Chapter 7

1. Prescription Processing Chapter 7

2. Processing a Prescription: A Step-by-Step Approach Five basic steps for filling a prescription: Taking in the prescription Translating the prescription Entering information in database Filling the script Patient counseling

3. Taking in the Prescription Prescriptions arrive in various ways: Written order Hand carried Faxed Called in Computer-generated prescriptions becoming more common. May be provided to patients on discharge from hospitals or physician’s office.

4. Prescription Information: Community Pharmacy Setting Ensure correct information is listed on prescription (Box 7-2). Information needed on any OTC and herbal medications the patient may be using. Information needed on allergies and current medications.

5. Important Patient Information Patient InformationProvider’s Information Name Name Phone number and address Phone number and address Insurance information, Provider’s license number if applicable Age or date of birth Provider’s DEA number, if applicable

6. Important Patient Information (cont’d) Prescription Information Name of medication Strength Dosage form Quantity Route of administration Sig Refill information Provider’s signature Date written “Brand necessary” if brand name drug is desired

7. Prescription Information: Community Pharmacy Setting (cont’d) Medical record number needed if patient is member of HMO. DEA number is necessary for controlled substance. Controlled drug written in ink or indelible pencil.

8. Prescription Information:Inpatient Setting Inpatient information required different from outpatient. Doctor’s license and DEA number are on file at hospital. Dosing in 24-hour period. Doctor writes for daily dose. Antibiotics have automatic stop date.

9. Translation of an Order Look at whole order if difficult to decipher. If in doubt, ask another person or pharmacist.

10. When to Ask for Help When handwriting is poor, assistance is needed. Filling scripts under pressure can lead to “guessing.”

11. Entering the Information into the Database: Outpatient Setting After doctor’s order is read, enter into computer. Check computerized label against prescription after it is filled. Two labels generated: one for the vial; other for back of original prescription. Pharmacist initials needed on both labels; some states require technician’s initials also.

12. Entering the Information into the Database: Inpatient Setting Pharmacists or technicians enter new prescriptions in computer. Multiple orders on patient sent during stay. Computers alert to drug interactions. Pharmacist calls physician to change order.

13. 1. Verifying the Prescription Label checked many times before it reaches patient. Hold original script next to label to check for errors or discrepancies. Look at names of drug, strength, dosage form, sig (directions).

14. 2. Pulling the Correct Medication Take label to shelf when getting medication from the shelf. Label helps you not to forget. Can compare label with information on the bottle.

15. 3 & 4. Counting and Filling the Medication Checking label and script against bottle for accuracy. Counting trays are still used. Digital counters and automated machines are used. Baker Cells used in larger pharmacies. Pill counters

16. 5. Prescription Lids Appropriate lid applied after medication is filled. Problem for elderly patient: safety lid. Elderly lose dexterity and strength. Older patients do not want safety lids. Can replace with snap-on lid.

17. 6. Applying the Label Professionalism is needed when applying label. Do not place torn or crooked label on bottle. Label not to cover lot and expiration date on full bottle prescriptions. Auxiliary labels must be easily read.

18. 6. Applying the Label (cont’d) Computer systems print label and information on one sheet. Law requires certain information to be on label.

19. 7. Technician’s Initials Technicians should initial all orders they fill. Pharmacist gives final check-off and knows who filled it by initials. Pharmacist can notify or ask technician if errors or questions occur. Pharmacist must always sign off after completion.

20. 8. Auxiliary Labels Auxiliary labels are usually printed with prescription label. Drug classification, interactions, and side effects need to be known for auxiliary labels if not computerized.

21. 9 & 10. The Pharmacist’s Final Inspection The last step in filling scripts is passing the filled vial, along with medication container from shelf, and original prescription to the pharmacist. Filling one prescription at a time is important to avoid errors. Mark newly opened stock bottle with an X (do not cover NDC number or expiration date).

22. Community Dispensing Systems Automated dispensing systems are used for three primary reasons: To cut down on errors To increase productivity For inventory control Automated systems can visually identify all the info on a label through a bar code located on the side of the prescription label. Candy machine

23. Filling Orders in a Hospital Setting Institutional pharmacies do not follow the same steps as outpatient pharmacies for filling medication orders. Wider range of medications is needed.

24. Computer Dispensing Systems Major versions of dispensing systems: Outpatient dispensing systems Inpatient dispensing systems Nursing care facilities Large mail-order companies

25. Inpatient Dispensing Systems Hospitals need medications around the clock. Computerized dispensing systems cut down on staffing needs; gives doctors and nurses access. Control narcotics and track their movement. Automated Dispensing Machines Mobile dispensing machines

26. The 5 Rights of Medication Safety Right patient Right drug Right dose Right route Right time

27. Pharmacist Consultations: When and Who Needs Them First-time prescriptions flagged and pharmacist is alerted. Patient needs consultation with new script. Federal law: all new or changed prescriptions need consultation. See OBRA 1990.

28. Miscellaneous Inpatient Orders: Daily Hard-Copy Printing (QUE) Prescription labels are run off first thing in the morning and rechecked throughout the day. Running off the que in the morning saves the afternoon crew from having to hunt for labels and fill scripts at the last minute, thus reducing errors and stress.

29. Refills A pharmacy technician may phone a prescriber's office and receive authorization for a prescription refill.

30. Zero Refill Reorders Additional phone lines are set up in pharmacies for refill. Patient should allow 2 days to get proper authorization from prescriber.

31. Transfers Previously filled prescriptions are transferred by pharmacist from one pharmacy to another. Most Boards of Pharmacy prefer to allow only one transfer. Federal law states that narcotics prescriptions can be transferred one time only.

32. Refilling Automated Dispensing System (ADS) Machines Often the technician is the one who refills the ADS machines. It is important to ensure that the right drug is getting into the right dispensing hopper.

33. Filing Prescriptions Hard copy prescriptions manually filed. Hard copy filed for future reference. Prescription kept on file for 2 years. Prescription numbers used.

34. Filing Prescriptions (cont’d) All controlled substances are stamped with a red “C” 1 inch down on right-hand side of prescription label for easy location. All Schedule II medications must be filed separately.

35. Early Fills Filling a prescription early can be done if the patient has a good reason. Many insurance prescription plans allow for one early refill per medication, per calendar year.

36. Medication Pick-Up Patients can wait for prescriptions. Have prescriptions delivered. Can pick up another day by self or relative. All third-party prescriptions must have a signature of the person receiving medication. Check all ID before releasing medication for controlled substances.

37. Billing Patients No third-party coverage—patient charged full price. Each type of insurance has limitations and conditions.

38. Changing Trends “Meat and potatoes” of pharmacy is interpreting, transcribing, producing a label, filling, and checking scripts. OBRA 1990 requires consultation with patients. Pharmacist moved away from filling counter and technician placed in front line.