Transcript Pharmacy Technician’s Course. LaGuardia Community College

The Prescription
 The pharmacy technician is often the first person to
examine the patient’s prescription for completeness
and other issues.
 Due to this it is very important that a pharmacy
technicians understands the basic elements of the
prescription to save time and to ensure customer
satisfaction. This is probably the technician’s primary
function in the retail setting.
The Elements of the Prescription
 Patient’s name
 Prescriber’s name, address and phone.
 Date it was written
 Name, strength, and quantity of drug
 Directions for use (sig)
 Signature of the prescriber (very important)
 Route of administration
 Refills
Controlled Substance Prescription
 In addition to the above elements, the following is
required as well:
 Patient’s and Prescriber’s address
 Prescriber’s DEA number
 Probably the most important element on the prescription
is the signature of the prescriber. Whether electronic or
hard copy the signature must be there for the prescription
to be valid.
 In NYS, according to article 137 of the education law 6802
electronic prescriptions are allowed in NYS. An electronic
prescription is a prescription that is created and generated by
the prescriber and sent electronically (E prescribing).
Prescriptions for controlled substances are not permitted to
be electronically generated in NYS; however under federal law
CII-CV can be sent electronically.
 Section 6810 states that in addition to the signature, the
stamped or imprint name of the prescriber must be on the
prescription
 In NYS, the pharmacist is permitted to clarify and enter data on the
prescription to include all information with the exception of the
signature. If a prescription is filled without the signature the
pharmacist will be guilty of professional misconduct under Part 29.7 of
the board of regents. In addition, the date can’t be added on an Rx for a
controlled substance
 If the patient’s information and/or the prescriber’s information is
readily retrievable in the pharmacy computerized records, the physical
presence of this information on the prescription is not necessary
 The face of the prescription must be signed or initialed by the
pharmacist with the date filled; refills must be documented on the
back with the date filled along with the Pharmacist’s initials. Records
of refills may be stored electronically (NYS)
 Remember, CII can’t be refilled.
 CIII can be refilled 5 times or 6 months
 CIV and CV for 11 refills or one year.
Prescription Elements Continued
 Other elements on the prescription may include
 Prescriber’s license number and registration number
 Prescriber’s DEA number (required to write a controlled
substance prescription)
 Prescriber’s NPI or national provider’s identification
number.
NPI numbers
 The NPI is a ten digit number that was created by HIPAA
act of 1996. The NPI is a unique identifier that is used by
CMS to identify healthcare providers for the purposes of
administrative issues and reimbursements.
 Often other third party payers utilize this number to file
claims and payments to pharmacies.
 Often an adjudication is denied because of lack of
prescriber’s NPI. The NPI for various providers can be
found at:
https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forwa
rd=static.npistart
Who can write prescriptions?
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MD
NP
DO
DVM
DPM
Ophthalmologists
DDS
PA
Physician’s assistants can in general write for prescriptions so long as their
primary supervising physician name, address, and registration number is on
the prescription. Often the PA will use his/her physician’s prescription blank
so long as the PA signs the Rx and stamps his/her name on it with his
registration number.
 Physician Assistants, as of 2007, can write for prescriptions for CII and other
scheduled drugs. In this case he/she would use his own Rx blanks with their
own DEA numbers.
Filing Prescriptions
 Most states require hard copy Rx to be stored for a 5 year
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period.
Further federal regulations require that controlled
substance Rx’s be filed in such a way as to be easily
retrievable by law enforcement.
Option 1: three separate cabinets for CII, CIII-CV, and other
legend Rxs.
Option 2: two drawer system: CII-CV with CIII-CV marked
with a red “C” in the lower right corner in one drawer and
all other prescription in second file.
Option 3: CII in one file with CIII-CV/other legend drugs in
second file. CIII-CV must have red C in lower right corner
Prescription Transfers
 A refill(s) may be transferred from one pharmacy to another either in the same
state or different states.
 A pharmacist is to handle Rx transfers.
 Federal law permits the transfer of all the refills on a prescription provided that
amount transferred does not exceed the total number of refills remaining.
 The pharmacist that transfers the refills must do the following documentation:
 Document the pharmacist he/she spoke with
 Name, address, DEA, and the NABP# of the pharmacy transferred to
 VOID that original prescription
 The receiving pharmacist must document:
 Pharmacist spoken with
 Name, address, DEA, NABP# of the pharmacy transferred from
 All the information on the original prescription with the old pharmacy Rx
number
 Must write “TRANSFER” on the face of the prescription
 Federal Law allows transfer of controlled substance Rx in schedules III-V on a
one time basis
Federal Law on Retail Prescription
 Federal law provides many means for prescribers to issues
prescriptions
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Written
Electronic
Fax
Telephone
 Fax copies of C3-C5 are acceptable as original (remember state law may
be stricter)
 Controlled Substance Rx: Federal law
 C2
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No fax as original (exceptions: LTCF, Hospice, Infusion centers)
30 days only
No refill
Partial fill ok with remainder to be fill in 72 hours. If can’t fill balance in 72 hours,
the balance is voided. (exception is LTCF or terminal ill patient)
If Patient requests a partial fill; the balance cannot be fill later; the balance is void
 CIII-CIV
 30 days only maximum
 5 refills or 6 months life
 CV (Federal Law)
 Codeine containing cough syrup must be combined with other med and be no more than 2
mg/ml codeine
 opiates in small amounts combined with a noxious drug to prevent abuse (diphenoxylate
2.5 mg/Atropine 0.0025 mg)
 Depending on state law can be dispensed without a prescription
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Patient must be 18 or older
Sale by pharmacist mandatory
Log book maintained
Max of 120 ml in 48 hours of a codeine containing product or 24 dose units per 48 hours per patient
of solid dosage products
 Oral Controlled Substances (Federal Law)
 Permitted on CIII-CV
 CII emergency oral Rx
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For the emergency period only ( 5 days in NY)
Must reduce to writing by pharmacist
No alternative available
72 hours MD must deliver hard copy
Must know prescriber in good faith
If any are in question, can and should refuse to fill
 Exceptions to the 30 day rule for controlled substance
prescriptions
 With certain medical conditions many states have laws
permitted greater than 30 day filling of Rx
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Code A= panic disorders
Code B= ADHD
Code C= neurologically (seizures)
Code D= Pain relief in incurable conditions
 If a patient is a resident in a LTCF or a terminally ill
patient then a CII prescription may be filled for up to 60
days.
Medication Orders in the Hospital
 An order usually contains patient name, DOB, and MRN.
 Patient’s Diagnosis, Allergies, Location in Hospital
 Patient’s height and Weight
 Date and hour the order is written.
 Name of Drug, dose, frequency and if routine, STAT or
PRN.
 Route
 Name of the prescriber and the pager
 Can be a paper order sent to the pharmacy or an order
entered into a CPOE.
 Depending on State Law, a physician or other
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prescriber may call in a verbal order to the institution’s
pharmacy as an emergency measure.
This is called a Emergency Verbal Order
This is called to help speed up the processing of the
medication
Example: Alteplase Injection. 100 mg/100 ml of Sterile
water for injection. IV infusion over a 60 minute hang
time
A written order is followed up
Types of Institutional Medication
Orders
 Routine orders- Daily order that are order on an
ongoing basis. Example: Enalapril 10 mg Daily
 STAT orders- orders that are needed as an emergency
measure. i.e. Dilitiazem 5 mg IVP X 1
 PRN- as needed order- ordered as per patient request
 i.e. Percocet 1-2 tablets q4h PRN for pain
Intravenous Medication Labeling
 Labeling rules are governed by the state, non governmental
agencies guidelines (JCAOH, USP797)
 Include the following:
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Patient’s name, location in institution, MRN
Drug and strength
Base fluid
IV Route type: IVPB, CI (continuous infusion), or IVP
The intended time of administration of drug
Rate of administration if LVP (or hang time if SVP)
Prep by field and Verified by field
Product expiration field
 In addition a nursing label may be attached detailing:
 When product was “hung” (i.e. started)
 By whom the product was hung
Sample IV Label
LaGuardia College Hospital
32 Thomson Ave
Long Island City, N.Y 11345
Name: John Doe
Location: CICU
Amiodarone 450 mg
In: D5W 250 ml
Continuous Infusion
Administration time: 03/15/2015 19:00
Rate of Infusion: 33 ml/hr
Prep by:____
Verified by:______
Expiration : 03/16/15 18:00
MRN: 1234567
Bed: 2
Sample IV Label II
LaGuardia College Hospital
32 Thomson Ave
Long Island City, N.Y 11345
Name: John Doe
Location: CICU
Ceftriaxone 1,000 mg
In: D5W 50 ml IVPB
Administration time: 03/15/2015 19:00
Hang Time: 15 minutes
Prep by:____
Verified by:______
Expiration : 03/16/15 18:00
MRN: 1234567
Bed: 2