Transcript pharm tech 2016-2017 class 3 ch 14 thru 19x

Ch 19: Introduction to
Pharmacy Math
O Roman Numerals
O Fractions
O Decimals
O Rounding Numbers
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Roman Numeral Symbols
ss = one-half
I = one
V = five
X = ten
L = fifty
C = one hundred
D = 500 hundred
M = one thousand
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Roman Numerals
O Often used in prescription orders
O Three Cardinal Rules:
#1 If a symbol follows another symbol of equal or greater value,
the two symbols are added together
#2 If a symbol follows another symbol of lower value, the lower
value is subtracted from the higher value
#3 First perform any necessary subtraction, then add the
resulting values together to get the final answer
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Roman Numerals
IX = ?
9
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Roman Numerals
XXX = ?
30
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Roman Numerals
XCII = ?
92
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Fractions
O A numerical representation of pieces of a
whole
O Bottom number is the denominator
O tells us how many total pieces there are
O Top number is the numerator
O tells us how many pieces of the whole we have
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Fractions
O Fractions with a numerator that is smaller than the
denominator are called “proper fractions”
O Fractions with a numerator that is larger than the
denominator are called “improper fractions”
O For our purposes we won’t worry about reducing
improper fractions
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Addition and Subtraction
of Fractions
O Must have a common denominator
O Then just add or subtract the
numerators
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Fractions
1/3 + 3/9 = ?
6/9
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Fractions
9/30 + 4/10 = ?
21/30
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Fractions
12/14 – 3/7 = ?
6/14
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Multiplication of Fractions
O Simply multiply the two numerators and the
two denominators
O Do NOT need a common denominator
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Fractions
2/6 x 5/7 = ?
10/42
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Fractions
3/9 x 2/4 = ?
6/36
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Division of Fractions
O The order of the fractions is important
O The second fraction is the divisor
O the divisor is what we are dividing by
O Invert the divisor and then multiply the
fractions
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Fractions
1/8 divided by 5/6 = ?
6/40
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Fractions
6/3 divided by 7/8 = ?
48/21
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Decimals
O Three general rules when working with decimals
#1 Never leave a decimal point “uncovered”
O too easy to misread and make a mistake
#2 Unless working with money, Never add zeros to the right
of the decimal point
O the end signifies the accuracy of the number
#3 The answer you get can be only as accurate as the least
accurate number used in the calculation
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Rounding Numbers
O If the number following the place you are
rounding to is 5 or higher, you round up
O If the number following the place you are
rounding to is 4 or lower, you round down
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Try some rounding
10.359 to tenths
10.4
0.143 to hundredths
0.14
9.9982 to thousandths
9.998
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Ch 14: Requirements of the
Drug Order
O Retail  the PRESCRIPTION
O Hospital  the Hospital Drug Order
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Methods of Transmitting a
Retail Prescription
May Use Four Methods:
O Written
O Telephoned
O Faxed
O E-scribe
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Written Prescriptions
O Non-Controlled Drugs
O May be written
O Must be signed by prescriber
O Schedule III thru IV Drugs
O May be written
O Must be signed by prescriber
O Schedule II Drugs
O May be written
O Must be signed by prescriber
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Telephoned Prescriptions
O Non-Controlled Drugs
O May be telephoned
O May be called in by the prescriber’s agent
O Schedule III thru IV Drugs
O May be telephoned
O May be called in by the prescriber’s agent
O Schedule II Drugs
O ONLY allowed under emergency situations
O VERY RARE
**ALL TELEPHONED PRESCRIPTIONS MUST BE REDUCED TO WRITING IMMEDIATELY**
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Faxed Prescriptions
O Non-Controlled Drugs
O May be faxed
O Must be signed by prescriber or electronic signature
O Schedule III thru IV Drugs
O May be faxed
O Must be signed by prescriber or electronic signature
O Schedule II Drugs
O May be faxed ONLY UNDER THREE SPECIAL
SITUATIONS
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Situations That Allow for the
Faxing of Schedule II
Prescriptions
O Compounding of a narcotic for direct
administration by a parenteral route
O Residents of a long term care facility
O Patients enrolled in a hospice program
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E-Scribed prescriptions
O Requires special software for the prescriber and
pharmacy
O Generates an electronic signature for the provider
O Four main components of the e-prescribe system:
O The prescriber
O The transaction hub
O The pharmacy benefit manager (PBM) if the patient has
prescription insurance
O The pharmacy
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E-Scribed Prescriptions
O Non-Controlled Drugs
O May be e-scribed
O Must be electronically signed by the prescriber
O Schedule III thru IV Drugs
O May be e-scribed
O Must be electronically signed by the prescriber
O Schedule II Drugs
O May be e-scribed ONLY WITH SPECIAL SOFTWARE
O Must be electronically signed by the prescriber
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REMEMBER!
O We are studying FEDERAL LAW in this class
O The laws of your state may forbid some
methods of transmission, and your instructor
will point out the differences
O For the purposes of the certification
examinations and our examinations,
remember the FEDERAL requirements
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Anatomy of the Prescription
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Requirements of
Tamper Resistance
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Required Information on the
Prescription
Prescriber’s name, address, DEA number
Patient’s name, address
Date prescription was written
Drug name, strength, dosage form, &
Quantity
O Instructions for use
O Refill information
O Doctor’s signature (in ink)
O
O
O
O
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Optional Information on the
Prescription
O Refill information
O Diagnosis
O “Dispense as written” information
O Prescriber’s numbers
O Special instructions for preparation
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Controlled Substance
Prescriptions
O Should have written out quantity
and/or date according to state law
ie.) THIRTY, not 30
O Patient’s full name and address
O Prescriber’s full name and address
O Prescriber’s DEA number
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Medicare Part B
Requirements
O Cannot be telephoned prescription / order
O Patient’s full name and address
O Prescriber’s full name, address, and NPI number
O The disease code the order is meant to treat
O The exact product name (trade name if applicable)
O The exact directions for use (NOT “as directed”)
O Must have written out date and quantity
O Prescriber must sign and date the rx next to signature
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Veterinary Prescriptions
O Must have name of pet and species
O Must have owner’s name and full address
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Restricted Drug Programs
O Created due to special risks associated with certain
O
O
O
O
medications
Involves targeted education and approval process
IPLEDGE
- Isotretinoin causes birth defects
Clozapine Registry
- Clozapine can cause life threatening blood
changes
Thalidomid REMS
- Thalidomide can cause severe birth defects
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Ch 15: Interpreting the
Prescription
O Never guess at anything you’re
O
O
O
O
O
O
not sure of!
Abbreviations
Directions for use (the sig)
Calculating the amount to
dispense
Written Date and the time limits
it imposes
Number Limitations
Generic Substitution
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Know these Abbreviations?
qam
every morning
hs
at bedtime
qD
every day
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BID
twice daily
QID
four times daily
TID
three times daily
qOD
every other day
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q8hr
every 8 hours
ac
before meals
pc
after meals
prn
as needed
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gtt
drop
ud
as directed
OD
right eye
OS
left eye
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OU
both eyes
AD
right ear
AS
left ear
AU
both ears
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Let’s Try Some Sigs
1TID
1 three times daily
2 po TID ac
2 by mouth 3 times daily before meals
2gtt OU qid
Instill 2 drops in both eyes 4 times daily
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How many do we give?
1 TID x 10days
30
2 qOD x 30 days
30
4ml BID x 1 week
56ml
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The Prescription Date
O The federal laws do not put a limit on
Schedule 2 or legend drugs!
O Schedule 3 thru 5 are only good for 6
months from the date the prescription is
written
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Number of Refills
O Legend drugs- no limit
O Schedule 3 thru 5 – 5 Refills max
O Schedule 2- no refills allowed
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Partial filling of Schedule 2’s
O The only time you may have 2 separate
fillings from one Schedule 2 prescription is if
you do not have enough medication in stock
to fill it completely the first time
O You only have 72 hours to provide the
remaining balance or the remainder is void
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Review
O A schedule 3 prescription is good for ____ months
and _____ refills
6 months / 5 refills
O A schedule 2 prescription is good for ____ months
and _____ refills
no federal limit / NO refills
O A non-controlled prescription is good for _____
months and _____refills
no federal limit / no federal limit
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Ch 16: Patient Information on
the Hospital Drug Order
O The patient’s name
O The patient’s age
O The patient’s location
O The hospital billing number
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Medication Information on
the Hospital Drug Order
O Drug name
O Strength
O Dosage form
O Route of administration
O Exact times of administration
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Prescriber Information on the
Hospital Drug Order
O Practitioner’s name & title
O NO DEA NUMBER IS NECESSARY FOR CONTROLLED
SUBSTANCE ORDERS……….why?
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Review & Comparison
Prescription
Hospital Order
O Address
O Room number
O DEA number
O NO DEA number
O Exact quantity
O Hospital policy
O Refill information
determines length of
supply
O Exact times
O Billing number
O Less precise sig
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The Hospital Drug Order
O Prescriber electronically enters into system
O Sent to the pharmacist
O Pharmacist reviews and releases order
O Order becomes active and available for
administration
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The Hospital Formulary
O Simply stated, a formulary is a list of the medications
a pharmacy normally stocks
O Limited list based on factors such as drug cost,
effectiveness, frequency of need, storage
requirements and adverse effects
O Dictated by the “Pharmacy & Therapeutics”
Committee
O Creates a list of needed medications without
stocking unnecessary or duplicate drugs
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Distribution in the Hospital
O In-patient pharmacy
O Out-patient pharmacy
O IV room
O Floor stock
O Emergency carts & trays
O Automated dispensing units
REMEMBER- No matter where the drugs are stored in
the hospital, they are the PHARMACY’S
responsibility!
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Ch 17: Medication Order
Entry
O Components of the computer
O Importance of scheduled backups
O Methods of order entry into the pharmacy computer
O Manual entry
O Internet transmission (e-scribe)
O Fax transmission
O Telephone entry system
O Automated refills
O Prescription process on the computer
O entry and verification
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Medication Order Entry
O Study the steps of prescription entry in Chapter 17
O Always take a moment and review what you have
entered into the computer BEFORE you hit the key to
accept the information
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Ch 18: The Patient Records
O Retail  Patient Profile
O Hospital  Patient Chart
Many differences you need to know
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RETAIL PROFILE
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Name
Home Address
Third Party Information
Diagnosis
Allergy Information
Date of Birth
Concurrent Medications
------------------------------------------------Previous Rxs filled
----------------Refill Information
---------
PATIENT CHART
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
Name
Room / Location
Billing Number
Diagnosis
Allergy Information
Date of Birth
-------Height & Weight
Lab & Radiology Reports
24hr observation notes
Nursing Care Plan
Dr notes & orders
Hx of drug or alcohol abuse
Hx of previous hospital visit
Physical or mental handicap
Physical therapy plan
--------Dietary Information© 2013
Abbreviations Found on the
Chart
Abbreviations commonly found in the hospital
are listed in Chapter 18
MEMORIZE the abbreviations!!
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Questions?
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