Prescriptions

Introduction Filling a prescription: most common and important duty of a technician Transcribing a doctor’s orders can be frustrating – occasionally must get clarification Pharmacist makes the call to the doctor or makes a decision about the order if it’s not clear.

Definition Prescription: a written order from a practitioner for the preparation and administration of a medicine or device

Elements of Prescription Prescriber information Name, title, office address and telephone number. Patient information Name and address of patient. Date the prescription was written. Inscription: The body of the prescription, containing the name and amount or strength of each ingredient. Signa: contains the directions to the patient, e.g. "1 cap t.i.d. pc" Refill instructions DAW (dispense as written): don’t substitute for a generic form Signature of prescriber DEA # if applicable

Definitions (within the Prescription) Superscription: The date when the prescription order is written The name, address and age of the patient The symbol Rx (an abbreviation for "recipe," the Latin for “take thou”). Inscription: The actual body of the prescription; drug name, strength, dosage form and quantity.

Definitions (within the Prescription) Subscription: The directions to the pharmacist, usually consisting of a short sentence such as: "make a solution," or "mix and place into 10 capsules.” Signa or Sig: The directions for use; the drug amount, frequency, and route of administration, EX: 1 cap t.i.d. pc

Processing a Prescription: A Step-by-Step Approach Five basic steps for filling a prescription: Taking in the prescription Translating the prescription Entering information in database Filling the script Patient counseling The first four steps are the usual responsibilities of a pharmacy technician. Patient counseling must be done by a registered pharmacist or pharmacist intern, not a pharmacy technician.

Taking in the Prescription Prescriptions arrive in various ways: Written order Hand carried Faxed Called in Electronic Some pharmacies allow e-mail or online prescription refill orders.

Translation of a Prescription Look at whole order if difficult to decipher If in doubt, ask another person or pharmacist When to Ask for Help When handwriting is poor, assistance is needed Filling scripts under pressure can lead to “guessing” Patients can be harmed by incorrectly filled prescriptions and lawsuits are awarded

Checklist for Prescription Intake Is the FULL name clear? Is the patient’s DOB, street address, telephone #, insurance info, preference for brand or generic drugs, and allergy info already on file? Is the medication for an OTC product that the patient can receive without a prescription?

Checklist cont… When was the prescription written? Is the drug available in the quantity written? Does it need compounding? Is the prescription suspicious or legitimate? All written in the same handwriting? Do the quantities and directions seem appropriate?

Entering the Information into the Database After the doctor’s order is read, it is entered into the computer Check computerized label against prescription after it is filled Two labels generated: one for the vial; other for back of original prescription Pharmacist initial is needed on both labels JH

Checking the Label Against the Script Label is checked many times before it reaches the patient Hold original script next to label to check for errors or discrepancies Look at names of drug, strength, dosage form, sig (directions)

Prescription Labels An identification label placed on the outside of the bottle. Translated from the original prescription into language the patient can understand. Directions For Use Should start with a verb: “take” – for internal/oral route “instill” or “place” – for eye/ear/nose “inhale” – for respiratory use “insert” – for rectal/vaginal application “ apply” - for topical medication This will indicate the route

PHARMACY LABEL

Prescription Labels(cont) Use whole words not abbreviations (use “tablets” not “tabs”) Use familiar words, especially in measurements (“two teaspoons” or “10 ml”)

Applying the Label Professionalism is needed when applying label Do not place torn or crooked label on bottle Label not to cover lot and expiration date on full bottle prescriptions Auxiliary labels must be easily read Why is it important not to apply a torn label to a bottle of medicine, even if all the information is present and legible? A patient who sees a torn label could wonder whether important information has been lost. In addition, a torn or crooked label conveys the impression that the prescription has been filled carelessly.

Filling the Prescription After preparation, the prescription will be filled. Pulling the Correct Medication Take label to shelf when getting medication from the shelf Label helps you not to forget Can compare label with information on the bottle Do not rely on memory when going to the shelf to pull a prescription. Always take a hard copy of the prescription for side-by-side comparison.

Counting and Filling the Medication Check label and script against bottle for accuracy of amount Counting trays are still used Digital counters and automated machines can be used sometimes A Baker Cell is an electronic pill-counting device. Each cell contains a bulk quantity of a different medication.

Prescription Lids Appropriate lid is applied after medication is filled Problem for elderly patient: safety lid Elderly lose dexterity and strength Older patients do not want safety lids Can replace with snap-on lid Why are a few medicines, such as nitroglycerin, always dispensed without a safety cap? Nitroglycerin is used as an emergency treatment for people who are having chest pain. It might be very difficult for a person in that situation to quickly open a standard container. Snap-on Lid Safety Lid

Auxiliary Labels Additional colored WARNING labels that are placed on filled prescription containers. Examples: “Take with food”, “May cause drowsiness”, “Take medication on an empty stomach” ALL controlled substances from C-I to C-IV use this warning: CAUTION: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed. Drug classification, interactions, and side effects need to be known for auxiliary labels if not computerized

Placing the Auxiliary Labels Auxiliary labels usually printed with prescription label Make sure there are no creases. Place the appropriate auxiliary labels on the container. Auxillary labels used on all vials for eye drops and ear drops or eye ointments.

Technician’s Initials Technicians should initial all orders they fill Pharmacist gives final check-off and knows who filled it by initials Pharmacist can notify or ask technician if errors or questions occur Pharmacist must always sign off after completion Do pharmacists always have to write their initials on prescriptions they have filled? No. Some computer programs insert the pharmacist’s initials on prescription labels, and most state boards of pharmacy accept this practice.

The Pharmacist’s Final Inspection The last step in filling scripts is passing the filled vial, along with medication container from shelf, and original prescription to the pharmacist Filling one prescription at a time is important to avoid errors Mark newly opened stock bottle with an X (do not cover NDC number or expiration date) The pharmacy technician should not pass a prescription to the pharmacist for inspection if there are any questions that have not been either already addressed or else flagged for review.

Pharmacist Consultations: When and Who Needs Them First-time prescriptions flagged and pharmacist is alerted Patient needs consultation with new script Federal law: all new or changed prescriptions need consultation OBRA 1990 What information might the pharmacist and patient discuss during a consultation? They might discuss when and how to take the medication, possible side effects, and possible drug interactions. If the medicine needs to be measured, the pharmacist can demonstrate this.

Filing Prescriptions Hard copy prescriptions manually filed for future reference Kept for 3 years All controlled substances (Schedule II) stamped with a red “C” 1 inch down on right-hand side of prescription label All Schedule II medications must be filed separately HIPAA guidelines state that prescription numbers or patient numbers should be used as the primary means of patient identification instead of Social Security numbers.

Medication Pick-Up Patients can wait for prescriptions Have it delivered Pick up another day by self or relative All third-party prescriptions must have a signature of the person receiving medication Check all ID before releasing medication for controlled substances Some reimbursement plans require that the patient’s signature be kept on file to indicate a medication was picked up. Is it a HIPAA privacy violation if a pharmacist counsels a patient’s relative about a new prescription? No. HIPAA regulations allow the pharmacist the practical discretion to discuss personal health information (PHI) with a person who has the patient’s implicit permission to act on his or her behalf. Explicit (written) consent might be required by state law or institution protocol, however, and any stricter rule must be followed.

Medication Pick-Up As you dispense new medications, a pharmacist will compare new medication with meds patient was previously taking Avoid potential harmful interactions Ensure most appropriate medication being given Screen for fraud or misuse Screen for underuse of drug therapy Is it a HIPAA privacy violation if a pharmacist counsels a patient’s relative about a new prescription? No. HIPAA regulations allow the pharmacist the practical discretion to discuss personal health information (PHI) with a person who has the patient’s implicit permission to act on his or her behalf. Explicit (written) consent might be required by state law or institution protocol, however, and any stricter rule must be followed.

Package Inserts Required Every time these drugs are dispensed (new prescription OR refills): Oral contraceptives Estrogens Progesterones Isotretinoin (Accutane) Intrauterine Devices Isoproterenol (Isuprel) Inhalation Products

Adverse Drug Reactions Must be reported to the FDA (Food and Drug Administration)

The Rights of a Patient Right dose Right medication Right route Right time Right price Right dosage form Right patient

HIPAA Protected Health Information (PHI) All patients must be provided with a written notice of the pharmacy’s privacy practices procedures including their privacy rights.

Study these notes!!! You will be performing these skills every day as a Pharmacy Technician in training. You need to know this material…. Not just glance over it. Expect heavy testing on this subject next week to be sure you have mastered the information you will be expected to perform when you do skills in the pharmacy