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CHAPTER 5
PRESCRIPTIONS
CHAPTER OUTLINE
 Prescriptions
 Pharmacy Abbreviations
 Prescription Information
 The Fill Process
 Labels
 HIPPA
 Review
PRESCRIPTIONS
A prescription is an instruction and an authorization from a
medical practitioner to issue a drug or device to a patient.
•
Unrestricted
– Medical Doctors (MD)
– Doctors of Osteopathy (DO)
•
In their field of practice
– Dentists (DDS, DMD)
– Veterinarians (DVM)
– Podiatrists (DPM)
– Opticians (OD)
•
Limited to some states and
based on protocols
– Nurse Practitioners (NP)
– Physician assistants (PA)
– Pharmacists (RPh)
DISPENSING PRESCRIPTIONS
• Community pharmacists
– Dispense directly to the patient.
– The patient is expected to administer the medication
according to the pharmacist’s directions.
• Institutional pharmacies
– Nursing staff generally administer medications to patients.
– Patient charts are referred to prior to administration because
they provide the most up-to-date physician instructions.
THE PRESCRIPTION PROCESS
1. A prescription is ordered by a prescriber.
2. The prescription arrives at the pharmacy.
 The patient drops off the prescription, or the
pharmacy receives the prescription directly
from the prescriber.
THE PRESCRIPTION PROCESS, CONT’D
3. The pharmacy technician:
•
Checks the prescription to make certain it is
complete
and authentic.
•
Verifies that the patient is in the pharmacy
database.
•
Obtains and/or verifies the patient’s
demographic, insurance, and allergy information.
•
Verifies any special instructions, such as pick-up
time and days supply.
THE PRESCRIPTION PROCESS, CON’D
4.The technician enters the prescription into the
computer system.
 The technician scans a copy of the prescription into the
computer and keys data from the prescription into the
system.
 Safety and accuracy checks are completed as per
pharmacy protocol.
THE PRESCRIPTION PROCESS, CONT’D
5. Insurance and billing information is
processed.

The computer system evaluates the data against
stored information and process any third-party billing.

The pharmacy technician asks the pharmacist to
check drug utilization review (DUR) messages such as
regarding drug interactions.

If a claim is rejected, the technician reviews the reject
message and resubmits the claim, as appropriate.
THE PRESCRIPTION PROCESS, CONT’D
6. Label is generated.
•
Once the payment is approved by the third party, the
computer generates a label, patient handout, and the
patient co-payment amount.
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THE PRESCRIPTION PROCESS, CONT’D
7.
The pharmacy technician prepares the
prescription by:

Selecting the appropriate medication and verifying the
national Drug Code (NDC) number on the computergenerated medication label against the medication being
dispensed.

Preparing the medication per the prescription (e.g., counting
tablets or measuring liquid).

Packaging the medication in the appropriate container.

Placing the computer-generated medication label on the
prescription container.

Organizing everything for the pharmacist’s final check.
THE PRESCRIPTION PROCESS CONT’D
8.
The pharmacist checks the prescription.
•
The pharmacist performs a final safety and accuracy
check and then signs off on the prescription.
•
The pharmacy technician “bags” the approved
prescription for patient sale and attaches a drug
information sheet regarding indications,
interactions, and possible side effects.
THE PRESCRIPTION PROCESS, CONT’D
9. Patient receives the prescription.
•
The technician delivers the packaged prescription to
the cash register area for patient pickup.
•
At pickup, the technician checks to make sure the
correct patient is picking up the correct medication.
•
The patient or a representative signs the insurance log.
•
If the patient has not signed the pharmacy’s notice of
HIPAA compliance, they are given a copy and asked to
sign that log.
THE PRESCSRIPTION PROCESS CONT’D
10. The pharmacist provides counseling.
•
The technician calls the pharmacist to the
counter to counsel the patient per OBRA ’90,
other state or provincial statutes, and
pharmacy protocol.
PHARMACY ABBREVIATIONS
• Most common abbreviations are for:
– Route of administration
– Dosage form
– Time of administration
– Measurement
ROUTES OF ADMINISTRATION
ABBREVIATIONS
ad = right ear
as = left ear
au = each ear
od = right eye
os = left eye
ou = each eye
po = by mouth
SL = sublingually,
under the tongue
top =topically, locally
PR, REC = rectally
PV, VAG = vaginally
inh, puff = inhalation, inhale
per neb, via neb = by nebulizer
SC, subc, = subcutaneous
Subq, SQ
IM = intramuscular
IV = intravenous
IVP = intravenous push
IVPB= intravenous piggyback
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permission from the publisher.
DOSAGE FORM ABBREVIATIONS
tab
= tablet
cap
= capsule
SR, XR, XL
= slow/extended release
sol
= solution
susp
= suspension
syr
= syrup
liq
= liquid
supp
= suppository
crm,cm
= cream
ung, oint
= ointment
ADMINISTRATION TIME
ABBREVIATIONS
bid
tid
qid
am/qam
pm
hs.
prn
ac
pc
stat, STAT
q __ h
= two times a day
= three times a day
= four times a day
= morning/ each morning
= afternoon or evening
= at bedtime
= as needed
= before meals, before a meal
= after meals, after a meal
= immediately, now
= every __ hour(s)
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permission from the publisher.
MEASUREMENT ABBREVIATIONS
i, ii, etc.
ss
= one, two, etc.
= one-half
gtt
Ml
Tsp, tsp
Tbsp, tbsp
fl oz
l, L
= drop
= milliliter, millilitre
= teaspoon (=5 ml)
=tablespoon (=15 ml)
= fluid ounce (= 30 ml)
= liter, Litre
mcg, µg
Mg
g, G, gm
mEq, meq
= microgram
= milligram
= gram
= milliequivalent
aa
ad
aq. ad
qs, qs ad
= of each
= to, up to
= add water up to
= add sufficient quantity to make
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permission from the publisher.
OTHER ABBREVIATIONS
UTD
= as directed
NR, Ø = no refill
DAW
= dispense as written
_
c, w
= with
s, w/o
= without
EXAMPLES
Drug
Rx
Label Directions
Synthroid®
100 mcg tablets
i po q am
Take one tablet by mouth once daily in
the morning
azithromycin 250 mg
tablets
ii po today,
i po daily days 2-5
Take two tablets by mouth today, then
take one tablet once daily on days 2
through 5
Alphagan-P® 0.1% eye
drops
i gtt q8h ou
Instill one drop into each eye every 8
hours
Advair Diskus® 100/50
inh i po BID
Inhale the contents of one blister, by
mouth, twice daily.
[Rinse mouth after use.]-Optional
Enbrel® 50 mg SC injection
i q week
Inject the contents of one syringe,
subcutaneously, once weekly
THE ELEMENTS OF PRESCRIPTIONS
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permission from the publisher.
PRESCRIPTION INFORMATION SAFETY
• Is the patient’s full name clearly written on the prescription? Has
a nickname or initial been used?
• Is the patient’s information on file (e.g., date of birth, address, insurance,
allergy)? Is it current?
• Is the medication for an over-the-counter product?
• Is the prescription for a Schedule II controlled drug?
• Is the prescription current (i.e., written in the past few weeks)?
• Is the drug available in the quantity requested?
• Does the prescription look suspicious in any way?
THE FILL PROCESS: SAFETY
CONSIDERATIONS
• Is the prescription for a high-alert medication?
• Are the instructions logical?
• Are the directions clear?
• Are there look-alike names?
• Pay attention to warnings!
– Call a pharmacist to evaluate each warning.
• Check against the original!
• Don’t add information!
CAUTION!
• Is the prescription for a high alert medication?
– High-alert medications are known to cause significant harm to
the patient if an error is made.
• Are the fill instructions logical?
– Is it q pm or prn; 4 ml or .4 ml.
• Are the directions clear?
– “Take two tablets daily” vs. “Take one tablet twice daily”
vs. “Take two tablets once daily.”
• Are there look-alike names?
– Is it:
• Janumet® or Sinemet®?
• Zovirax® or Zyvox®?
CAUTION!
• Pay attention to warnings!
– When warning screens appear, call a pharmacist to evaluate
each warning.
• Check against the original!
– During the fill process, always refer to the original prescription
first and then refer to the label.
• Don’t add information!
– Never add information based on what you assume the prescriber meant.
The prescriber has knowledge of the patient’s condition
that you don’t.
THE PHARMACY TECHNICIAN’S ROLE
• Assisting the pharmacist in routine, technical aspects of
prescription filling.
• Treating each patient, their personal information, and
their medications with respect.
• Accepting new prescriptions from patients, obtaining all
necessary information, and keying it into the computer.
• Alerting the pharmacist whenever a DUR warning screen
appears while filling a prescription.
• Faxing or telephoning refills and clarification requests
to prescribers.
THE PHARMACY TECHNICIAN’S ROLE CON’T
• Consulting formularies and responding appropriately to thirdparty adjudication messaging such as: non-preferred drug, prior
authorization or step-edit required.
• Quickly locating the correct medication for dispensing,
calculating quantities, repackaging medication, and locating the
corresponding patient medication guide.
• Compounding a prescription under supervision.
• Recording the dispensing of controlled drugs.
THE PHARMACY TECHNICIAN’S ROLE
CONT’D
• Checking the work of other technicians, as instructed by a
pharmacist.
• Referring patients to a pharmacist for counseling on the use of
prescription and over-the-counter medications, or any other
question requiring judgment.
• ALWAYS ensuring the accuracy and safety of the prescription
by incorporating quality control checks into every step in the
process.
LABLES
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permission from the publisher.
RULES FOR WRITING DIRECTIONS FOR USE
• Start with a verb.
– take, instill, inhale, insert, apply
• Indicate route of administration.
–
–
–
–
Apply to affected area.
Take one tablet by mouth.
Insert rectally.
Place one tablet under the tongue.
• Do not use abbreviations.
• Use familiar words.
– teaspoonful or 5 ml
AUXILIARY LABELS
INSTITUTIONAL LABELS
• Unit dose packing is widely used
in institutions such as hospitals
and nursing homes.
• Contain only the following information:
– name, strength, manufacturer, lot number,
expiration date, and dosage form of the
medications
Image copyright Perspective Press and Morton Publishing Company. May not be copied, re-used, reproduced, or re-transmitted without express written
permission from the publisher.
PRESCRIPTION-TO-LABEL EXAMPLES
Images copyright Perspective Press and Morton Publishing Company. May not be copied, re-used, reproduced, or re-transmitted without express written permission
from the publisher.
PRESSCRIPTION-TO-LABEL EXAMPLES
CONT’D
Images copyright Perspective Press and Morton Publishing Company. May not be copied, re-used, reproduced, or re-transmitted without express written permission
from the publisher.
lNSTITUTIONAL MEDICATION ORDER
EXAMPLES
Images copyright Perspective Press and Morton Publishing Company. May not be copied, re-used, reproduced, or re-transmitted without express written permission
from the publisher.
WHAT IS HIPAA?
• Health Insurance Portability and Accountability Act of 1996.
• Federal law enacted to:
• Ensure the privacy of an individual’s protected
health information (PHI).
• Provide for individual rights regarding PHI.
• Provide security for electronic and physical
exchange of PHI.
• Provide for the continuation of health insurance coverage
for workers who leave their jobs.
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PHI: PROTECTED HEALTH INFORMATION
– Any personal information that could be used to identify an
individual or their health history.
– Includes patient’s:
• Name, address telephone, e-mail address.
• Medical diagnosis, medical records, and prescription drug
history.
• Identifying numbers, including Social Security, insurance
numbers, credit card account numbers.
• Birth date, dates of admission and discharge, or death.
• Payment records.
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