Transcript Working in the PHARMACY community * hospital * mail order

Working in the
PHARMACY
community – hospital – others
Chaps. 15, 16, 17
Pgs. 392 - 473
• 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
community
• 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)
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TJC
CMS
DPH
BOP
USP
DEA
HOSPITAL
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.
Chap 17