Transcript W0523 08 PPT

Chapter 8
Prescription Processing
Copyright © 2004 by Elsevier Inc. All rights reserved.
Introduction
• Filling a prescription: most common
and important duty of a technician
• Transcribing doctor’s orders:
frustrating
• Clarification is needed at times
• Pharmacist makes the call
Copyright © 2004 by Elsevier Inc. All rights reserved.
Processing a Script:
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
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Taking the Prescription
• Prescription arrives by various methods
• Written order
• Hand carried
• Faxed
• Called in
Copyright © 2004 by Elsevier Inc. All rights reserved.
Taking the Prescription
• Computer generated prescriptions
becoming more common
• May be provided to patients on
discharge from hospitals or
physician’s office
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Prescription Information-Outpatient
• Ensure correct information is listed
on prescription
• Allergy information for new patient
needed
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Important Patient Information
Patient Information
Provider's Information
Name
Name
Phone number and address
Phone number and address
Insurance information,
if applicable
Provider's license number
Age or date of birth
Provider's DEA number
if applicable
Name of medication
Strength
Dosage form
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Important Patient Information
(continued)
Provider's Information
Route
Quantity
Route of administration
Sig
Refill information
Provider's signature
Date written
"Brand necessary" if brand
name drug is desired
Copyright © 2004 by Elsevier Inc. All rights reserved.
Prescription Information-Outpatient
• 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
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Prescription Information-Inpatient
• Information required different than
outpatient
• Doctor’s license and DEA number
on file at hospital
• Dosing 24-hour period
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Prescription Information-Inpatient
• Doctor writes for daily dose
• Antibiotics have automatic stop date
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Translation of an Order
• Look at whole order if difficult to
decipher
• If in doubt, ask another person
or pharmacist
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When to Ask for Help
• When handwriting is poor, assistance
is needed
• Filling scripts under pressure can
lead to “guessing”
• See example 8.1 on page 117
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Entering the Information into
the Database-Outpatient
• 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 initial needed on both labels
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Entering the Information into
the Database-Inpatient
• Pharmacist enters new prescriptions
in computer, not technicians
• Multiple orders on patient sent
during stay
• Computers alert to drug interactions
• Pharmacist calls physician to
change order
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Filling the Script
• After label preparation, match with
original order and fill
• 10 steps to prevent errors
(See list on page 119)
Copyright © 2004 by Elsevier Inc. All rights reserved.
Checking the Label Against
the Script
• 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)
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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
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Counting and Filling
the Medication
• Check label and script against bottle
for accuracy
• Counting trays still used
• Digital counters and automated
machines
• Baker cells used in larger pharmacies
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Prescription Lid
and Auxiliary Label
• 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
Copyright © 2004 by Elsevier Inc. All rights reserved.
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
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Applying the Label
• Computer systems print label and
information on one sheet
• Law requires certain information to
be on label
• See list on page 121 for required label
information
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Technician’s Initials
• Technicians should initial all orders
filled by them
• 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
Copyright © 2004 by Elsevier Inc. All rights reserved.
Auxiliary Labels
• Auxiliary labels usually printed with
prescription label
• Drug classification, interactions, and
side effects need to be known for
auxiliary labels if not computerized
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The Pharmacist’s
Final Inspection
• Passing the filled vial, along with
medication container from shelf, and
original prescription to the pharmacist
is the last step in filling scripts
• 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)
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Computer Dispensing Systems
• Two major versions of dispensing
systems:
– One for filling outpatient
prescriptions
– Those used in hospitals
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Outpatient Dispensing Systems
• Three primary reasons for using
dispensing systems:
– Cut down on errors
– Increase productivity
– Inventory control
• Disadvantage–high cost
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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
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Inpatient Dispensing Systems
• Robot dispensing machine
incorporated into hospital pharmacies
• Dispenses unit-dose medications
• Fills with 99% accuracy
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The Rights of a Patient
• Right dose
• Right medication
• Right route
• Right time
• Right price
• Right dosage form
• Right patient
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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
• OBRA 1990
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Miscellaneous Orders
• Technicians, clerks, and pharmacy
interns fill refills and transfer
prescriptions over the phone
• Technicians may phone and receive
authorization for a prescription refill
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Zero Refill Recorders
• Additional phone lines set up in
pharmacies for refill
• Patient should allow two days to get
proper authorization from prescriber
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Transfers
• Previously filled prescriptions
transferred by pharmacist from one
pharmacy to another
• Boards of Pharmacy prefer transfer
only one time
• Federal law states only narcotics be
transferred one time
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Filing Prescriptions
• Hard copy prescriptions manually filed
• Hard copy filed for future reference
• Prescription kept on file for three years
• Prescription numbers used
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Filing Prescriptions
• All controlled substances stamped
with a red “C” 1 inch down on right
hand side of prescription label for
easy location
• All Scheduled II medications must
be filed separately
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Medication Pick-Up
• Patients can wait for prescriptions
• Have it delivered
• 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
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Billing
• No third-party coverage–patient
charged full price
• Each type of insurance has limitations
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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
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