processing the prescription(1)
DESCRIPTION
pharma prescriptionTRANSCRIPT
PROCESSING THE PRESCRPTION ORDER
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PROCESSING THE PRESCRIPTION ORDER
Dispensing refers to the pharmacists function of taking an order or prescription, preparing the drug/s according to the instructions of a physician/dentist/veterinarian and delivering it to the patient or client with proper instructions.
Dispensing
10 Strategies for minimizing Dispensing Errors
Ensure correct entry of Rx
Transcription error
Omission
Inaccuracies
10 Strategies for minimizing Dispensing Errors
2. Confirm that Rx is correct and complete
Illegible/ambiguous
Nonstandard abbreviations
Acronyms
Decimals
10 Strategies for minimizing Dispensing Errors
3. Beware of LASA/SALAD
Similar drug names
Aldactone Aldazide
Gliclazide - Glipizide
10 Strategies for minimizing Dispensing Errors
4. Be careful with zeros & abbreviations
Misplaced zeros
Decimal points
Faulty units
10 Strategies for minimizing Dispensing Errors
5. Organize work place
Organize work space
Work environment
Workflow
10 Strategies for minimizing Dispensing Errors
6. Reduce distraction when possible
Multitasking
Distraction during work
10 Strategies for minimizing Dispensing Errors
7. Focus on reducing stress and balance heavy workload
Workload increase
10 Strategies for minimizing Dispensing Errors
8. Take time store drug properly
Avoid mix - ups
10 Strategies for minimizing Dispensing Errors
9. Thoroughly check all Rx
Repeat checking
Counterchecking
Compare written Rx & the product
10 Strategies for minimizing Dispensing Errors
10. Always provide through patient counseling
PROCESSING PRESCRIPTION
RX3
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consultationPrescription written by authorized prescriber
Patient presents prescription to the pharmacy
Prescription is checked for completeness; prescriber info, drug name, strength, dose, and directions
Correct patient info is entered into computer system
Prescription is prepared. Correct amount of med prescribed is measured and placed into container
Pharmacy label is generated. Make sure all the legal items are identified
Prescription is interpreted and confirmed by pharmacy system. Third party is billed online (optional)
Prescription is prepared by pharmacy technician, and final check done by pharmacist
Patient receives script, pharmacy assistant must offer counseling to the patient. Then script is rung on cash register, and insurance log signed
Pharmacist provides counseling on the medication prescribed and all medically related questions
R
LABEL
How is a prescription processed?
receiving the prescription
reading and checking the prescription
numbering and dating
Labeling
preparing the prescription
packaging
rechecking
delivering and patient counseling
recording and filling
pricing the prescription
What is the purpose of numbering and dating the
prescription?
The same number of the original prescription should appear at the label of the filled prescription to avoid error in dispensing
The date of the prescription is not the same date that should be placed on the filled prescription for identification purposes
Information to be recorded in the Prescription Book
1.name of physician
2.name of the drug
3.quantity
4.date when dispensed
5.balance (quantity if any)
6.pharmacist signature, etc
1. RECEIVING THE PRESCRIPTION
Enhance the pharmacist patient relationship
PHARMACIST should:
Estimate length of time required to fill the Rx
To price the Rx if requested by the patient.
Receiving the Rx
The appropriateness of the Rx for that patient can be assessed
Any required records can be completed correctly
The product can be labelled for that patient
If, necessary, the Rx can be delivered to the correct patient at the correct address
The patient can be contacted, if necessary, even after the medicine has been dispensed and supplied to the patient
2. READING AND CHECKING THE Rx
Read the Rx in the privacy of the prescription department
There should be no doubt as to the ingredient or quantities prescribed
2. READING AND CHECKING THE Rx
If something is illegible or if it appears that an error has been made. Pharmacist should consult another pharmacist or the prescriber.
Should verify omission or failure to specify desired strength of medication
2. READING AND CHECKING THE Rx
The size and frequency of dose be carefully noted and checked:
1. Age2. Weight and condition of patient3. Possible influence of other drugs being taken4. Frequency of administration
Clinical and Legal Checking of Rx
Suggested Way to do this REVIEW is
IDEAL CASE
Checking of Rx
Interaction
Dose
Evidence of harm/benefit
Appropriate
Legal and complete ( and here is where we make a CASE for the medication)
CASE
Cost effective
Acceptable to the patient
Safe
Effective
INTERACTION
Does the drug interact with any other items the patient is taking or with the patients condition?
DOSE
Specific dose per day
A specific dose per day for a specific time
A specific dose for a specific number of times per day
A combination of the above
Example: 200mg/day/individual doses, for 15 days
An initial dose
A dose per kg of body weight
A maximum dose
Reading and Checking
Aldactone Aldactide
Betnesol Betnetan
Co-amifruse Co-amilazide
Cordene Codeine
Daonil Danol
Gliclazide Glipizide
Nicardipine Nifedipine
Promazine Promethazine
Zocor - Zoton
CARBOplatin CISplatin
cefiXIME cefuROXIME
DOBUtamin DOPamine
ephEDRINE epINEPHRINE
FOLIC acid FOLINIC acid
hydrOXYZINE hydraALAZINE
INFLIXimab RITUXimab
metFORMIN metRONIDAZOLE
vinCRISTINE - vinBLASTINE
3. NUMBERING AND DATING THE Rx
It is a universal practice to number the Rx order and to place the same number on the label.
To connect the bottle or package with the original medication order.
4. LABELING THE Rx
Prescription label prepared by pharmacist, an assistant may be employed for this purpose.
Rx labels should be computerized or typewritten to make them neat, attractive and legible
4. LABELING THE Rx (cont.)
A prescription should have an aesthetic and professional appearing label.
The size of the label should be in conformance with the size of the prescription container.
4. LABELING THE Rx (cont.)
Name, address and telephone number of the pharmacy are generally imprinted in the label
The pharmacist should give clear directions
4. LABELING THE Rx (cont.)
Label of Compounded Rx should include:
Number of Rx
Date of filling
Name of Patient
Quality and quantity of ingredients
4. LABELING THE Rx (cont.)
Label of Compounded Rx should include:5. Directions for administration6. Name of Physician
4. LABELING THE Rx (cont.)
Label of Unit Dose Rx should include:
Name of Patient
Generic name of drug
Brand Name
Manufacturer
4. LABELING THE Rx (cont.)
Label of Unit Dose Rx should include:
5. Dosage strength6. Expiry date7. Directions for use8. Name of Pharmacist
4. LABELING THE Rx (cont.)
AUXILIARY LABELS emphasize a number of important aspects of the dispensing medication including:1. proper use2. handling3. storage
4. LABELING THE Rx (cont.)
AUXILIARY LABELS4. Refill status5. Necessary warnings and precautionsExample: Shake well POISON Should Not Be Swallowed Keep Out of Reach of Children
Standard Requirements for Labeling Dispensed Medicines
Name of the preparation, strength and form
The name which appears on the label must be the same as the one which appears on the prescription
Standard Requirements for Labeling Dispensed Medicines
2. Quantity
The quantity which appears on the label will be the quantity which has been prescribed
Standard Requirements for Labeling Dispensed Medicines
3. Instruction for use
No patient should leave a pharmacy without knowing
How much
How often
How to use
Recommended wording for directions
Recommending wording
Wording to be replaced
Do not swallow
Not to be taken
Put two drops in the affected eye
Instill 2 drops into the affected eye
For creams, ointments: spread thinly
Use sparingly
For Pessaries or suppositories: gently put one into the vagina/rectum
Insert one into the vagina or rectum
Auxiliary labels
Shake well
Keep in the refrigerator, Do not Freeze
Do not use after
Refrigerate, Shake well, Discard After
External Use Only
May cause drowsiness; Alcohol and Operating Car or Machine Warning
Do not Drink Alcohol
Avoid Sun Exposure
Take with food
Take on an Empty Stomach
Finish all this medication
Do not take Aspirin
5. PREPARING THE Rx
Information Necessary:
Adjuvant used
Order of mixing
Amount of each ingredients
Capsule size
5. PREPARING THE Rx (cont.)
Information Needed:5. Type and size of container
Name and product identification number of manufacturer.
5. PREPARING THE Rx (cont)
Partially filled Rx should be returned to the buyer after recording the partial filling in the Rx book
Partial filling of prohibited or List A drugs shall not be allowed.
6. PACKAGING
Pharmacist should consider the size, shape, mouth opening, color and composition in packaging
6. PACKAGING
TYPES OF CONTAINERS GENERALLY USED:
Round Vials for solid dosage forms as capsules and tablets.
Prescription Bottles for dispensing liquids of low viscosity
6. PACKAGING
Pharmacist should CHECK for:1.Permeability of containers to atmospheric gases and to moisture vapor.2. Leaching of constituents of the container to internal content
6. PACKAGING
Pharmacist should CHECK for:3. Absorption of drugs from content container4. Transmission of light through the container5. Alteration of the container on storage, particularly at extremes in temperature.
6. PACKAGING
Child-Resistant Containers
To prevent accidental poisoning resulted from ingestion of medication and other household chemicals by children.
With safety closures
7. RECHECKING
The importance of this step should not be overemphasized
Every Rx should be rechecked by the Pharmacist
All details of the label should be rechecked against the Rx order to verify directions, patients name, Rx number, date and prescribers name
8. DELIVERING THE PRESCRIPTION
Every prescription leaving the store should not only be correctly and skillfully compounded but the physical appearance of the finished preparation should indicate the pride and care which the pharmacist has taken in his professional work.
9. RECORDING
A record of the prescriptions dispensed should be maintained in addition to the prescription files.
This would permit rapid location of prescription orders.
9. RECORDING (cont.)
Different RECORDS used:
1. Prescription Book 2. Poison Book 3. Dangerous Drug Record Book
10. PRICING
MOST COMMONLY USED:
% Mark-up
Dispensing Price =Cost of Ingr. + (Cost of Ingr. X % Mark-up)
10. PRICING (cont.)
2. % Mark-up + Minimum Fee DP = Cost of Ingr. + (Cost of Ingr. X % mark-up) + Minimum Fee*DP = dispensing priceMinimum Fee - recover the combined cost of container, label, overhead & professional service
10. PRICING (cont.)
3. Professional FeeDP = Cost of Ingr. + Professional Fee
The greater the cost of the Rx ingredients the greater is the fee
Professional fee - represents the payment for professional service
10. PRICING (cont.)
Code in Pricing letters selected should have 10 letters with no duplicate letters.Example:B L A C K S M I T H1 2 3 4 5 6 7 8 9 0
11. FILING
Too be kept for 2 years
Prescription File Types:
1. metal or cardboard unit2. partitioned drawers
11. FILING (cont.)
Methods of Preserving Prescriptions:
1. Filing on string or wire2. Pasting on scrap book (old method)3. Writing a copy in a blank book and returning the original
11. FILING (cont.)
Methods of Preserving Prescriptions:
4. Wrapping the Rx in packages of 100 and packing ten consecutive hundreds in wooden box (old method)5. Pasting the Rx to a card which is then filed in a cabinet
11. FILING (cont.)
Computer filing of prescription is most recommended.
Exercises:
RxSalbutamol tablet.2mgTheophylline tablet ..125mgLactose q.s. .300mgIn one cap # 20Sig. One cap b.i.d. p.c. and H.S.
Data
Nuelin tablet .. P 3.75Ventolin tablet .. P 4.50Lactose . P 40.00 / half KgCapsule . P 0.75/pieceMinimum fee P30.00% mark up 15 % and Professional Fee P 50.00
QUESTIONS:
What is the dispensing price using the % mark up plus minimum fee method?
Cost of the above Rx per capsule
What is the dispensing price using professional fee method?
What is the daily dose of Salbutamol?