1. Medication order entry and fill process

2. Policies and Procedures
Each pharmacy must have a policies and procedures manual:
Mission statement: States the purpose and goals of an organization
Policy: A definite course or method of action; a plan establishing goals and objectives
Procedure: Process of accomplishing a task to ensure efficiency and consistency; a step-by-step method to accomplish a policy
Provide standards for the operation of a pharmacy
The policies and procedures manual can be used as a reference book and can promote safety in the workplace.
What are some of the professional and regulatory agencies that require policies? (The American Society of Health-System Pharmacists [ASHP], the American Pharmacists Association [APhA], and The Joint Commission [TJC])

3. Outpatient pharmacy

4. Filling Process Video

5. Step 1: receiving a prescription
Walk in
Verbal Order
E-Prescribing
Fax
Step 1: receiving a prescription

6. Hardcopy prescription

7. Required Prescription Information
Date the prescription was written
Patient information (patient’s name and address)
Inscription
Name of medication (may be either brand or generic)
Strength of medication (if applicable)
Dosage form
Quantity of medication to be dispensed
Subscription: Instructions to the pharmacist
Physician’s signature
Handwritten prescriptions must have the physician's signature in ink; stamped signatures are illegal.
Patients address- can be readily retrievable in some states

8. Dispense as Written Codes (DAW)
Used to ensure the pharmacy is properly reimbursed by a third-party provider:
0 = No product selection indicated
1 = Substitution not allowed by provider
2 = Substitution allowed; patient-requested product dispensed
3 = Substitution allowed; pharmacist-selected product dispensed
4 = Substitution allowed; generic drug not in stock
5 = Substitution allowed; brand drug dispensed as generic
6 = Override
7 = Substitution not allowed; brand drug mandated by law
8 = Substitution allowed; generic drug not available in marketplace
9 = Other
The DAW code is written based on how the prescription is written.
See p. 182 for other information important to prescription processing

9. Step 2: Entering the prescription

10. Step 2A: enter patient information
Patient name, DOB, Address, Phone Number
Insurance Information, if applicable
To be discussed in later chapters
Disease states or health conditions
Medication patient is taking
Drug allergies
What type of information should be included in patient information? (Name, sex, address, and age of patient; obtaining the telephone [home, mobile, and work] numbers of the patient is highly recommended)
Why is it important to know health conditions? (Specific medications can have an adverse effect on a disease state or condition; drug–disease interactions)
What types of medications are important to know about? (Prescription, OTC, or complementary and alternative medications; this information is used to prevent drug–drug interactions)
See p. 181 for the list of information that is required about a prescriber.

11. Step 2B: enter Prescription information
Date the prescription was written
Patient name (if not already in patient profile)
Inscription
Name of medication
Strength of medication
Dosage form
Quantity of medication to be dispensed
Subscription: Instructions to the pharmacist
DAW code
To prevent autosubstitution
Physician’s signature
What type of information should be included in patient information? (Name, sex, address, and age of patient; obtaining the telephone [home, mobile, and work] numbers of the patient is highly recommended)
Why is it important to know health conditions? (Specific medications can have an adverse effect on a disease state or condition; drug–disease interactions)
What types of medications are important to know about? (Prescription, OTC, or complementary and alternative medications; this information is used to prevent drug–drug interactions)
See p. 181 for the list of information that is required about a prescriber.

12. Step 3: Filling the prescription

13. Filling the prescription
Pull medication from the shelf
Check prescription label against the NDC number found on bulk container;
Scan the UPC code on the bottle to ensure the correct medication was selected
Measure or count the medication; if counted manually, count in multiples of five
Select an appropriately sized container and pour the medication into the container
Place an appropriately sized child-resistant top on the container
Or, if requested, a non-child resistant top
Whether counting manually or using automatic counting equipment, always recount the quantity for accuracy.
If any penicillin or a sulfa drug is dispensed, the pill counting tray should be wiped down using isopropyl alcohol.
If a patient requests an EZopen top, have the patient sign the back of the original prescription indicating the request.

14. Step 4: labeling the prescription vial

15. Labeling Process: Required Prescription Information
Date when the prescription was filled
Serial (prescription) number of the prescription
Name and address of the pharmacy
Name of the patient
Name of the prescribing physician
All directions for use of the prescription
Generic or brand name of the prescription
Strength of the medication
Name of the drug manufacturer
Quantity of the drug
The expiration date, initials of the pharmacist, and number of refills allowed are also required on a prescription label.
**Don’t forget to add auxiliary labels after adding the prescription label!**

16. Patient Package Insert Requirements
Information found on a package insert includes the following:
Description
Clinical pharmacology
Indications and usage
Contraindications
Warnings
Precautions
Adverse reactions
Drug abuse and dependence
Overdosage
Dosage and administration
How supplied
Required to all patients receiving metered-dose inhalers, oral contraceptives, estrogen, progesterone, and Accutane
What is a patient package insert? (An informational leaflet written for the lay public describing the benefits and risks of medications)

17. Step 5: Prepare the vial for pharmacist check

18. Preparing the prescription vial for pharmacist check
Place the completed prescription container in a bin/basket, and slide over to pharmacist
Certain pharmacies: place filled RX on top of the original prescription with the bulk container that has been pulled from the shelf (in certain pharmacies)
The pharmacist checks the completed prescription and bags the prescription
The completed prescription is placed in the appropriate pick- up bin
Patient consultation is an important part of the prescription filling process, so be sure to ask the patient or person picking up the prescription if he or she has any questions for the pharmacist.
Pharmacy technicians are not permitted to counsel patients.

19. Summary: pharmacy technician tasks

20. Pharmacy Technician Tasks
Accepting new prescriptions from the patient
Receiving prescription refills from the patient
Requesting refill authorization from the patient’s prescriber
Collecting patient information
Maintaining patient profiles
Entering patient, prescriber, and medication information into the pharmacy’s information system
Pharmacy technicians are permitted to perform a wide range of tasks during the order entry and prescription filling process.

21. Pharmacy Technician Tasks
Interpreting the prescription
Billing prescription to third-party prescription providers
Counting and pouring the correct medication
Labeling prescription bottles
Returning medication bottles to the pharmacy shelves
Repackaging medication
Preparing unit-dose medications
What does the Latin word "signa" mean? (To write)

22. Switching gears

23. Mail order Outpatient pharmacy

25. Switching gears

26. Inpatient pharmacy (Hospital)

27. Step 1: receiving a prescription
Orders are transmitted through the hospital’s internal computer system directly to the pharmacy
STAT: Should be filled within 15 minutes of receiving it in a hospital
ASAP (as soon as possible): Does not have the priority of a STAT order but needs to be processed as soon as possible
PRN (as needed): May be filled or administered when a patient requests it
Step 1: receiving a prescription

28. Required Medication Order Information
Prescriber’s information
Date of order
Patient information, including the room number, bed number, and ID number assigned to the patient
Name, strength, and dosage form of medication
When to be administered (frequency)
Duration of therapy
Prescriber’s signature
What prescriber information is needed? (The physician’s name, DEA number [controlled substances only], and hospital-assigned ID)
See pp for the information required for a prescription refill.

29. Step 2: Filling a prescription

30. Remember, all medications sent to patients are “unit doses”

31. Unit dose medications 2 options for unit dose packaging:
Ordering unit-dose specific packing directly from warehouse
Ordering bulk packaging from warehouse, and unit-dosing the medication using in-house equipment

32. Unit-Dose Packaging Procedures
Unit-dose log:
Date unit dose was prepared
Drug (generic name)
Medication strength
Dosage form
Quantity prepared
Drug manufacturer
Drug manufacturer lot number
Manufacturer’s expiration date
Pharmacy-assigned beyond- use date
The pharmacy lot number, pharmacy technician's initials, and pharmacist's initials are also required on the unit-dose log.
See pp for information about personnel, facility, equipment, and materials used with regard to unit-dose packaging as well as the types of unit-dose packages.

33. Unit-Dose Labeling Requirements
Trade or generic name of drug
Drug manufacturer
Strength of drug
Beyond-use date
Lot number of medication
A unit-dose log must be maintained.

34. Or…
Sterile compounding is performed!

35. Step 3: delivering the prescription to the patient

36. Drug Distribution Systems
Automated dispensing systems:
A storage, dispensing, and charging system that is used to save time, improve inventory control tracking, and reduce medication errors
Most commonly found in hospitals:
Centralized pharmacy
Decentralized pharmacy
Otherwise, medication is manually delivered to each unit via carts
What is a centralized pharmacy? (Found in the central pharmacy; used to improve manual unit-dose cart fill process. A disadvantage of the centralized system is its inability to handle all dosage forms.)
What is a decentralized pharmacy? (Found in the patient care areas of a hospital to eliminate or reduce management issues that include narcotic diversion and poor record keeping)
Advantages of a decentralized system include the ability to dispense and return medications, document medication waste, and produce reports.

37. https://www. bing. com/videos/search
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42. All hospital pharmacy inventory system

43. Switching gears

44. Misc. information applicable to both inpatient and outpatient pharmacies

45. Auxiliary Labels
Provide additional information (special instructions, warnings, or storage conditions) to the patient
Are printed with the prescription label and should be affixed to the container so that they do not cover any words on the prescription label
What are some examples of auxiliary labels? (Do Not Drink Alcohol, May Cause Drowsiness, Avoid Sunshine)

46. Beyond-Use Date vs. Expiration Date
The expiration date is determined by the drug manufacturer
Beyond-use is used when medications are repackaged from a bulk container
Beyond-use dates need to be in accordance with the manufacturer's approved labeling.

47. Packaging Requirements
Types of containers used:
Round vials: Used for solid dosage forms such as tablets or capsules
Prescription bottles: Used for liquids of low viscosity
Wide-mouth bottles: Used for bulk powders or large quantities of tablets, capsules, and viscous liquids that cannot be poured readily from narrow-necked containers
Dropper bottles: Used for ophthalmic, nasal, otic, or oral liquids to be administered by drop
Applicator bottles: Used for applying liquid medications to a wound or skin surface
Ointment jars and collapsible tubes: Used to dispense semisolid dosage forms
Hinged-lid or slide boxes: Used for dispensing suppositories and powders
See pp for the various classifications of containers used such as tamper-evident packaging and light-resistant containers.
See p. 185 for information regarding child-resistant containers.

48. Storage Temperature Terminology
Freezer- -25°C and -10°C
Cold- 8°C
Cool- 8°C and 15°C
Room temperature- the temperature prevailing in a working environment
Controlled room temperature- 20°C-25°C
Warm- 30°C and 40°C
Excessive heat- >40°C
Protect from freezing
Dry place- does not exceed 40% relative humidity
What term refers to any temperature between 8° and 15° C? (Cool)
What term denotes a place that does not exceed 40% relative humidity? (Dry place)
See p. 185 for descriptions of each of the above terms.

49. Questions?