Pharmaneek's Process Flow Chart & Description

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PROCESS FLOW CHART &

DESCRIPTION

“Order Entry”

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Order Entry Floor

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Order Entry Process Flow Chart

Clinic Pharmacy Manager

Special Order Entry STAT Order Entry

IV Orders

Regular Orders

Damar & RSI

OrdersUneek Dose Order

Pharmacist Verification

STAT Order Entry

Check Entered Orders and Fill Prescriptions

Delivery

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GENERAL ORDER ENTRY

Order Entry

Regular Order Entry

• Order Entry Process Involves: Pharmacy Technicians or In Training Pharmacy Technicians, Pharmacists or In Training Pharmacist. • Perform General Order Entry Duties.__________________________________________________________________

•Receive documents (Fax Machines or e-scripts)•Inform Order Entry if there is new admit in the queue, prescriptions need to be entered, or inform Pharmacists If transfers needed. •Process doc-u-flow (Documents Received Thru Paperless Document management system will be assigned to proper category and processed in a timely manner)•Preview: System will recognize the bar code then determine the Category•Order Entry Techs will assign each category to the department for completion of the document.•Follow-up: This queue contains any document where further information is needed. Complete Documents: If a document in completed documents is re-opened, it must be closed again when finished or it will remain in the completed documents. •Archived Documents:•Audit Follow up Documents•Verify Anything Needed•Complete Batch.

•Damar & RSI Orders: Due to Special Care for any received by Clients and the Medical Records, they are only handled by Ahsley, Matt & Laura.

• Ronnie : Intake•Bree : Order Entry•Chelsea : Order Entry•Ashley : Backup OE•Heather : Backup OE•Anna : Backup OE

Damar & RSI Orders

•Ashley•Matt•Laura

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Uneek Dose Order Entry

Order Entry

Uneek Dose Order Entry

Heather : Order EntryAshley : Order EntryChelsea : BackupBree : Backup

Uneek Dose• Check Uneek Dose Calendar in order to determine which cycle needs to be processed• Prepare cycles to be sent to pacmed machine.• Review all profile sheets of each individual to ensure no orders have changed or added. Also check if all prescriptions have refills. • If prescription need refill call or fax Doctor’s Office. • Bill all scripts to verify no billing issues. • Place Labels with Profile Sheet and send cycle to pacmed machine. • Give the Labels and Profile Sheet to the pacmed operator. • When working on facility batch several residents together and send to the Machine and give profile sheets to the pacmed operator.

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STAT ORDER

Order Entry

STAT ORDER

STAT ORDER• Start a STAT Sheet• Fill out all information needed on the sheet , resident, date, time, fax or call on any clarification.• Page floor to make sure they are aware of the STAT. • Order Entry Specialist enter the order in a batch. • Pharmacist verify the batch• Print to zone printer. • Walk the STAT sheet and labels to the floor. • Verify with the Pharmacist the Stat is on the Floor. • Verify with the Pharmacist if the STAT has been given to the Delivery. • Verify the STAT has left the building. • if any of the STAT claims are not paid send a 3 day emergency supply to get the proper information to the insurance carrier.

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FILLING PRESCRIPTION

Filling Prescriptions

Prescriptions

Holly : Fill TechBree : BackupAnna : BackupAshley : BackupHeather : Backup

Filling Prescriptions• Check Daily Orders Bin.• Scan inventory in Pharmacy Software from Wholesaler• Place Label on Each product and stack it on shelves. • Any C2 Narcotics need to be scanned into inventory by Pharmacist in Software system & update Inventory Book. • Process all back orders that are due for particular day. • Fill all daily orders placed in the daily basket. • Determine if orders are to be filled in Vials, Punch cards or in Original Containers. • Fill all Orders from the refill report for the next day. • Pharmacist will check and verify the orders• Pack and put Delivery Ticket on Order and hand it over to delivery team. • Any medication that needs to be ordered, place the order and send the order at end of the day.

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PHARMACIST VERIFICATION

Pharmacist Verification Pharmacist Verification

• Pharmacist will check all orders filled and placed in filling area. • Scan the bar code. • Approve the filled order. • Place in designated area for delivery ticket. • Filled Prescription is sealed properly by Pharm Tech. •Put it on Delivery Rack and inform the delivery team.

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Delivery Process

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Delivery

Pharmacist Verification

Delivery

•Dashona• Ketra• Markeeta• Adrian • Dave•Catrina

Dispatch / Delivery• After Pharmacist Verification Order is ready for delivery• Pharm Tech will print delivery ticket and place the order on Delivery rack• Delivery team will be informed about the order placed. • Delivery team will call the Patient about the delivery to scheduled for the date and time. • Check with patient if will be available to accept the delivery. • Give any special instructions to drivers about the delivery. • Driver will inform Pharmacy once the delivery is made.

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Driver arrives at

Pharmaneek

Route is assigned to driver

Completed Manifest is given

to driver

Driver verifies he/she has the correct number of items for each stop loaded into vehicle.

All Totes must be sealed by a Pharmacy tech prior to

being handled by a driver.

Details # of items for each stop.

Leave Pharmaneek with all items on Manifest.

Stop at patients home in the order listed on

Manifest.

Upon arrival at patient’s home. Park in designated parking spot. Do not

park in fire lane, handicap, visitor, or other specially marked parking.

Ask for the patient if someone else opens the

door. Disclose the purpose of visit.

Only hand over prescription after verifying the patient

name. In case of patient not able to walk. Hand over the

prescription to family member or nurse.

Have nurse / family member or patient sign the white copy of

delivery ticket.

Ask if any items needs to be returned to Pharmaneek. Or any discrepancies. Note on

the delivery ticket.

Go to next delivery location – Return all

signed delivery tickets to Pharmaneek.

If any are returned.

Return all delivery ticket paperwork and

all return items to Pharmaneek.

Hand all items to Pharmacy Technician

upon arrival at Pharmaneek

Technician Will File delivery ticket/ paperwork in the appropriate

folder.

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Med Select, Control Letter and EDK Billing

Pod

Med-Select

Monitor data Update Inventory

Order Entry Daily & Weekly Reports Billing for all med-select drug usage

Control Letters

Daily Routine of C2 Letter Tech Go through doc-u-flow, link, print and complete all signed letters.

Follow up on unsigned letters. All signed orders for PRN medication are called on to assess the need for

a refill. Calling to assess the need for emergency supply on outstanding orders in

the cart.

EDK Billing

Collect all EDK Slips Enter into Prodigy

Contact Facilities for any questions Bill for medication

Monitor process Fill EDK slips

Clinical PharmacyManager

Med-Select EDK Billing ControlLetters

Med-SelectSpecialist

EDK BillingSpecialist

Order EntrySpecialist

Med Select

EDK Billing

Control Letters

Pod

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EDK Emergency Drug KitsStandard

Refrigerated

Narcotic

IV

Emergency DrugKits

EDK

IV EDK kits aresupplied by ourIV department.All IV EDK kitsare logged withexpiration dateand contents.Each kits has anIdentificationcode barcode.

Narcotic EDK'sshould bedouble locked.Narcotic EDK'shave numberties.Reordering anykit the first timeit is opened toinsure adequatemedications onhand.

When youdetermine theneed to removea medicationfrom an EDK dothe following:

Break SealIdentify the MedneededComplete EDKcharge SlipRe-order EDK

All RefrigeratedEDK kits need toremain intemperaturecontrolledrefrigerator.The temperatureneeds to becheck andlogged daily.

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• Re-Writes• Doc - u – flow• Capture• Flow Sheets• Add Writes• Fax / Clarification• Add / Writes• Service Emails.

Customer New Re-Admit

• Place in Totes• Shipped Product• Driver Scans Delivery

Pharmaneek Medical Records

Specialist

Re- Routing Orders for IV / Wound / Care Nutritionals

• Month End Reports• Print Assembly

Quality Assurance

Telephone Orders

Medical Records

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Billing Department

BillingManager

BillingSpecialist

BillingSpecialist

JuniorAccountant

BillingSpecialist Billing

SpecialistMed B

Specialist

BillingSpecialist

CollectionSpecialist

BillingSpecialist

5000Canon Dell5300w DDDD2330

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835 Process

• One vital element of receivables management and cash flow is the processing of insurance payments. Timely posting of accurate payment and adjustment information can accelerate cash flow by advancing the patient account to the next stage of billing or collections. Although HIPAA implemented a standard format for electronic remittance of data, the ANSI 835, a majority of the remittance documentation received by the healthcare industries today is still on paper.

• The healthcare industry spends 15% of each dollar on payment processing compared to only 2% in retail industries1. Of the remittances processed by healthcare facilities, 80% - 90% are still provided on paper.

• Paper insurance remittances are generally translated manually into payment and adjustment transactions for each documented account. This process is very time consuming and prone to error. In addition, vital details about these payments are often excluded in the interest of time. For example, charge level denials and other detailed adjustments that are often available in the electronic remittances or on the paper equivalent are often summarized or excluded.

• It is our Junior Accountants responsibility to update all remittance information, captures, and communicate with each insurance payee type regarding updated processes and procedures.

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Pharmaneek Daily Census Procedure

All facilities are requested and have agreed to provide Pharmaneek with:• • A complete month to date census in alphabetic order by resident last name every

Monday.• • Daily update changes for all other days of the week Tuesday thru Friday.

(Saturday and Sunday updates will come on Monday)• • We should receive these by 10am each day via email or fax.

Daily: Monday thru Friday• • Check off spreadsheet to confirm receipt of census (check all places; email, doc-

u-flow, fax machine in billing office• • If census is not received by 10am, send email to BOM/ED for the facility

requesting (politely) the census or census updates depending on what day of the week it is.

• • If no responses by 1pm, call facility ask to speak with Business Office Manager, politely request the census or census updates

• • If no response, send another email detailing efforts (who and when emails were sent, who you spoke with when you called)

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Prior Authorizations

Pharmaneek Long Term Care provides a highly trained Billing Specialists to handle prior authorizations:

• Call the facility to obtain the information regarding the patient (s) history, diagnosis, past medications tried etc.

• Call the insurance company to obtain or start the prior authorization process.

• If insurance requires paperwork to be signed by the Doctor our nurse cannot sign but will get the process started and will follow up with the Doctor until resolved.

• If labs are required, we will start this request process.

• If a PA cannot be resolved the same day the medications are ordered, we will contact your facility via fax to notify you of the status of the PA.

• Pharmaneek will attempt to get an initial override to get you the medication that day, but sometimes this is not possible.

• All information will be communicated to your facility.

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Update Administrative Staff with updated

Reports

Get Census Please all updated

documentation in MARS and TARS

Troubleshoot faxmachines.

Clean glass, Monitor usage, update firmware

and reset counter

Med-Cart Check Review Overstock

Med Room Audit

Review facility changes and help discuss ways of

improvement. Updated census, Proper return process, Prior

Authorization and ControlLetters.

Conduct and Attend Health Fairs

AccountManager

Conduct In-ServicesMonthly

and Train on updatedsoftware

Account Manager

Meet with Administration Staff

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Pre-pack

• Re-package bulk medications into standard packaging for dispensing suitable for long term care. The top 250 to 500 medications are packaged to streamline efficiencies in dispensing of prescriptions.

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Nurse Transcribes order to a telephone order form

Nurse Notifies Physician to

call Pharmaneek @ 317-293-

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Physician Calls a verbal order to Pharmaneek

Pharmacist. (DEA # will be

verified)

Nurse Faxes Telephone Order to

Pharmaneek

Physician Verifies that Physicians

verbal order and nurses telephone

order match

Pharmaneek Process the Now

Validated RX

Processing A Controlled Substance Obtaining a VERBAL RX

Pharmaneek Procedures for Processing an RX for a

controlled Substance in accordance with DEA

regulations (Obtaining a verbal prescription – not

allowed for CII meds)

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Processing A Controlled Substance Obtaining a Written RX

Nurse Transcribes order to a telephone

order form & Telephone

order is Faxed to Pharmaneek

Pharmacy Process information – generates Rx

Template for Doctors Signature.

RX Template is Faxed to Dr- Monitored Daily by

Pharmaneek for Signature Receipt.

Physician Signs RX and Faxes back to Pharmaneek.

Pharmaneek Process the

now Validated RX

FinishMedication is Delivered to

LTCF

Pharmaneek procedures for processing an RX for a

controlled substance in accordance with DEA

regulations (Obtaining a written prescription)

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Medication Returned

Full Card/ Full Sealed Bulk / Unit

Dose

Expiration Date Less Than 6 Months

Expiration Date Less Than 6 Months

No Credit Card / Bulk Med Defaced / unit Dose (not re-

usable

Card / Bulk Med / Unit

Dose Re-usable

No Credit Credit

Note: Refrigerated Items Must be

returned in a cooler to be eligible for

credit

Partial Credit / Full Card or Bulk

defaced

Compound / Special Order

Refrigerated (Not Stored or

transported properly)

Below minimum re-stock fee

No Credit

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Compounding

• Prepare medications that are not manufactured in the form or combination prescribed. Ex: mixture of multiple creams, compounding medications into an oral solution or suspension that are only available commercially in an oral solid form. Compounding must be done in a clean environment following sound industry standards. Compound templates must be carefully developed and executed by licensed pharmacy personnel.

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Through the Patient file Maintenance

Record.

In CompletedDocuments

Through searchingarchived documents

Documents areRetrievable

Documents are linked to each patient record by assigning the

document to the Patient.

Documents are triaged

and assigned to category

All patient documents related to billing are received through paperless

via email.

Face Sheet&

Billing Information

How to retrieve Face Sheet and Billing Information

Retention andRetrieving

Prescription Records

DeliveryReceipts


Documents are assigned to each

RX record on the delivery ticket. By recognized

Bar Code.

Receipts contain date,

time, nursessignature

All delivery receipt are Faxed or emailed to our paperless system

How to Retrieve Delivery Receipt

RX Record


Through Searching Archived Documents

Patient file Documents

PrescriptionRecords


Document are linked to each RX

Documents are Triaged and Assigned

to Category

Document Received

How to RetrievePrescriptionRecords

RX Record


Through Searching Archived Documents

New Orders are retrievable from Patient

file Documents

Retention and Retrieving Prescription

Records

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Parata Fill

Prodigy System Parata System

PharmacyTechnician

Parata Filling OrdersPharmacist VerificationDelivery

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Parata Fill (PACMED)

• Orders are sent to Pacmed Fill, days in advance from Prodigy System.

•Pharmacy Tech Checks the inventory of drugs in Pacmed Fill and make sure the counts are sufficient to run Batches

•Once Pharmacy Tech Approves the inventory in Parata. Pharmacy Tech starts the Equipment for Filling process.

•Pharmacy Tech Verifies # of Pills in Packets.

•After Prescriptions are filled. Pharmacist Verifies each filled order.

•Once Pharmacist Verifies the Prescription. Delivery department is informed about it. All tickets are printed as per the delivery and prescription is out for Delivery.

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Accreditation

What is Accreditation:• Are all Long Term Care Pharmacies alike? No• Quality can differ significantly from one pharmacy to another• There are 1,000’s of public and private pharmacies nationwide with new ones opening every day. • Goal: to protect the consumer, states have licensure laws governing these pharmacies. (Usually minimum

requirements).• Centers for Medicare and Medicaid services (CMS) have established requirements.• Another form of consumer protection is voluntary accreditation.• Standards of care are based upon the consensus of professionals of elements that should exist in LTC Pharmacies, that

have gone the “extra mile”

Accreditation is a means of :• Measuring the organizational management• Internal processes• Patient safety • Service outcomes• Organizations that have earned accreditation usually are most serious about maintaining the quality of services and

products they provide.

Accreditation is• A professional peer review administered by a private nonprofit organization• It is structured to establish higher standards than state and federal requirements• This is voluntary and the Pharmacies do have to pay a fee to participate.

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PROCESS IN PIPELINE

IV Order / IV Order Entry

Consultant Pharmacist

Med Select

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IV Order Entry

Order Entry

IV Order Entry

IV Order Entry

• Select the drug • Add Expiration Date

• Add NDC / Quick Code • Check IV ED

• Dosage Form • Check Pump Allocation

• Route of Administration • Send IV Pole and equipment Needed

• Dispensing Unit • Log all pump locations

• Main Ingredient •Log EDK Expiration pickup dates

• Add Sub Ingredients • Provide Pump Training

• Call to verify daily before refilling

• Provide IV Support to facilities

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Update all Reports for Monthly Summary

and Graph Changes

Get Census Get Pending

recommendations

Med pass observation

Chart ReviewGradual Dose Reduction

Look for diagnosis and Labs Med count: 9+ routine meds are

a flag (yearly)Recommendations

Facility Observation and Tour

Provide scheduledIn-services

and Discuss future In-Services

needs



Discuss all observations with administrative staff

Meet with Administration Staff

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Med-SelectPurpose:The Med Select unit will replace the EDK and can be used for first dose of medications until the full supply arrives from the Pharmacy.Scanning each medication removed from the system verifies it is the correct medication and reduces med errors.

Procedure:If not already logged in, log into the DT using your User ID and Biometric/PIN. Once logged in you will see the patient browser screen.To select a patient begin typing the LAST name and then select the desired patient and select Continue.Select the medications) to be dispensed.Enter desired quantity.Select the Dispense button.When a drawer opens, a window on the screen will display the medication to be dispensed with the cabinet location. Remove the requested medications) in the requested amount and close the drawer.

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If multiple medications are being dispensed - remove the medication and close the drawer - the next drawer will open and the screen will display the medication and the location. This process will continue until all requested medications are dispensed. After removing all requested medications, begin scanning the barcode on each package.If barcode scanning is unavailable, you must have a witness to visually verify the medication. Select the desired medication and press Verify.

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Policy:•All medication removed from the Med Select unit must be signed out to a patient.

•All medication removed from the Med Select unit must have a physician’s order.

•All medication orders must be reviewed and approved by a licensed pharmacist prior to dispensing except for in emergency situations (SEC. I).

•When dispensing medication the nurse must scan the medication for verification. If the nurse is unable to scan the package they must have a witness visually verify the medication.

•Medications will be available to dispense for a limited time before and after scheduled administration time. PRN orders will always be available.

•If a controlled (Class 2-5) medication is stored in a drawer it must be the only item in that drawer. The system will require a user count each time the item is dispensed. Count discrepancies will be monitored on a daily basis.

Med-Select

Pharmaneek's Process Flow Chart & Description

Health & Medicine

Transcript of Pharmaneek's Process Flow Chart & Description