1 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 7 Prescription Processing

2 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1. Describe the responsibilities of a technician filling prescriptions within a community and institutional setting. 2. List the 10 steps of carefully filling a medication order. 2a. List the necessary information required for prescriptions and labels. How to Fill a Prescription Lesson 7.1

3 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3. Differentiate between inpatient and outpatient information requirements. 4. List the types of automated machines used in filling prescriptions. Additional Responsibilities of the Pharmacy Technician in Filling Prescriptions Lesson 7.2

4 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5. List the 5 rights of a patient in regard to medication safety. Additional Responsibilities of the Pharmacy Technician in Filling Prescriptions (cont’d) Lesson 7.2

5 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Introduction  Filling a prescription is the _______ ______________ and important duty of a technician.  Transcribing doctor’s orders: frustrating.  Clarification is needed at times.  Pharmacist makes _____ ________.

6 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Processing a Prescription: A Step-by-Step Approach  Five basic steps for filling a prescription:  _______ _____ the prescription  Translating the prescription  _________ information in database  Filling the script  Patient counseling

7 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Taking in the Prescription  Prescriptions arrive in various ways:  Written order  _________ carried  Faxed  __________ in

8 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Taking in the Prescription (cont’d)  __________________-generated prescriptions becoming more common.  May be provided to patients on discharge from hospitals or physician’s office.  See Box 7-1.

9 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Prescription Information: Community Pharmacy Setting  Ensure ____________ information is listed on prescription (Box 7-2).  Information needed on any OTC and herbal medications the patient may be using.  Information needed on ___________ and current medications.

10 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Important Patient Information Patient InformationProvider’s Information ____________NamePhone number and address Insurance information, Provider’s license number if applicable _________ or date of birthProvider’s _____ number, if applicable Name of medication Strength Dosage form

11 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Important Patient Information (cont’d) Provider’s Information __________ Quantity Route of administration ______ Refill information Provider’s signature __________ written “Brand necessary” if brand name drug is desired

12 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Prescription Information: Community Pharmacy Setting (cont’d)  Medical record number needed if patient is member of ____.  _____ number is necessary for controlled substance.  Controlled drug written in ______ or indelible pencil.

13 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Prescription Information: Inpatient Setting  Inpatient information required different from outpatient.  Doctor’s license and ____ number are on file at hospital.  Dosing in 24-hour period.  See Box 7-3.

14 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Prescription Information: Inpatient Setting (cont’d)  Doctor writes for ______ dose.  Antibiotics have automatic stop date.

15 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Translation of an Order  Look at _________ order if difficult to decipher.  If in doubt, ask another person or pharmacist.

16 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. When to Ask for Help  When handwriting is poor, assistance is ______________.  Filling scripts under pressure can lead to “guessing.”

17 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Entering the Information into the Database: Outpatient Setting  After doctor’s order is read, enter into computer.  Check computerized _______ against prescription after it is filled.  Two labels generated: one for the vial; other for ________ of original prescription.  Pharmacist initials needed on both labels; some states require technician’s initials also.

18 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Entering the Information into the Database: Inpatient Setting  Pharmacists or technicians enter ___ prescriptions in computer.  Multiple orders on patient sent during stay.  Computers alert to _____ interactions.  Pharmacist calls physician to change order.

19 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Filling the Prescription in a Community Setting  After label preparation, _________ with original order and fill.  Ten important steps to follow to avoid errors.

20 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1. ___________ 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).

21 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2. Pulling the Correct __________  Take label to shelf when getting medication from the shelf.  Label helps you not to forget.  Can compare label with information on the bottle.

22 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 & 4. _____________ 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.

23 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5. Prescription Lids  Appropriate lid applied after medication is filled.  Problem for elderly patient: ______ lid.  Elderly lose dexterity and strength.  Older patients do not want safety lids.  Can replace with ___________ lid.

24 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6. Applying the Label  _____________________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 __________ read.

25 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6. Applying the Label (cont’d)  Computer systems print label and information on one sheet.  Law requires certain information to be on label.

26 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7. Technician’s Initials  Technicians should ______________ all orders they fill.  Pharmacist gives final check-off and knows who filled it by initials.  Pharmacist can notify or ask technician if ____________ or questions occur.  Pharmacist must always sign off after completion.

27 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8. _________ Labels  Auxiliary labels are usually printed with prescription label.  Drug classification, interactions, and _______ _________ need to be known for auxiliary labels if not computerized.

28 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 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 _________.  Filling one prescription at a time is important to avoid errors.  Mark newly opened stock bottle with an __ (do not cover NDC number or expiration date).

29 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Community Dispensing Systems  Automated dispensing systems are used for three primary reasons:  To cut down on __________  To increase productivity  For inventory control  Automated systems can visually identify all the info on a label through a ____ _________ located on the side of the prescription label.

30 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Filling Orders in a Hospital Setting  Institutional pharmacies do not follow the same steps as ___________ pharmacies for filling medication orders.  Wider range of medications is needed.

31 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Computer Dispensing Systems  Major versions of dispensing systems:  Outpatient dispensing systems  ____________dispensing systems  Nursing care facilities  Large mail-order companies

32 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Inpatient Dispensing Systems  Hospitals need medications around the ____________.  Computerized dispensing systems cut down on staffing needs; gives doctors and nurses access.  Control narcotics and track their movement.

33 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. The 5 Rights of Medication Safety  Right patient  Right ________  Right dose  Right route  Right _________

34 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pharmacist Consultations: When and Who Needs Them  First-time prescriptions flagged and __________________is alerted.  Patient needs consultation with new script.  Federal law: all new or changed prescriptions need consultation.  See ________ 1990.

35 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Miscellaneous Orders: Outpatient Setting  Technicians,__________, and pharmacy interns fill refills and transfer prescriptions over the phone.  Technicians may phone and receive authorization for a prescription refill.

36 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Miscellaneous Orders: Daily Hard-Copy Printing (QUE)  Prescription labels are run off first thing in ____ _____________ 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 _________ and stress.

37 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Refills  A pharmacy technician may phone a prescriber's office and receive ________________ for a prescription refill.

38 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Zero Refill Reorders  Additional phone lines are set up in pharmacies for___________.  Patient should allow __ days to get proper authorization from prescriber.

39 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Transfers  Previously filled prescriptions are transferred by pharmacist from ____ pharmacy to another.  Most Boards of Pharmacy prefer to allow only _______ transfer.  Federal law states that narcotics prescriptions can be transferred ____ time only.

40 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Refilling Automated Dispensing System (ADS) Machines  Often the technician is the one who refills the ________machines.  It is important to ensure that the right drug is getting into the right dispensing hopper.

41 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Filing Prescriptions  Hard copy prescriptions _______filed.  Hard copy filed for future reference.  Prescription kept on file for __ years.  Prescription numbers used.

42 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Filing Prescriptions (cont’d)  All controlled substances are stamped with a _____ “C” 1 inch down on right-hand side of prescription label for easy location.  All Schedule II medications must be filed separately.

43 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Early Fills  Filling a prescription early can be done if the patient has a good ______________.  Many insurance prescription plans allow for one early refill per medication, per calendar year.

44 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Medication Pick-Up  Patients can wait for prescriptions.  Have prescriptions _____________.  Can pick up another day by self or relative.  All third-party prescriptions must have a _______________ of the person receiving medication.  Check all __ before releasing medication for controlled substances.

45 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. Billing Patients  No third-party coverage—patient charged full price.  Each type of insurance has limitations and conditions.

46 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 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.