1. AFAMS Receive a Prescription Order (Dari) EO 003.02

2. AFAMS Purpose of Lesson (Dari) The pharmacy technician student will learn how to: (1)Screen prescriptions for completeness and authenticity. (2) Complete the proper patient prescription intake procedure. This topic will be taught using a lecture format and students will be given a chance to practice these skills during an in-class assignment as well as during a skills lab. AFAMS Insert Dari

3. AFAMS Overview of Lesson (Dari) (1) Outpatient vs. Inpatient (2) Essential components of an outpatient prescription. (3) Essential components of an inpatient medication order (MoD form 58). (4) Stepwise approach to outpatient prescription intake. (6) In-class assignment AFAMS Insert Dari

4. AFAMS Outpatient vs. Inpatient (Insert Dari) An outpatient is a patient who is hospitalized for 24 hours or less. It is a patient who visits a hospital, clinic, or facility for diagnosis or treatment. An inpatient is admitted to the hospital and stays overnight or for a longer amount of time, usually several days or weeks.

5. AFAMS Outpatient vs. Inpatient Prescriptions (Insert Dari) Hospital pharmacies provide services for both outpatients and inpatients. Outpatient prescriptions are usually brought to the pharmacy to by the patient or a family member of the patient. Inpatient prescriptions will be brought to the pharmacy by a nurse from the ward on which the patient is staying. Outpatient and inpatient prescriptions look different and also have different information requirements. Insert Dari

6. AFAMS Outpatient Prescriptions (Insert Dari)

7. AFAMS Outpatient Prescriptions (Insert Dari) Information required on the prescription: (1)Hospital/facility name (2)Patient’s name (3)Patient’s gender and date of birth (4)Patient’s father’s name (5)Patient medical condition (if known) (6)Date the prescription was written (7)Drug name (8) Drug strength and dose to be administered (9) Instructions for use, including route of administration, frequency and duration of use. (10) Quantity to be dispensed Insert Dari

8. AFAMS Outpatient Prescriptions (Insert Dari) (11) Doctor’s signature (12) Doctor’s name (13) Doctor’s address and contact information. (14) Doctor’s license/registration number Insert Dari

9. AFAMS Insert Dari

10. AFAMS Instructor lead discussion (Insert Dari) The instructor will take 10 minutes to discuss the question on the following slide with the class. Insert Dari

11. AFAMS Discussion Topic (Insert Dari) Why are the following pieces of information important to have on the prescription? Doctor’s contact information Date the prescription was written Medical condition Patient’s gender and date of birth. Insert Dari

12. AFAMS Possible Responses (Insert Dari) Doctor’s contact information: If there is a problem with the prescription (i.e. the prescription is incomplete, drug not on the formulary etc) the pharmacist may need to contact the doctor. Date the prescription was written: It is important to know when the prescription was written. Do you think it would be appropriate to fill a prescription that was written 10 months ago? Likely not, the patient should be re-evaluated by a physician. Insert Dari

13. AFAMS Possible Responses (Insert Dari) Patient’s medical condition: Allows the pharmacist to evaluate if the choice of medication is appropriate and if it is being dosed appropriately. Patient’s gender and date of birth: Gender is important to know for the pharmacist to evaluated if the medication is appropriate and if there is specific information the patient should know (i.e. issues with pregnancy, side effects etc). Date of birth is important to know if you are dealing with a child or an adult, which affects how medication is dosed. Insert Dari

14. AFAMS Inpatient Prescriptions: Medication Orders and MoD Form 58 (Insert Dari)

15. AFAMS What is a medication order? (Insert Dari) Medication order refers to a written request on a physician’s order form (in the patient’s chart) or a transcribed verbal or telephone order in an inpatient setting (ward). Medication orders are then transcribed onto the MoD Form 58 for all the patients on the ward. This is usually done by the nurse and is approved by the physician prior to the MoD Form 58 being brought to the pharmacy for filling. In the pharmacy the pharmacist on duty will review the MoD Form 58 and sign off prior to the medications being filled. Insert Dari

16. AFAMS Role of the clinical pharmacist on the ward (Insert Dari) One of the major roles for a clinical pharmacist working on a ward is to review medication orders for completeness, accuracy and therapeutic use (i.e. dose, route of administration, indication etc.) Insert Dari

17. AFAMS Form 58

18. AFAMS Form 58 Patient Total of Each Drug Required Drug Strength Amount of Drug Required for Each Patient

19. AFAMS Differences between inpatient and outpatient prescriptions (Insert Dari) Each outpatient prescription is for a single patient. It can have multiple medications on one form but the medications are all for the same patient. MoD form 58 (an inpatient prescription) can have orders for multiple patients and multiple medications on the same form. Insert Dari

20. AFAMS Stepwise procedure for outpatient prescription intake (Insert Dari)

21. AFAMS Step #1 (Insert Dari) Greet the patient and introduce yourself: This makes the patient feel more comfortable and welcome. Be sure to identify yourself as a pharmacy technician. Insert Dari

22. AFAMS Step #2 (Insert Dari) Verify patient identity including: (1)Name (2)Date of birth (3)Gender Insert Dari

23. AFAMS Step #3 (Insert Dari) Ask the patient if they have any medication allergies that they are aware of. Insert Dari

24. AFAMS What is an allergy? (Insert Dari) Review from anatomy and physiology: Undesirable over-reaction of the immune system to normally harmless substances such as medications. The immune system ‘thinks’ the medication is a ‘foreign invader’. Reactions can be damaging and uncomfortable. Symptoms can include: - itchy rash - difficulty breathing Insert Dari

25. AFAMS Medication intolerance vs. Medication allergy (Insert Dari) Often patients will confuse an intolerance with an allergy. An intolerance refers to a normal side effect experienced when taking a medication (i.e. stomach irritation with an antibiotic). A true medication allergy is characterized by breathing problems or a full body rash. Insert Dari

26. AFAMS Step #3 Continued (Insert Dari) Ask the patient if they have any medication allergies that they are aware of. Regardless, if a patient identifies themselves as having an allergy you must get a pharmacist to speak with the patient before proceeding. Insert Dari

27. AFAMS Step #4 (Insert Dari) Verify the medical condition/diagnosis for which the patient is taking the medication. If there is an inconsistency between what is written on the prescription and what the patient says, do not proceed and refer the issue to the pharmacist on duty. Insert Dari

28. AFAMS Step #5 (Insert Dari) Confirm the name of the medication with the patient. Note: not all patients will remember the name of the medication that has been prescribed for them and that’s okay. Insert Dari

29. AFAMS Step #6 (Insert Dari) Ask the patient if they have taken this medication before. If they have not taken this medication before, the patient may wish to speak with the on duty pharmacist regarding side effects and any concerns or questions they may have. Insert Dari

30. AFAMS Step #7 (Insert Dari) Now that you have verified all the appropriate information with the patient you should screen the prescription for completeness and authenticity. Ensure all 14 components of the outpatient prescription are complete Check for signs of counterfeit prescriptions (see next slide). If any information is missing or the prescription appears to be counterfeit refer to the pharmacist on duty. Insert Dari

31. AFAMS Counterfeit Prescriptions (Insert Dari) Look for: –Use of two colours of ink. This may indicate changes made after it was written. –Unknown prescriber. –Incorrect registration number –Drug names misspelled –Quantity does not match direction requirements –Not written on an official prescription form. –No Sig Code –Quantities changed by crossing out In all these instances the Pharmacist will have to investigate.

32. AFAMS IMPORTANT: Be sure to keep the patient informed of any issues encountered throughout the intake process. This will help ensure they understand any time delays in receiving their medication. (Insert Dari)

33. AFAMS Step #8 (Insert Dari) Inform the patient of the approximate wait time until their prescription will be ready. Be sure to tell them: Where they can wait in the meantime. If you will get them when their medication is ready or if they should check back at the pharmacy. Insert Dari

34. AFAMS Step #10 (Insert Dari) Fill the prescription (will be covered in EO 003.03) Insert Dari

35. AFAMS 1.Greet the patient/ introduce yourself (insert Dari) 2. Verify patient identity -Age, gender, date of birth. (Insert Dari) 3. Ask if the patient has any allergies (Insert Dari) 4. Confirm the medical condition/diagnosis (Insert Dari) 5. Confirm the name of the medication (Insert Dari) 6. Ask if they have taken the medication before (Insert Dari) 7. Ensure the prescription is complete/authentic (Insert Dari) 8. Inform the patient of the wait time. (Insert Dari) Continue to the next step in the process (Insert Dari) Refer to the on duty pharmacist (Insert Dari) None (Dari) Yes (dari) Matches with the prescription (Insert Dari) Doesn’t match with the prescription (Insert Dari) Yes (Dari) No (Dari)

36. AFAMS In-class Assignment (Insert Dari) Identify the missing piece(s) of information with the following prescriptions and determine whether you need to refer the issue to a pharmacist or if it is something you can just ask the patient. Insert Dari

37. AFAMS 1.

38. AFAMS 2.

39. AFAMS 3.

40. AFAMS 4.

41. AFAMS 5.

42. AFAMS Answers (Insert Dari)

43. AFAMS 1. The doctor’s signature is missing (Insert Dari) This is an issue that you should refer to the on duty pharmacist. They can contact the physician to obtain the signature. Insert Dari

44. AFAMS 2. The name of the drug is missing (Insert Dari) This is an issue that you should refer to the on duty pharmacist. They can contact the physician to obtain the correct information. Insert Dari

45. AFAMS 3. The date the prescription was written is missing (Insert Dari) This is an issue that you should refer to the on duty pharmacist. They can contact the physician to obtain the correct information. Insert Dari

46. AFAMS 4. The diagnosis is missing (Insert Dari) You can ask the patient what condition they are being treated for. Once you obtain that information you can then discuss it with the on duty pharmacist. Insert Dari

47. AFAMS 5. The gender and date of birth is missing (Insert Dari) You can ask the patient for the date of birth and fill it in along with gender, then take the prescription to the on duty pharmacist. Insert Dari