1. Chapter 5 Prescriptions

2. Learning Objectives understanding of the prescription process. knowledge of abbreviations used in pharmacy. knowledge of the information elements of a prescription. knowledge of the information elements of a medication order. knowledge of the fill process. knowledge of label information. knowledge of auxiliary labels.

3. Prescription Process Prescription Process Prescription is written It’s presented to pharmacy Information is checked Data is entered into pharmacy system

4. Prescription Process Online processing Label is generated Prescription is prepared.

5. Prescription Process Check by pharmacist Patient (signs log) receives prescription Counseling is provided

6. Pharmacy Abbreviations ROUTES ad right ear im inramuscular po by mouth etc. FORMS aq water caps capsules ung ointment etc.

7. Pharmacy Abbreviations TIME ac before meals pc after meals bid twice a day prn as needed etc MEASUREMENT oz ounce gtt drops tea teaspoon ml milliliter etc

8. Pharmacy Abbreviations OTHER ◦ c with ◦ sig write (directions for use) ◦ utd as directed

9. ROUTE ad _____________ as _____________ au _____________ im, IM _____________ inj. _____________ iv, IV _____________ ivp, IVP _____________ IVPB _____________ od _____________ os _____________ ou _____________ po _____________ npo _____________ SC, SQ _____________ top _____________ PR, rec _____________ SL _____________ Quiz

10. FORM Tab/T _____________ C/Cap _____________ Ts _____________ Elix _____________ Liq _____________ NS _____________ supp _____________ Syr _____________ Cs _____________ Ung _____________

11. TIME ac _____________ am _____________ bid _____________ hs _____________ qhs _____________ pc _____________ prn _____________ qid _____________ q _____________ qd _____________ qh _____________ stat _____________ tid _____________ qod _____________

12. MEASUREMENT aa _____________ d _____________ dil _____________ f, fl. _____________ g, G, gm _____________ gtt _____________ L _____________ mcg _____________ mEq _____________ mg _____________ ml _____________ qs _____________ ss _____________ tbsp _____________ tsp _____________ U _____________

13. OTHER c_____________ Disp _____________ f, ft _____________ L _____________ s _____________ ut dict/utd _____________ Sig _____________ tat _____________ NTE _____________ nkda, nka _____________

14. The Prescription

15. Medication Order

16. Elements of the Prescription Elements of the Prescription Patient InformationProvider's Information NameName Phone number and addressPhone number and address Insurance information, Provider's license number if applicable Age or date of birthProvider's DEA number if applicable Name of medication Strength Dosage form

17. Elements of the Prescription Elements of the Prescription Provider's Information cont. Route Quantity Route of administration Sig Refill information Provider's signature Date written "Brand medically necessary" if brand name drug is desired

18. Prescription Information Checklist Prescription Information Checklist NAME, NAME, NAME DEA number is necessary for controlled substances Controlled drug written in ink Inpatient (slightly different) ◦ Doctor’s license and DEA number on file at hospital ◦ Dosing 24-hour period ◦ Doctor writes for daily dose ◦ Antibiotics have automatic stop date

19. The Pharmacy Technician’s Role ◦ Taking in the prescription ◦ Translating the prescription ◦ Entering information in database ◦ Filling the script

20. The Pharmacist’s Role ◦ Can help with the following:  Taking in the prescription  Translating the prescription  Entering information in database  Filling the script ◦ But responsible for the final check and patient counseling

21. Prescription Label

22. The Fill Process Considerations ◦ After label preparation, match with original order and fill ◦ 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) ◦ Take label to shelf when getting medication from the shelf

23. The Fill Process Considerations ◦ Label helps you not to forget ◦ Can compare label with information on the bottle ◦ Check label and script against bottle for accuracy ◦ Counting trays still used ◦ Digital counters and automated machines ◦ Baker cells used in larger pharmacies

24. The Fill Process Considerations ◦ 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

25. Placing 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 Computer systems print label and information on one sheet Law requires certain information to be on label

26. 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

27. 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)

28. Auxiliary Labels Auxiliary labels usually printed with prescription label ◦ Drug classification ◦ interactions ◦ side effects (need to be known for auxiliary labels if not computerized)

29. Auxiliary Labels TAKE WITH FOOD MAY CAUSE DROWSINESS DO NOT DRINK ALCOHOLIC BEVERAGES WHEN TAKING THIS MEDICINE DO NOT TAKE ASPIRIN OR ASPIRIN CONTAINING PRODUCTS WITHOUT CONSULTING A PHYSICIAN TAKE MEDICATION ON AN EMPTY STOMACH THIS DRUG MAY IMPAIR YOUR ABILITY TO DRIVE OR OPERATE MACHINERY FOR EXTERNAL USE ONLY AVOID PROLONGED EXPOSURE TO SUNLIGHT WHILE TAKING THIS MEDICATION CAUTION: FEDERAL LAW PROHIBITS THE TRANSFER OF THIS DRUG TO ANY PERSON OTHER THAN THE PATIENT FOR WHOM IT WAS PRESCRIBED.

30. Auxiliary Labels

31. HIPAA: The Health Insurance Portability and Accountability Act of 1996 Primarily concerns the continuation of health insurance coverage for workers who leave their jobs Also includes regulations regarding privacy and protected health information (PHI) that all “covered entities” must follow. Examples of protected health information (PHI): ◦ patient name and address ◦ date of birth ◦ social security number ◦ payment history ◦ account number ◦ name and address of health care provider and/or health plan ◦ medical & prescription drug history

32. HIPAA: The Health Insurance Portability and Accountability Act of 1996 As of May 23, 2007 HIPAA requires that all health care providers use a National Provider Identifier (NPI) for all standard transactions covered by HIPAA. Pharmacies must make “good faith effort” to obtain a signed acknowledgement that the patient has received the pharmacy’s notice of privacy practices. Pharmacies may disclose “minimum necessary” PHI, without patient approval, to other covered entities such as doctors offices and insurance companies.

33. HIPAA: The Health Insurance Portability and Accountability Act of 1996 All personnel must be formally trained regarding HIPAA. Penalties for violations range from fines ($100 to $250,000) to jail (up to ten years).