Chapter 5

Prescriptions

Learning Objectives

understanding of the prescription process.knowledge of abbreviations used in

pharmacy.knowledge of the information elements of

a prescription.knowledge of the information elements of

a medication order.knowledge of the fill process.knowledge of label information.knowledge of auxiliary labels.

Prescription Process Prescription is written

It’s presented to pharmacy

Information is checked

Data is entered into pharmacy system

Prescription ProcessOnline processing

Label is generated

Prescription is prepared.

Prescription ProcessCheck by pharmacist

Patient (signs log) receives prescription

Counseling is provided

Pharmacy Abbreviations ROUTESad right ear im inramuscularpo by mouthetc.

FORMSaq watercaps capsulesung ointmentetc.

Pharmacy Abbreviations

TIME ac before meals pc after meals bid twice a day prn as needed etc

MEASUREMENT oz ounce gtt drops tea teaspoon ml milliliter etc

Pharmacy AbbreviationsOTHER

◦c with◦sig write (directions for use)◦utd as directed

ROUTE

ad _____________as _____________au _____________im, IM _____________inj. _____________iv, IV _____________ivp, IVP _____________IVPB _____________od _____________os _____________ou _____________po _____________npo _____________SC, SQ _____________top _____________PR, rec _____________SL _____________

Quiz

FORM

Tab/T _____________C/Cap _____________Ts _____________Elix _____________Liq _____________NS _____________supp _____________Syr _____________Cs _____________Ung _____________

TIME

ac _____________am _____________bid _____________hs _____________qhs _____________pc _____________prn _____________qid _____________q _____________qd _____________qh _____________stat _____________tid _____________qod _____________

MEASUREMENT

aa _____________d _____________dil _____________f, fl. _____________g, G, gm _____________gtt _____________L _____________mcg _____________mEq _____________mg _____________ml _____________qs _____________ss _____________tbsp _____________tsp _____________U _____________

OTHER

c _____________Disp _____________f, ft _____________L _____________s _____________ut dict/utd _____________Sig _____________tat _____________NTE _____________nkda, nka _____________

The Prescription

Medication Order

Elements of the Prescription

Patient Information Provider's InformationName NamePhone number and address Phone number and addressInsurance information, Provider's license number if applicableAge or date of birth Provider's DEA number

if applicableName of medicationStrengthDosage form

Elements of the Prescription

Provider's Information cont.RouteQuantityRoute of administrationSigRefill informationProvider's signatureDate written"Brand medically necessary" if brandname drug is desired

Prescription Information Checklist

NAME, NAME, NAMEDEA number is necessary for

controlled substancesControlled drug written in inkInpatient (slightly different)

◦Doctor’s license and DEA number on file at hospital

◦Dosing 24-hour period◦Doctor writes for daily dose◦Antibiotics have automatic stop date

The Pharmacy Technician’s Role

◦Taking in the prescription◦Translating the prescription◦Entering information in database

◦Filling the script

The Pharmacist’s Role

◦Can help with the following: Taking in the prescription Translating the prescription Entering information in database Filling the script

◦But responsible for the final check and patient counseling

Prescription Label

The Fill ProcessConsiderations

◦After label preparation, match with original order and fill

◦Label checked many times before it reaches patient

◦Hold original script next to label to check for errors or discrepancies

◦Look at names of drug, strength, dosage form, sig (directions)

◦Take label to shelf when getting medication from the shelf

The Fill ProcessConsiderations

◦Label helps you not to forget◦Can compare label with information

on the bottle◦Check label and script against bottle

for accuracy◦Counting trays still used◦Digital counters and automated

machines◦Baker cells used in larger pharmacies

The Fill ProcessConsiderations

◦Appropriate lid 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

Placing the LabelProfessionalism is needed when applying

labelDo not place torn or crooked label on

bottleLabel not to cover lot and expiration date

on full bottle prescriptionsAuxiliary labels must be easily readComputer systems print label and

information on one sheetLaw requires certain information to be on

label

Technician’s InitialsTechnicians should initial all

orders filled by themPharmacist gives final check-off

and knows who filled it by initialsPharmacist can notify or ask

technician if errors or questions occur

Pharmacist must always sign off after completion

The Pharmacist’sFinal Inspection

Passing the filled vial, along with medication container from shelf, and original prescription to the pharmacist is the last step in filling scripts

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)

Auxiliary Labels

Auxiliary labels usually printed with prescription label◦Drug classification ◦interactions◦side effects (need to be known for

auxiliary labels if not computerized)

Auxiliary Labels

TAKE WITH FOOD MAY CAUSE DROWSINESS DO NOT DRINK ALCOHOLIC BEVERAGES WHEN TAKING THIS

MEDICINE DO NOT TAKE ASPIRIN OR ASPIRIN CONTAINING PRODUCTS

WITHOUT CONSULTING A PHYSICIAN TAKE MEDICATION ON AN EMPTY STOMACH THIS DRUG MAY IMPAIR YOUR ABILITY TO DRIVE OR OPERATE

MACHINERY FOR EXTERNAL USE ONLY AVOID PROLONGED EXPOSURE TO SUNLIGHT WHILE TAKING

THIS MEDICATION CAUTION: FEDERAL LAW PROHIBITS THE TRANSFER OF THIS

DRUG TO ANY PERSON OTHER THAN THE PATIENT FOR WHOM IT WAS PRESCRIBED.

Auxiliary Labels

HIPAA: The Health Insurance Portability and Accountability Act of 1996 Primarily concerns the continuation of health insurance

coverage for workers who leave their jobs

Also includes regulations regarding privacy and protected health information (PHI) that all “covered entities” must follow.

Examples of protected health information (PHI):◦ patient name and address◦ date of birth◦ social security number◦ payment history◦ account number◦ name and address of health care provider and/or health plan◦ medical & prescription drug history

HIPAA: The Health Insurance Portability and Accountability Act of 1996As of May 23, 2007 HIPAA requires that all health

care providers use a National Provider Identifier (NPI) for all standard transactions covered by HIPAA.

Pharmacies must make “good faith effort” to obtain a signed acknowledgement that the patient has received the pharmacy’s notice of privacy practices.

Pharmacies may disclose “minimum necessary” PHI, without patient approval, to other covered entities such as doctors offices and insurance companies.

HIPAA: The Health Insurance Portability and Accountability Act of 1996All personnel must be formally

trained regarding HIPAA.

Penalties for violations range from fines ($100 to $250,000) to jail (up to ten years).