Community Pharmacy Practice
According to FR 45ML of a medication is needed for a liquid compound. if the medication contains 12.5mg/5ml, how many mg of this medication would be added to the compound?
112.5MG
A prescription calls for 5mg 2 tabs po now then 1 tab po tid x 5 days (brand necessary) how many tablets are to be dispensed for this prescription?
17 tablets
A physician has ordered 25mg tid and 8mg are in every milliliter of medication. How many milliliters of medication will the patient need to take in one dose.
3.125mL
Calculate the days supply for a prescription when the total amount dispensed is 90 capsules and the patient must take 3 per day.
30
A prescription calls for 80g of a 10% testosterone gel. How many grams of the gel will be the base?
72G
If a prescription calls for 12 mL bid x 5 days, how many tablespoons are included in the total dosage?
8 TBS in the total dosage
A prescription calls for Inderal 250mg / qd #30. How many mg of Inderal will be in each dose?
8.33mg
Nonformulary
A drug that isn't on the insurance carrier's preferred drugs list
Lab 29: Preparing and Processing Gels
A gel is a light water-in-oil (W/O) preparation made to penetrate the skin. These can also be prepared via extemporaneous compounding. The sample prescription provided for this lab in the worktext is for 60 g of a 5 percent testosterone gel. It's to be made using testosterone powder and a base gel. Disregard the calculations in the worktext and follow those below. 5% is 50 mg per g. Since 60 g is needed, 3 g of testosterone powder is needed so that 5% of the 60 g is the drug. It can also be calculated by multiplying 0.05 × 60 g = 3 g. Therefore, the remainder will be the base (57 g). Although women can be prescribed testosterone, male gender was chosen in the Drug and Class Type section of the Drugs box (pictured here).
Compounding Record (CR)
A log created that includes prescription number, ingredients, and person who prepared the compound
National Drug Code (NDC)
A unique identifier for all US human drugs (OTC and prescription) consisting of a 3-segment, 10-digit number
Which medication, used for severe acne, requires male patients to sign consent to treatment by acknowledging the increased risk of adverse effects?
Accutane or isotretinoin
Drug Utilization Review (DUR)
Alerts to drug interactions, allergies, and disease states based on the patient's profile
Quick Codes
Allow faster searching for drugs when filling prescriptions
Icon
An image or symbol representing a file, function, or other linked information
Lab 13: Narcotic Inventory and Management
An inventory is kept continuously of all Schedule II controlled substances (CII). Each time a CII drug is filled, the prescription is logged and the quantity is subtracted from the inventory. You must have up-to-date knowledge regarding the state and federal laws about your role in dispensing and keeping accurate records of controlled substances. You also must keep in mind that a given drug may be a controlled substance at the state level and not at the federal level (or vice versa). Performing inventory functions, including for controlled substances, involves obtaining a Control Drug Report. Follow the steps in the worktext to practice generating a report. Begin by choosing Reports in the bar at the top of the Visual SuperScript screen. When following the steps in the worktext, choose older dates (for example from the previous year) to ensure getting an actual list of drugs in the report. If you choose the current date, it may result in a lack of results (in other words, no records found). See the example in the figure.
Lab 19: Investigational Drugs and Tobacco Products
An investigational drug is a medication that's still under study and doesn't yet have approval from the FDA to be marketed and sold in the United States. As new products are introduced, the FDA must review the safety and health concerns to the public and consider regulations to include warnings, designation as over-the-counter (OTC) versus prescription medication, and even advertising. For the lab exercise, use the National Cancer Institute's website to find an investigational drug for cancer treatment. After choosing a drug, use that to practice completing informed consent documentation. The World Health Organization has a template you can use.
Dialog Box
Any box containing text fields that opens as a result of clicking a menu item, text box, or other button
Medication Therapy Management (MTM)
Broad range of services supported by the pharmacy team; includes reviews, consults, and immunizations
Controlled substances that are considered _______ drugs are kept in a special double-locked cabinet or apart from regular stock.
CII
Lab 18: Special Medications—Risk Evaluation and Mitigation Strategies (iPLEDGE) Program
Certain drugs that aren't controlled substances are still regulated by the Food and Drug Administration (FDA) because of their high risk of adverse effects in patients. For example, some drugs have a high potential to cause birth defects. For this reason, these drugs are regulated through the Risk Evaluation and Mitigation Strategies (REMS). For example, in the case of prescribing a woman of child-bearing age a drug with a high potential to cause birth defects, the prescriber, pharmacists, and female patient are registered in the iPLEDGE program. Registering in the program indicates that consent to treatment exists and the risks have been explained and the patient understands them. This lab will review the procedure for processing prescriptions for iPLEDGE medications. The iPLEDGE Program Patient Introductory Brochure provides information and guidelines (including for patients) regarding the use of prescribed isotretinoin. For example, there are a number of steps women who are prescribed isotretinoin and who can become pregnant must do, including the following three things: • Choose two effective forms of birth control• Use the two effective forms of birth control together• Get blood or urine tests for pregnancy
Lab 21: Entering Immunization Syringes (Batch Preparation)
Community and institutional pharmacies can offer preventive or wellness programs that include providing immunizations. The vaccines may be supplied in vials as liquids or powders that must be diluted. The vaccines must be prepared and drawn in syringes using aseptic technique. This lab will help you develop the skill to process immunization orders and prepare labels for them. After following the worktext example of entering a new drug, in this case a new measles, mumps, and rubella syringe, use your knowledge of producing labels to make one for a measles, mumps, and rubella syringe for the following patient (and repeat for the rest of the patients in the list of the worktext): Evarista Sandoval, DOB (date of birth): 1/18/74
Lab 28: Preparing and Processing Capsules
Compounding also entails preparing capsules. Medication powders are combined with a powder base and used to fill blank capsules. The size of the capsules used is dictated by the final drug amount. Large quantities of capsules are prepared using automated filling machines. However, the technician may prepare small numbers of capsules using the punch method. With this method, the narrower part of the capsule is punched into the powder and the wider cap is then attached. Follow the worktext instructions as you've been doing for the previous labs to input the capsule type for the example (Cafergot). Make sure to consult the FR to apply the correct quantity of each ingredient. Once the compound is in the system, you can process the prescription. The label will look like the example provided here.
Lab 24: Preparing and Processing Creams
Creams are also made of oil and water, but differ from ointments in that they're water in oil mixtures (W/O) that are made to penetrate the skin. The same procedures are used to prepare and process prescription cream compounds. The differences will be in regards to the choice of ingredients and instructions for mixing. The database entry method is the same as that used to process prescription ointments. When actually preparing the cream, a master formula record is followed. Read the simulation FR to be familiarized with the information used to prepare cream compounds. Practice preparing a CR using the example provided on the Evolve website and the worktext.
How do creams differ from ointments?
Creams are water in oil mixtures that are made to penetrate the skin. Ointments are oil in water mixtures made to provide a skin barrier.
A written prescription indications that the medication is brand necessary; what does that mean and what dispense as written DAW code would be entered for this prescription?
DAW 1 If a prescriber has indicated "brand name medically necessary" on the patient's prescription, then the brand name drug, rather than the generic, MUST be dispensed.
Practice Example 1
Doctor's information: Dr. Jasmine Abbosh, 836 Farmington Avenue, Worcester, MA 01601, ph: 617-734-6340, fax: 617-734-6340Patient information: Richard Clemens, 345 Fenwick Dr, Chestnut Hill, MA 02167Number of refills: NoneRx: Azithromycin 250 mg 2 tabs po now, then 1 tab po qd x 4 days (Brand necessary) DEA # BA4884533 Remember that this process begins by choosing Fill Rx's on the left side of the main menu screen. When the customer information appears (if already in the system), make sure that it's the correct patient and the information corresponds to the prescription. Delete the database-provided doctor name if a new doctor ordered the prescription for the patient. The written prescription indicates that it's brand necessary; therefore, DAW 1 is chosen for this prescription. You'll see the generic and the Zithromax brand under the available choices. This will allow you to choose the Zithromax brand after verifying with the doctor's office (the brand wasn't written on the prescription).
Which main menu button is selected to correct the name of a prescriber in the database?
Doctors
Batch Refill
Drugs prepared for distribution in a disaster or emergency
DME
Durable medical equipment, including wheelchairs, monitors, and oxygen, prescribed by a physician
Lab 3: Making a Change to the Patient Profile or Prescriber Information
Editing Information In Lab 3, you'll learn and practice how to update and edit patient profiles and prescriber information for existing entries in the software. To begin, go to the Visual SuperScript main screen and follow the steps for Lab 3 in your worktext. Remember to click Customers to make changes to patient information. Since you'll be changing information already entered, click the Find icon. Use the name Mary E. Shedlock for this example. When typing the first letter of the last name, you'll see the list of last names beginning with S. You can then double-click on the name whose information you want to change (in this case, Mary E. Shedlock). You can also click on the Edit button on the bottom right of the Customer Lookup box. Now that Mary E. Shedlock's customer box is open, click the Edit icon (see the arrow in the image). The Name field's color will change to blue with the name highlighted in red. Use the Tab key or the mouse to select the Birthdate field and change the date to 08/30/1961. Then click the Family button to change the head of family name to Chris Shedlock.
Lab 12: ePrescribing Using the eRX Feature
Electronic submission of prescriptions has the following advantages: Prevents the misinterpretation that can occur with handwritten prescriptions Allows rapid information transfer Provides the most current profile To see the Queued Rxs, open the Visual SuperScript program and click the top left pink bar that says New eRxs. Any queued Rx's will be listed in the resulting Queued Rxs box. Prioritize the list to refill prescriptions in the following order: WALK INS first, then NEW prescriptions, and last REFILL prescriptions (except when a special situation requires a different ordering).
Lab 15: Prescription Verification Using Bar-Coding Technology
Ensuring and verifying that the correct medication is dispensed based on the NDC, lot number, and expiration date can be effectively achieved using a barcoding verification process. The bulk bottle corresponding to the ordered medication can be scanned for the NDC and other information. This lab will help you to practice how to verify a medication for pickup. Follow the instructions in the worktext to bring up the Rx Activity/Batching dialog box. When reaching the Final Verification box, enter the NDC number; you may copy it from the left side of the Final Verification box (00093-0150-10). Then click the Mark as Verified button and close. Repeat the process for additional prescription items for the patient. Once completed, the batch can be prepared for patient pickup.
_______ is a common function of pharmacy practice and includes preparing ointments, creams, lotions, gels, capsules, and tablets.
Extemporaneous compounding
Refill Authorization Form
Form generated in the database to send to a prescriber to obtain permission to refill a prescription; used when there are no more previously authorized refills
Prior Authorization Request Form
Form used to request medical justification prior to processing a prescription
Lab 4: Adding Third-Party Payment Information to the Database and Reviewing Patient Plan Information
In Lab 4, you'll learn how to add a new insurance plan to the database and enter information regarding the insurance billing procedures. To begin, from the Visual SuperScript main menu, click Insurance Plans. The Insurance Plans dialog box will appear. Here, click the New icon so that the blue Insurance Plan Lookup box appears. Enter the name of the insurance plan (COSPLS) to add in the Plan Name data entry field. Since this plan doesn't exist, you need to click Add Plan, located at the bottom of the Insurance Plan Lookup dialog box. A small box will appear that asks if you want to add the plan. Click Yes. In the first of three major tabs, Insurance Plan Data, go to the Company data entry field and click on the arrow next to the space to see the drop-down menu. Type in the first three letters of the company name. You'll see a list of names appear; you can then choose the company name and click OK. The information for the additional fields includes identifying data for the insurance company, provider and pharmacy information needed for insurance billing, and billing information. The second major tab, Pricing Parameters, is used to enter information such as drug markup factors, copay information, insurance payment maximum, and percent of cost difference between generic and brand-name drug. The Electronic Billing Options tab is used to input information regarding with whom and how insurance claims are settled. After making selections suggested in the worktext, click Save. After completing the first exercise at the end of the Lab 4 demonstration, the information under the Insurance Plan tabs should look like the following three figures.
What's a consequence of applying the incorrect DAW code for a drug in the database?
Incorrect reimbursement amounts to the pharmacy
_______ drugs are most commonly associated with cancers, HIV, autoimmune diseases, and myocardial infarctions.
Investigational
What are two advantages of blister packing?
It allows the return of unused medication and makes frequent dose changing feasible.
A doctor provides authorization to refill an expired prescription for a patient. how do you proceed to fill the prescription now that you have the authorization?
It's necessary to type in the prescription number, then to click on Copy to New Rx in the Can't refill, select copy options box.
While filling a prescription via the database, you must add abbreviated directions regarding how the patient is to take the medication. Where do you enter this info and how do you get to that area?
It's typed in the SIG field of the prescription processing box.
Lab 14: Durable and Nondurable Medication Equipment and Supplies
Many pharmacies provide various types of durable and nondurable medical equipment (DME, non-DME), medical supplies (for instance, wheelchairs and prosthetic devices), nondrug therapeutic agents, nutritional products, and more. Therefore, the pharmacy technician must be able to process orders for patients needing these types of items. For this lab, you'll use the prescription data entry knowledge you've gained in previous labs to fill orders for non-drug items and medical supplies. See the figure as an example of the default entries that can be used to fill an order for supplies. For a glucose meter, for example, the number of refills was entered as 0, and 30 was entered for Prescribed Days Supply. Below is an example of a label for a medical nutritional product according to the practice entry for the Ronald Gaston exercise.
What's the purpose of the master formula record FR and what does it include?
Master formula record FR is essentially a recipe for a compound and includes all of the ingredients and instruction for preparation of the compound and its documentation.
Lab 17: Medication Therapy Management
Medical therapy management encompasses services such as performing medication therapy reviews, pharmacotherapy consultation, vaccinations, wellness programs, and more. In these efforts, pharmacy technicians can prepare personal medication records from patient profiles so pharmacists can use these to prepare for patient counseling appointments. From the medical therapy review performed by the technician, the pharmacist develops plans to help patients get the most benefits from their medications and help prevent medical errors and other problems with the patients' medications. This lab will provide the opportunity to practice the review and recording of profile data needed for a patient medication reconciliation report.
Lab 20: Reconstitution and Flavoring Pediatric Medications
Medications are flavored to help increase patient tolerance. This applies to human and animal patients. This is especially important for pediatric medications, given the well-known difficulties many parents and caregivers have when giving medications to children. The overall goal of medication flavoring is to encourage medication compliance. Many medications available are in dry forms (powders) that need to have liquid added (a process called reconstitution) before they're taken. There are situations when pharmacy technicians must reconstitute a medication before dispensing, or provide easy-to-follow instructions to patients on how to reconstitute the medications themselves, as well as how to store them between dosing. To properly dispense and provide patient instructions, you'll use your mathematics knowledge to interpret a prescription in such a way that a patient can take the reconstituted medication. This is particularly true if the medication will be dosed using the household measurement system (teaspoons, drops, and so on). Here is an example of how to use the steps provided in the worktext to determine how to process the following prescription from one of the exercises: Patient: Adele Wilson Doctor: Dr. Terrance Abbamont (as spelled in Visual SuperScript) Zithromax 200 mg/5 mL susp., 400 mg × 1 day, then ¾ tsp × 4 days 10 mL will be needed the first day to provide 400 mg of Zithromax ¾ tsp = 3.75 mL 4 days × 3.75 mL = 15 mL. Therefore, a total of 25 mL will be needed. A bottle that's reconstituted to 30 mL is available (with a final concentration of 200 mg/5 mL). Therefore, this bottle will be used for dispensing.
Lab 1: Adding a Physician or Prescriber to the Database
Most of the labs in your worktext include steps to print medication labels to submit to an instructor. You're not required to submit the results of your labs for this course. While completing your labs, you'll be able to see the results of your labels by viewing a print preview, but you should move on to the next step without printing. The purpose of the first lab in the Pharmacy Management Software worktext is to learn how to add doctor or prescriber information to the database. In the case of prescriptions for controlled substances, the prescriber's Drug Enforcement Administration (DEA) number must be on the prescription. These are nine-character codes, and the first two characters are letters (A, B, F, M, or X). A mathematical formula (the checksum test) can be performed to determine if the DEA number is valid. Using the textbook example, the steps are as follows: Dr. Jack Jenkins (AJ3456781) The first letter is one of the DEA-approved letters indicated. The second letter is the first initial of the prescriber's last name (J in this case). 1. Sum the first, third, and fifth digits: 3 + 5 + 7 = 152. Sum the second, fourth, and sixth digits: 4 + 6 + 8 = 183. Multiply the answer of step 2 by 2: 18 × 2 = 364. Add the answers from step 1 and 3: 15 + 36 = 51 Look at the last digit of the final answer, in this case, 1. This should be the same as the last digit of the DEA number. The numbers are the same; therefore, the DEA number is valid. Use the information on a prescription to add the prescriber or doctor information to the database. Use the following information, which is pulled from the Exercise section of Lab 1 in your worktext, to add the prescriber information to the database: Dr. Emma Francis2208 Colonial Acres Court, Suite 444Herndon, VA 20170Phone: 703-430-3814 Fax: 703-430-3813DEA: BF2368529State License/Medicaid: 023569Contact: Office Secretary Follow the steps below to input the information. Go to the main screen of the Visual SuperScript program. Look for and click on the Doctors button located along the left side of the screen. (It's the fourth box from the top.) When you click on that, a box appears with the title Doctors. The box will show the information of the first doctor on the list by default; this information will change when you select or add a new doctor. If there's no information in the database yet, the program will be in add mode. You'll see a hand pointing to a magnifying glass, the Find icon, in the toolbar. Click on the Find icon (magnifying glass symbol) on the top left of the toolbar, and the Doctor Lookup dialog box will appear. Enter the first three letters (fra) of the prescriber's last name in the name field. If this is a new doctor, the name isn't found on the list. You'll need to add the doctor's name by clicking Add. Click Yes when asked if you want to click the name manually. Enter the prescriber name in the Name field (which is a required field) by typing the complete last name, comma, space, and then the complete first name; in this case, enter Francis, Emma. In the Contact field (under the Name field), you may add the contact. This would be the person with whom you'll speak when clarifying information or getting authorization for a refill. For this example, type Office Secretary. Enter the prescriber's address in the Address field, and enter the city, state, and ZIP code in the City/State/Zip fields. For this example, the address information isn't in the ZIP pop-up box that appears once the ZIP code is typed in the correct field. If the ZIP were listed, you could click it and then click OK; since it isn't, click Cancel to close the box and return to the Doctors screen. To add the missing ZIP code to the list in the ZIP popup box, hover the mouse cursor over the Zip field and right-click. A smaller box with a short drop-down menu will appear. Choose Add new from this drop-down menu. You'll see another box where you can add the prescriber's ZIP code, city, and state abbreviation. When you've entered the date, click on the Save icon located at the top right of the ZIP codes box. After that, click the Close icon (an open door) located to the right of the Save icon You can verify addition of the correct ZIP code information by clicking on the combo-box arrow immediately to the right of the ZIP code data entry field. When you do this, you'll see the ZIP code, city, and state information if you've added it correctly. You may now add the remaining information: Add the prescriber's phone number, 703-430-3814, to the Off Phone 1 field. The additional shorter box to the right is used to add an extension when there is one; in this example, there isn't. Add the fax number, 703-430-3813, to the Fax field. Type the prescriber's initials in the Quick Code field. Enter the DEA number, BF2368529, in the DEA # field. The DEA # field is located in the blue colored area of the Doctors box. When adding the DEA number, you'll get an error message that says, "DEA Number is not Valid. Retry?" This error appears because the DEA number used is an example, not a real DEA number. Click No to continue. Enter the state license number, 023569, in the State License # field. Enter the prescriber's Medicaid number, 023569, in the Medicaid # field. In the blue colored area, the small white box next to the phrase "Covered by Medicaid" is already checked. In your work, you'll keep this checked if the prescriber has the authorization to write prescriptions for patients with Medicaid. Click the arrowhead next to the field under "Hospital." You'll see a drop-down area. Choose City Hospital. This will then appear in the "Hospital" field. Click the drop-down arrow next to the Status field. Choose the Active option. This option means that the prescriber is actively practicing. Click the Save button at the top of the dialog box. You may print the screen with the information filled into the Doctors box. This is done by pressing the Print Screen button on your computer keyboard (labeled Print Scrn or PrtScn on many keyboards). Then open a blank Microsoft Word document, right-click in the white space of the document, and select Paste from the menu that appears. You can close the Doctors screen by clicking the Close icon.
What drug information is used to add a new medication to the database?
NDC
What's the term for a drug that isn't on an insurance company's preferred drug list?
Nonformulary
Lab 23: Preparing and Processing Ointments
Ointments are oil in water mixtures (O/W) made to provide a skin barrier. The preparation of ointments is part of the extemporaneous or nonsterile compounding process. Some terms you should be familiar with in association with ointment preparation are: Master formula record (FR): Essentially a recipe for the compound; includes all of the ingredients and instructions for preparation of the compound and its documentation Compounding record (CR): A log generated on completion of the preparation that serves as a record of the compound Safety data sheet (SDS): The chemical information for each active ingredient that's included as part of the compound documentation The resulting Drugs box after following the instructions for processing a compounded ointment is below. The quick code selected was NITR02, but you can create your own quick code. Once in the system, the prescription can be processed. An example label for the ointment example of the worktext is provided below. When actually preparing the cream, a master formula record (FR) is followed. Read the simulation FR to be familiarized with the information used to prepare ointment compounds. Practice preparing a CR using the example provided on the Evolve website and the worktext.
The _______ grid contains information about additional drugs the patient is taking
Other Drugs
Extemporaneous (Nonsterile) Compounding
Preparing medications in a mixture or dose form that isn't available from the manufacturer
What must the pharmacy request when a prescribed drug is nonformulary?
Prior approval (to request medical justification)
Lab 10: Processing a Prior Authorization
Prior approval is the provision of a medical justification for a drug. The pharmacy must complete documentation before processing the prescription when prior approval is needed. This is often required when the prescribed drug is nonformulary—not on the insurance company's list. When performing the sample exercise in the worktext, the prescription will be rejected, and a DUR must be completed. Choose Prior Auth/DUR in the Prescription Processing form and apply the indicated prior authorization code and prior authorization number provided. After that, close, save, and submit (Xmit). The Claim Status will now show as paid.
Practice Example 2
Process a refill request for the following patient. Karen AndersonDOB: August 03, 1973Requested Refill: Ortho Evra Patch In the Prescription Processing form, find and choose Customer History/Refill. Find and choose the customer. You'll see the list of prescriptions and can choose the corresponding drug(s) to refill. In this case, it's the Ortho Evra Patch. Once the drug to be refilled is chosen, click the Fill Rx button. You'll be returned to the Prescription Processing screen When you choose Continue as is, you'll see the screen as it appears in the following image.
What will you submit to the prescriber to provide another refill for a patient whose refills have run out?
Refill authorization form
Lab 11: Refilling, Transferring, Filling, and Prescription Reversal
Refilling Prescriptions This lab of the worktext will show you how to refill prescriptions, transfer a prescription to another pharmacy, and perform a prescription reversal. The steps to refill a prescription are similar to the steps followed to process a new prescription in the database. The difference is that the prescriptions already will be listed in the Customer History: Refill Rx's box. Search for the patient's name by clicking the Prescriptions on File tab then clicking the checkbox next to the prescription you need to refill. If you're refilling more than one prescription, more than one checkbox can be selected to process them all at once rather than individually. Transferring Prescriptions Because of travel, economic, or other factors, a patient may need a prescription transferred to another pharmacy. This can be done using the Transfer Out (Xfer Out) option on the Customer History: Transfer Rx Out form. Each state has specific pharmacy regulations, which may determine whether medications can be transferred between states. To begin transferring prescriptions, click Fill Rx's from the main menu. Then click the transparent arrow next to the term "Misc," located on the Prescription Processing form. This will make dropdown information appear. Choose Xfer Out. If you don't see the "Misc" term listed on the left side of the Prescription Processing form, click the transparent up arrows next to the other terms to collapse the other dropdown lists. If too many of the lists are open, "Misc" has likely been pushed below the window and out of sight. After you click Xfer Out, a box titled "Customer History: Transfer Rx Out" will appear. Select the correct customer by searching for the customer name. Next, select the prescriptions to be transferred by clicking the checkmark box next to each. Then click Xfer Out at the top of the dialog box. In the Transfer Rx Out popup, complete all necessary information and click the Transfer Rx button. In the Transfer Rx Out box, use the arrow next to the Store field to choose the pharmacy to which the prescription will be transferred. After entering that and the new pharmacist name, choose Transfer Rx at the bottom of the box. Putting Prescriptions on File for Later Filling As your worktext explains, putting a prescription on file for later filling can be done when patients aren't sure they'll need the prescribed medication but would like the medication to be filed in case they wish to get it filled at a later time. You'll begin this process by entering the patient information as if a new prescription is being filled. Once the information is entered, click the Hold This button (located under Xmit/Record) on the Prescription Processing form. The patient's insurance company won't be charged while the prescription is on hold. Now, work through the Putting a Prescription on File exercise in your worktext. Reversing a Prescription Order If a patient no longer wishes for a prescription to be filled, the prescription can be reversed. To start the reversal, click the Rx Reversal button in the "PA, DUR, etc" dropdown list on the left side of the Prescription Processing form. A box labeled Rx Reversal appears. Enter the prescription number and filled date into the appropriate text boxes. The insurance field is then highlighted. Select the correct insurance information and then click Proceed to complete the reversal.
Risk Evaluation and Mitigation Strategies (REMS)
Regulations for certain drugs that increase the chance of severe adverse effects and birth defects
Master Formula Record (FR)
Required ingredients and instructions to prepare and document a compound
When using a program such a Visual SuperScript, why is it important to follow the name-entering format suggested?
Sample answer: Following a consistent format makes it much easier to search for and find names in the database. It will also help to locate multiple entries for the same person when merging customer information.
Why is blister packing and batch filling customarily used for home care facilities such as nursing homes and long-term care facilities?
Sample answer: The use of blister packing is more feasible given the individual dose packing. This also allows return of unused medications, which is more common in home care patient populations. The batch filling allows the preparation of medications for several patients of a single facility.
On the prescription processing screen, in what text box would you find the instructions "APPLY ONE PATCH EVERY WEEK, THEN SKIP ON WEEK"?
Sig
Which of the following is an important factor affecting the transfer of prescriptions out of state?
State regulations
What's the meaning of the sig abbreviation shortcut 1T BID?
Take one table twice per day.
Which tab of the Drugs form is used to list non sterile compound components?
The Compound Drug Ingredients tab.
What's the advantage of using the NDC code when adding new drugs to the database?
The NDC code allows the accurate and quick identification of the exact drug data for addition to the database. In addition, adding the drug to future prescription orders will be made simpler because you can look it up by the NDC. It also will eliminate sound-alike/look-alike drug errors when typing in data.
Customers
The button clicked to begin adding new patient information
While reviewing Jason Thomson's electronic profile, you're prompted to the Customer Lookup text box. What do you enter to look up this customer's history?
The first three letters of the customer's last name. In this situation you would type THO
Reviewing a Patient's Electronic Profile and Completing a Personal Medication Record
The instructions in the worktext indicate the steps to get the patient history. The procedures used are similar to the steps learned in previous labs. The Prescription Processing form can be used to obtain the prescription history for a patient, while the Customer button to the left of the initial program screen can be used to get additional information such as birthdate, disease history, existence of any allergies, lab and diet orders, and more for recording on an MTM form. An example of the customer box for the patient in the exercise (Miguel Sanchez) is provided.
What does the Max Refills data entry field represent?
The maximum number of refills allowed under the insurance plan
Who is the head of household?
The medical card for ****John Doe**** has listed: Health Plan 123-45678-90 Member ID 987654321 Group Number 111222 Member John Doe State Health Plan Dependents Jill Doe and Jack Doe Payer ID 12345 Rx Plan Rx Bin 987654 RxGrp DAAHC13
Lab 16: Emergency and Disaster Planning
The pharmacy technician must be able to participate in disaster planning and preparedness. This includes the ability to distribute emergency medications and supplies during a disaster. Patient privacy must still be ensured during a disaster. There must be effective communication with team members and coordination during emergency activities. This lab will demonstrate the preparation of a batch refill and a corresponding report. To prepare a batch refill, you'll enter the prescription processing form as you've done in the previous refill exercises. Once the refill request is completed, the process is repeated for each patient. Print all of the labels and take the stock bottles from the shelf for one patient at a time. The NDC of the stock bottle is then compared to the labels. An individual patient's medication, label, stock bottle, and delivery ticket are grouped and kept together for the pharmacist's verification. The worktext provides the steps to prepare the batch refill report beginning with clicking Reports at the very top of the Visual SuperScript screen, followed by Customer Reports, then Customer History. When choosing dates in the dialog box, use an older date so there are results (not the current date of the exercise). For example, use 04/04/2017. View the sample report provided here.
Lab 25: Preparing and Processing Medicated Troches (Lozenges
The preparation of lozenges (medicated troches) is another dosage form involving extemporaneous or nonsterile compounding. These can be prescribed for patients with oral or throat infections, lesions, or injuries. These are prepared by adding flavorings and colorings. Follow these basic steps in preparing lozenges: • Melt the base on a hot plate.• Add the medication, flavorings, and colorings to the melted base.• Allow cooling and pour into a mold (where it's further cooled). The following figure shows the Drugs box for the lozenge entry. The FR form contains the quantities needed for each stock ingredient and is used to enter the quantities for each ingredient.
You filled a prescription for a patient who hasn't yet picked up her medicine. She calls and says she no longer what's the medication. What action in the database will need to be performed?
The prescription can be reversed by choosing the Rx Reversal box on the left side of the Prescription Processing Form.
Lab 26: Preparing and Processing Compounded Oral Liquids
The processing of liquid and suspension compounds is very similar to that for the other types of extemporaneous compounds. Remember to refer to the FR to obtain the needed quantities that are entered into the Drugs form/box. According to the FR, 60 mL of each ingredient listed for the worktext example is needed. DD DiphenhydrAMIN (Benadrl) 12.5 mg/5 mL 473 mLDD Al/Mag/Simethicon 200 mg/mL (Maalx) 473 mLDD Triamcinolon acet (Nystatn) 100,000 units/mL suspension 473 mLDD Lidocain HCl 2% oral topical viscous solution 100 mL The prescription for Magic Mouthwash can now be processed.
Lab 27: Preparing and Processing Medicated Lollipops
The processing of medicated lollipops is very similar to that for the preparation of lozenges. Again, refer to the FR to obtain the needed quantities that are entered into the Drugs form/box. The amount of each ingredient is provided below. DD Acetaminophn-APAP powder 100 g 100 gDD POWDER Steviosid 100 g 0.12 gDD SIMBASE LOLLIPOP 500 0.15 gDD Grape flavor 120 mL 3 mLDD Color (violet) 1-2 gtts (0.05-0.1 mL) **Skip if not found in database After entering the ingredients, the Drugs form would appear as follows.
Lab 2: Adding a New Patient to the Database
The purpose of Lab 2 is to practice adding patient information to the database. The steps are similar to those for adding prescriber information. Go to the main screen of the Visual SuperScript program. Click the Customers button, located along the left side of the screen under the Doctors button. A Customers dialog box will appear. Follow the steps as indicated in Lab 2 in your worktext. You can see that the steps are very similar to those for adding the prescriber's information. If a typographical error is made or if the field doesn't contain valid information, a small error box will appear briefly in the upper right side of the customer box. For example, if an invalid date is entered into the Birthdate field—such as 02/30/1995 (an impossible date, since February only has 28 or 29 days) or 05/05/2040 (a date in the future, which couldn't logically be a birthdate)—an error message will appear and you'll be unable to continue until you enter a valid date. After adding the head of family information (address, phone number), save and close. You'll return to the Customers box again. You'll be able to add Patient is hard of hearing in left ear in the Notes box. There, you may add driver's license and Social Security information (located on the top right of the box). Note that the Driver License field is a drop-down box; if the patient doesn't have a driver's license, another form of identification can be selected from the drop-down box and entered into the text box. Under that field is the patient ID box where you'll actually type the driver's license or ID information. The ChildProof Option area already has CP selected by default. If something else is specified on the prescription, such as easy-open lids, this can be specified. In that case, you would click on the combo-box arrow next to ChildProof Option. To apply the allergy information, click the Allergies tab located on the bottom half of the form. Then, click on the New button (which looks like a blank page), located to the right of the allergies list. The Allergen Lookup dialog box appears. You'll be able to choose an allergy from that list. You can type the first three letters of an allergy name in the Name field to find the corresponding allergen more quickly. Select the allergen you need, then click OK. The allergen will now be listed under the Allergies tab. After clicking the Disease Profile tab, click the Add New button, which will highlight a row of the Disease list. Right-click the highlighted row to see a small drop-down list. In that list, click Picklist and the CDIAGCODE box appears. You may also press the F2 function key on your keyboard to get the CDIAGCODE box. You'll then be able to choose diseases from that list. You can type the first few or all letters of the disease to find it more quickly. Note that for the worktext example, the code for diabetes mellitus is stated as 208, but the program indicates a code of 250. You need to make sure you choose diabetes mellitus only. After choosing the diseases that the patient has, they'll appear in the Disease list. You can then save, print the screen, and close the dialog box.
Lab 9: Obtaining a Refill Authorization
The steps for this lab in your worktext will walk you through completion of a refill authorization request. A refill authorization request is performed in cases when there are no authorized refills in a patient profile. An example of when this may be needed is when a patient needs to continue a prescribed medication that has finished before he or she can be seen at a return doctor's appointment. To complete the exercise provided, first input the prescription. Use a prescription and dispense date that would be expired. Take note of the prescription number. However, you can choose Cus History/refill to see the prescription and number. Once it's in the system, you can input the prescription number into the Rx # box of the Prescription Processing form. You also can check the prescription in the customer box (after using Cus History/refill) to refill it by choosing Fill Rx in this area. In the Cannot Refill, Select Copy Options dialog box that appears, click Copy to New Rx (after receiving authorization to fill the prescription). Type in the number of refills authorized in the Refills Ordered field of the Prescription Processing box. You then can save and perform Xmit/Record to complete the refill. View the image of the resulting label for the exercise of the worktext. If the prescription number is known, you can choose Refill by Rx # in the Prescription Processing box then input the number to perform the refill authorization request.
Dialog box
The visual superscript program the name of the boxed area where info can be filled in or selected.
Helpful Navigation Notes
There are many ways to enter data, such as names, prescription numbers, and dispensing dates. Data can be typed into text boxes manually. List boxes, indicated with a down arrow icon, allow you to click one of a number of choices, but you can't type in information. These work similarly to drop-down menus. Combo boxes, indicated with a down arrow icon with a line under it, are very similar to list boxes, but the information in these can be changed. You'll become familiar with these and other functions as you move through your labs. Before you begin Lab 1, familiarize yourself with the icons found in the Introduction section of your worktext. Remembering how these icons function will make navigating the software and completing the labs much easier. Many of the figures found in this course are screen captures of the Visual SuperScript program and have been formatted to better fit your screen. Clicking on the figures will enlarge them, making them easier to read in some cases. Remember this as you work through your course.
Lab 8: Drug Utilization Review Using Electronic Patient Profiles
This lab applies the steps and concepts applied in the previous labs of this section. The exercise of this lab will give additional practice in filling a prescription, changing doctor information, and performing the tasks necessary when encountering a drug utilization review (DUR) warning. The DUR warnings are generated when the program compares the prescription information with the patient profile data. Warnings regarding contraindications appear so the pharmacist can review and communicate with the prescribing doctor. If the prescribing doctor indicates going forward with the prescription that generated a DUR warning, the Prior Authorization/DUR procedure can be performed to fill the prescription.
Lab 7: Processing a New Prescription for a Patient with a Third-Party Payment Type
This lab covers the procedures to fill a prescription and add data for an insured patient. This includes identifying the necessary entry data from an insurance card. After entering the information for the patient in the worktext example (Brian Davidson), the label should look like the following example, which includes the price and copay information. For the exercise to practice refilling a prescription too soon, the worktext instructions indicate how to simulate a refill rejection by changing the prescription date to a week ago, and the dispense date to two weeks ago. However, the correct way to do this is to change the prescription date to two weeks ago, and the dispense date to one week ago. The prescription date must be earlier than the dispense date. Once you've done that, the first prescription (in this example, amitriptyline) can be filled. Once completed, go back and do the early refill steps provided in the worktext using the actual date you're working on in this lab exercise. When there's an issue with drug warnings while filling a prescription, a Clinical Results dialog box appears with various warnings related to the drug and patient status. If instructed by the pharmacist to continue with the prescription, a rejection will occur with the reason. This is the same screen (Claim Status) that appears when refilling too soon. When closing, a pop-up box occurs (to make changes and submit) as it did with refilling too soon. Choose the Prior Author/DUR tab to the left. Choose the New Rx icon in the upper right corner of this box and type the provided conflict codes in the table at the top of the box. Close the box and choose Xmit/Record to process the order. The following three figures show the results of applying the Prior Author/DUR process for one prescription in the lab exercise section (for Tanya Bramwell, coumadin).
Lab 6: Entering and Preparing New Prescriptions in a Community Setting
To add a prescription to the database, click Fill Rx's on the left side of the main menu. This will open the Prescription Processing form. When there's already information regarding pharmacists of a facility, a Select Available Pharmacist box may appear. In this case, click on the arrow, choose any available pharmacist, and click OK. After that, the Prescription Processing form will appear. Click the New Rx icon located at the top left of the form, indicated by the pointing finger icon in the figure below. Type the first three letters of the customer's last name and then press Enter, which brings up the Customer Lookup box. Scroll down and choose the correct name. In the Prescribed Drug area of the box, type LIP for Lipitor. The Drug Name Lookup box will appear. Choose Lipitor 40 mg tablet. After completing the prescription entry for the demonstration provided in the worktext, the printed label will appear as in the following example.
When entering data for a refill, you open the Customer History/Refill tab, which contains other tabs. How many tabs are there, and what are they called?
Two tabs: Prescriptions on File and Refill Rx
Lab 5: Adding a Drug to the Database and Other Inventory Tasks
Using the Drugs dialog box, you can add new drugs to the database, identify a drug using the images in the database, and make inventory-related entries. Start by choosing the Drug tab on the left of the Visual SuperScript window. This opens the Drugs dialog box. There are three tabs in this box, Drug and Packaging, Pricing and Stock, and Welfare & Misc. Begin practicing by using the first tab. Using the Zithromax example provided in the worktext, add the drug using the NDC number. After adding the NDC number provided, various fields will populate. You then can add an abbreviation in the Quick Code field. Quick codes allow quicker searching for drugs. If the Verification Date (the date and time that the new drug is being added to the inventory) isn't automatically populated, you may enter it manually. The format for this information is as follows: mm/dd/yyyy hh:mm:ss AM/PM After following the worktext instructions for adding Zithromax, use the Pricing and Stock tab to add price-related and inventory information. The minimum stock and reorder quantities (Reorder Qty) are added in the Track Inventory section. Following the instruction provided in Lab 5, you can adjust reorder quantities and verify drug identity. To change reorder quantities and minimum stock quantity for a drug in the database, click on the Find icon in the Drugs form. You can then navigate to the Track Inventory tab under the Pricing and Stock tab to change these values. To verify a drug's identity, use the same Find icon to search for the drug. When you find the drug, use the Edit icon on the bottom right of the form (not the one on the top) to open the "Drug NDC" box to view the data for the drug. An example drug to identify in the exercise is Tegretol. After using the steps to identify a drug, the tabs will appear as follows:
What does the term extemporaneous compounding refer?
When a patient is prescribed a specific dose form that's not available from the manufacturer.
Lab 22: Extemporaneous Compounding
When a patient is prescribed a specific mixture or dose form that isn't available from the manufacturer, the medicine can be prepared by extemporaneous (at the spur of the moment) or nonsterile compounding. The pharmacy technician must know how to enter this type of prescription in the database. This will allow the proper preparation of and proper charging for the compounded medication. To begin entering compound drug information, click Data on top of the Visual SuperScript program's main menu. Choose Drugs, which is an option in the drop-down menu that appears. Then click the New icon, then click Label Name. The top half of this Drugs form has three tabs: Drug and Packaging, Pricing and Stock, and Welfare and Misc. Continue to follow the steps as they're described in the worktext. The Item Type field is where you'll indicate that the medicine is a compound. The bottom half of the Drugs form has three other tabs: Manufacturer and Available NDCs, Compound Drug Ingredients, and 3rd Party NDC Preferences. The ingredients of the new compound will be entered under the Compound Drug Ingredients tab. After choosing this tab, click the New icon at the bottom right of the form. Start listing the ingredients by typing in the first three letters of the first ingredient. A drop-down list will appear. Choose the correct ingredient from the menu. Once the correct drug is chosen, a small box will pop up to apply the quantity of the drug. Repeat these steps for each ingredient. Note: When choosing the water for injection as an ingredient in the worktext example, you may choose the 5 mL vial.
What is the correct format to enter dr. seri asantewa's prescriber name info
asantewa sheri
when it's necessary to change patient info the box on the left of the main menu that must be chosen is the
customers
what's the first selection of the main menu to begin the process of merging data for a patient whose info is entered twice with differences in the entered name
data maintenance.
Prior to prescribing a women of childbearing age a drug with a high potential to cause birth defects, the prescriber, pharmacist, and female patient are registered in what program?
iPLEDGE program
where in the database do you input info regarding the minimum quantity of a medication that the pharmacy needs to maintain?
in the track inventory tab under the pricing and stock tab
Extemporaneous, or nonsterile, compounding includes preparing _______, such as solutions or suspensions.
liquids
Where do you search for the NDC to add a drug to the database?
located on the drug packaging
In what situation will you need to use the Xfer Out selection in the database?
patient needs a prescription transferred to another pharmacy because of travel, economic, or other factors.
A pharmacy technician can assist the pharmacist by preparing the history sections or a _______ from the profile for review before the pharmacist attends a counseling appointment.
personal medication record (PMR)
What is the purpose of creating a quick code?
quick note allows faster searching for drug information in the database
