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Bleeding Disorder Program Procedures (15.9)

Bleeding Disorder Program Procedures (15.9) - Policies, Clinical, UWHC Clinical, Department Specific, Pharmacy, Clinics

15.9





Effective Date:

March 2006
Pharmacy Policy Manual
Chapter: Clinics
Operations Procedure Manual
Chapter

Policy #: 15.9

Original
Revision 11/16

Page 1
of 6

Title: Bleeding Disorder
Program Clotting Factor
Ordering Procedures



I. PURPOSE: To outline processes used to care for patients and manage drugs and supplies in
the care of patients by the UWHC Comprehensive Program for Bleeding Disorders.

II. POLICY: UWHC will provide medications to patients as follows.

III. PROCEDURE:
A. Management of Clotting Factor Inventory
1. The Bleeding Disorders Clinician will be responsible for managing
UWHC inventory levels for each clotting factor to minimize the cost of
product on hand and wastage while ensuring that appropriate quantities of
each product are maintained to provide high level care for program
patients.
a. Inventory guidelines will be established for each product by the
Bleeding Disorders Clinician based upon the number of patients
using each product and the quantity of product dispensed per
month.
b. Items to be added or deleted from UWHC inventory will be
communicated by the Bleeding Disorders Clinician to the
Assistant Director of Pharmacy for Financial Management and
Reimbursement and the Pharmacy Purchasing Coordinator.
2. The Purchasing Coordinator will utilize eForm to have the item added to
the UWHC Bleeding Disorder Inventory and all UWHC Information
System and Automation Databases.
a. A note is added to the eForm comments field indicating that the
product is purchased under 340b pricing.
b. A separate catalog entry will be created for all systems with 340b
listed in the catalog description.
c. Specific CDM codes need to be created in Enterprise with
appropriate HCPCS coding.
d. The Purchasing Coordinator will also notify the Pharmacy
Informatics Support Specialist to update the Bleeding Disorder
inventory database as needed.
3. The University Station Pharmacy staff will maintain a database on the J:
Drive of the hospital network to record information on products in stock as
they are received and dispensed so that a perpetual inventory system and
levels of each product by expiration date and lot number is maintained.
4. As needed the Bleeding Disorders Clinician will review the database.
a. Compare inventory levels with inventory guidelines for each
product.





Effective Date:

March 2006
Pharmacy Policy Manual
Chapter: Clinics
Operations Procedure Manual
Chapter

Policy #: 15.9

Original
Revision 11/16

Page 2
of 6

Title: Bleeding Disorder
Program Clotting Factor
Ordering Procedures


b. Evaluate and update guidelines based upon changes in patient
usage of each product.
c. Generate an order to the vendor for each product to maintain
adequate inventory levels.
B. Ordering Clotting Factor from Vendor
1. After review of the current clotting factor inventory as outlined in the
Bleeding Disorders Clinician will contact the vendor of the product to
place an order. The Clotting Factor Order Form will be completed based
upon the products ordered (Appendix B).
a. A PO Number for each order will be assigned using the
following format:
i. MMDDYY-IN (Example 040105-JS)
 MM = Month (Example April = 04)
 DD = Day (Example = 01 or April 1st)
 YY = Year (Example 05)
 IN = Ordering Individual’s Initials (IN = JS for Jane
Smith)
b. All other elements of the order form including unit cost will be
completed and the form will be signed.
c. A copy of the completed order form will then be faxed to the
University Station Pharmacy (Fax # 263-7945) and UWHC
Pharmacy Purchasing (Fax# 262-6185).
d. Completed order forms awaiting receipt will be maintained in a
binder in the pharmacy until the product arrives and is received
(see section 3 for details)
C. Receiving of Clotting Factor Order
1. When an order of clotting factor is received by the University Station
Pharmacy, a staff member will complete the following steps.
a. Compare product that has arrived with the details of the packing
slip and the order prepared by the Bleeding Disorders Clinician.
i. The Bleeding Disorder Clinician and Pharmacy
Purchasing Coordinator will be notified of all
discrepancies between product shipped and product
ordered or invoiced. A note describing the discrepancy
will be made on the order form and packing slip.
b. Fax a copy of the packing slip (invoice) and the order form to the
pharmacy purchasing office (Fax# 262-6285).
c. Update the Clotting Factor database to reflect product received.
i. Separate lines must be kept for each vial size, lot number,
NDC number, and unit price and expiration date.





Effective Date:

March 2006
Pharmacy Policy Manual
Chapter: Clinics
Operations Procedure Manual
Chapter

Policy #: 15.9

Original
Revision 11/16

Page 3
of 6

Title: Bleeding Disorder
Program Clotting Factor
Ordering Procedures



ii. Contact the Pharmacy Informatics Support Specialist for
issues related to the database.
2. The pharmacy purchasing staff will review the packing slip (invoice),
prepare a purchase order and complete electronic receiving using the
Peoplesoft purchasing system.
a. Purchasing Staff will verify that correct pricing and quantities
was applied to invoice and resolve discrepancies with the vendor
as identified.
b. Purchasing staff will then forward completed PO and receiving
documents and send to UW Accounts Payable office and
maintain a copy of all documents.
D. Patient Orders for Clotting Factors
1. Patients will contact the Bleeding Disorders Clinician for new or refill
supplies of clotting factor.
a. Patients are not allowed to contact the UWHC pharmacy directly
for refill of clotting factor unless all bleeding disorders staff is
unavailable and patient has urgent need for factor.
2. Bleeding Disorder Clinician will verify patients insurance.
a. If patient has no insurance, the Bleeding Disorder Clinician will
work with UWHC fiscal affairs department to determine
appropriate coverage.
b. Factor will not be provided to patients without insurance unless
directed to do so by the UWHC fiscal affairs department.
3. Bleeding Disorder Clinician will review drug inventory database to
determine quantities of factor available for dispensing.
4. Bleeding Disorder Clinician will enter a telephone encounter in Health
Link and prepare a Bleeding Disorder Factor Order flowsheet. Once
completed, route to University Station Pharmacy (P US Pharmacy)and call
the pharmacy to let them know to expect the order.
a. For new prescriptions, e-prescribe in Health Link and route to
UW HEALTH - UNIVERSITY STATION CLINIC - 2880
UNIVERSITY AVE.
b. For refill prescriptions, Rx Number will be entered by pharmacy
staff.
5. University Station Pharmacy will fill the prescription and provide to the
patient as indicated on the order.
a. Delivery will be done using Federal Express or Dunham Express.
b. Patients may pickup filled orders directly from the pharmacy.





Effective Date:

March 2006
Pharmacy Policy Manual
Chapter: Clinics
Operations Procedure Manual
Chapter

Policy #: 15.9

Original
Revision 11/16

Page 4
of 6

Title: Bleeding Disorder
Program Clotting Factor
Ordering Procedures


c. Bleeding Disorder Clinician may pickup filled orders from
pharmacy and facilitate delivery to patient.

E. Prescription Filling and Preparation for shipping
1. When filling the prescription the number of vials used are deducted from
the inventory and entered into the database.
2. Shipping is done using special temperature controlled boxes.
3. Packaging will include the following:
a. An absorbent pad is placed inside the insulated box with the
absorbent side facing up.
b. The product is placed inside plastic bag. Plastic bag is then tied
and put inside insulated box on top of absorbent pad.
c. Bubble wrap is placed around and on top of plastic bag
containing product and packing slip. At least one frozen gel
pack is placed on top of the bubble wrap. There should be
enough space at the top of the box to allow for air circulation
within the box.
d. Top insulating box piece is put in place. Packing slip is placed
on top of insulated piece to ensure that it is kept dry.
e. The box is closed and sealed with packing tape and labeled with
patient name and shipping address.
f. Shipping forms are attached to the top of the box.
4. Packing Slip will be specialized document including the following :( see
Appendix E.
a. Description and quantity of product (factor and supplies).
b. Method and place of delivery or pickup
c. Signature of responsible party if order picked up at the pharmacy
or tracking number of package if send via Dunham Express or
Federal Express.
5. When patient or representative picking up
a. Patient may request the product be packaged in a non-insulated
box.
b. Based on ambient weather conditions the pharmacy staff will
judge if appropriate.
c. Patient will be instructed to prevent exposure to excessive heat
(>86^F) and to refrigerate product within 1-2 hours.
d. Note: All current factor concentrates that UW carries have a
room temperature allowance for at least 3 months.

F. Supply Inventory Management





Effective Date:

March 2006
Pharmacy Policy Manual
Chapter: Clinics
Operations Procedure Manual
Chapter

Policy #: 15.9

Original
Revision 11/16

Page 5
of 6

Title: Bleeding Disorder
Program Clotting Factor
Ordering Procedures


1. The Bleeding Disorders Pharmacist will be responsible for managing
UWHC supply to minimize the cost of product on hand and wastage while
ensuring that appropriate quantities of each product are maintained to
provide high level care for program patients.
a. Inventory guidelines will be established for each product by the
Bleeding Disorders Pharmacist based upon the number of
patients using each product and the quantity of product dispensed
per month.
b. Items to be added or deleted from UWHC inventory will be
communicated by the Bleeding Disorders Clinician to the
Pharmacy Purchasing Coordinator and Pharmacist.
2. The Pharmacy Purchasing Coordinator will utilize Peoplesoft to have the
item added to the UWHC Bleeding Disorder Inventory and appropriate
databases.
3. The University Station Pharmacy staff will maintain supply inventories
based upon established levels listed on the bar code inventory stock label.
a. Items from Central Supply will be ordered using the CS Online
Catalog.
b. Items from Pharmacy will be ordered using the OrdeRx system.
G. Patient Orders for Supplies
1. Patients will contact the Bleeding Disorders Clinician for supply needs.
a. Patients are not allowed to contact the UWHC pharmacy directly
for supply items.
b. UWHC will supply necessary supplies for the administration of
factor at no additional charge.
2. Bleeding Disorder Clinician will enter a telephone encounter in Health
Link and prepare a Bleeding Disorder Factor Order flowsheet. Once
completed, route to University Station Pharmacy (P US Pharmacy)and call
the pharmacy to let them know to expect the order.
a. Some supply items will require a prescription (heparin and
normal saline flush syringes).
i. For new prescriptions, prescribe in Health Link and
route to UW HEALTH - UNIVERSITY STATION
CLINIC - 2880 UNIVERSITY AVE

3. University Station Pharmacy will fill the prescription and provide to the
patient as indicated on the order
a. Delivery will be done using Federal Express or Dunham Express.
b. Patients may pickup filled orders directly from the pharmacy.





Effective Date:

March 2006
Pharmacy Policy Manual
Chapter: Clinics
Operations Procedure Manual
Chapter

Policy #: 15.9

Original
Revision 11/16

Page 6
of 6

Title: Bleeding Disorder
Program Clotting Factor
Ordering Procedures


c. Bleeding Disorder Clinician may pickup filled orders from
pharmacy and facilitate delivery to patient.
H. Miscellaneous Items
1. Inpatient pharmacy may borrow drug which was purchased using 340b
pricing and repay it with product purchased at non-340b pricing under
emergency circumstances.
2. ARC Blood Services Division will continue to stock clotting factor so this
division may be contacted for emergency acquisition of factor for
inpatients (phone # 227-1208)
3. UHWC Bleeding Disorder Program can not supply factor purchased at
340b pricing to any patient not in the Bleeding Disorder Program.
I. Updating Factor Prices
1. Factor prices shall be updated on a quarterly basis
2. The last week of each calendar quarter, the University Station pharmacist
will contact each of the factor suppliers to obtain to 340B price for the
following quarter.
3. The latest quarterly price will be updated and maintained in a spreadsheet
designed for that purpose accessible at J:\Rx\RXShare\Bleeding Disorders
Program Quarterly Factor Pricing Information.xls

IV. REVIEWERS:
Clinical Social Worker, UWHealth Comprehensive Program for Bleeding Disorders
Clinic Coordinator, UWHealth Comprehensive Program for Bleeding Disorders
Outpatient Pharmacy Coordinator, UWHealth Comprehensive Program for Bleeding
Disorders
Pharmacy Manager, Pharmacy Business Operations
Pharmacy Technical Supervisor, Pharmacy Purchasing
Sr Informatics Analyst, Pharmacy Inpatient Services
Sr Informatics Analyst, Pharmacy Informatics
Pharmacy Supervisor, Specialty Pharmacy Services




Approved By: ____________________________
Director of Pharmacy Services

Date: ____________