A Few questions about anesthesiology and hospital pharmacy

drhemi70

Member
10+ Year Member
Mar 18, 2005
116
1
Status
For those of you currently working in hospital pharm,
I posted a similar question on the anesthesiology board to get their side of this but I also want to ask the pharmacist.

How does your hospital pharmacy deal with suppling meds to anesthesiologists? Do you use pyxis? Do you use trays? Who does the billing? Who does the wasting. I am in a small 70 bed hospital and we are having back and forth with the anesthesiologists. They tell us that our current system isn't working well(we use low-high use trays), we change in the way they ask for the most part and then one of the other anesthesiologists comes and says the new system isn't working at all. We currently do the billing, and change out the trays when the anesthesiologists ask us to.

The current system is somewhat cumbersome because the anesthesiologists aren't keeping great track of what they use and just fill out their sheets at the end of the day. We can tell some what of what they use by what is missing, but because we are currently billing by the ml we are not sure we are billing properly espcially because the anesthesiologists do the wasting with an observer there.

Second question. Do you guys test what you get back for diversion? From what I have been reading this can be difficult to pick up because there is all the equipment in an OR to back fill a vial to the amount that the doc says they have given the patient with NACL or H20. If you do test for diversion can you describe how you do it and your methods for developing standards and things of that nature?

Thanks,
DR
 

trishias

Gotta love Proud Snax!!
10+ Year Member
5+ Year Member
Mar 1, 2005
241
0
38
Chicago, IL
Status
drhemi70 said:
For those of you currently working in hospital pharm,
I posted a similar question on the anesthesiology board to get their side of this but I also want to ask the pharmacist.

How does your hospital pharmacy deal with suppling meds to anesthesiologists? Do you use pyxis? Do you use trays? Who does the billing? Who does the wasting. I am in a small 70 bed hospital and we are having back and forth with the anesthesiologists. They tell us that our current system isn't working well(we use low-high use trays), we change in the way they ask for the most part and then one of the other anesthesiologists comes and says the new system isn't working at all. We currently do the billing, and change out the trays when the anesthesiologists ask us to.

The current system is somewhat cumbersome because the anesthesiologists aren't keeping great track of what they use and just fill out their sheets at the end of the day. We can tell some what of what they use by what is missing, but because we are currently billing by the ml we are not sure we are billing properly espcially because the anesthesiologists do the wasting with an observer there.

Second question. Do you guys test what you get back for diversion? From what I have been reading this can be difficult to pick up because there is all the equipment in an OR to back fill a vial to the amount that the doc says they have given the patient with NACL or H20. If you do test for diversion can you describe how you do it and your methods for developing standards and things of that nature?

Thanks,
DR

At my hospital, we use several methods. In the my specific pavilion, we have an Omnicell for the fast-movers, narcs and expensive stuff like zofran for the general OR's. In each OR, there is a cart that contains stuff they use for the cases like sux, rocuronium, robinul, ephedrine, decadron, propofol, etc, etc. At the end of the day, the swing shift tech goes and charges the patients based on the anesthesia record. Its a duplicate form, so its hard to read when the top sheet is gone.

For the labor and delivery OR's, we have regional and general trays. In the mornings, the swing shift tech goes up and restocks the trays. Basically, we replace whatever is missing from the tray and use a green lock to lock it. We charge the patients by indicating on a sheet, that anesthesia or the RN's put in the tray, what was used. In this area, there used to be a huge potential for diversion because we didnt lock up the pentothal and ketamine (we use these in the general trays). i think there was an incident with one of the docs so now we keep a limited supply in the area and use narc sheets to keep track.

In the main building, im not sure exactly how they do it. I do know that they pass out fentanyl and versed like candy (my opinion) but they keep track of it well and sign it out to the patient and charge them at the end of the day. But I cant comment on those pharmacies.

Maybe you can change the billing by charging the entire vial because u cant give a partial vial to another patient (this is what we do). This way u can simplify your billing. Also, maybe u can get the individual trays so one patient gets one tray and someone restocks them one a daily basis. Although this can be tedious, its a better method of trying to accurately charge the patients.

I cant answer in terms of diversion because we really dont have those problems. If we do, I dont know about them. Although our process is tedious, it works pretty well when they remember to put a name with the trays.

I hope this helps and if u need more info, please feel free to pm me.
 

baggywrinkle

cranky old fart
7+ Year Member
15+ Year Member
Aug 14, 2003
549
4
Tacoma, Washington
Visit site
Status
drhemi70 said:
How does your hospital pharmacy deal with suppling meds to anesthesiologists? Do you use pyxis? Do you use trays? Who does the billing? Who does the wasting. I am in a small 70 bed hospital and we are having back and forth with the anesthesiologists. They tell us that our current system isn't working well(we use low-high use trays), we change in the way they ask for the most part and then one of the other anesthesiologists comes and says the new system isn't working at all. We currently do the billing, and change out the trays when the anesthesiologists ask us to.

The current system is somewhat cumbersome because the anesthesiologists aren't keeping great track of what they use and just fill out their sheets at the end of the day. We can tell some what of what they use by what is missing, but because we are currently billing by the ml we are not sure we are billing properly espcially because the anesthesiologists do the wasting with an observer there.

Second question. Do you guys test what you get back for diversion? From what I have been reading this can be difficult to pick up because there is all the equipment in an OR to back fill a vial to the amount that the doc says they have given the patient with NACL or H20. If you do test for diversion can you describe how you do it and your methods for developing standards and things of that nature?

Thanks,
DR
Pyxis is great when you have it. My place went to patient boxes filled
with a standard list approved by anethesiology. The docs are relieved of
charging. All they have to do is write the patient's name and throw it in
the tackle box. Pharmacy does the charging, resets the box and reissues it.
Done from a satellite one box is issued at a time. Done from central pharmacy
the doc will pick up his entire case load of boxes for the day.

The first quarter after this system was instituted 500,000 dollars in lost charges were captured over previous measuring periods.

For diversion just let it be known you are testing whether or not you actually
are.
 
About the Ads