Tatum Johnson-Herwick

The incumbent is responsible for assisting in providing and coordinating complete pharmaceutical care activities in the Inpatient Pharmacy, Outpatient Pharmacy, patient care areas, and/or various medication-related areas in agreement with the mission, vision, and goals of the VA Sierra Nevada Health Care System. The incumbent is required to carry VA issued phone, pager, or other form of electronic communication devices for communication with other hospital staff and pharmacy team all times while on active duty. As required and assigned, the technician can function in the role of a pharmacy technician completing normal duties related to ordering, stocking, delivering, inventory inspections, prescription set ups, sterile and non-sterile compounding, and drug packaging, dispensing, and distribution of medications, and preparing reports for pharmacy quality assurance. The technician works to support the pharmacist, VA and VHA mission, and Veterans in our system.

• Knowledge of pharmacy technician principles, practices, concepts, and theories provides for sound independent work.
• Knowledge of the computerized prescription process and input of prescriptions and medication orders, or electronic equivalent.
• Ability to resolve pharmacy/medication issues with other members of the healthcare team, Veterans, and external customers.
• Ability to train developmental pharmacy technicians and students.
• Ability to dispense medication or sterile products following all regulations, policies, and procedures to ensure safe medication distribution.
• Ability to troubleshoot automated dispensing equipment (ADE) or technology platforms/databases.
• Accurate medication orders, stock, and storage.
• Medication orders (unit dose, ward stock, parenteral products) are processed and filled accurately in accordance with all laws, rules, regulations, and policies.
• Medications deemed unnecessary or unusable by nursing staff and placed in the Return to Pharmacy bins are returned to pharmacy in a timely manner and assessed for appropriateness of reuse. Medication returned from CBOCs, offsite clinics, and schedule cart fills are processed and returned to stock timely.
• Potential medication order problems are brought to the attention of the pharmacist for assistance with immediate resolution.
• Rotating stock, reviewing stock for outdated and/or deteriorated medications is performed accurately and within established guidelines as evidenced by supervisor review or reports of incidents received by the supervisor.
• Outdated and/or deteriorated medications are pulled from the pharmacy stocks, automated equipment, and ward stock in a timely manner and are disposed of according to pharmacy policy with special attention to ensure patient confidentiality is maintained.
• Adequate stock of pharmaceuticals and supplies for the pharmacy area is maintained by communicating with the procurement personnel for items that are below par levels or out of stock. Usage level of medications and supplies for the assigned area including automation devices is monitored, and par levels are adjusted accordingly. In addition, out of stock medications are communicated to the pharmacist at the time of discovery so that pharmacists can follow up with the prescribing provider in a timely manner. Compliance is evidenced by supervisor review or report of incidents received by the supervisor.
• Recalled drugs are properly returned to Pharmacy Service, isolated, and secured to prevent re-dispensing, as evidenced by supervisor review or report of incidents received by the supervisor.
• All hazardous drugs, as defined by United States Pharmacopeia (USP) 800 and/or the Environmental Protection Agency (EPA), and all pharmaceutical waste are consistently handled and disposed of according to health care system policy.
• Pharmacy equipment and machines are cleaned and quality assurance (QA) performed, per policy, to ensure safety and proper functioning of equipment. This is documented daily or as required in hospital policy.
• Hazardous medications, including chemotherapy agents are stored, maintained, and handled appropriately and in accordance with departmental policies and procedures, and state and federal laws and regulations. Exposure to hazardous drugs during compounding is documented daily in chemotherapy exposure logs.
• Medication variances (i.e., actual events as well as close calls) and adverse drug reactions are documented and reported per policy by completing the appropriate documentation tool in a timely and accurate manner.
• Assigned storage areas are maintained according to Pharmacy Service policy (e.g., labeling of SALAD, high alert, and chemotherapy medications; timely disposal of corrugated cardboard; etc.) as evidenced by supervisor review or report of incidents received by the supervisor.
• Refrigerators/freezers are monitored daily for adequate temperature control through electronic monitoring systems. Appropriate action is initiated and documented for out-of-range temperature, and problems are resolved in a timely manner to ensure no drug is wasted due to improper storage.
• Communications with supervisors, coworkers, nurses, and others in the organization are consistently courteous and cooperative in nature and, overall, contribute to the effective operation of the workplace and the development of a collaborative working relationship as observed by supervisor and reports of incidents/complaints received by the supervisor. Verbal and/or written information is provided in a timely manner to customers, which is thorough and correct, using clear and precise communication methods to ensure customers understand.
• Ability to adjust to change or work pressure in a pleasant and efficient manner; functions as an effective team member through active participation in working towards team objectives and assisting in the group effort whenever and wherever possible as observed by supervisor and reports of incidents/complaints received by the supervisor.
• Demonstrate sensitivity and an understanding of a wide variety of staff and their needs by taking ownership of the problem and adopting the customers’ needs as their own. Customers are treated in a professional manner with tact, courtesy, and respect as observed by supervisor and report of incidents/complaints received by the supervisor. Confidence and trust are instilled with supervisors, peers and subordinates by providing timely and quality service to Veterans. Established time frames and deadlines are consistently met for the employee’s area of responsibility.
• Actively participate in the Service Improvement Model (SIM) at the section level to address operational needs of the Pharmacy Service. This includes participation and engagement in the daily tiered huddles and submitting continuous process improvement proposals. Actively participates in the Pharmacy Service strategic plan by helping implement action plans and meet targeted goals.
• Communications (in person and via telephone) with customers (e.g., patients, family members, general public) are in a courteous, tactful, and helpful manner that is responsive to the customer’s needs, as observed by supervisor and reports of incidents received by the supervisor.
• Compliance with the Joint Commission, VHA, VA and other program review criteria that govern service is exhibited and documented as evidenced by both internal and external reviews. Employee demonstrates high ethical standards and prevents violations of the law.
• Proficiency in the operation of the relevant VISTA computer packages (to include CPRS, outpatient, inpatient, hospital information, Time and Attendance, etc.) is consistently demonstrated as assessed by the supervisor.
• Maintains proficiency in the operation of the relevant pharmacy automation and equipment as assessed by the supervisor including cleaning, restocking, replenishing, reporting, and troubleshooting.
• Patient sensitive materials are consistently disposed of in sensitive waste receptacles as required by Federal rules and regulations/HIPAA. Faxes, messages, written orders and other communications are handled appropriately without deviation from the patient confidentiality requirements as evidenced by supervisor observation and reports of incidents to the supervisor.
• Pharmaceutical waste is consistently handled and disposed of according to health care system policy as evidenced by supervisor observation and reports of incidents to the supervisor.
• Work is prioritized and completed in a timely manner, with minimal supervision. Assignments are completed within specified time frames as evidenced by reports received by the supervisor. Anticipated workload is planned for in a timely manner.
• Employee work area and breakroom are consistently maintained in a clean, organized and secure manner as evidenced by supervisory review. Shared work areas are adequately stocked with supplies to ensure subsequent staff have appropriate tools to perform work as evidenced by supervisory review and reports received by the supervisor.
• Serves as a preceptor for students or trainees. Responsible for insuring student or trainee follows all applicable policies, procedures, laws and/or regulations with regard to pharmacy practice. Responsible for all work performed by student or trainee.
• ADP Security - In the performance of official duties, the employee has regular access to printed and electronic files containing sensitive information, which must be protected under the provisions of the Privacy Act of 1974, Health Insurance Portability and Accountability Act (HIPAA) of 1996, and other applicable laws, and regulations. The employee is responsible for protecting that data from unauthorized release or from loss, alteration or unauthorized deletion and adhering to the provisions of the ADP security agreement signed by the employee.
• Maintains patient confidentiality.
• Adheres to all medical center and department policies and regulations.
• Manages information security within areas of responsibility to assure that computer system security and confidentiality of sensitive information is maintained, and that employee access to sensitive information is limited only to that which the employee requires to perform their duties. Takes action as necessary to report and address violations of information security.

Unit dose:

• Performance of cleaning the Parata Automatic Tablet Packager (ATP).
• Knowledge of troubleshooting ATP (shutting down, restarting, changing the paper and ribbon, manually connecting software, etc.)
• Use of VISTA to print, send, and process patient medication orders to ATP.
• Ability to refill medication canisters to ensure they have the correct drug, lot number, expiration, and number of tablets or capsules.
• Use of medication trays to fill slow moving medications to go in the ATP.
• Prints the patient medication orders on a roll through the ATP, which packages each medication individually.
• Demonstrates ability to use Parata Inspect RX to take pictures of medications packaged by the ATP.
• Fills patient specific medication drawers with as needed (PRN) medications along with medications packaged by the ATP.
• Ensure that each patient specific medication drawer is properly labeled with the correct name, room number, and bed.
• Returns from previous cart fills are credited and returned to stock.
• Use of VISTA to enter the number of medications we are giving to patients, including what was credited.
• Use of VISTA to run patient movement reports and unit dose updates to see updates for admissions, discharges, transfers, and changes in medication orders.
• Exchange previous patient medication drawers for B4, B5, and CLC for new drawers for the next 24 hours worth of medications.
• Enters final numbers of medications delivered to units both electronically and physically for physical records.

Ward stock:

• Uses BD Pyxis to run pyxis refill and ordered medications not loaded reports.
• Ability to interpret which oral medications need to be loaded into different Pyxis machines around the hospital.
• Uses the Pyxis refill reports to pull stock from inventory to be checked by pharmacists or certain pharmacy technicians before they are delivered to their respective locations.
• Checks each area for any stock that may be expiring within the next 30 days to be replaced.
• Use of VISTA to run and input inventory lists of items that are not stocked in Pyxis.
• Use of VISTA to input the numbers of medications that were delivered and which area they were delivered to.
• Completion of non-controlled substance total inventories and refrigerator cleanings that need to be done quarterly.
• Assigned monthly ward inspections and pharmacy stock area inspections are thoroughly and consistently performed by the 25th of the month as evidenced by completed reports submitted to the supervisor.
• Completion non-Pyxis outdates, and return bins for Pyxis’ without controlled substances.
• Ability to travel off-site in Reno, Susanville, Carson Valley, Fallon, and Winnemucca to complete ward inspections and deliver medications.
• Knowledge of how to complete LEAF car and travel requests for upcoming travel.
• Communicates with staff regarding special requests before traveling, such as off-sites needing pill boxes, take-away bags, specific vaccines, long acting injections (LAIs), and other non-Pyxis items.
• Use of Microsoft Word and Excel to complete end-of-month reports which include: common infractions summaries of emergency boxes, crash carts, and single dose vials; trend data; monthly ward inspection summary; and executive summary report.

Delivery:

• Interprets pre-exchange and missing dose orders for new and existing orders for patients.
• Medications are delivered to the customer or patient care area in a timely manner to ensure standards for turnaround times are met. If assigned, controlled substances delivered (unit dose, IV medications, etc.) to patient care areas have signed documentation of the chain of custody.
• Medications are accurately repackaged manually or by using automation equipment to prepare unit dose medications that are consistent with Pharmacy procedures. All necessary information (e.g., manufacturer, lot number, expiration date, etc.) is entered in the automation database or on the generated paperwork. Bulk liquid medications are accurately repackaged into specified unit dose volumes and quantities using various containers, typically oral syringes, or cups. Repackaging of all unit doses is completed in a timely and accurate manner, and each repackaged unit is reviewed for accuracy and completeness (e.g., empty package, crushed tablets, multiple quantities, no air bubbles in syringe, etc.) prior to pharmacist verification. Appropriate barcodes and auxiliary or warning labels are placed on the prepared packages as needed.
• Use of VISTA to resolve missing dose requests and document the extra units that were dispensed for the patient.
• Files pre-exchange and missing dose paperwork for review by supervisor.
• Promptly responds to failed Pyxis drawers and cubies so nursing can access medications needed for patients.
• Use of VISTA to run IV batch labels and prepare the batch for the next 24 hours.

Sterile Compounding:

• Checks the refrigerator daily to ensure refrigerated IVs are not expired and completes documentation that the check was done.
• Checks IV labels, infusion schedule, and chemotherapy schedule and plans accordingly to ensure compounded sterile products (CSPs) are made on time.
• Ability to navigate Simplifi to log daily room temperatures and pressures of the ante room, non-HD room, and HD room, and bulk storage room (temperature only).
• Ability to navigate and use BD Pyxis IV Prep.
• Demonstrates aseptic technique when preparing CSPs.
• Knowledge of proper hand hygiene, non-HD and HD garbing.
• Uses complex technical functions to prepare CSPs. These functions are performed accurately and thoroughly in accordance with USP 797 guidelines as evidenced by supervisor review and reports of incidents received by the supervisor.
• Proper labeling of all compounded materials before dispensing, accurate documentation and appropriate pharmacist verification of all compounded materials, and ensuring correct beyond-use-date for all components used in the compounding of non-sterile products.
• Mandatory records, documents, and logs (i.e. chemo logs) are maintained by the technician appropriately and accurately as described in USP 797/USP 800 and hospital policy. IV Room Quality Assurance programs are actively participated in as necessary and appropriate.
• Current departmental, state and federal laws and regulations, and manufacturers’ instructions applicable to the compounding CSP are strictly adhered to. Pharmacy CSP or commercially available stock items are not released from pharmacy custody unless and until they are verified and initialed by a Registered Pharmacist.
• Inventory management: Usable and unused IV products are recycled for reuse if appropriate. Stock supplies and stock levels are maintained appropriately.
• Maintenance and cleaning activities required by external certification agencies (OSHA, Joint Commission, etc.), and Infection Control monitors are performed thoroughly and consistently, and documentation of completion is logged concurrently. IV Room refrigerator, freezer, eye wash/shower devices, room temperature, humidity, and air quality are inspected and maintained according to department policies. Periodic inspections are performed and documented accurately, thoroughly, and consistently. Compliance is evidenced by supervisor review and the completion of relevant logs.
• Chemotherapy and hazardous agents are received, stored, maintained, compounded, and disposed appropriately in accordance with departmental policies, procedures, and State and Federal laws and regulations. Chemotherapy waste and all other hazardous waste materials are environmentally contained and disposed of properly. Chemotherapy/hazardous waste spills and/or exposures are handled properly and promptly in accordance with departmental policies and procedures.
• Knowledge of Closed System Transfer Device (CSTD) use for HD CSPs.
• Ability to properly clean and disinfect LAFW.
• Ability to clean and disinfect the cleanroom suite, segregated compounding area (SCA), and Secondary Engineering Controls (SEC).

• Maintained accurate records and inventory of pharmaceuticals, supplies, and equipment.
• Provided customer service to patients regarding their prescription medications.
• Knowledge of navigating and using Intercom Plus.
• Oversaw the ordering, receiving, and storage of pharmacy inventory using RX Inventory (RXI).
• Trained new employees on pharmacy operations, policies, procedures, and safety protocols.
• Filled prescriptions accurately under the direction of a pharmacist.
• Managed inventories, rotated stock, removed expired or damaged drug products and resolved discrepancies in drug counts.
• Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.
• Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
• Worked with insurance companies to process claims, resolve problems and obtain payments.
• Consulted with customers via telephone or in-person to assist with navigating pharmacy systems and completing requests.
• Monitored controlled substances inventory and maintained compliance with regulations.
• Assisted patients with performing COVID-19 rapid and PCR tests.
• Garbing PPE to handle and process COVID-19 test samples.
• Administered intramuscular and subcutaneous vaccine injections to patients 3 years and older.
• Prepared non-sterile compounded medications under direct pharmacist supervision.
• Completed smart counts on inventory using RXI.
• Use of WebIZ to check patient immunization history before giving vaccines and/or to give to patients for their own records.
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