prescriptions chapter 5. chapter outline prescriptions pharmacy abbreviations prescription...
TRANSCRIPT
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PRESCRIPTIONS
CHAPTER 5
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CHAPTER OUTLINE
Prescriptions
Pharmacy Abbreviations
Prescription Information
The Fill Process
Labels
HIPPA
Review
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PRESCRIPTIONS
• Unrestricted– Medical Doctors (MD)– Doctors of Osteopathy (DO)
• In their field of practice– Dentists (DDS, DMD)– Veterinarians (DVM)– Podiatrists (DPM)– Optomotrist (OD)
• Limited to some states and based on protocols– Nurse Practitioners (NP)– Physician assistants (PA)– Pharmacists (RPh)
A prescription is an instruction and an authorization from a medical practitioner to issue a drug or device to a patient.
Rx are governed by
federal and state rules
and regulations to
provide minimal
standards of practice
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DISPENSING PRESCRIPTIONS
• Community pharmacists– Dispense directly to the patient.– The patient is expected to administer the medication
according to the pharmacist’s directions.
• Institutional pharmacies– Nursing staff generally administer medications to patients.– Patient charts are referred to prior to administration because
they provide the most up-to-date physician instructions.
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THE PRESCRIPTION PROCESS
1. A prescription is ordered by a prescriber.
2. The prescription arrives at the pharmacy. The patient drops off the prescription, or the
pharmacy receives the prescription directly from the prescriber.
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THE PRESCRIPTION PROCESS, CONT’D
3. The pharmacy technician:
• Checks the prescription to make certain it is complete and authentic. (look for different handwriting, different colored ink, wrong DEA number, etc)
• Verifies that the patient is in the pharmacy database.
• Obtains and/or verifies the patient’s demographic, insurance, and allergy information.
• Verifies any special instructions, such as pick-up time and days supply. (if unclear about the directions for the prescription the pharm tech should ask the pharmacist for clarification)
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4.The technician enters the prescription into the
computer system.
The technician scans a copy of the prescription into the computer and keys data from the prescription into the system.
Safety and accuracy checks are completed as per pharmacy protocol.
THE PRESCRIPTION PROCESS, CON’D
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THE PRESCRIPTION PROCESS, CONT’D
5. Insurance and billing information is processed. The computer system evaluates the data against stored
information and process any third-party billing (pt’s insurance = third party)
The pharmacy technician asks the pharmacist to check drug utilization review (DUR) messages such as regarding drug interactions.
If a claim is rejected, the technician reviews the reject message and resubmits the claim, as appropriate.
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THE PRESCRIPTION PROCESS, CONT’D6. Label is generated.
• Once the payment is approved by the third party, the computer generates a label, patient handout, and the patient co-payment amount.
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THE PRESCRIPTION PROCESS, CONT’D
7. The pharmacy technician prepares the prescription by: Selecting the appropriate medication and verifying the
national Drug Code (NDC) number on the computer-generated medication label against the medication being dispensed.
Preparing the medication per the prescription (e.g., counting tablets or measuring liquid).
Packaging the medication in the appropriate container.
Placing the computer-generated medication label on the prescription container.
Organizing everything for the pharmacist’s final check.
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THE PRESCRIPTION PROCESS CONT’D
8. The pharmacist checks the prescription.• The pharmacist performs a final safety and accuracy
check and then signs off on the prescription.
• The pharmacy technician “bags” the approved prescription for patient sale and attaches a drug information sheet regarding indications, interactions, and possible side effects.
Only the PHARMICIST can perform the final label and product check
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THE PRESCRIPTION PROCESS, CONT’D
9. Patient receives the prescription. • The technician delivers the packaged prescription to
the cash register area for patient pickup. • At pickup, the technician checks to make sure the
correct patient is picking up the correct medication.
• The patient or a representative signs the insurance log.
• If the patient has not signed the pharmacy’s notice of HIPAA compliance, they are given a copy and asked to sign that log.
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THE PRESCSRIPTION PROCESS CONT’D
10. The pharmacist provides counseling.
• The technician calls the pharmacist to the counter to counsel the patient per OBRA ’90, other state or provincial statutes, and pharmacy protocol.
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PHARMACY ABBREVIATIONS
• Most common abbreviations are for:
– Route of administration
– Dosage form
– Time of administration
– Measurement
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ROUTES OF ADMINISTRATION ABBREVIATIONS
a.d. = right eara.s., a.l. = left eara.u . = each ear
o.d. = right eyeos, ol = left eyeo.u. = each eye
p.o. = by mouthS.L. = sublingually, under the tonguetop. = topically,
locally
p.r. = rectally
p.v. = vaginally
inh = inhalation, inhale
per neb = by nebulizer
SC, subc, = subcutaneous subq
i.m., IM = intramuscular
i.v., IV = intravenous
i.v.p., IVP = intravenous push
IVPB = intravenous
piggyback
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DOSAGE FORM ABBREVIATIONS
tab. = tablet
cap = capsule
SR, XR, XL = slow/extended release
sol = solution
susp = suspension
syr. = syrup
liq. = liquid
supp. = suppository
crm = cream
ung., oint = ointment
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ADMINISTRATION TIME ABBREVIATIONS
bid = two times a daytid = three times a dayqid = four times a daya.m./q a.m. = morning/ each morning p.m. = afternoon or eveningh.s. = at bedtimeprn = as neededa.c . = before mealsp.c. = after mealsstat. = immediately, nowq __ h = every __ hour(s)
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MEASUREMENT ABBREVIATIONSi, ii, etc. = one, two, etc.ss = one-half
gtt. = dropml,., mL = milliliter, millilitreTsp. = teaspoon (=5 ml)Tbsp. = tablespoon (=15 ml)fl . oz. = fluid ounce (= 30 ml)l, L = liter, Litre
mcg., µg = microgrammg. = milligramg., G., gm. = grammEq. = milliequivalent
a.a. or aa = of eachad = to, up toaq. ad = add water up toqs, q.s. ad = add sufficient quantity to make
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OTHER ABBREVIATIONS
UTD = as directed
NR, Ø = no refill
DAW = dispense as written_c, w = with
s, w/o = without
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EXAMPLESDrug Rx Label Directions
Synthroid® 100 mcg tablets
i po q am Take one tablet by mouth once daily in the morning
azithromycin 250 mg tablets
ii po today, i po daily days 2-5
Take two tablets by mouth today, then take one tablet once daily on days 2 through 5
Alphagan-P® 0.1% eye drops
i gtt q8h ou Instill one drop into each eye every 8 hours
Advair Diskus® 100/50 inh i po BID Inhale the contents of one blister, by mouth, twice daily. [Rinse mouth after use.]-Optional
Enbrel® 50 mg SC injection
i q week Inject the contents of one syringe, subcutaneously, once weekly
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THE ELEMENTS OF PRESCRIPTIONS
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Required on valid written prescription when presented for filing:
• Patient name• Physician name and signature• Drug name and quantity• Date prescription written• Directions for use
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PRESCRIPTION INFORMATION SAFETY
• Is the patient’s full name clearly written on the prescription? Has a nickname or initial been used?
• Is the patient’s information on file (e.g., date of birth, address, insurance, allergy)? Is it current?
• Is the medication for an over-the-counter product?
• Is the prescription for a Schedule II controlled drug?
• Is the prescription current (i.,e., written in the past few weeks)?
• Is the drug available in the quantity requested?
• Does the prescription look suspicious in any way?
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THE FILL PROCESS: SAFETY CONSIDERATIONS
• Is the prescription for a high-alert medication?
• Are the instructions logical?
• Are the directions clear?
• Are there look-alike names?
• Pay attention to warnings!– Call a pharmacist to evaluate each warning.
• Check against the original!
• Don’t add information!
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CAUTION!
• Is the prescription for a high alert medication?– High-alert medications are known to cause significant harm to
the patient if an error is made.
• Are the fill instructions logical? – Is it q pm or prn; 4 ml or .4 ml.
• Are the directions clear? – “Take two tablets daily” vs. “Take one tablet twice daily”
vs. “Take two tablets once daily.”
• Are there look-alike names? – Is it:• Janumet® or Sinemet®?• Zovirax® or Zyvox®?
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CAUTION!
• Pay attention to warnings! – When warning screens appear, call a pharmacist to evaluate
each warning.
• Check against the original! – During the fill process, always refer to the original prescription
first and then refer to the label.
• Don’t add information! – Never add information based on what you assume the prescriber meant.
The prescriber has knowledge of the patient’s condition that you don’t.
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THE PHARMACY TECHNICIAN’S ROLE
• Assisting the pharmacist in routine, technical aspects of prescription filling.
• Treating each patient, their personal information, and their medications with respect.
• Accepting new prescriptions from patients, obtaining all necessary information, and keying it into the computer.
• Alerting the pharmacist whenever a DUR warning screen appears while filling a prescription.
• Faxing or telephoning refills and clarification requests to prescribers.
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THE PHARMACY TECHNICIAN’S ROLE CON’T
• Consulting formularies and responding appropriately to third-party adjudication messaging such as: non-preferred drug, prior authorization or step-edit required.
• Quickly locating the correct medication for dispensing, calculating quantities, repackaging medication, and locating the corresponding patient medication guide.
• Compounding a prescription under supervision.
• Recording the dispensing of controlled drugs.
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THE PHARMACY TECHNICIAN’S ROLE CONT’D
• Checking the work of other technicians, as instructed by a pharmacist.
• Referring patients to a pharmacist for counseling on the use of prescription and over-the-counter medications, or any other question requiring judgment.
• ALWAYS ensuring the accuracy and safety of the prescription by incorporating quality control checks into every step in the process.
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LABLES
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RULES FOR WRITING DIRECTIONS FOR USE
• Start with a verb.– take, instill, inhale, insert, apply
• Indicate route of administration.– Apply to affected area.– Take one tablet by mouth.– Insert rectally.– Place one tablet under the tongue.
• Do not use abbreviations.
• Use familiar words.– teaspoonful or 5 ml
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AUXILIARY LABELS
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INSTITUTIONAL LABELS
• Unit dose packing is widely used in institutions such as hospitals and nursing homes.
• Contain only the following information:
– name, strength, manufacturer, lot number, expiration date, and dosage form of the medications
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PRESCRIPTION-TO-LABEL EXAMPLES
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PRESSCRIPTION-TO-LABEL EXAMPLES CONT’D
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lNSTITUTIONAL MEDICATION ORDER EXAMPLES
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