The Pharmacy The Pharmacy Technician 4ETechnician 4E

Chapter 5Chapter 5PrescriptionsPrescriptions

Chapter Outline

• Prescriptions• Pharmacy Abbreviations• Prescription Information • The Fill Process• Labels• HIPPA

PrescriptionsPrescriptionsPrescriptions are a written order from a practitioner for the Prescriptions are a written order from a practitioner for the preparation and administration of a medicine or a device.preparation and administration of a medicine or a device.

UnrestrictedUnrestricted Medical Doctors (MD)Medical Doctors (MD) Doctors of Osteopathy (DO)Doctors of Osteopathy (DO)

In their field of practiceIn their field of practice• Dentists (DDS)Dentists (DDS)• Veterinarians (DVM)Veterinarians (DVM)• Podiatrists – their field of Podiatrists – their field of

practicepractice• OpticiansOpticians

Limited to some StatesLimited to some States• Nurse Practitioners Nurse Practitioners • Physician assistancePhysician assistance

Based on protocolsBased on protocols• PharmacistsPharmacists

Dispensing PrescriptionsDispensing Prescriptions

Community PharmacistsCommunity Pharmacists Dispense directly to the patient.Dispense directly to the patient. The patient is expected to administer the The patient is expected to administer the

medication according to the pharmacist direction.medication according to the pharmacist direction. Institutional PharmacyInstitutional Pharmacy

Nursing staff generally get the medications mostly Nursing staff generally get the medications mostly from the pharmacists and administers to patients. from the pharmacists and administers to patients.

The Prescription ProcessThe Prescription Process

1. A prescription is written by a prescriber.1. A prescription is written by a prescriber.

2. The patient drops off the prescription.2. The patient drops off the prescription.

The Prescription ProcessThe Prescription Process

3. The pharmacy technician checks the prescription to 3. The pharmacy technician checks the prescription to make certain it is complete and authentic. make certain it is complete and authentic.

Verify that the patient is in the pharmacy Verify that the patient is in the pharmacy database. database.

If the patient is not in the pharmacy database, If the patient is not in the pharmacy database, the technician obtains necessary demographic, the technician obtains necessary demographic, insurance, and allergy information from the insurance, and allergy information from the patient.patient.

Enters the information into the computer.Enters the information into the computer.

Guidelines For Receiving And Reviewing Guidelines For Receiving And Reviewing PrescriptionsPrescriptions

4. Checking for completeness of each part of a prescription include: 1. prescriber information, 2. the date, 3. patient information, 4. the symbol Rx, 5. the inscription, 6. the subscription, 7. the signa, 8. additional instructions, and 9. the signature.

The Prescription ProcessThe Prescription Process

5. The pharmacy technician enters the prescription 5. The pharmacy technician enters the prescription into the into the computercomputer and the insurance and billing information is and the insurance and billing information is processed.processed.

Bills the insurance company or the patient.Bills the insurance company or the patient. The computer system evaluates the data against stored The computer system evaluates the data against stored

information and process any third party billing online.information and process any third party billing online. The pharmacy technician asks the pharmacist to check The pharmacy technician asks the pharmacist to check

the drug use review (DUR) or drug interaction that might the drug use review (DUR) or drug interaction that might be generated.be generated.

If claims rejected, review the data and resubmit claim.If claims rejected, review the data and resubmit claim.

The Prescription ProcessThe Prescription Process

6. Label is generated.6. Label is generated. Once the payment is approved by the third Once the payment is approved by the third

party, a label that contains copayment is party, a label that contains copayment is printed. printed.

The Prescription ProcessThe Prescription Process

7. Prescription is prepared.7. Prescription is prepared. The pharmacy technician selects the appropriate medication The pharmacy technician selects the appropriate medication

and verifies the and verifies the National Drug Code (NDC) National Drug Code (NDC) number on the number on the computer-generated medication label.computer-generated medication label.

Prepares the medication(s).Prepares the medication(s). E.g., the prescribed number of tablets is counted or the E.g., the prescribed number of tablets is counted or the

liquid measured..liquid measured.. Packages the medication in the appropriate container.Packages the medication in the appropriate container. Labels the prescription container with the computer-Labels the prescription container with the computer-

generated medication label. In some states the law requires generated medication label. In some states the law requires the pharmacist to affix the label to the container.the pharmacist to affix the label to the container.

The Prescription ProcessThe Prescription Process8. The pharmacy technician prepares the filled 8. The pharmacy technician prepares the filled

prescription for the pharmacist to check.prescription for the pharmacist to check. THE PHARMACIST CHECKS THE PHARMACIST CHECKS the prescription(s) the prescription(s)

and may initial it.and may initial it. The pharmacy technician bags the approved The pharmacy technician bags the approved

prescription for patient sale and attaches an prescription for patient sale and attaches an information sheet about the prescription, information sheet about the prescription, including indications, interactions, and possible including indications, interactions, and possible side effects.side effects.

The Prescription ProcessThe Prescription Process

9. 9. Patient receives the prescription. Patient receives the prescription. The pharmacy technician returns the bulk The pharmacy technician returns the bulk

product container to the shelf.product container to the shelf. Delivers the packaged prescription to the cash Delivers the packaged prescription to the cash

register area for register area for PATIENT PICKUP .PATIENT PICKUP . The patient or a representative signs the The patient or a representative signs the

insurance log.insurance log. If the patient has not signed the pharmacy’s If the patient has not signed the pharmacy’s

notice of HIPAA compliance, they are given a notice of HIPAA compliance, they are given a copy and asked to sign the log.copy and asked to sign the log.

The Prescription ProcessThe Prescription Process

10. Pharmacists provide counseling.10. Pharmacists provide counseling. OBRA ‘90 and other state or provincial OBRA ‘90 and other state or provincial

statures, require the pharmacist to be statures, require the pharmacist to be called to the counter to provide called to the counter to provide counseling on all prescriptions.counseling on all prescriptions.

Pharmacy AbbreviationsPharmacy Abbreviations

Most common abbreviations:Most common abbreviations: RouteRoute FormForm TimeTime MeasurementMeasurement

Route of Administration Route of Administration AbbreviationsAbbreviations

ad = right earad = right earas., al – left earas., al – left earau = each earau = each ear

IMIM - intramuscular - intramuscularIV = intravenousIV = intravenousod = right eyeod = right eyeos = left eyeos = left eye

ou = each eyeou = each eyepo = by mouthpo = by mouthsl = sublinguallysl = sublingually

Time of Administration AbbreviationsTime of Administration Abbreviations

ac = before mealsac = before mealspc = after mealspc = after mealshs = at bedtimehs = at bedtimeqd = every dayqd = every dayprn = as neededprn = as neededqid = four times a dayqid = four times a daytid = three times a daytid = three times a daybid = two times a daybid = two times a day

Dosage Form AbbreviationsDosage Form Abbreviations

elix = elixirelix = elixir supp = suppositorysupp = suppository ung = ointmentung = ointment tab = tablettab = tablet cap = capsulecap = capsule SR, XR, XL = slow/extended releaseSR, XR, XL = slow/extended release sol = solutionsol = solution susp = suspensionsusp = suspension

Measurement AbbreviationsMeasurement Abbreviations

i, iii, iigttgttgmgmgrgrllmcgmcgmgmgmeqmeqmlmlqsqsdispdisp

= one, two= one, two= drop= drop= gram= gram= grain= grain= liter= liter= microgram= microgram= milligram= milligram= milliequivalent= milliequivalent= milliliter= milliliter= a sufficient quantity= a sufficient quantity= dispense= dispense

Others AbbreviationsOthers Abbreviations

Stat = now Stat = now NR = no refillNR = no refillUD = as directedUD = as directedqs = a sufficient quantityqs = a sufficient quantitydispdisp

ExamplesExamplesDrugDrug RxRx Label DirectionsLabel Directions

Diovan® 80 Diovan® 80 mg tabletmg tablet

i po qdi po qd Take one tablet by Take one tablet by mouth once dailymouth once daily

Cephalexin Cephalexin 250 mg 250 mg capsulescapsules

ii stat, i po ii stat, i po QID x 10 dQID x 10 d

Take two capsules by Take two capsules by mouth now, then take mouth now, then take one capsule four times one capsule four times daily for ten daysdaily for ten days

Alphagan-P® Alphagan-P® 0.1% eye 0.1% eye dropsdrops

i q 8h oui q 8h ou Instill one drop into each Instill one drop into each eye every 8 hourseye every 8 hours

Strettera® 25 Strettera® 25 mg capsulesmg capsules

i q a.mi q a.m Take one capsule by Take one capsule by mouth every morningmouth every morning

Enbrel® 50 Enbrel® 50 mg SC mg SC injectioninjection

i q weeki q week Inject the contents of Inject the contents of one syringe, one syringe, subcutaneously, once subcutaneously, once weeklyweekly

Elements Of The Prescription Elements Of The Prescription InformationInformation

Prescriber information Prescriber information - Name, title, office address, - Name, title, office address, and telephone number.and telephone number.

Date: Date: The date the prescription is written.The date the prescription is written. Inscription: Inscription: Name (brand or generic), strength of Name (brand or generic), strength of

medication and quantity.medication and quantity. Name and address of patient Name and address of patient Signa:Signa: Sig or S and indicate the directions for use and Sig or S and indicate the directions for use and

the administration route (e.g., p.o., p.r., sc).the administration route (e.g., p.o., p.r., sc). Refill instructionsRefill instructions

Elements Of The Prescription Elements Of The Prescription InformationInformation

DAW/PSCDAW/PSC: Dispense As Written/Product Select Code: Dispense As Written/Product Select Code—generic substitution instructions (optional).—generic substitution instructions (optional).

Signature of prescriberSignature of prescriber: Required on written : Required on written prescriptions.prescriptions.

National Provider Identifier (NPI): National Provider Identifier (NPI): Prescriber’s Prescriber’s unique national identification number.unique national identification number.

Drug Enforcement Agency (DEA) registration Drug Enforcement Agency (DEA) registration number of prescriber:number of prescriber: Required for all controlled Required for all controlled substances).substances).

The Fill Process ConsiderationsThe Fill Process Considerations

Are the fill instructions clear and reasonable? Are the fill instructions clear and reasonable? Are the administration directions clear?Are the administration directions clear? Are there look-alike names?Are there look-alike names? Don’t add information!Don’t add information! Call a pharmacist to evaluate each warning.Call a pharmacist to evaluate each warning. Check against the original!Check against the original!

The Pharmacy Technician's RoleThe Pharmacy Technician's Role

Assisting the pharmacist Assisting the pharmacist in routine, technical aspects in routine, technical aspects of prescription filling.of prescription filling.

Treating each patient, their personal information, and Treating each patient, their personal information, and their medications their medications with respect.with respect.

Accepting new prescriptionsAccepting new prescriptions from patients, obtaining from patients, obtaining all necessary information, and keying it into the all necessary information, and keying it into the computer. computer.

Requesting the advice of a pharmacist Requesting the advice of a pharmacist whenever a whenever a warning screen appears while filling a prescription.warning screen appears while filling a prescription.

Faxing or telephoning Faxing or telephoning refills and clarification requests refills and clarification requests to prescribers.to prescribers.

The Pharmacy Technician's RoleThe Pharmacy Technician's Role

Consulting formulariesConsulting formularies and responding appropriately to and responding appropriately to third-party adjudication messaging such as: non-third-party adjudication messaging such as: non-preferred drug, prior authorization or step-edit required.preferred drug, prior authorization or step-edit required.

Quickly Quickly locating the correct medication locating the correct medication for dispensing, for dispensing, calculating quantities, repackaging medication, and calculating quantities, repackaging medication, and locating the corresponding patient medication guide.locating the corresponding patient medication guide.

Compounding Compounding a prescription under supervision.a prescription under supervision. RecordingRecording the dispensing of controlled drugs. the dispensing of controlled drugs.

The Pharmacy Technician's RoleThe Pharmacy Technician's Role CheckingChecking the work of other technicians, as instructed the work of other technicians, as instructed

by a pharmacist.by a pharmacist. Referring patients Referring patients to a pharmacist for counseling on to a pharmacist for counseling on

the use of prescription and over-the-counter the use of prescription and over-the-counter medications, or any other question requiring medications, or any other question requiring judgment as per your job description.judgment as per your job description.

ALWAYS ensuring the accuracy ALWAYS ensuring the accuracy and safety of the and safety of the prescription by incorporating prescription by incorporating Quality control checks Quality control checks into every step in the process.into every step in the process.

Caution!Caution! Are the fill instructions clear and reasonable?Are the fill instructions clear and reasonable?

Is it q.i.d. or q.d; 4 ml or .4 ml.Is it q.i.d. or q.d; 4 ml or .4 ml. Are the administration directions clear? Are the administration directions clear?

Are these the same? “Take two tablets daily” vs. Are these the same? “Take two tablets daily” vs. “Take one tablet twice daily” vs. “Take two tablets “Take one tablet twice daily” vs. “Take two tablets once daily.”once daily.”

Are there look-alike names? Are there look-alike names? Is it Metadate® 10 mg or Methadone 10 mg; Is it Metadate® 10 mg or Methadone 10 mg;

Lamictal® or Lamisil®?Lamictal® or Lamisil®?

Caution!Caution!

Don’t add information! Don’t add information! Never add information based on what you assume Never add information based on what you assume

the prescriber meant. The prescriber has knowledge the prescriber meant. The prescriber has knowledge of the patient’s condition that you don’t.of the patient’s condition that you don’t.

Pay attention to warnings! Pay attention to warnings! When warning screens appear, call a pharmacist to When warning screens appear, call a pharmacist to

evaluate each warning. evaluate each warning. Check against the original! Check against the original!

During the fill process, always refer to the original During the fill process, always refer to the original prescription first and then refer to the label.prescription first and then refer to the label.

LabelsLabels

Label PreparationLabel Preparation The name, address, and telephone number of the The name, address, and telephone number of the pharmacy.pharmacy. A A prescription number.prescription number. The The datedate dispensed. dispensed. The The name of the patient. name of the patient. Directions for use .Directions for use . The The medication dispensed.medication dispensed. Expiration date Expiration date of the medication.of the medication. The name of the The name of the prescriber.prescriber. The pharmacist The pharmacist initials.initials. Refill Refill information.information.

Rule When Writing Directions For UseRule When Writing Directions For Use START WITH A VERBSTART WITH A VERB

Take, instill, inhale, insert, or applyTake, instill, inhale, insert, or apply Indicate Indicate ROUTE of ADMINISTRATIONROUTE of ADMINISTRATION

Apply to Apply to affected area.affected area. Take one tablet Take one tablet by mouth.by mouth. Insert Insert rectally.rectally. Place one tablet Place one tablet under the tongue.under the tongue.

NO ABBREVIATIONSNO ABBREVIATIONS Use familiar wordsUse familiar words

Teaspoonfuls or 10 mlTeaspoonfuls or 10 ml

Auxiliary LabelsAuxiliary LabelsProvide additional information to the patient Provide additional information to the patient

and applied to the prescription containerand applied to the prescription container

Institutional LabelInstitutional Label

Unit dose packingUnit dose packing is widely used. is widely used. Contains the following information Contains the following information ONLYONLY::

The name, strength, manufacturer, lot number, The name, strength, manufacturer, lot number, expiration date, and dosage form of the expiration date, and dosage form of the medications.medications.

The patients medical condition change relatively The patients medical condition change relatively quickly, so are the medications orders.quickly, so are the medications orders.

Prescription Label ExamplesPrescription Label Examples

Prescription Label ExamplesPrescription Label Examples

Institutional Prescription Label Institutional Prescription Label ExamplesExamples

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What is HIPAA?What is HIPAA?

HIPAA is a federal law enacted to:HIPAA is a federal law enacted to:• Ensure the privacy of an individual’s protected Ensure the privacy of an individual’s protected

health information (PHI).health information (PHI).• Provide security for electronic and physical Provide security for electronic and physical

exchange of PHI.exchange of PHI.• Provide for individual rights regarding PHI.Provide for individual rights regarding PHI.

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Personal Identifiers under HIPAAPersonal Identifiers under HIPAA

Patient Patient namename, all types of , all types of addressesaddresses including email, URL, including email, URL, home.home.

Identifying numbersIdentifying numbers, including Social Security, medical , including Social Security, medical records, insurance numbers, account numbers.records, insurance numbers, account numbers.

Full facial Full facial photos.photos. DatesDates, including birth date, dates of admission and , including birth date, dates of admission and

discharge, or death.discharge, or death. Personal identifiers coupled with a broad range of Personal identifiers coupled with a broad range of

health, health care or health care payment information health, health care or health care payment information creates PHI.creates PHI.

Terms to RememberTerms to RememberTerms to RememberTerms to Remember

1. DAW1. DAW2. DEA number2. DEA number3. Extemporaneous compounding3. Extemporaneous compounding4. HIPAA4. HIPAA5. National Provider Identifier (NPI)5. National Provider Identifier (NPI)6. OTC drugs6. OTC drugs7. Prescription7. Prescription8. Schedule II drugs8. Schedule II drugs9. Signa, sig9. Signa, sig