Chapter 7 - Medication Order Entry & Fill Process
Who are responsible for setting up and maintaining patient profiles?
Pharmacy Technicians
What is the first segment of the National Drug Code (NDC) number called?
The Labeler Code
What type of drug interaction warning is an indication that the patient has more than one active prescription for the same medication or has two different medications that produce the same or similar effect?
Therapeutic Duplication
What is the best way to choose the correct medication?
To choose by the National Drug Code (NDC)
What does a drug interaction cause in most cases? 1) _____ 2) _____
1) An increase or decrease in the drug's effect 2) Sometimes a completely different, unintended effect.
After patient name changes, pharmacy technicians can avoid dispensing a prescription to the wrong patient or adding multiple, incomplete profiles for the same patient by verifying the name with: 1) _____ 2) _____ 3) _____ What is this verification called? What does it ensure?
1) Birthdate 2) Or Address 3) Or phone number ------------------------------ Double-check ------------------------------ The correct prescription is being processed for the correct patient.
What must be written on a prescription by the prescriber if a patient must receive a brand name drug? 1) _____ 2) _____
1) Brand necessary 2) Dispense as written (DAW)
Once the medication process has been completed, what three things will the pharmacy technician do? 1) _____ 2) _____ 3) _____
1) Complete billing process 2) Bag the prescription 3) Place it in a bin for the patient to take.
What is the basic procedure for processing and filling a prescription? 1) Review prescription/medication order for _____. 2) Review patient's profile in relation to _____. 3) Select the prescribed medication in the right _____, _____, and _____ from the _____ in the computer. 4) _____ 5) _____ information entered into the computer and _____. 6) The prescription might not print until prescription has been _____. 7) _____ 8) Set the _____, _____ used, and _____ for the pharmacist's _____ and _____. 9) _____ the finished product _____.
1) Completeness. 2) The new order. 3) Dosage form/// Strength/// Quantity /// Formulary database 4) Generate the prescription label. 5) Double-check /// Print label. 6) Charged to the correct party. 7) Select, count, and pour the correct medication. 8) Original prescription ///Stock bottles ///Finished product /// Final approval /// Verification. 9) Store /// Properly.
What does confusion on which drug strength to fill cause? 1) _____ 2) _____
1) Delay in patient care 2) Creates potential for medication error.
What are two way besides handwritten and verbal order that a prescription may be sent to the pharmacy for processing? 1) _____ 2) _____
1) Fax 2) Electronically
What should all warnings and alerts be forwarded to the pharmacist for? 1) _____ 2) _____
1) For further investigation 2) Possible consultation
When reviewing the patient's profile during the step two of the processing prescriptions process, what questions should you ask yourself? 1) _____ 2) _____ 3) _____
1) Is the patient on similar medications? 2) Does the patient have reported allergies that may be triggered by this medication? 3) Can this medication interact unfavorably with other medications the patient is taking?
The patient profile in a hospital pharmacy may also indicate barriers that may impeded the treatment processes for the patient, such as: 1) _____ 2) _____ This information becomes part of the patient _____ or _____.
1) Language difficulties 2) Disabilities --------------------- Permanent hospital --------------------- Medical record information
Besides current and past prescription medications, what else should a patient's prescription history include? 1) _____ 2) _____ Why?
1) OTC Medications 2) Herbal Medications ----------------------- Some are contraindicated with certain medications.
What information is found on a patient profile? 1) _____ 2) _____ 3) _____ 4) _____ 5) _____ 6) _____
1) Patient Demographics 2) Insurance & Billing Information 3) Medical History 4) Prescription History 5) Prescription Preferences 6) Refusal of Information
What are the important parts of maintaining the processes for filling and dispensing patient medications? 1) _____ 2) _____
1) Patient Profiles 2) Medication Records
Patient profiles in hospital pharmacies may also include: 1) _____ 2) _____ 3) _____ 4) _____ 5) _____ 6) _____
1) Patient's account number 2) Patient's room number 3) Diagnosis 4) Names of practitioners 5) Allergies 6) Dietary restrictions
Besides being confidential legal records, what do patient profiles give to the pharmacist? 1) _____ 2) _____
1) Patient's diagnosis 2) Treatment history
Although the pharmacy software automatically checks for drug interactions, whose main responsibility is it to protect the patient and follow the prescriber's directions? 1) _____ 2) _____
1) Pharmacy Technician 2) And ultimately the pharmacist.
What are the ten essential elements that make up a prescription order that are required before dispensing to the patient? 1) _____ 6) _____ 2) _____ 7) _____ 3) _____ 8) _____ 4) _____ 9) _____ 5) _____ 10) _____
1) Prescriber Information 2) Patient Demographics 3) Date Prescribed 4) Drug Name & Strength 5) Drug Quantity 6) Route of Administration 7) Sig/Directions 8) Number of Refills 9) Indication for Brand/Generic 10) Prescriber's Signature
What are two primary elements to the practice of pharmacy when it comes to medication order entry and fill processes? 1) _____ 2) _____
1) Prescriptions 2) Medication Orders
What are some of the most common warnings/alerts for drug interactions? 1) _____ 2) _____ 3) _____ 4) _____ 5) _____ 6) _____
1) Therapeutic Duplication 2) Drug-Drug Interaction 3) Drug-Food Interaction 4) Drug-Disease Interactions 5) Drug-Lab Interactions 6) IV Incompatibility
What are sig codes or abbreviation designed for? 1) _____ 2) _____
1) To save time 2) To standardize label language.
What are patient demographics required for? 1) _____ 2) _____
1) Verification of patient profile information 2) Insurance processing
What questions should the directions on the prescription label answer? 1) _____ (Example?) 2) _____ (Example?) 3) _____ (Example?) 4) _____ (Example?)
1) What the patient should do with the drug. (take, apply, instill) 2) What should the patient take, apply, or instill (tablet, ointment, 2 drops) 3) How should the patient take, apply, or instill the drug? (mouth, to rash, each eye) 4) How often should the patient take, apply, or instill the drug?
What is the typical path of a prescription from the time it is written to the time it is dispensed? 1) Prescriber writes the prescription and _____. Or, _____. 2) The patient/patient's agent _____. 3) The pharmacy tech checks the prescription for _____. 4) The pharmacy tech enters the prescription into _____, where the _____ begins and the _____ is generated. 5) The pharm tech selects the correct drug from the shelf and verifies the _____. 6) Pharm tech fills the order either by _____ or _____ or _____ the prescribed drug. 7) Pharm tech verifies _____ & places it on the _____. 8) Pharm techs place drug for _____. 9) Pharmacist verifies and attaches _____, then _____ for the drug to be _____.
1) gives it to the patient/patient's agent. ///Prescriber/Prescriber's agent gives verbal order to pharmacy. 2) takes the prescription to the pharmacy. 3) completeness (10 essential elements of a prescription) 4) the pharmacy's computer ///billing process///prescription label 5) prescription label against prescription order. 6) counting ///pouring ///compounding 7) drug label ///prescription container. 8) verification with the pharmacist. 9) any auxiliary labels /// signs off /// dispensed to the patient.
How many essential elements are there that make up a prescription order, which are required before dispensing to a patient?
10
How many digits are in the NDC number? How many segments? Who assigns the number?
10 ---------------- 3 ---------------- US Food and Drug Administration (FDA)
It is important to remember that CII drugs may only be filled for _____.
A 30 day supply.
What is an example of a prescriber's authorized agent?
A nurse
What is important with prescription and medication orders to ensure that the patient has a safe and effective treatment experience?
Accuracy
What does ACE inhibitor stand for?
Angiotensin-Converting Enzyme Inhibitor
The prescription must have the number of refills permitted if _____.
Applicable
Route of administration is important to ensure that the patient receives a route of administration _____. What is an example of this?
Appropriate to the patient. ------------------------------- An infant can't swallow a pill, so liquid is ordered.
There is specific information a prescription must contain before _____ and _____ for _____.
Being filled ----------------- Verified ----------------- Dispensing the medication to the patient.
How do health systems that use CPOE help decrease the risk of medication error?
By having the prescriber input the medication treatments directly into the system.
How can the technician use the NDC code to know the correct drug has been selected?
By matching the number on the label with the number on the stock bottle.
What type of drugs are not permitted to have refills?
CII Drugs
What is an example of IV incompatibility with TPN? Why can't these two substances be mixed together?
Calcium and phosphate ----------------------------- It can cause precipitate to form.
What does CPOE stand for?
Computer Physician Order Entry
What part of the prescriber's information is not required on a prescription that doesn't involve a controlled substance?
DEA Number
What do complete prescription histories allow the pharmacist to do? Who are these mandated for?
Develop complete and accurate drug utilization reviews (DUR) ------------------------------ For all Medicare patients.
What occurs when a substance or condition affects the pharmacologic activity of a drug?
Drug Interaction
What part of the ten essential elements for a prescription must be indicated on the prescription in order to provide the patient with enough medication to complete the necessary therapy?
Drug Quantity
What does DUR stand for?
Drug Utilization Review
What type of drug interaction warning occurs when a past, present, or current patient medical condition precludes use of the drug?
Drug-Disease Interactions
What type of drug interaction warning is an indication that the patient has a medication in their profile that will cause an unfavorable reaction if it is taken along with the new prescription?
Drug-Drug Interaction
What type of drug interaction warning is indicated when the medication being prescribed interacts with certain foods?
Drug-Food Interactions
What type of drug interaction warning occurs because when in a hospital setting, certain medical tests may interfere with the patient's medications, therefore requiring temporary suspension of the patient's drug therapy?
Drug-Lab Interactions
What does the sig/directions help eliminate?
Errors
What do patient demographics help prevent?
Errors that might occur due to similar names.
When generating the prescription label, the directions typed out on the label must be ______, as well as clear enough for _____ and _____.
Exactly the same as the prescriber intended. ------------------------------ The patient to understand. ------------------------------ Follow
How long are prescription refills permitted for?
For a period of 1 year from the date the prescription was originally filled.
In many states, the pharmacist may provide the patient with a _____ unless otherwise indicated.
Generic equivalent
A prescription may be _____ and given to the _____, or the _____ for presentation at the pharmacy of the _____, or communicated directly to _____ through _____ or _____ given by the patient's prescriber, or the prescriber's _____.
Handwritten --------------------- Patient --------------------- Health-care professional --------------------- Patient's choice --------------------- Pharmacist --------------------- Telephone --------------------- Verbal order --------------------- Authorized agent
What type of drug interaction warning indicates that there is a potential interaction if two or more IV drugs are mixed together in the same container?
IV incompatibility
When reviewing the prescription, what should technicians always ask patients? What are examples? 1) _____ 2) _____ 3) _____
If there have been any changes to their profile information. -------------------------- 1) Change of name 2) Change of address 3) Change of phone number
What will the pharmacy technician ask when the patient comes to pick up their prescriptions?
If they need a consultation.
What is it imperative that the technician should do should the computer system alert them to a potential problem, reaction, or allergy to a drug?
Immediately inform the pharmacist.
On a prescription, a prescriber must _____ whether it is permitted for a patient to receive a _____ or a _____.
Indicate ------------------ Brand name drug ------------------ Generic equivalent
On a patient's profile, what includes the patient's insurance company, phone number, group number, patient identification number, and other information that specifically identifies the patient?
Insurance and Billing Information
Filling a prescription with the generic equivalent, but indicating instead that the brand was filled is considered _____ and is punishable by _____ under _____.
Insurance fraud -------------------- Federal law -------------------- HIPPA
When verifying that the information on a patient's profile are up to date, what else should a technician verify at this time? Why?
Insurance information ------------------------ Insurance carriers change due to employment or benefits change.
Technicians need to ensure that the patient's profile is always _____.
Kept up to date with the correct information.
What should the pharmacy tech makes sure take care to keep intact in order to save the patient from any harm?
Making correct filling and dispensing processes.
On a patient's profile, what includes any past or present information related to the patient's condition and treatment, as well as any known allergies?
Medical History
What does MAR stand for?
Medication Administration Record
In a hospital or institutional setting the _____ will be slightly different than in a retail setting.
Medication processing
What is one of the most important items in a patient's profile?
Name
What does NDC stand for?
National Drug Code
A 10-digit, three-segment, permanent and unique number assigned to the drug by the US Food and Drug Administration when it first becomes available in the United States.
National Drug Code (NDC)
Why is information about the patient's reactions, severe allergic reactions, and the type essential for the protection of the patient?
Omitting it could have fatal consequence for the patient.
Who is permitted to take a verbal prescription or medication order?
Only a pharmacist.
With drug alerts, what is outside the scope of the technician's practice to do?
Override most of these alerts.
On a patient's profile, what includes the patient's complete name, patient identification or medical record number, address, date of birth, sex, and name of parent or legal guardian if applicable?
Patient Demographics
What part of the ten essential elements for a prescription includes the patient's name, address, and date of birth?
Patient Demographics
If a patient has had any reactions or severe allergic reactions, where would this information be indicated? What should also be indicated with it?
Patient Profile --------------------- The type of reaction (hives, difficulty breathing, etc.)
Regarding drug interactions, most pharmacy computer systems have automatic warnings that will alert the technician of _____. A qualified and competent technician will have _____.
Possible adverse reactions. ----------------------- A working knowledge of these potential problems.
What part of the ten essential elements for a prescription includes the prescriber's name, address, phone number, state license number, and DEA number?
Prescriber Information
A written, verbal, or electronic order from a prescriber to a pharmacist for a drug or drug device to be dispensed to a patient.
Prescription
On a patient's profile, this section states whether the patient prefers brand or generic medications. What else does this section list a preference of?
Prescription Preferences ------------------------- Whether they want non-child resistant containers with easy-off lids.
On a patient's profile, this is a list of medications the patient has taken in the past or is taking at present. Where might this also be listed?
Prescription history ------------------------ In the patient's medical history.
What are the safety processes implemented in a pharmacy critical for? What happens when one of these steps is interrupted or omitted?
Protecting the patient from potential harm. -------------------------- The risk to the patient increases exponentially.
On a patient's profile, this section states whether a patient has ever refused to sign pharmacy documents. What type of documents might these be? 1) _____ 2) _____
Refusal of Information ----------------------------- 1) HIPPA Forms 2) Insurance Forms
What includes making sure the patient is in the database and collecting any changes that need to be made to the patient's profile (demographic, history, insurance/billing)?
Reviewing the prescription (Step 1 of processing prescriptions.)
After the technician receives a prescription, the challenge is to get the _____ to the _____ in the _____ and _____ at the _____, and at the same time, _____.
Right medication -------------------- Right patient -------------------- Right form -------------------- Strength -------------------- Charge the responsible party
In a hospital or institutional pharmacy, after a pharm tech has filled the medication, the pharmacist has verified it, and it has been delivered to the nursing unit, the nurse will ____ to verify it against the patient's _____ for drug administration.
Scan the medication ----------------------- Medication Administration Record (MAR)
What part of the ten essential elements for a prescription includes instruction on how the patient should take the prescribed medication.
Sig/Directions
What identifies the manufacturer or distributor of the drug?
The Labeler Code - The first segment of the NDC number.
What is the third segment of the National Drug Code (NDC) number called?
The Package Code
What part of the NDC code identifies the type and size of the drug package?
The Package Code - Third Segment
What is the second segment of the National Drug Code (NDC) number called?
The Product Code
What part of the NDC code identifies the dosage form, strength, and formulation of the drug?
The Product Code - Second Segment
If a prescriber's signature has not been written on the prescription, _____ may _____ and sign as _____. What is the one exception to this?
The pharmacist ------------------ Call for verbal verification ------------------ The prescriber's authorized agent ------------------------------- CII Medications
What type of drug interaction warning is common among patients who have more than one doctor writing prescriptions for them?
Therapeutic Duplication
What does TPN stand for?
Total Parenteral Nutrition
How does the prescriber usually order a patient's therapy while in a hospital or institutional setting?
Using a process known as Computer Physician Order Entry (CPOE)
In a hospital or institutional pharmacy, after a prescriber has inputted the medication order into the CPOE, the order is then _____ and _____.
Verified by the pharmacist. ------------------------------- A label will be printed.
What is a common type of drug-drug interaction?
Warfarin and Aspirin