1. Prescriptions

2. 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.

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

4. 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

5. 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.

6. 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

7. 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.

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

9. 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

10. 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?

11. 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?

12. 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

13. 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)

14. 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

15. PHARMACY LABEL

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

17. 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.

18. 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.

19. 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.

20. 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

21. 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

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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

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

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

33. 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.

34. 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