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• Filling a prescription: most common and important duty of a technician • Transcribing a doctor’s orders can be frustrating – occasionally must get clarification • Pharmacist makes the call to the doctor or makes a decision about the order if it’s not clear. Prescription: a written order from a practitioner for the preparation and administration of a medicine or device Prescriber information Name, title, office address and telephone number. Patient information Name and address of patient. Date the prescription was written. Inscription: The body of the prescription, containing the name and amount or strength of each ingredient. Signa: contains the directions to the patient, e.g. "1 cap t.i.d. pc" Refill instructions DAW (dispense as written): don’t substitute for a generic form Signature of prescriber DEA # if applicable • Superscription: – The date when the prescription order is written – The name, address and age of the patient – The symbol Rx (an abbreviation for "recipe," the Latin for “take thou”). • Inscription: – The actual body of the prescription; drug name, strength, dosage form and quantity. • Subscription: – The directions to the pharmacist, usually consisting of a short sentence such as: "make a solution," or "mix and place into 10 capsules.” • Signa or Sig: – The directions for use; the drug amount, frequency, and route of administration, – EX: 1 cap t.i.d. pc • Five basic steps for filling a prescription: – – – – – Taking in the prescription Translating the prescription Entering information in database Filling the script Patient counseling • Prescriptions arrive in various ways: – Written order – Hand carried – Faxed – Called in – Electronic • Look at whole order if difficult to decipher • If in doubt, ask another person or pharmacist • When to Ask for Help – When handwriting is poor, assistance is needed – Filling scripts under pressure can lead to “guessing” • Patients can be harmed by incorrectly filled prescriptions and lawsuits are awarded •Is the FULL name clear? •Is the patient’s DOB, street address, telephone #, insurance info, preference for brand or generic drugs, and allergy info already on file? •Is the medication for an OTC product that the patient can receive without a prescription? •When was the prescription written? •Is the drug available in the quantity written? Does it need compounding? •Is the prescription suspicious or legitimate? –All written in the same handwriting? –Do the quantities and directions seem appropriate? •After the doctor’s order is read, it is entered into the computer •Check computerized label against prescription after it is filled •Two labels generated: one for the vial; other for back of original prescription •Pharmacist initial is needed on both labels JH •Label is checked many times before it reaches the patient •Hold original script next to label to check for errors or discrepancies •Look at names of drug, strength, dosage form, sig (directions) • An identification label placed on the outside of the bottle. • Translated from the original prescription into language the patient can understand. • Directions For Use – Should start with a verb: • • • • • “take” – for internal/oral route “instill” or “place” – for eye/ear/nose “inhale” – for respiratory use “insert” – for rectal/vaginal application “ apply” - for topical medication – This will indicate the route •Use whole words not abbreviations (use “tablets” not “tabs”) •Use familiar words, especially in measurements (“two teaspoons” or “10 ml”) •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 • After preparation, the prescription will be filled. • Pulling the Correct Medication – Take label to shelf when getting medication from the shelf – Label helps you not to forget – Can compare label with information on the bottle •Check label and script against bottle for accuracy of amount •Counting trays are still used •Digital counters and automated machines can be used sometimes •Appropriate lid is 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 Safety Lid Snap-on Lid • Additional colored WARNING labels that are placed on filled prescription containers. • Examples: “Take with food”, “May cause drowsiness”, “Take medication on an empty stomach” • ALL controlled substances from C-I to C-IV use this warning: – CAUTION: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed. • Drug classification, interactions, and side effects need to be known for auxiliary labels if not computerized •Auxiliary labels usually printed with prescription label •Make sure there are no creases. •Place the appropriate auxiliary labels on the container. •Auxillary labels used on all vials for eye drops and ear drops or eye ointments. •Technicians should initial all orders they fill •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 •The last step in filling scripts is passing the filled vial, along with medication container from shelf, and original prescription to the pharmacist •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) •First-time prescriptions flagged and pharmacist is alerted •Patient needs consultation with new script •Federal law: all new or changed prescriptions need consultation •OBRA 1990 •Hard copy prescriptions manually filed for future reference –Kept for 3 years •All controlled substances (Schedule II) stamped with a red “C” 1 inch down on righthand side of prescription label •All Schedule II medications must be filed separately •Patients can wait for prescriptions •Have it delivered •Pick up another day by self or relative •All third-party prescriptions must have a signature of the person receiving medication •Check all ID before releasing medication for controlled substances •Some reimbursement plans require that the patient’s signature be kept on file to indicate a medication was picked up. • As you dispense new medications, a pharmacist will compare new medication with meds patient was previously taking – Avoid potential harmful interactions – Ensure most appropriate medication being given – Screen for fraud or misuse – Screen for underuse of drug therapy • Every time these drugs are dispensed (new prescription OR refills): – Oral contraceptives – Estrogens – Progesterones – Isotretinoin (Accutane) – Intrauterine Devices – Isoproterenol (Isuprel) Inhalation Products • Must be reported to the FDA (Food and Drug Administration) • Right dose • Right medication • Right route • Right time • Right price • Right dosage form • Right patient • Protected Health Information (PHI) • All patients must be provided with a written notice of the pharmacy’s privacy practices procedures including their privacy rights. • You will be performing these skills every day as a Pharmacy Technician in training. • You need to know this material…. Not just glance over it. Expect heavy testing on this subject next week to be sure you have mastered the information you will be expected to perform when you do skills in the pharmacy