processing the prescription(1)

PROCESSING THE PRESCRPTION ORDER

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PROCESSING THE PRESCRIPTION ORDER

Dispensing refers to the pharmacists function of taking an order or prescription, preparing the drug/s according to the instructions of a physician/dentist/veterinarian and delivering it to the patient or client with proper instructions.

Dispensing

10 Strategies for minimizing Dispensing Errors

Ensure correct entry of Rx

Transcription error

Omission

Inaccuracies


2. Confirm that Rx is correct and complete

Illegible/ambiguous

Nonstandard abbreviations

Acronyms

Decimals


3. Beware of LASA/SALAD

Similar drug names

Aldactone Aldazide

Gliclazide - Glipizide


4. Be careful with zeros & abbreviations

Misplaced zeros

Decimal points

Faulty units


5. Organize work place

Organize work space

Work environment

Workflow


6. Reduce distraction when possible

Multitasking

Distraction during work


7. Focus on reducing stress and balance heavy workload

Workload increase


8. Take time store drug properly

Avoid mix - ups


9. Thoroughly check all Rx

Repeat checking

Counterchecking

Compare written Rx & the product


10. Always provide through patient counseling

PROCESSING PRESCRIPTION

RX3

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consultationPrescription written by authorized prescriber

Patient presents prescription to the pharmacy

Prescription is checked for completeness; prescriber info, drug name, strength, dose, and directions

Correct patient info is entered into computer system

Prescription is prepared. Correct amount of med prescribed is measured and placed into container

Pharmacy label is generated. Make sure all the legal items are identified

Prescription is interpreted and confirmed by pharmacy system. Third party is billed online (optional)

Prescription is prepared by pharmacy technician, and final check done by pharmacist

Patient receives script, pharmacy assistant must offer counseling to the patient. Then script is rung on cash register, and insurance log signed

Pharmacist provides counseling on the medication prescribed and all medically related questions

R

LABEL

How is a prescription processed?

receiving the prescription

reading and checking the prescription

numbering and dating

Labeling

preparing the prescription

packaging

rechecking

delivering and patient counseling

recording and filling

pricing the prescription

What is the purpose of numbering and dating the prescription?

The same number of the original prescription should appear at the label of the filled prescription to avoid error in dispensing

The date of the prescription is not the same date that should be placed on the filled prescription for identification purposes

Information to be recorded in the Prescription Book

1.name of physician

2.name of the drug

3.quantity

4.date when dispensed

5.balance (quantity if any)

6.pharmacist signature, etc

1. RECEIVING THE PRESCRIPTION

Enhance the pharmacist patient relationship

PHARMACIST should:

Estimate length of time required to fill the Rx

To price the Rx if requested by the patient.

Receiving the Rx

The appropriateness of the Rx for that patient can be assessed

Any required records can be completed correctly

The product can be labelled for that patient

If, necessary, the Rx can be delivered to the correct patient at the correct address

The patient can be contacted, if necessary, even after the medicine has been dispensed and supplied to the patient

2. READING AND CHECKING THE Rx

Read the Rx in the privacy of the prescription department

There should be no doubt as to the ingredient or quantities prescribed


If something is illegible or if it appears that an error has been made. Pharmacist should consult another pharmacist or the prescriber.

Should verify omission or failure to specify desired strength of medication


The size and frequency of dose be carefully noted and checked:

1. Age2. Weight and condition of patient3. Possible influence of other drugs being taken4. Frequency of administration

Clinical and Legal Checking of Rx

Suggested Way to do this REVIEW is

IDEAL CASE

Checking of Rx

Interaction

Dose

Evidence of harm/benefit

Appropriate

Legal and complete ( and here is where we make a CASE for the medication)

CASE

Cost effective

Acceptable to the patient

Safe

Effective

INTERACTION

Does the drug interact with any other items the patient is taking or with the patients condition?

DOSE

Specific dose per day

A specific dose per day for a specific time

A specific dose for a specific number of times per day

A combination of the above

Example: 200mg/day/individual doses, for 15 days

An initial dose

A dose per kg of body weight

A maximum dose

Reading and Checking

Aldactone Aldactide

Betnesol Betnetan

Co-amifruse Co-amilazide

Cordene Codeine

Daonil Danol

Gliclazide Glipizide

Nicardipine Nifedipine

Promazine Promethazine

Zocor - Zoton

CARBOplatin CISplatin

cefiXIME cefuROXIME

DOBUtamin DOPamine

ephEDRINE epINEPHRINE

FOLIC acid FOLINIC acid

hydrOXYZINE hydraALAZINE

INFLIXimab RITUXimab

metFORMIN metRONIDAZOLE

vinCRISTINE - vinBLASTINE

3. NUMBERING AND DATING THE Rx

It is a universal practice to number the Rx order and to place the same number on the label.

To connect the bottle or package with the original medication order.

4. LABELING THE Rx

Prescription label prepared by pharmacist, an assistant may be employed for this purpose.

Rx labels should be computerized or typewritten to make them neat, attractive and legible

4. LABELING THE Rx (cont.)

A prescription should have an aesthetic and professional appearing label.

The size of the label should be in conformance with the size of the prescription container.


Name, address and telephone number of the pharmacy are generally imprinted in the label

The pharmacist should give clear directions


Label of Compounded Rx should include:

Number of Rx

Date of filling

Name of Patient

Quality and quantity of ingredients


Label of Compounded Rx should include:5. Directions for administration6. Name of Physician


Label of Unit Dose Rx should include:

Name of Patient

Generic name of drug

Brand Name

Manufacturer


Label of Unit Dose Rx should include:

5. Dosage strength6. Expiry date7. Directions for use8. Name of Pharmacist


AUXILIARY LABELS emphasize a number of important aspects of the dispensing medication including:1. proper use2. handling3. storage


AUXILIARY LABELS4. Refill status5. Necessary warnings and precautionsExample: Shake well POISON Should Not Be Swallowed Keep Out of Reach of Children

Standard Requirements for Labeling Dispensed Medicines

Name of the preparation, strength and form

The name which appears on the label must be the same as the one which appears on the prescription


2. Quantity

The quantity which appears on the label will be the quantity which has been prescribed


3. Instruction for use

No patient should leave a pharmacy without knowing

How much

How often

How to use

Recommended wording for directions

Recommending wording

Wording to be replaced

Do not swallow

Not to be taken

Put two drops in the affected eye

Instill 2 drops into the affected eye

For creams, ointments: spread thinly

Use sparingly

For Pessaries or suppositories: gently put one into the vagina/rectum

Insert one into the vagina or rectum

Auxiliary labels

Shake well

Keep in the refrigerator, Do not Freeze

Do not use after

Refrigerate, Shake well, Discard After

External Use Only

May cause drowsiness; Alcohol and Operating Car or Machine Warning

Do not Drink Alcohol

Avoid Sun Exposure

Take with food

Take on an Empty Stomach

Finish all this medication

Do not take Aspirin

5. PREPARING THE Rx

Information Necessary:

Adjuvant used

Order of mixing

Amount of each ingredients

Capsule size

5. PREPARING THE Rx (cont.)

Information Needed:5. Type and size of container

Name and product identification number of manufacturer.

5. PREPARING THE Rx (cont)

Partially filled Rx should be returned to the buyer after recording the partial filling in the Rx book

Partial filling of prohibited or List A drugs shall not be allowed.

6. PACKAGING

Pharmacist should consider the size, shape, mouth opening, color and composition in packaging

6. PACKAGING

TYPES OF CONTAINERS GENERALLY USED:

Round Vials for solid dosage forms as capsules and tablets.

Prescription Bottles for dispensing liquids of low viscosity

6. PACKAGING

Pharmacist should CHECK for:1.Permeability of containers to atmospheric gases and to moisture vapor.2. Leaching of constituents of the container to internal content

6. PACKAGING

Pharmacist should CHECK for:3. Absorption of drugs from content container4. Transmission of light through the container5. Alteration of the container on storage, particularly at extremes in temperature.

6. PACKAGING

Child-Resistant Containers

To prevent accidental poisoning resulted from ingestion of medication and other household chemicals by children.

With safety closures

7. RECHECKING

The importance of this step should not be overemphasized

Every Rx should be rechecked by the Pharmacist

All details of the label should be rechecked against the Rx order to verify directions, patients name, Rx number, date and prescribers name

8. DELIVERING THE PRESCRIPTION

Every prescription leaving the store should not only be correctly and skillfully compounded but the physical appearance of the finished preparation should indicate the pride and care which the pharmacist has taken in his professional work.

9. RECORDING

A record of the prescriptions dispensed should be maintained in addition to the prescription files.

This would permit rapid location of prescription orders.

9. RECORDING (cont.)

Different RECORDS used:

1. Prescription Book 2. Poison Book 3. Dangerous Drug Record Book

10. PRICING

MOST COMMONLY USED:

% Mark-up

Dispensing Price =Cost of Ingr. + (Cost of Ingr. X % Mark-up)

10. PRICING (cont.)

2. % Mark-up + Minimum Fee DP = Cost of Ingr. + (Cost of Ingr. X % mark-up) + Minimum Fee*DP = dispensing priceMinimum Fee - recover the combined cost of container, label, overhead & professional service

10. PRICING (cont.)

3. Professional FeeDP = Cost of Ingr. + Professional Fee

The greater the cost of the Rx ingredients the greater is the fee

Professional fee - represents the payment for professional service

10. PRICING (cont.)

Code in Pricing letters selected should have 10 letters with no duplicate letters.Example:B L A C K S M I T H1 2 3 4 5 6 7 8 9 0

11. FILING

Too be kept for 2 years

Prescription File Types:

1. metal or cardboard unit2. partitioned drawers

11. FILING (cont.)

Methods of Preserving Prescriptions:

1. Filing on string or wire2. Pasting on scrap book (old method)3. Writing a copy in a blank book and returning the original

11. FILING (cont.)

Methods of Preserving Prescriptions:

4. Wrapping the Rx in packages of 100 and packing ten consecutive hundreds in wooden box (old method)5. Pasting the Rx to a card which is then filed in a cabinet

11. FILING (cont.)

Computer filing of prescription is most recommended.

Exercises:

RxSalbutamol tablet.2mgTheophylline tablet ..125mgLactose q.s. .300mgIn one cap # 20Sig. One cap b.i.d. p.c. and H.S.

Data

Nuelin tablet .. P 3.75Ventolin tablet .. P 4.50Lactose . P 40.00 / half KgCapsule . P 0.75/pieceMinimum fee P30.00% mark up 15 % and Professional Fee P 50.00

QUESTIONS:

What is the dispensing price using the % mark up plus minimum fee method?

Cost of the above Rx per capsule

What is the dispensing price using professional fee method?

What is the daily dose of Salbutamol?

processing the prescription(1)

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