1. Chapter 8 Prescription Processing
Copyright © 2004 by Elsevier Inc.  All rights reserved.

2. 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

3. 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

4. Taking the Prescription
Prescription arrives by various methods
Written order
Hand carried
Faxed
Called in

5. Taking the Prescription
Computer generated prescriptions becoming more common
May be provided to patients on discharge from hospitals or physician’s office

6. Prescription Information-Outpatient
Ensure correct information is listed on prescription
Allergy information for new patient needed

7. Important Patient Information
Patient Information Provider's Information
Name Name
Phone number and address Phone number and address
Insurance information, Provider's license number if applicable
Age or date of birth Provider's DEA number if applicable
Name of medication
Strength
Dosage form

8. 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

9. 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

10. Prescription Information-Inpatient
Information required different than outpatient
Doctor’s license and DEA number on file at hospital
Dosing 24-hour period

11. Prescription Information-Inpatient
Doctor writes for daily dose
Antibiotics have automatic stop date

12. Translation of an Order
Look at whole order if difficult to decipher
If in doubt, ask another person or pharmacist

13. 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

14. 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

15. 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

16. Filling the Script
After label preparation, match with original order and fill
10 steps to prevent errors (See list on page 119)

17. 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)

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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)

26. Computer Dispensing Systems
Two major versions of dispensing systems:
One for filling outpatient prescriptions
Those used in hospitals

27. Outpatient Dispensing Systems
Three primary reasons for using dispensing systems:
Cut down on errors
Increase productivity
Inventory control
Disadvantage–high cost

28. 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

29. Inpatient Dispensing Systems
Robot dispensing machine incorporated into hospital pharmacies
Dispenses unit-dose medications
Fills with 99% accuracy

30. The Rights of a Patient Right dose Right medication Right route
Right time
Right price
Right dosage form
Right patient

31. 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

32. 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

33. Zero Refill Recorders
Additional phone lines set up in pharmacies for refill
Patient should allow two days to get proper authorization from prescriber

34. 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

35. Filing Prescriptions Hard copy prescriptions manually filed
Hard copy filed for future reference
Prescription kept on file for three years
Prescription numbers used

36. 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

37. 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

38. Billing No third-party coverage–patient charged full price
Each type of insurance has limitations

39. 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