CHS Pharmacy News 

March 2023

Business Hours

Normal business hours are 9 AM – 5:30 PM M-F, and 9 AM – 3PM Saturday and Closed on Sunday
*Emergency services available 24/7/365

Diversion of Controlled Substances

With full awareness of the opioid crisis, it is important to put into place various barriers to detour individuals from the diversion of controlled substances (CS). These barriers could include, but not limited to:

• Implement an anonymous reporting system for staff to inform administration of concerns.
• Develop a “for cause” drug testing policy for staff
• Implement policy and procedures that exceed minimal state and federal requirements
• Never leave CS unattended and locked at all times.
• Develop a count back procedure for shift change
• Consider random “for cause” drug testing policy for patients to verify medication is administered
• Destroy, as legally defined and in accordance with state and federal regulations, any expired, discontinued, or used CS medications or delivery devices.

Intervention Ideas for Mealtimes in LTC1*

Families and residents ranked “dining environment” as their top priority for identifying ways to make the long-term care centers more like home. Of these, ideas included:

• Play quiet, instrumental music during meals
• Do not rush the mealtime
• Offer fresh, seasonal fruit or offer treats
• Improve staff knowledge on how to engage in safe practices

Antihypertensives and Fall Risk**

Residents may be at a higher risk for falls with aggressive blood pressure control, or when treated to goals of less than 120/80 or 130/80. Results have shown, that when a resident with antihypertensives has been identified for dosage reduction, the resident had a lower 30-day fall risk compared to those without the dosage reduction. It is important to record and report trends to the treating provider for appropriate dosage adjustments to reduce likelihood of a medication related fall.

Administration Tips: Insulin Pen Priming***

It is important to make sure that the insulin pen is injecting insulin correctly prior to EACH dose administered. To verify that the pen is working correctly, and the pen needle tip is not faulty, perform the following prior to each administration:

1. Remove the pen cap and wipe the rubber seal with alcohol swab
2. Obtain and place a new insulin pen needle tip onto the insulin pen
3. Remove the needle caps (there are 2)
4. PRIME THE PEN: typically, most insulin pens require 2 units, some may be more, check with pharmacy for specifics
5. If you see insulin appear from the needle time with the first 2 units, the prescribed dosage may then be administered to the patient
6. If no insulin left the pen with the priming dose, repeat step 4 up to a maximum of 4 times. If after 4 times, replace the needle time and start the priming process again.

Optimizing Sleep for Residence in LTC****

Sedative medications have been associated with potential harm to the elder population, specifically with more complex comorbidities. Utilization of sleep logs and developing and auditing individual sleep patterns, a resident-centered educational intervention can result in a trend toward reduced sedative use and significantly improved sleep patterns. Given the high prevalence of sleep issues among frail elders, nonpharmacologic interventions should be incorporated into the long-term care setting as clinically appropriate.

1. *Ann Longterm Care. 2019;27(6):e8-e12. doi:10.25270/altc.2019.03.00062 Received March 6, 2018; accepted June 29, 2018. Published online April 3, 2019.
2. **Antihypertensive De-intensification May Lessen Fall Risk. (n.d.). Retrieved from managedhealthcareconnect.com
3. ***lilly.com
4. Ann Longterm Care. 2019;27(12):e7-e12, s1-s3. doi:10.25270/altc.2019.09.00086 Received December 3, 2018; accepted January 29, 2019. Published online October 1, 2019.