Working in the PHARMACY community – hospital – others Chaps. 15, 16, 17 Pgs

community Community or retail pharmacy practice is the practice of providing prescription services to the public. – Also sell OTC medications, health, and beauty products. Almost two-thirds of all prescriptions are dispensed by community pharmacies. Involves close interaction with patients; need good interpersonal skills.

community Types of community pharmacies – Independently owned Pharmacies – Chain Pharmacies – Mass Merchandiser Pharmacies – Food Store Pharmacies

community Pharmacies programs: – DSM – MTM – Walk-in clinics Techs assist with these services with billing, scheduling and taking patient information.

community Pharmacy Organization elements of the pharmacy Transaction window Storage area Prescription Counter Compounding Area Prescription Bins/ Shelves

community A major responsibility of the technician is to process new prescriptions and refills. Need to verify insurance information and patient profile information (pg. 402). When entering script information, you need: Physician’s name and DEA number, correct drug and strength, directions for use, quantity, number of refills, and DAW/ Dispensing code.

community DAW Codes/ Dispensing codes (for Billing) 0 – no product selection 1 – substitution NOT allowed 2 – substitution allowed, patient requested product 3 – substitution allowed, pharmacist selected product 4 – substitution allowed, generic not in stock 5 – substitution allowed, brand dispensed as generic 6 - Override 7 – substitution not allowed, brand drug mandated by law 8 – substitution allowed, generic not available in marketplace 9 - Other

community Preparing the prescription – Generating the label (computerized print label after information placed in system). – Containers: generally amber colored to protect from light. Require a safety cap unless patient request otherwise. – Counting medications: can use trays, pill counting devices, or automated filling machines.

community Prepackaged medications – label is affixed directly on the package or container. Auxiliary Labels – identify important usage information to include: administration, proper storage, possible side effects, and potential food and drug interactions. Final step – checked by pharmacist; leave stock bottles with prescription. Once checked return items to storage area and place prescription to bin/ shelf.

community Prescription pick up: – generally requires patient signature to record proof to third party billers that prescription was dispensed to patient. Also can show proof that MTM was offered. When picking up Schedule II and sometimes Schedule III – V, require photo ID.

community Other tech duties Know location of OTC medications Reorder stock prn Keep pharmacy neat, clean, and in working order Separation and removal of trash

HOSPITAL Pharmacy techs in the HOSPITAL work under direct supervision of a pharmacist or supervising technician. They play a vital role in the preparation, storage, and delivery of medications to patients.

HOSPITAL Tech roles in the hospital Can work in many different areas to include: – Front counter – Satellite pharmacy – Delivery – Outpatient pharmacy – Order processing – Compounding/ unit dosing – Monitoring drug therapy – Investigational Drug Therapy

HOSPITAL Roles Cont’d – Inventory control – Narcotics/ controlled substance – Cart fills – IV/ Clean room – Chemotherapy – QA – Pharmacy Tech Supervisor/ Staff Development

HOSPITAL Formulary: list of drugs that have been selected by health care professionals at the hospital. Closed Formulary – hospital ONLY carries medications on formulary list. Non-formulary - drugs may require special form stating why the physician requires the medication. Some hospitals have a “Therapeutic Interchange” – allows pharmacist to change some medications without notifying physician.

HOSPITAL Must have communication between departments to coordinate patient care. – Answering and directing phone calls – Written/ printed information Doctors orders Fax machine Computer printouts – Electronically transmitted communication Computer entered orders – Tube systems – MUST maintain confidentiality!!!

HOSPITAL Medication Orders – Can be written by physician, PA, or NP. Also, a nurse, pharmacist, or in some settings a respiratory therapist can write an order when directly instructed by a physician (telephone orders which must be cosigned by the physician who approved them). – Prescriptions written on an order form, with all other hospital orders – not a prescription form. Some facilities use a CPOE.

HOSPITAL Different types of medication orders. – Standing orders: scheduled medications – PRN orders: given as needed – STAT order: given immediately Found on a MAR (Medication Administration Record) – 24 hour form that tracks medications given to a patient.

HOSPITAL Order entry into computer may be done by a technician. – Each medication order must contain medication name, dose, route, and frequency. It may include duration. Tech must be aware of special protocols in place by hospital such as restricted meds and auto stop orders. Need to check for accurate dose for each patient (mg/kg). Also screen for any medication prescribing errors.

HOSPITAL Order processing – Once order received in pharmacy – tech prepares medication – Places all needed labels (refrigeration/ High Risk), attaches filter if needed – Places it to be checked by a second person; most states this is a pharmacist – some states allow a second technician. – Medications delivered to nursing units (usually on hourly rounds) and pick up medication returns for credit to patient.

HOSPITAL Inventory – Techs are responsible for inventory control which includes monitoring par levels, ordering, storing, and drug recalls. – Primary Concern is controlled substances. This requires an exact record of amount and location of EVERY item. Most facilities require two people to count before it is stored. If narcotic is damaged, two people must sign a witness of disposal form.

HOSPITAL Storing of medications: – First, generally based on route of administration. – Second, generally alphabetically order by generic name. – Narcotics and controlled substances in a secure area of the pharmacy – Refrigeration or freezer storage of meds. Temperatures: R: 36 to 46 Fahrenheit (2-8 Celsius) and F: -15 to 5 Fahrenheit (-10 to -20 Celsius)

HOSPITAL Regulatory Agencies (just for hospital pharmacies) TJC CMS DPH BOP USP DEA

Chap 17 Other Environments where the Pharmacy Technician can work: Mail Order Pharmacy Long Term Care Facilities Home Infusion Therapy Nuclear Pharmacy

Chap 17 Nuclear Pharmacy Specially licensed and regulated pharmacies that prepare radioactive materials that are used for diagnosis as well as treatment of diseases. Radiopharmaceuticals are considered hazardous materials. Techs who work with these materials are required to wear badges to monitor radiation exposure.