chapter 8 prescription processing copyright © 2004 by elsevier inc. all rights reserved

Chapter 8Chapter 8

Prescription ProcessingPrescription Processing

Copyright © 2004 by Elsevier Inc. All rights reserved.


IntroductionIntroduction

• Filling a prescription: most common Filling a prescription: most common and important duty of a technicianand important duty of a technician

• Transcribing doctor’s orders: Transcribing doctor’s orders: frustratingfrustrating

• Clarification is needed at timesClarification is needed at times

• Pharmacist makes the callPharmacist makes the call


Processing a Script:Processing a Script:A Step-by-Step ApproachA Step-by-Step Approach

• Five basic steps for filling a Five basic steps for filling a prescriptionprescription

– Taking in the prescriptionTaking in the prescription

– Translating the prescriptionTranslating the prescription

– Entering information in databaseEntering information in database

– Filling the scriptFilling the script

– Patient counselingPatient counseling


Taking the PrescriptionTaking the Prescription

• Prescription arrives by various methodsPrescription arrives by various methods

• Written orderWritten order

• Hand carriedHand carried

• FaxedFaxed

• Called inCalled in


Taking the PrescriptionTaking the Prescription

• Computer generated prescriptions Computer generated prescriptions becoming more commonbecoming more common

• May be provided to patients on May be provided to patients on discharge from hospitals or discharge from hospitals or physician’s officephysician’s office


Prescription Information-OutpatientPrescription Information-Outpatient

• Ensure correct information is listed Ensure correct information is listed on prescriptionon prescription

• Allergy information for new patient Allergy information for new patient neededneeded


Important Patient InformationImportant Patient Information

Patient InformationPatient Information Provider's InformationProvider's Information

NameName NameName

Phone number and addressPhone number and address Phone number and addressPhone number and address

Insurance information, Insurance information, Provider's license number Provider's license number if applicable if applicable

Age or date of birthAge or date of birth Provider's DEA number Provider's DEA number if applicableif applicable

Name of medicationName of medication

StrengthStrength

Dosage formDosage form


Important Patient Information Important Patient Information (continued)(continued)Provider's InformationProvider's Information

RouteRoute

QuantityQuantity

Route of administrationRoute of administration

SigSig

Refill informationRefill information

Provider's signatureProvider's signature

Date writtenDate written

"Brand necessary" if brand"Brand necessary" if brandname drug is desiredname drug is desired


Prescription Information-OutpatientPrescription Information-Outpatient

• Medical record number needed if Medical record number needed if patient is member of HMOpatient is member of HMO

• DEA number is necessary for DEA number is necessary for controlled substancecontrolled substance

• Controlled drug written in ink or Controlled drug written in ink or indelible pencilindelible pencil


Prescription Information-InpatientPrescription Information-Inpatient

• Information required different than Information required different than outpatientoutpatient

• Doctor’s license and DEA number Doctor’s license and DEA number on file at hospitalon file at hospital

• Dosing 24-hour periodDosing 24-hour period


Prescription Information-InpatientPrescription Information-Inpatient

• Doctor writes for daily doseDoctor writes for daily dose

• Antibiotics have automatic stop dateAntibiotics have automatic stop date


Translation of an OrderTranslation of an Order

• Look at whole order if difficult to Look at whole order if difficult to decipherdecipher

• If in doubt, ask another person If in doubt, ask another person or pharmacistor pharmacist


When to Ask for HelpWhen to Ask for Help

• When handwriting is poor, assistance When handwriting is poor, assistance is neededis needed

• Filling scripts under pressure can Filling scripts under pressure can lead to “guessing”lead to “guessing”

• See example 8.1 on page 117 See example 8.1 on page 117


Entering the Information into Entering the Information into the Database-Outpatientthe Database-Outpatient

• After doctor’s order is read, enter After doctor’s order is read, enter into computerinto computer

• Check computerized label against Check computerized label against prescription after it is filledprescription after it is filled

• Two labels generated: one for the vial; Two labels generated: one for the vial; other for back of original prescriptionother for back of original prescription

• Pharmacist initial needed on both labelsPharmacist initial needed on both labels


Entering the Information into Entering the Information into the Database-Inpatientthe Database-Inpatient

• Pharmacist enters new prescriptions Pharmacist enters new prescriptions in computer, not techniciansin computer, not technicians

• Multiple orders on patient sent Multiple orders on patient sent during stayduring stay

• Computers alert to drug interactionsComputers alert to drug interactions

• Pharmacist calls physician to Pharmacist calls physician to change orderchange order


Filling the ScriptFilling the Script

• After label preparation, match with After label preparation, match with original order and filloriginal order and fill

• 10 steps to prevent errors 10 steps to prevent errors (See list on page 119)(See list on page 119)


Checking the Label Against Checking the Label Against the Scriptthe Script

• Label checked many times before it Label checked many times before it reaches patientreaches patient

• Hold original script next to label to Hold original script next to label to check for errors or discrepanciescheck for errors or discrepancies

• Look at names of drug, strength, Look at names of drug, strength, dosage form, sig (directions)dosage form, sig (directions)


Pulling the Correct MedicationPulling the Correct Medication

• Take label to shelf when getting Take label to shelf when getting medication from the shelfmedication from the shelf

• Label helps you not to forgetLabel helps you not to forget

• Can compare label with information Can compare label with information on the bottleon the bottle


Counting and FillingCounting and Fillingthe Medicationthe Medication

• Check label and script against bottle Check label and script against bottle for accuracyfor accuracy

• Counting trays still usedCounting trays still used

• Digital counters and automated Digital counters and automated machinesmachines

• Baker cells used in larger pharmaciesBaker cells used in larger pharmacies


Prescription LidPrescription Lidand Auxiliary Labeland Auxiliary Label

• Appropriate lid applied after Appropriate lid applied after medication is filledmedication is filled

• Problem for elderly patient–safety lidProblem for elderly patient–safety lid

• Elderly lose dexterity and strengthElderly lose dexterity and strength

• Older patients do not want safety lidsOlder patients do not want safety lids

• Can replace with snap-on lidCan replace with snap-on lid


Applying the LabelApplying the Label

• Professionalism is needed when Professionalism is needed when applying labelapplying label

• Do not place torn or crooked label Do not place torn or crooked label on bottleon bottle

• Label not to cover lot and expiration Label not to cover lot and expiration date on full bottle prescriptionsdate on full bottle prescriptions

• Auxiliary labels must be easily readAuxiliary labels must be easily read


Applying the LabelApplying the Label

• Computer systems print label and Computer systems print label and information on one sheetinformation on one sheet

• Law requires certain information to Law requires certain information to be on labelbe on label

• See list on page 121 for required label See list on page 121 for required label informationinformation


Technician’s InitialsTechnician’s Initials

• Technicians should initial all orders Technicians should initial all orders filled by themfilled by them

• Pharmacist gives final check-off and Pharmacist gives final check-off and knows who filled it by initialsknows who filled it by initials

• Pharmacist can notify or ask Pharmacist can notify or ask technician if errors or questions occurtechnician if errors or questions occur

• Pharmacist must always sign off Pharmacist must always sign off after completionafter completion


Auxiliary LabelsAuxiliary Labels

• Auxiliary labels usually printed with Auxiliary labels usually printed with prescription labelprescription label

• Drug classification, interactions, and Drug classification, interactions, and side effects need to be known for side effects need to be known for auxiliary labels if not computerizedauxiliary labels if not computerized


The Pharmacist’sThe Pharmacist’sFinal InspectionFinal Inspection

• Passing the filled vial, along with Passing the filled vial, along with medication container from shelf, and medication container from shelf, and original prescription to the pharmacist is original prescription to the pharmacist is the last step in filling scriptsthe last step in filling scripts

• Filling one prescription at a time is Filling one prescription at a time is important to avoid errorsimportant to avoid errors

• Mark newly opened stock bottle with an Mark newly opened stock bottle with an X (do not cover NDC number or X (do not cover NDC number or expiration date)expiration date)


Computer Dispensing SystemsComputer Dispensing Systems

• Two major versions of dispensing Two major versions of dispensing systems:systems:

– One for filling outpatient One for filling outpatient prescriptionsprescriptions

– Those used in hospitalsThose used in hospitals


Outpatient Dispensing SystemsOutpatient Dispensing Systems

• Three primary reasons for using Three primary reasons for using dispensing systems:dispensing systems:

– Cut down on errorsCut down on errors

– Increase productivityIncrease productivity

– Inventory control Inventory control

• Disadvantage–high costDisadvantage–high cost


Inpatient Dispensing SystemsInpatient Dispensing Systems

• Hospitals need medications around Hospitals need medications around the clockthe clock

• Computerized dispensing systems Computerized dispensing systems cut down on staffing needs; gives cut down on staffing needs; gives doctors and nurses accessdoctors and nurses access

• Control narcotics and track their Control narcotics and track their movementmovement


Inpatient Dispensing SystemsInpatient Dispensing Systems

• Robot dispensing machine Robot dispensing machine incorporated into hospital pharmaciesincorporated into hospital pharmacies

• Dispenses unit-dose medicationsDispenses unit-dose medications

• Fills with 99% accuracyFills with 99% accuracy


The Rights of a PatientThe Rights of a Patient

• Right doseRight dose

• Right medicationRight medication

• Right routeRight route

• Right timeRight time

• Right priceRight price

• Right dosage form Right dosage form

• Right patientRight patient


Pharmacist Consultations:Pharmacist Consultations:When and Who Needs ThemWhen and Who Needs Them

• First-time prescriptions flagged and First-time prescriptions flagged and pharmacist is alertedpharmacist is alerted

• Patient needs consultation with Patient needs consultation with new scriptnew script

• Federal law–all new or changed Federal law–all new or changed prescriptions need consultationprescriptions need consultation

• OBRA 1990OBRA 1990


Miscellaneous OrdersMiscellaneous Orders

• Technicians, clerks, and pharmacy Technicians, clerks, and pharmacy interns fill refills and transfer interns fill refills and transfer prescriptions over the phoneprescriptions over the phone

• Technicians may phone and receive Technicians may phone and receive authorization for a prescription refillauthorization for a prescription refill


Zero Refill RecordersZero Refill Recorders

• Additional phone lines set up in Additional phone lines set up in pharmacies for refillpharmacies for refill

• Patient should allow two days to get Patient should allow two days to get proper authorization from prescriberproper authorization from prescriber


TransfersTransfers

• Previously filled prescriptions Previously filled prescriptions transferred by pharmacist from one transferred by pharmacist from one pharmacy to anotherpharmacy to another

• Boards of Pharmacy prefer transfer Boards of Pharmacy prefer transfer only one timeonly one time

• Federal law states only narcotics be Federal law states only narcotics be transferred one timetransferred one time


Filing PrescriptionsFiling Prescriptions

• Hard copy prescriptions manually filedHard copy prescriptions manually filed

• Hard copy filed for future referenceHard copy filed for future reference

• Prescription kept on file for three yearsPrescription kept on file for three years

• Prescription numbers usedPrescription numbers used


Filing PrescriptionsFiling Prescriptions

• All controlled substances stamped All controlled substances stamped with a red “C” 1 inch down on right with a red “C” 1 inch down on right hand side of prescription label for hand side of prescription label for easy location easy location

• All Scheduled II medications must All Scheduled II medications must be filed separatelybe filed separately


Medication Pick-UpMedication Pick-Up

• Patients can wait for prescriptionsPatients can wait for prescriptions

• Have it deliveredHave it delivered

• Pick up another day by self or relativePick up another day by self or relative

• All third-party prescriptions must have All third-party prescriptions must have a signature of the person receiving a signature of the person receiving medicationmedication

• Check all ID before releasing Check all ID before releasing medication for controlled substancesmedication for controlled substances


BillingBilling

• No third-party coverage–patient No third-party coverage–patient charged full pricecharged full price

• Each type of insurance has limitationsEach type of insurance has limitations


Changing TrendsChanging Trends

• ““Meat and potatoes” of pharmacy is Meat and potatoes” of pharmacy is interpreting, transcribing, producing interpreting, transcribing, producing a label, filling, and checking scriptsa label, filling, and checking scripts

• OBRA 1990 requires consultation with OBRA 1990 requires consultation with patientspatients

• Pharmacist moved away from filling Pharmacist moved away from filling counter and technician placed in counter and technician placed in front linefront line

chapter 8 prescription processing copyright © 2004 by elsevier inc. all rights reserved

Documents

prescription prescription

address insurance information

desired slide

addressphone number

providers license number

controlled substancedea

hour period slide

indelible pencil slide