Transcript File

• 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.
Prescription: a written order
from a practitioner for the
preparation and administration
of a medicine
or device
 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
• 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.
• 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
• Five basic steps for filling a
prescription:
–
–
–
–
–
Taking in the prescription
Translating the prescription
Entering information in database
Filling the script
Patient counseling
• Prescriptions arrive in various
ways:
– Written order
– Hand carried
– Faxed
– Called in
– Electronic
• 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
•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?
•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?
•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
•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)
• 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
•Use whole words not abbreviations
(use “tablets” not “tabs”)
•Use familiar words, especially in
measurements
(“two teaspoons”
or “10 ml”)
•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
• 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
•Check label and script against bottle for
accuracy of amount
•Counting trays are still used
•Digital counters and automated machines
can be used sometimes
•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
Safety Lid
Snap-on Lid
• 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
•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.
•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
•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)
•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
•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 righthand side of prescription label
•All Schedule II medications
must be filed separately
•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.
• 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
• Every time these drugs are dispensed
(new prescription OR refills):
– Oral contraceptives
– Estrogens
– Progesterones
– Isotretinoin (Accutane)
– Intrauterine Devices
– Isoproterenol (Isuprel) Inhalation
Products
• Must be reported to the FDA
(Food and Drug Administration)
• Right dose
• Right medication
• Right route
• Right time
• Right price
• Right dosage form
• Right patient
• Protected Health Information (PHI)
• All patients must be provided with a
written notice of the pharmacy’s
privacy practices procedures
including their privacy rights.
• 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