Transcript EO 003.02 - Filling a Prescription Order

Filling a Prescription Order
(Dari)
EO 003.04
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Purpose of Lesson
(Dari)
The pharmacy technician student will
learn how to:
(1) Confirm the availability of the
ready form medication.
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(2) Prepare the ready-form
medication/pharmaceutical for
dispensing.
(3) Label the prescription container
according to the prescription
order.
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Purpose of Lesson
(Dari)
(4) Identify the difference in process
when filling an inpatient
prescription versus an outpatient
prescription.
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This topic will be taught using a lecture
format and students will be given a
chance to practice these skills during
an in-class assignment as well as
during a skills lab.
Note: Students should be provided
with a copy of the ANA formulary for
this lesson.
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Overview of Lesson
(Dari)
(1) Confirming availability of
medication
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(2) Prepare the medication
(3) Label the medication
(4) Check the prescription.
(5) MoD Forms used
(6) Process for filling in-patient
medications.
(7) In-class assignment
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Confirming Availability of the
Medication
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Is the medication available?
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Once you have received the prescription
and verified the appropriate information
with the patient the next step is to
confirm that the medication ordered
is available.
This includes:
(1) Verifying that the medication is
listed in the ANA formulary.
(2) Confirm that the medication is
available in the correct dosage
form, as ordered on the
prescription.
(3) Confirm that the medication is in
stock and that there is sufficient
quantity to fill the prescription.
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ANA Formulary
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The pharmacy should only carry the
medications that are listed on the ANA
formulary.
For the most part, only medications
that are listed on the ANA formulary
can be prescribed for patients.
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ANA Formulary
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There will be times when a medication
is prescribed that is not on the ANA
formulary. This can be for one of two
reasons:
(1) The physician is unaware of what
is listed on the formulary.
(2) The physician feels strongly that
the medication they have
prescribed is the best treatment
for the patient and is seeking
special permission.
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A patient presents
to the pharmacy
with the following
prescription: Is
this medication on
the ANA
formulary?
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Answer: No it is not.
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Class discussion: As
a pharmacy
technician what do
you do next?
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What you should do:
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You should present the prescription
to the on duty pharmacist and
inform the patient that there may be
a slight delay in preparing their
prescription.
The pharmacist will likely then contact
the physician to determine if this is a
special request for a non-formulary
medication or if an alternative
medication that is on the formulary can
be prescribed instead.
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Special request for a non-formulary medication
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If the physician is requesting special
permission to prescribe a nonformulary medication the pharmacists
can assist them in that process.
This involves discussion with the chief
of pharmacy and the P&T Committee.
The patient will not be able to have
their prescription filled that day as the
approval process may take some time.
Also the medication will have to be
purchased as it is most likely not in
stock in the pharmacy.
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Confirm that the medication ordered is in stock
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In order to confirm that the medication
is in stock you must check the
pharmacy shelves.
You can verify that there is enough is
in stock by checking the balance on the
stock card.
If there is not enough in stock, then the
pharmacy technician should check with
the quartermaster to see if there are any
additional stores in the QM.
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Stock Cards
tablets
Metoprolol 100mg
Issues
Remarks
Expiry Date
Balance
In
Previous quantity
24 Sep 14
200
0
0
Date
05 Sep 13
W93A21 5199 0001
31 Oct 14
400
0
200
05 Sep 13
To Pharmacy Dispensary
24 Sep 14
200
200
0
08 Sep 13
Out
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Selecting the appropriate dosage form
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It is very important that the correct
formulation of the medication that has
been ordered is the one that is given to the
patient (i.e. tablet, liquid, inhaler,
eyedrop).
For example: if a patient was prescribed
prednisolone eye drops and tablets were
dispensed instead the patient may not
receive the desired effect.
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Selecting the appropriate dosage
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Many medications come in different
strengths/concentrations.
For example: Naproxen
Comes in 250mg and 500mg tablets.
Pharmacy technicians must pay careful
attention to ensure that they select the
correct one.
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Selecting the appropriate dosage
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Physicans may prescribe a strength of
medication that does not exist in readyform.
For example: Prednisone
Usually comes in 5mg and 50mg tablets.
If a doctor were to prescribe:
Prednisone 30 mg od for 10 days
You would have to make up the
prescription using 5mg tablets. Therefore
the patient would have to take 6 tablets per
day = a total prescription of 60 tablets.
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Prepare the Medication
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Number of units dispensed
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In order to ensure that patients receive
the appropriate length of therapy the
correct amount of medication must be
dispensed.
Medication can be dispensed in number
of tablets, capsules, mls, grams and
units (i.e. inhaler, bottle etc.).
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Counting
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When counting pills and
capsules we count in either
2’s or 5’s (depending on the
amount required).
Generally 2’s if the amount
is less than 10.
The rationale for counting
by 5’s is that 5 is the largest
number that the human eye
can easily recognize.
Counting trays are generally
used when counting pills
and tablets.
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Weighing medications
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Occasionally you will need to talk a bulk
format product (i.e. a large tub of cream)
and dispense a portion of it.
For example: Hydrocortisone 1% cream
Sig: AAA bid prn
Mite: 30 g
Hydrocortisone cream comes in a bulk
container of 500 g.
You will need to weigh out 30g of the
cream to be dispensed to the patient.
The details of weighing medication will be
covered in PO 004.
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Selecting an appropriate container
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Many medications come in a readyform that is appropriate to dispense to
the patient.
However, some medication come in
bulk format and need to be placed in a
smaller or more appropriate container to
be dispensed to the patient.
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Label the Medication
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Why it is important to label a medication
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•
For clear identification of what the
medication is and what strength it is.
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So the patient doesn’t have to try and
remember what the directions are for
the medication, they can simply read
them off the label.
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What’s required on a label
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•
•
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Patient’s name
Prescriber’s name
Drug name
Drug strength
Drug dose
Patient instructions
Quantity dispensed
Date dispensed
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Labeling: Medication Insert
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This is a small piece of paper that the labeling information is written on. It can be inserted into
the medication box, taped onto a bottle or simply handed to the patient with their prescription.
These inserts should also have the pharmacy information (name and contact info pre-printed on
the top).
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Auxiliary Labels : Pictograms
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‫‪Pictograms‬‬
‫پکتوگرام ها‬
‫پکتوگرام ها برای اشخاص مسلکی صحی یک وسیله‬
‫ارتباطی هدایات دوا را همراه با مردم قرار میدهد که‬
‫زبان رسمی را نمی فهمند ویا بیسواد هستند‪ .‬از‬
‫پکتوگرام ها نیز برای اشخاص استفاده میشود که اندکی‬
‫اختالل در شناخت یا مشکالت در دیدن دارند مانند‬
‫اشخاص مسن‪ .‬بمنظور بهبود ارتباطات‪ ،‬شکل های‬
‫مختلف هدایات دوا را میتوان چاپ نموده و در دسترس‬
‫مریض قرار داد‪ .‬پکتوگرام ها میتوان برای مریض‬
‫کمک کند تا هدایات را بفهمد یعنی چطور و چی وقت‬
‫دوای توصیه شده را اخذ کند‪.‬‬
‫‪AFAMS‬‬
‫‪Pictograms give health professionals a‬‬
‫‪means of communicating medication‬‬
‫‪instructions to people with no common‬‬
‫‪language and / or who may be illiterate.‬‬
‫‪Pictograms may also be used for those who‬‬
‫‪have slight cognitive impairment or‬‬
‫‪difficulties seeing such as the elderly.‬‬
‫‪Pictograms may help the patient understand‬‬
‫‪the instructions on how and when to take‬‬
‫‪the medication prescribed.‬‬
Checking a Prescription
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What does ‘checking’ a prescription mean?
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Checking a prescription means to verify
that the medication being given to the
patient matches what is ordered on the
prescription. This is a technical check.
The Five rights:
(1)
(2)
(3)
(4)
(5)
Right drug
Right dose
Right formulation
Right directions
Right patient
A pharmacist would take a further step to
evaluate if the drug is appropriate for the
patient and the indication.
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Who checks a prescription?
(Insert Dari)
If possible, it is ideal to have a pharmacist
check a prescription to ensure that it is
correct from both a technical and
therapeutic or treatment point of view.
However, it is not always possible to have a
pharmacist check each prescription.
Therefore, technicians can check other
technicians work.
This is commonly referred to in North
American as tech-check-tech.
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Tech-check-tech
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First Technican
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Pharmacy Technician Rotations
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During the pharmacy technician practical
rotations students will be required to check
100 prescriptions without error.
This will be completed at the polyclinic and
NMH pharmacy (to be covered in more
detail during presentation on student
rotations).
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MoD Forms Used
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MoD Forms
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There are two MoD forms on which
prescriptions dispensed must be
recorded:
(1) Mod Form 9
(2) Stock Card (quantity dispensed)
Both of these will be covered in further
detail in EO 006.
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In-patient prescription processing
(Insert Dari)
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In-patient prescriptions
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Inpatient prescriptions are brought to the
pharmacy at the NMH twice a week from
the wards. They are written on the MoD
form 58.
If a medication order for a patient changes
between the twice weekly prescription
submissions, the physician will write a
single prescription (same format as the
outpatient prescription). This prescription
will be brought to the pharmacy by a nurse
and filled in the same manner as an
outpatient prescription.
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Reminder: MoD Form 58
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Process for MoD Form 58
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The MoD Form 58 will be review by the on
duty pharmacist. If there are any problems
encountered the pharmacist will deal with
them.
The patients listed on the MoD Form 58 are
verified against the hospital bedroll.
If the pharmacist is satisfied, they will sign
the MoD Form 58, approving the
medications to be filled.
A technician will then fill the order.
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Filling an inpatient order
Request for inpatient medications are not
filled individually for each patient.
Rather the total quantity requested for each
drug will be filled.
For example: On the order pictured patient
# 5845 required 30 tabs of morphine
and patient 5846 requires 10 tabs of
morphine.
To fill the this order you would count out
40 morphine tablets.
You fill the total quantity requested for
each of the medications listed.
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(Insert Dari)
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MoD Forms Required
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Just like outpatient prescriptions the stock
card for each medication must be updated.
Each inpatient will have their own MoD
form 9 on which the medication issued
must be entered.
This is just a general understanding for
now and how to enter the information on
these forms will be covered in PO 006.
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Checking the order
(Insert Dari)
Ideally a pharmacist should check the order,
however, a pharmacist may not always be
available and often technicians will have to
check eachother’s work.
The technician filling the order will verify
that they have filled:
(1) The correct medications
(2) For the correct total amounts requested
The technician checking the order will also
verify the information and sign off.
The same stamp should be used as is used
for the outpatient prescriptions.
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In-class Assignment
(Insert Dari)
Students will be given 30 min to complete this
assignment. This assignment will consist of 5
prescriptions and from the prescriptions students
must create the label (medication insert). Students
are to be given copies of the blank medication inserts.
(Insert Dari)
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1.
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2.
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3.
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4.
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5.
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Answers
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‫‪Answers‬‬
‫)‪(Insert Dari‬‬
‫اسم مریض ___________________‬
‫اسم داکتر_________________‬
‫نام دوا_____________‬
‫دوز_________________________‬
‫تعداد______________________‬
‫دستورات_____________________‬
‫______________________________‬
‫‪AFAMS‬‬
‫اسم مریض ___________________‬
‫اسم داکتر_________________‬
‫نام دوا_____________‬
‫دوز_________________________‬
‫تعداد______________________‬
‫دستورات_____________________‬
‫______________________________‬
‫اسم مریض ___________________‬
‫اسم داکتر_________________‬
‫نام دوا_____________‬
‫دوز_________________________‬
‫تعداد______________________‬
‫دستورات_____________________‬
‫______________________________‬
‫اسم مریض ___________________‬
‫اسم داکتر_________________‬
‫نام دوا_____________‬
‫دوز_________________________‬
‫تعداد______________________‬
‫دستورات_____________________‬
‫______________________________‬
‫اسم مریض ___________________‬
‫اسم داکتر_________________‬
‫نام دوا_____________‬
‫دوز_________________________‬
‫تعداد______________________‬
‫دستورات_____________________‬
‫______________________________‬
Questions?
(Insert Dari)
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