Advanced CPhT cheat sheet

Inventory turnover = cost of goods sold ÷ average inventory value; days in inventory = 365 ÷ turnover ratio.

ABC analysis: Class A items are roughly 20% of stock lines but about 80% of annual dollar volume; Class C is the reverse, so control effort follows dollar value, not unit count.

Reorder point = (average daily usage × lead time in days) + safety stock; it marks the inventory level that triggers a new purchase order.

Fill rate (%) = (order lines filled completely on first attempt ÷ total order lines ordered) × 100.

USP <797> requires the ISO Class 5 primary engineering control to be located inside an ISO Class 7 buffer area, with an ISO Class 8 ante-area where a segregated compounding area is not used.

A compounded sterile preparation's beyond-use date may never exceed the manufacturer's expiration date for any starting component.

340B covered entities may not bill Medicaid for a drug purchased at the 340B ceiling price unless the manufacturer rebate is excluded, to prevent a duplicate discount.

Compounding personnel qualification includes gloved-fingertip sampling and a media-fill or equivalent sterility test before compounding and at defined intervals thereafter.

Failure mode and effects analysis (FMEA) is prospective; root cause analysis (RCA) is retrospective and is triggered by a sentinel event.

Risk priority number (RPN) = severity × occurrence × detection; higher RPN scores identify failure modes that get redesigned first.

Hierarchy of effectiveness, strongest to weakest: forcing functions and constraints → automation and computerization → standardization and protocols → checklists and independent double checks → rules and policies → education and reminders.

Just culture decision rule: human error is consoled, at-risk behavior is coached, and reckless behavior is sanctioned.

ADE rate per 1,000 patient days = (number of adverse drug events ÷ total patient days) × 1,000.

ISMP high-alert categories include anticoagulants, insulin, opioids, concentrated electrolytes, neuromuscular blockers, and chemotherapy agents.

ISMP error-prone abbreviations include 'U' for units, 'QD' and 'QOD', trailing zeros (1.0 mg), and missing leading zeros (.5 mg).

An independent double check is valid only when the second checker completes the calculation or selection without seeing the first checker's result.

PDSA sequence: Plan (state a prediction) → Do (run a small test) → Study (compare observed result to the prediction) → Act (adopt, adapt, or abandon).

Schedule I substances have no currently accepted medical use and cannot be prescribed; Schedule II substances may be prescribed but never refilled.

Schedule III–V prescriptions may be refilled up to 5 times, and every refill must be dispensed within 6 months of the date the prescription was issued.

An emergency oral or electronic Schedule II order requires the prescriber to deliver a written prescription to the pharmacy within 7 days.

DEA Form 222 (or its CSOS electronic equivalent) is required to order or transfer Schedule II controlled substances; a power of attorney authorizes an agent to sign.

DEA Form 106 reports theft or significant loss and is filed with the DEA field division in writing within one business day of discovery; DEA Form 41 records destruction.

A complete controlled substance inventory is taken on the date of registration and biennially thereafter (every 2 years), with Schedule II records maintained separately from other records.

Electronic prescribing of controlled substances requires identity proofing, two-factor authentication, and an auditable electronic record of each transaction.

DSCSA requires interoperable, electronic, unit-level product tracing: transaction information, history, and statements plus serialization and verification before dispensing.

Most states mandate a PDMP query before dispensing an initial opioid or other scheduled drug, with documented exceptions for hospice and long-term care.

Health literacy is the capacity to obtain, process, and understand basic health information; patient materials are typically written at a 5th–6th grade reading level, while the average U.S. adult reads at about an 8th grade level.

Proportion of days covered (PDC) = days covered by medication supply ÷ days in the measurement period; PDC ≥ 80% is the conventional adherence threshold.

Teach-back is a confirmation method: the patient restates the plan in their own words, and the pharmacist re-teaches any point the patient cannot restate.

OARS = Open-ended questions, Affirmations, Reflections, Summaries - the core microskills of motivational interviewing.

SBAR = Situation, Background, Assessment, Recommendation; the standardized structure for clinical handoffs.

Medication reconciliation compares the best possible medication history against active orders at admission, transfer, and discharge.

Stages of change: precontemplation → contemplation → preparation → action → maintenance; counseling content is matched to the patient's current stage.

Patients with limited English proficiency require a trained medical interpreter; family members, and especially children, should not be used to interpret.