PRESCRIPTIONS

CHAPTER 5

CHAPTER OUTLINE

Prescriptions

Pharmacy Abbreviations

Prescription Information

The Fill Process

Labels

HIPPA

Review

PRESCRIPTIONS

• Unrestricted– Medical Doctors (MD)– Doctors of Osteopathy (DO)

• In their field of practice– Dentists (DDS, DMD)– Veterinarians (DVM)– Podiatrists (DPM)– Optomotrist (OD)

• Limited to some states and based on protocols– Nurse Practitioners (NP)– Physician assistants (PA)– Pharmacists (RPh)

A prescription is an instruction and an authorization from a medical practitioner to issue a drug or device to a patient.

Rx are governed by

federal and state rules

and regulations to

provide minimal

standards of practice

DISPENSING PRESCRIPTIONS

• Community pharmacists– Dispense directly to the patient.– The patient is expected to administer the medication

according to the pharmacist’s directions.

• Institutional pharmacies– Nursing staff generally administer medications to patients.– Patient charts are referred to prior to administration because

they provide the most up-to-date physician instructions.

THE PRESCRIPTION PROCESS

1. A prescription is ordered by a prescriber.

2. The prescription arrives at the pharmacy. The patient drops off the prescription, or the

pharmacy receives the prescription directly from the prescriber.

THE PRESCRIPTION PROCESS, CONT’D

3. The pharmacy technician:

• Checks the prescription to make certain it is complete and authentic. (look for different handwriting, different colored ink, wrong DEA number, etc)

• Verifies that the patient is in the pharmacy database.

• Obtains and/or verifies the patient’s demographic, insurance, and allergy information.

• Verifies any special instructions, such as pick-up time and days supply. (if unclear about the directions for the prescription the pharm tech should ask the pharmacist for clarification)

4.The technician enters the prescription into the

computer system.

The technician scans a copy of the prescription into the computer and keys data from the prescription into the system.

Safety and accuracy checks are completed as per pharmacy protocol.

THE PRESCRIPTION PROCESS, CON’D

THE PRESCRIPTION PROCESS, CONT’D

5. Insurance and billing information is processed. The computer system evaluates the data against stored

information and process any third-party billing (pt’s insurance = third party)

The pharmacy technician asks the pharmacist to check drug utilization review (DUR) messages such as regarding drug interactions.

If a claim is rejected, the technician reviews the reject message and resubmits the claim, as appropriate.

THE PRESCRIPTION PROCESS, CONT’D6. Label is generated.

• Once the payment is approved by the third party, the computer generates a label, patient handout, and the patient co-payment amount.

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THE PRESCRIPTION PROCESS, CONT’D

7. The pharmacy technician prepares the prescription by: Selecting the appropriate medication and verifying the

national Drug Code (NDC) number on the computer-generated medication label against the medication being dispensed.

Preparing the medication per the prescription (e.g., counting tablets or measuring liquid).

Packaging the medication in the appropriate container.

Placing the computer-generated medication label on the prescription container.

Organizing everything for the pharmacist’s final check.

THE PRESCRIPTION PROCESS CONT’D

8. The pharmacist checks the prescription.• The pharmacist performs a final safety and accuracy

check and then signs off on the prescription.

• The pharmacy technician “bags” the approved prescription for patient sale and attaches a drug information sheet regarding indications, interactions, and possible side effects.

Only the PHARMICIST can perform the final label and product check

THE PRESCRIPTION PROCESS, CONT’D

9. Patient receives the prescription. • The technician delivers the packaged prescription to

the cash register area for patient pickup. • At pickup, the technician checks to make sure the

correct patient is picking up the correct medication.

• The patient or a representative signs the insurance log.

• If the patient has not signed the pharmacy’s notice of HIPAA compliance, they are given a copy and asked to sign that log.

THE PRESCSRIPTION PROCESS CONT’D

10. The pharmacist provides counseling.

• The technician calls the pharmacist to the counter to counsel the patient per OBRA ’90, other state or provincial statutes, and pharmacy protocol.

PHARMACY ABBREVIATIONS

• Most common abbreviations are for:

– Route of administration

– Dosage form

– Time of administration

– Measurement

ROUTES OF ADMINISTRATION ABBREVIATIONS

a.d. = right eara.s., a.l. = left eara.u . = each ear

o.d. = right eyeos, ol = left eyeo.u. = each eye

p.o. = by mouthS.L. = sublingually, under the tonguetop. = topically,

locally

p.r. = rectally

p.v. = vaginally

inh = inhalation, inhale

per neb = by nebulizer

SC, subc, = subcutaneous subq

i.m., IM = intramuscular

i.v., IV = intravenous

i.v.p., IVP = intravenous push

IVPB = intravenous

piggyback

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DOSAGE FORM ABBREVIATIONS

tab. = tablet

cap = capsule

SR, XR, XL = slow/extended release

sol = solution

susp = suspension

syr. = syrup

liq. = liquid

supp. = suppository

crm = cream

ung., oint = ointment

ADMINISTRATION TIME ABBREVIATIONS

bid = two times a daytid = three times a dayqid = four times a daya.m./q a.m. = morning/ each morning p.m. = afternoon or eveningh.s. = at bedtimeprn = as neededa.c . = before mealsp.c. = after mealsstat. = immediately, nowq __ h = every __ hour(s)

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MEASUREMENT ABBREVIATIONSi, ii, etc. = one, two, etc.ss = one-half

gtt. = dropml,., mL = milliliter, millilitreTsp. = teaspoon (=5 ml)Tbsp. = tablespoon (=15 ml)fl . oz. = fluid ounce (= 30 ml)l, L = liter, Litre

mcg., µg = microgrammg. = milligramg., G., gm. = grammEq. = milliequivalent

a.a. or aa = of eachad = to, up toaq. ad = add water up toqs, q.s. ad = add sufficient quantity to make

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OTHER ABBREVIATIONS

UTD = as directed

NR, Ø = no refill

DAW = dispense as written_c, w = with

s, w/o = without

EXAMPLESDrug Rx Label Directions

Synthroid® 100 mcg tablets

i po q am Take one tablet by mouth once daily in the morning

azithromycin 250 mg tablets

ii po today, i po daily days 2-5

Take two tablets by mouth today, then take one tablet once daily on days 2 through 5

Alphagan-P® 0.1% eye drops

i gtt q8h ou Instill one drop into each eye every 8 hours

Advair Diskus® 100/50 inh i po BID Inhale the contents of one blister, by mouth, twice daily. [Rinse mouth after use.]-Optional

Enbrel® 50 mg SC injection

i q week Inject the contents of one syringe, subcutaneously, once weekly

THE ELEMENTS OF PRESCRIPTIONS

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Required on valid written prescription when presented for filing:

• Patient name• Physician name and signature• Drug name and quantity• Date prescription written• Directions for use

PRESCRIPTION INFORMATION SAFETY

• Is the patient’s full name clearly written on the prescription? Has a nickname or initial been used?

• Is the patient’s information on file (e.g., date of birth, address, insurance, allergy)? Is it current?

• Is the medication for an over-the-counter product?

• Is the prescription for a Schedule II controlled drug?

• Is the prescription current (i.,e., written in the past few weeks)?

• Is the drug available in the quantity requested?

• Does the prescription look suspicious in any way?

THE FILL PROCESS: SAFETY CONSIDERATIONS

• Is the prescription for a high-alert medication?

• Are the instructions logical?

• Are the directions clear?

• Are there look-alike names?

• Pay attention to warnings!– Call a pharmacist to evaluate each warning.

• Check against the original!

• Don’t add information!

CAUTION!

• Is the prescription for a high alert medication?– High-alert medications are known to cause significant harm to

the patient if an error is made.

• Are the fill instructions logical? – Is it q pm or prn; 4 ml or .4 ml.

• Are the directions clear? – “Take two tablets daily” vs. “Take one tablet twice daily”

vs. “Take two tablets once daily.”

• Are there look-alike names? – Is it:• Janumet® or Sinemet®?• Zovirax® or Zyvox®?

CAUTION!

• Pay attention to warnings! – When warning screens appear, call a pharmacist to evaluate

each warning.

• Check against the original! – During the fill process, always refer to the original prescription

first and then refer to the label.

• Don’t add information! – Never add information based on what you assume the prescriber meant.

The prescriber has knowledge of the patient’s condition that you don’t.

THE PHARMACY TECHNICIAN’S ROLE

• Assisting the pharmacist in routine, technical aspects of prescription filling.

• Treating each patient, their personal information, and their medications with respect.

• Accepting new prescriptions from patients, obtaining all necessary information, and keying it into the computer.

• Alerting the pharmacist whenever a DUR warning screen appears while filling a prescription.

• Faxing or telephoning refills and clarification requests to prescribers.

THE PHARMACY TECHNICIAN’S ROLE CON’T

• Consulting formularies and responding appropriately to third-party adjudication messaging such as: non-preferred drug, prior authorization or step-edit required.

• Quickly locating the correct medication for dispensing, calculating quantities, repackaging medication, and locating the corresponding patient medication guide.

• Compounding a prescription under supervision.

• Recording the dispensing of controlled drugs.

THE PHARMACY TECHNICIAN’S ROLE CONT’D

• Checking the work of other technicians, as instructed by a pharmacist.

• Referring patients to a pharmacist for counseling on the use of prescription and over-the-counter medications, or any other question requiring judgment.

• ALWAYS ensuring the accuracy and safety of the prescription by incorporating quality control checks into every step in the process.

LABLES

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RULES FOR WRITING DIRECTIONS FOR USE

• Start with a verb.– take, instill, inhale, insert, apply

• Indicate route of administration.– Apply to affected area.– Take one tablet by mouth.– Insert rectally.– Place one tablet under the tongue.

• Do not use abbreviations.

• Use familiar words.– teaspoonful or 5 ml

AUXILIARY LABELS

INSTITUTIONAL LABELS

• Unit dose packing is widely used in institutions such as hospitals and nursing homes.

• Contain only the following information:

– name, strength, manufacturer, lot number, expiration date, and dosage form of the medications

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PRESCRIPTION-TO-LABEL EXAMPLES

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PRESSCRIPTION-TO-LABEL EXAMPLES CONT’D

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lNSTITUTIONAL MEDICATION ORDER EXAMPLES

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