Chapter 5

1. Chapter 5 Prescriptions

2. 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.

3. Prescription Process • Prescription is written • It’s presented to pharmacy • Information is checked • Data is entered into pharmacy system

4. Prescription Process • Online processing • Label is generated • Prescription is prepared.

5. Prescription Process Check by pharmacist • Patient (signs log) receives prescription • Counseling is provided

6. Pharmacy Abbreviations ROUTES • ad right ear • iminramuscular • po by mouth • etc. FORMS • aq water • caps capsules • ung ointment • etc.

7. Pharmacy Abbreviations TIME • ac before meals • pc after meals • bid twice a day • prn as needed • etc MEASUREMENT • oz ounce • gttdrops • tea teaspoon • ml milliliter • etc

8. Pharmacy Abbreviations OTHER • c with • sig write (directions for use) • utd as directed

9. Quiz ROUTE ad _____________ as _____________ au _____________ im, IM _____________ inj. _____________ iv, IV _____________ ivp, IVP _____________ IVPB _____________ od _____________ os _____________ ou _____________ po _____________ npo _____________ SC, SQ _____________ top _____________ PR, rec _____________ SL _____________

10. FORM Tab/T _____________ C/Cap _____________ Ts _____________ Elix _____________ Liq _____________ NS _____________ supp _____________ Syr _____________ Cs _____________ Ung _____________

11. TIME ac _____________ am _____________ bid _____________ hs _____________ qhs _____________ pc _____________ prn _____________ qid _____________ q _____________ qd _____________ qh _____________ stat _____________ tid _____________ qod _____________

12. MEASUREMENT aa _____________ d _____________ dil _____________ f, fl. _____________ g, G, gm _____________ gtt _____________ L _____________ mcg _____________ mEq _____________ mg _____________ ml _____________ qs_____________ ss _____________ tbsp _____________ tsp _____________ U _____________

13. OTHER c _____________ Disp _____________ f, ft _____________ L _____________ s _____________ utdict/utd _____________ Sig _____________ tat _____________ NTE _____________ nkda, nka _____________

14. The Prescription

15. Medication Order

16. Elements of the Prescription Patient InformationProvider's Information • Name Name • Phone number and address Phone number and address • Insurance information, Provider's license number if applicable • Age or date of birth Provider's DEA number if applicable Name of medication Strength Dosage form

17. Elements of the Prescription Provider's Information cont. • Route • Quantity • Route of administration • Sig • Refill information • Provider's signature • Date written • "Brand medically necessary" if brandname drug is desired

18. Prescription Information Checklist • NAME, NAME, NAME • DEA number is necessary for controlled substances • Controlled drug written in ink • Inpatient (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

19. The Pharmacy Technician’s Role • Taking in the prescription • Translating the prescription • Entering information in database • Filling the script

20. 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

21. Prescription Label

22. The Fill Process Considerations • 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

23. The Fill Process Considerations • 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

24. The Fill Process Considerations • 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

25. Placing the Label • 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 • Computer systems print label and information on one sheet • Law requires certain information to be on label

26. Technician’s Initials • Technicians should initial all orders filled by them • 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

27. 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)

28. Auxiliary Labels • Auxiliary labels usually printed with prescription label • Drug classification • interactions • side effects (need to be known for auxiliary labels if not computerized)

29. 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.

30. Auxiliary Labels

31. 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

32. HIPAA: The Health Insurance Portability and Accountability Act of 1996 • As 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.

33. HIPAA: The Health Insurance Portability and Accountability Act of 1996 • All personnel must be formally trained regarding HIPAA. • Penalties for violations range from fines ($100 to $250,000) to jail (up to ten years).