Transcript Lesson 6 Medication Order Entry and Fill Process

Medication Order Entry and Filling
 Pharmacy Technician Tasks
 Accepting new prescriptions from patient
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New telephoned prescriptions in some states, NY included,
are not permitted to be accepted by pharmacy technicians
 Receiving refill requested from the patient
 Calling doctor’s office for refill authorizations
 Collecting patient’s data
 Maintaining patient’s profiles
 First step in order entry
 Receiving the prescription. According to federal law, a prescription
may be transmitted to the pharmacy in the following ways (controlled
substances may differ and state laws also apply)
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Written
Telephoned
Faxed
Electronically, e-prescribing
 Step 2
 Obtain patient and prescriber information
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Patient information includes full name, address, contact, date of birth, any drug
and food allergies, medical history
Prescriber’s information
 Name and address with contact
 DEA (required for controlls)
 NPI (required for most insurances)
 Registration/license (required by some insurances)
 Step 3
 Data input into electronic patient profile
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Name, address and other demographic data
DOB
Medical history
Drug allergy information and Food
Prior Medication/OTC/Herbal use
Drug selection
 NDC of the drug chosen must match the one entered into the
computer
 Determining if a generic can be used
Keying in direction data
Entering refills
DAW codes
DAW Codes
 DAW codes are used by insurances companies to help
determine the reimbursement to the pharmacy and if
the medication is eligible for full or partial coverage
 These codes are universal and used by all pharmacies
and insurance companies
 Codes are not required to be memorized for the exam
but know the following
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DAW=0 means no preference is indicated (generic ok)
DAW=1 means prescriber indicates brand drug to be
dispensed
DAW=2 means that generic is ok but patient requires brand
DAW=8 generic is ok but generic is not available in market
 Step 4
 Submitting the prescription claim to the insurance company for payment. This
online claim processing is called adjudication
 Step 5: Generating the label
 the following on all retail prescription labels affix to the container
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Pharmacy full information, including telephone
Patient, prescriber, and drug name (state)
Strength of the medication
Direction for use
Quantity dispensed
Date prescription was filled or refill
Rx number
Initials of the RPH
Number of refills
Manufacturer of drug (new amendment)
Expiration date of prescription
 Step 6 affix auxiliary Label to product
 Provide additional info to patient
 Common labels
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Avoid Alcohol: example Metronidazole
May cause drowiness: BDZ (Xanax); antihistamines (Bendryl)
Take with food or milk : example NSAIDS, (ibuprofen, diclofenac)
Shake well: all suspensions (including eye drops) Augmentin, Amoxicillin
Sample Label on Retail Prescription Vial
Milan Pharmacy
1600 Broadway
New York, N.Y. 10019
212-555-0000
John Doe
Rx# 1222222
1 Central Avenue, Ridgewood, N.Y. 11385 (optional)
Date filled: 03/5/2015
Date Rx written: 03/4/2015 (optional)
Simvastatin 20 mg
Take one tablet by mouth every day
Qnty: 30
Prescriber: Dr. Jane Doe
RPH: Milan Topalov
Drug: Simvastatin for Brand Zocor
Manufacturer: Dr. Reddy’s
NDC: (optional)
Prescription Expiration: 03/5/2016
Refills: 11
 Step 6
 Select the container of dispensing. Most drugs are light sensitive
and their dispensing in amber colored containers are required
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Vials for capsules and tablets
“Ovals” are wide mouthed containers for compounded creams and
ointments
Glass or plastic amber bottles for liquid medications
Some drugs require the original manufacturer labeled container to be
dispensed. A very important one (hint: it may be on the PTCE) is
Pradaxa ® (Dabigatran) is a anticoagulant used in place of warfarin for
many condition. FDA in 2011 requires that the pharmacist dispense drug
in the original container and the bottle be dated 60 days after opening
 Step 7
 Pharmacist check. Labeled container with the pulled bulk
medication and the original prescription
 Step 8: Dispensing to patient
 For all new patients to your pharmacy it is important to give them a
copy of the HIPPA notice of privacy practices and to document that
the patient received it; same holds true for doctor’s office
 As per OBRA 90 requires, the pharmacist must offer counseling
 Use of teaching sheets that provide preset information in layman’s
term of the medication
 Some medications require a patient package insert or PPI to be
dispensed with the prescription as per Federal law. These
medication classes include:
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Oral contraceptives (birth control)
Estrogen and progesterone products (menopausal products)
Isotretinoin (Accutane)
Metered dose Inhalers
PPI are laymen terms for what is contained in the Package Insert
 All dispensed prescriptions must comply with the poison
prevention packaging act of 1970
 Child resistant caps on all dispensed vials
Institutional Fill Process
 Hospitals, nursing homes, LTCF, etc follow the same procedures with
some differences:
 Ambulatory (out patient prescriptions) are not filled
 Patient’s data is not collected but is available on the electronic patient’s
profile
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Patient’s name, demographics, height, weight, address, DOB
Patient’s insurance information
Patient’s Diagnosis
Patient’s allergies
Patient’s laboratory data
Admission date
Admitting physician
MAR
Medication reconciliation record
 Dispensing to the patient directly is not done. Medication are
administered by an RN
 Dispensing to the patient’s nursing unit:
 Hand delivery to the unit by the pharmacy technician from a
centralized pharmacy
 Technicians deliver unit dose medications to a ADC
(automated dispensing cabinet). The medication is
accessible to the RN from the cabinet after the medication is
profiled by the pharmacist.
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Support a decentralized pharmacy system with specialty satellite
pharmacies (cardiac ICU unit would stock cardiac medications in
their ADC)
supports with turn around time
Supports pharmacy antidiversion efforts
Omnicell and Pyxis Medistation are the industry standards