PRESCRIPTIONS Chap. 5

Objectives Understand the prescription process: steps including creation of prescription, patient pick up, and counseling. Importance of preventing and identifying medication errors. Identify different responsibilities between pharmacist and technician. Importance of patient privacy.

Who can write scripts?? Medical Doctors Doctors of Osteopathy Primary Dentists DVMs In most states, including NC Physician Assistants Nurse Practitioners Pharmacists Primary Practitioners

The process Script order Arrives at pharmacy Patient and prescriber information gathered Script data entered into computer system Insurance and billing information processed Label generated Script prepared Pharmacist checks script Patient receives Pharmacist provides counseling

Where to get scripts? Institutional Pharmacy Community Pharmacy Staff (usually nurses) administer medications to patients Community Pharmacy Dispense directly to patient, who is then expected to take medication as prescribed.

Required Script Information Prescriber information DEA Number NPI Number (mandated by HIPAA, administered by NPPES) Date Drug name and strength Quantity Prescribers signature Name and address of patient Signa Refill instructions DAW/PSC

Additional Script Information Date dispensed NDC number Script origin code Script number Patient insurance information Price charged Technician and pharmacist initials involved in filling script

Technician’s Role Assist in routine, technical aspects of script filling Treat each patient and medications with respect Accept new scripts, obtaining information, and inputting into computer efficient and accurately Alert pharmacist whenever a DUR warning screen appears Faxing/ telephoning refill and clarification requests Consulting formularies and responding appropriately to 3rd party adjudication messaging Quick location of medication Compounding meds under supervision Recording of dispensing of controlled drugs Referring the patient to pharmacist for counseling ALWAYS ensuring accuracy/safety of scripts

Pharmacist’s Role Ensure physicians’ orders are carried out accurately and safely by checking: Correct medication, strength and dosage dispensed Directions are clear and accurate Patient knows how to take and refill medications No potential problems with drug allergies, drug disease interactions. DUR warnings important here!! Prescriber contacted if needed Patient understands expected outcomes of medication including side effects Accurately billed ONLY pharmacist can counsel on the use of OTC medications ONLY pharmacist can receive T.O. for new scripts

LABELS Three types of labels: Prescription label Auxiliary labels Unit dose labels

Unit Dose Labels Widely used in institutional pharmacies. Rules vary by institution; labels often contain only name, strength, manufacturer, lot number, expiration date, and dosage.

Auxiliary Labels Usually colored They provide additional information to the patient Many computerized systems will automatically print out appropriate labels For Controlled Substances the following preprinted label must be adhered: Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.

Script Label Includes information about the pharmacy, patient, prescriber, the script, and transaction number. Generally include all of the following: Pharmacy name, address, and phone number Script number Patient name Directions for use Medication name, strength, quantity, dosage, and manufacturer Drug expiration date Name of prescriber Refill information Initials of person who entered information and pharmacist who checked

HIPAA First in place in 1996 with many updates since. Has a large statue that concerns continuation of health insurance for workers who leave their jobs. Requires use of a NPI; is a 10 digit number. Each provider is assigned one that is theirs for life. Rules to cover PHI. All entities need to provide written notice of their written of their privacy practices to patients.

2 pages of abbreviations Chap 5 test on Thursday Pages 97-116 in book 2 pages of abbreviations Quias open Chap 5, 5.1, and 5.3