHC Clinical, Department Specific, Pharmacy, Clinics

15.7





Effective Date:

May 2004

Chapter: Clinics

Chapter:

Policy #: 15.7

Original
Revision 10/16

Page 1
of 3

Title: Virtual Colonoscopy Prep Kit




I. PURPOSE: To establish methods for patients to obtain medications from UW Hospital &
Clinics (UWHC) for Virtual Colonoscopy Procedures.

II. POLICY: UW Health will provide medications to patients per the following procedure.

III. PROCEDURE:
A. UWHC Ambulatory Patients
1. A physician/mid-level provider will fax a referral for a patient to have a virtual
colonoscopy (VC) exam to the VC Office or complete a VC procedure order in
Health Link.
2. The physician/mid-level provider will write a prescription for a VC Prep Kit and fax
this to the VC Office or order the appropriate VC Prep in Health Link, which will
then print in the VC Office. .
3. If the prep needs to be mailed to the patient immediately, the VC Office will fax or
walk the prep order to the mail order pharmacy and include the patient’s address on
the cover sheet indicating where the VC Prep Kit should be mailed.
4. All other VC prep prescriptions will be delivered to the East Clinic Pharmacy by the
VC Office, to be profiled until the patient arrives at the pharmacy location for pick
up, or calls and requests the prescription be filled.
5. There are two different kits
Peoplesoft # Product Name
4008102 PEG Virtual Colonoscopy Prep Kit
4010866 Routine Virtual Colonoscopy Kit
6. The Routine Virtual Colonoscopy Kit will be prepared and stocked in the following
pharmacies:
a. UW Health East Clinic Pharmacy(includes Mail Order Pharmacy)
5249 East Terrace Drive
Fax: 265-0927
b. UW Health West Clinic Pharmacy
451 Junction Road
Fax: 265-7456
c. UW Health Outpatient Pharmacy
600 Highland Avenue
Fax: 265-8878
d. UW Health Union Corners Pharmacy
2402 Winnebago St.
Fax: 245-6125
e. UW Health West Towne Pharmacy
7102 Mineral Pt Road
Fax: 828-7708
f. UW Health 1 S Park Pharmacy





Effective Date:

May 2004

Chapter: Clinics

Chapter:

Policy #: 15.7

Original
Revision 10/16

Page 2
of 3

Title: Virtual Colonoscopy Prep Kit


1S Park Street
Fax: 287-2987
g. UW HealthNortheast Family Medical Center Pharmacy
3209 Dryden Drive
Fax: 241-0857
h. UW Health University Station Clinic Pharmacy
2880 University Ave
Fax: 263-7945
i. UW Health at The American Center (TAC) Pharmacy
4602 Eastpark Blvd.
Fax: 240-4266

7. The PEG Virtual Colonoscopy Prep Kit is used only when severe cardiac, liver, or
renal disease is present, or in patients who cannot tolerate moderate fluid or
electrolyte shifts. Patients may only obtain this kit from the outpatient pharmacy at
UW Hospital (OPP), East Clinic Pharmacy, or via mail through the East Clinic
Pharmacy. This kit will not be stocked in any other pharmacy.
8. Kits will be prepared at UWHC Inpatient Pharmacy and delivered to all UWHC
Pharmacies.
9. Kits will be billed to the VC Program (Account 8022001) when they are prepared.
The kit charge will include a markup that will offset mailing, preparation, and
dispensing expenses incurred by each pharmacy.
10. Patients will not be billed for kit contents; instead, costs of these items will be a part
of the VC Exam charge.
a. UWHC staff will use the payor plan "VC Kits" in Enterprise.

B. UWMF Ambulatory Patients
1. UWMF will only be supplied with VC Kits through the 1 S Park Pharmacy. Kits
will be available for pick up or mail out.
2. UWMF VC Staff will walk prescriptions down to the 1 S Park Pharmacy along with
the UWMF patient information sheet with the 1 S Park VC Program information.
The nurse delivering the prescriptions will indicate whether they are for delivery or
pick-up.
3. Pharmacy staff will replace the UWHC HFFY sheet with the UWMF patient
instruction sheet when the kit is prepared for dispensing.
4. Pharmacy staff will use the product name “UWMF- Routine VC Prep Kit” or
“UWMF-PEG VC Prep Kit w/oral contrast”.
5. The UWMF VC kit will be dispensed at no charge to the patient utilizing the payor
plan “VC Kits” in Enterprise.
6. The UWMF VC kit will have the same contents as the UWHC VC kits.
7. Prescriptions that are walked down to the pharmacy more than 10 days before the
procedure are profiled, and the UWMF patient instruction sheet is filed under the
date 10 days before the procedure to be filled on that date. This date is noted in





Effective Date:

May 2004

Chapter: Clinics

Chapter:

Policy #: 15.7

Original
Revision 10/16

Page 3
of 3

Title: Virtual Colonoscopy Prep Kit


Enterprise in case the patient arrives early to pick up the VC kit so that the patient
instruction sheet can be easily located. The prescription is then filled for the patient
upon their arrival.
8. A biannual report will be run by the Ambulatory Pharmacy Office to identify how
many UWMF kits were dispensed by the pharmacy. UWMF VC Staff will use this
report to reimburse the UWHC Radiology department for the number of kits
dispensed.

C. Patients who receive a VC Procedure as inpatients
1. Patients will have VC exam orders in Health Link.
2. Patients will have VC Prep orders in Health Link with explicit listing of timing
and dosing of each product.
3. A pharmacist will process each component of the VC Prep in Health Link for
dispensing and charging.
4. Each component will be billed to the patient using the usual and customary
charges for each item administered to the patient (the drugs cannot be charged
to the Radiology Department when the patient is an inpatient).
5. If the inpatient is at TAC, and they do not stock the correct concentration of
Iohexol, this medication can be obtained from University Hospital and sent over
to TAC. Or, if needed urgently can be obtained from the outpatient pharmacy at
TAC by taking it out of a stock VC prep kit.
6. Administration of the VC Prep will be carried out by appropriate inpatient
nursing staff and documented using established procedures and systems.

Reviewers:
Pharmacy Manager, Ambulatory Services
Pharmacy Supervisor, Health Link Meds Management
Pharmacy Manager, Inpatient Services
Clinical Coordinator Radiology Nursing, Virtual Colonoscopy Program
Pharmacy Manger, Business Operations


Approved By: ____________________________
Director of Pharmacy Services

Date: ____________