Dispensing In The Community Pharmacy (Ch. 7)

patient profile

An electronic record, stored in the pharmacy computer system, that details the patient's personal and billing information, prescription records, medical conditions, etc.

Delivering the Filled RX to the Patient (Storage)

*Store the completed prescription (most pharmacies use alphabetical or numeric storage bins). *Refrigerate meds that require refrigeration once the final verification by the pharmacist is completed. *Other medications, such as antibiotic suspensions, must be mixed just before dispensing.

When should a prescriber be called prior to filling a prescription?

- If the date is missing on the prescription - anytime the prescription needs to be clarified - when there is a question about the authenticity of the prescription. * All the choices are correct.

What attribute will help a pharmacy technician deal with the variety of tasks expected of him or her?

- able to multi-task - attention to detail - a good listener and friendly * All the choices are correct.

When dispensing a prescription to a patient, the technician should double check the patient's name with the ________prior to completing the sale.

- address - telephone number - date of birth * All the choices are correct.

When a controlled substance is going to be prescribed using e-prescribing, how is the provider's identity authenticated and double protected?

- password - hard token - fingerprint * All the choice are correct.

Match the community pharmacy service and the chronic disease benefit -1. blood sugar check -2. smoking cessation counseling -3. blood pressure check -4. cholesterol screening -5. seasonal flu vaccination clinic

-1. diabetes, smoking cessation -2. COPD, blood pressure check -3. cardiac disease and hypertension -4. cardiac disease and hypertension -5. influenza

Prescriptions Not Yet Due

-A prescription not yet due does not have to be (or cannot be) filled until a future date. -A patient may have sufficient supplies at home, may not have enough cash on hand, or may have pending insurance coverage. -The prescription will be held in file box or entered into patient profile for a later date. -Most state boards do not allow Schedule II prescriptions to be stored for future use.

Written Prescription

-Paper or hard copy with preprinted prescriber info -Typically dropped off at the pharmacy -If unclear, check with pharmacist &, if still unclear, call prescriber's office -Tamper-resistant prescription pad (TRPP) required for Medicaid prescriptions -Any subscription comments on prescription must be included in medication label, such as "take for 10 days" -Critical that correct patient & drug selected when entering into computerized patient profile

What factor(s) in pharmacy cause the pharmacist to depend on good pharmacy technicians?

-free patient counseling -low reimbursements -value-added pharmacy services *All the choices are correct

Phone/Fax Prescriptions

-phone orders may be received by pharmacy technicians, but must be transcribed onto a written prescription by the pharmacist. -Faxed orders are entered into the patient profile & verified by the pharmacist prior to filling -Schedule II prescriptions cannot be faxed

In your pharmacy, 99.9% of prescriptions are filled correctly. If you fill 1500 prescriptions a week, how many errors per week may occur?

1-2

1st step filling New Prescription

1. PT checks the prescription to make certain it is complete and authentic.

10th step filling New Prescription

10. PT prepares the filled prescription (including original prescription, drug stock bottle, medication container label, and medication container) for the pharmacist to check.

11th step filling New Prescription

11. Pharmacist checks the prescription and may initial the label and prescription.

12th step filling New Prescription

12. The pharmacist or PT bags the approved prescription for patient sale and attaches an information sheet about the prescription, including indications, interactions, and possible side effects

13th step filling New Prescription

13. PT returns the drug stock bottle to the shelf. If the bottle is opened, then the bottle is so marked or labeled for inventory ordering.

14th step filling New Prescription

14. PT delivers the packaged prescription to the cash register area for patient pickup (or storage) and pharmacist counseling.

15th step filling New Prescription

15. If payment is due, then the patient pays by cash, credit card, or check. Most insurance providers require the patient to sign a form verifying that the prescription was picked up.

2nd step filling New Prescription

2. PT verifies that the patient information is contained in the pharmacy database. If not, enters required date.

3rd step filling New Prescription

3. PT enters (or scans) the prescription into the computer database that bills the insurance company or calculates the cost to the patient.

4th step filling New Prescription

4. The pharmacist verifies the accuracy of the PT's computerized entry against the original prescription and generates the medication container label.

5th step filling New Prescription

5. When required, PT asks the pharmacist to check the drug utilization review (DUR) or drug interaction warning screen.

6th step filling New Prescription

6. PT selects the appropriate medication and verifies the National Drug Code (NDC) number on the drug stock bottle against the computer-generated medication container label.

7th step filling New Prescription

7. PT prepares the medication: Prescribed # of tablets or capsules are counted or the prescribed amount of liquid is measured.

8th step filling New Prescription

8. PT packages the medication in the appropriate container.

9th step filling New Prescription

9. PT labels with the computer-generated medication container label. (In some states the law requires the pharmacist to affix the label to the container.)

tablet splitter

A device used to split tablets in half

Refill Requests

A patient calls or requests a refill in person. -The pharmacy technician verifies that a refill is available & forwards the request to the pharmacist for review. -Most insurance plans allow refills up to 5 days early. -Early refills are generally rejected by insurance, but permission may be granted for a one-time early refill. -No refills are allowed when a prescription is more than 12 months old (nonscheduled), 6 months old (Schedule III-V), or if it was already transferred to another pharmacy

Drug Utilization Review (DUR)

A program designed to alert physicians and pharmacists, identifying potential medication errors, drug interactions, allergies, etc.

DEA number

A registration number assigned to physicians by the Drug Enforcement Administration authorizing them to prescribe or dispense controlled drugs

auxiliary label

Additional labels placed on prescription packaging that provide supplementary information, various warnings, routes of administrations, etc.

During which step in the critical path of a new prescription should the pharmacy technician verify and update the patient's profile?

After receiving the new prescription.

A woman vacationing in your town asks to have her zolpidem 5mg prescription transferred to your pharmacy since she has run out of medicine. Which statement is true about this transaction?

All refills will be transferred in but cannot ever be transferred again.

During the drug utilization review, which screen code means there is allergy listed on the patient profile that may be cross reacting with the new prescription?

DA

What piece of information is required on a controlled substance prescription for OxyContin that would not be needed for a prescription for the antibiotic amoxicillin?

DEA number.

brand name medically necessary ("brand necessary")

Designation on the prescription by the physician indicating that substituting for the generic drug is not allowed

What part of a prescription's information may look different on the label but is not an error?

Drug name

Identify the incorrect statement concerning electronic prescriptions.

E-Rxs not allowed for any controlled substance.

Roles of A Retail Pharmacy Technician

Greeting customers - Answering the phone - Initiating refill requests - Clarifying prescription ?'s - Updating patient profiles - Entering & updating billing information - Entering new prescriptions - Submitting online prescription claims - Resolving eligibility & processing issues with insurance companies - Counting, reconstituting, packaging products - Affixing medication container labels - Retrieving products from drug storage - Returning stock bottles to their locations - Distributing labeled & verified meds to the patient - Storing completed prescriptions -Retrieving medications at pickup - Offering a medication counseling opportunity for patients - Accepting payments & co-payments

All new patients should be given a copy of the pharmacy's personal information privacy policies to comply with (the)

HIPAA.

A patient has one prescription to fill, and she was told it would be ready in 10 minutes but she is still waiting after 20 minutes. What should the pharmacy technician tell the patient?

Let me see where your prescription is in the process.

Which identification number for a prescriber may be looked up on-line and is needed for billing purposes?

NPI number

You receive a prescription for Vicodin that is not on tamper-resistant prescription paper (TRP). What should you do?

Notify the pharmacist

Delivering the Filled RX to the Patient (Counseling)

Pharmacist must offer counseling to patients for every new prescription. Counseling available at patient request for refill medications.

What marking on a prescription drug bottle label means that an official prescription from a legal prescriber is necessary for dispensing it to a patient?

Rx Only

critical path of a new prescription

Starts with receipt of prescription Ends with dispensing to patient Takes about 5 to 10 minutes Has many phases that are completed by the PT

Pharmacist's Final Check of Rx

The pharmacist *Reviews the original prescription order *Compares it with the patient profile *Confirms that the patient information sheet has been printed *Verifies that the drug selected by the technician (from the stock bottle) is correct *Checks the accuracy of the medication container label

Which product is labeled as a unit-of-use package?

Ventolin HFA Inhaler

Delivering the Filled RX to the Patient (Pick-up)

Verify that the correct patient is receiving the dispensed medication (ask for address or birth date), especially if someone else (i.e., a family member or a friend) picks up the prescription.

Partial Refills

When pharmacy does not have enough drug inventory to completely fill order -A 2 to 5 day supply of medication given when pharmacy has insufficient inventory to fill or refill a prescription -Patient typically billed only for amount received -Must alert patient about partial fill & inform them of when remainder can be picked up

drug seeker

a customer who attempts to acquire controlled substances - with the intent to abuse or sell them - by requesting early refills, or bringing prescriptions from multiple physicians

unit of use

a fixed number of dose units in a drug stock container, usually consisting of a month's supply

medication container label

a label with dosage directions for the patient

patient information sheet

a leaflet printed from the prescription software and provided to patients on each medication dispensed

out of stock (OOS)

a medication not in stock in the pharmacy; a drug that must be specially ordered from a drug wholesaler

partial fill

a situation in which the pharmacy cannot completely fill the prescribed quantity written on the prescription; pharmacy dispenses a sufficient amount for the patient to use until the pharmacy receives more of the requested drug

safety paper

a special tamper-proof paper required in many states for C-II prescriptions to minimize forgeries

Prior Authorization (PA)

additional approval from the prescriber, justifying the need for insurance to cover a high-cost drug that is not approved in the insurer's formulary; drug cannot be dispensed until PA is approved

In providing vaccine services in the community pharmacy, the technician is not allowed to

administer the vaccine.

To minimize the risk of medication errors at patient pick-up, the technician should ask for any of the following information with the exception of the patient's

age.

During the drug utilization review, an alert for a potential allergy and a drug-drug interaction occurs, what should the technician do?

alert the pharmacist for guidance

refill

an approval from a prescriber for the pharmacy to dispense more of a drug to a patient without a new Rx order

prescription

an order written by an authorized medical practitioner for a medication to be filled for a patient, to treat a medical condition

During the filling process, at what stage should an antibiotic be reconstituted?

at patient pick up

What automated equipment helps speed the filling of a prescription?

automated dispensing machines

What technology is being used by most pharmacies to decrease the risks of selecting the wrong drugs for filling prescriptions?

barcode scanning

A prescription for Cortisporin reads "OU." What do you type on the label?

both eyes

How often should the technician calibrate the automation technology in the pharmacy?

daily

Working at a chain pharmacy, you often enter prescription information on a _________ which is connected to a __________ that stores and processes the data.

dumb terminal, remote computer

What is an advantage of an e-prescription?

easy to read

e-prescribing

electronic generation, transmission, and filling of a medical prescription

When an automatic dispensing machine is used to fill a prescription, the pharmacist does not have to do a final check.

false

When collecting the patient's information, a physical address is required by law for

filling controlled substances.

Which abbreviation has the Institute for Safe Medication Practices (ISMP) designated as dangerous and should not be used?

hs

allergy

hypersensitivity to a substance, resulting in an inflammatory immune response

Dispense as Written (DAW)

instructions from the prescriber to "dispense as written," generic substitution is not allowed; "DAW2" indicates patient preference for brand name

Which of the following pieces of information is not legally required on a prescription?

insurance provider

The ability to exchange and process information between internal and external databases by a pharmacy software system is called

interoperability

If a patient uses more than one pharmacy, which component of the profile will not be 100% complete?

medication history

During which part of the prescription filling process is a drug-drug interaction most likely to be detected?

order entry

Which tasks should a pharmacy technician never do?

override computer alerts

With a _____ prescription fill, the pharmacy technician should provide the patient with a

partial fill, date for the rest to be filled

The pharmacy's personal information privacy policy needs to be signed by the patient and saved as part of the

patient profile.

When may a generic equivalent drug be dispensed for the brand name prescribed drug?

physician signs the "substitution permitted" line

What area in the community pharmacy is restricted to pharmacy personnel only?

prescription preparation area

signa ("sig")

section of prescription with instructions for the patient to follow when taking the medication

inscription

section of the prescription that gives the drug name, strength, dosage and instructions

subscription

section of the prescription with instructions for the pharmacist about dispensing, compounding, packaging, refill information, etc.

The directions for the patient to follow are contained in what part of the prescription?

signa

Which of the following is exempt from the Poison Prevention Packaging Act of 1970?

sublingual nitroglycerin tablets.

What part of a prescription has instructions to the pharmacist in dispensing the medication?

subscription

A prescription for amlodipine is over 12 months old, and a patient is requesting a refill on a Sunday because he is completely out of medication. What should the pharmacy technician do?

talk to the pharmacist

Which type of prescription does the Center for Medicare and Medicaid Services (CMS) require to be done on a tamper-resistant prescription pad?

written prescription

Prescription Processing

• Complex procedure that must be efficient & accurate • Requires teamwork and communication from the pharmacy technician & pharmacist • Begins with the receipt and review of the prescription • Ends with the dispensing of the prescription • Takes about 5 to 10 minutes per prescription without interruptions, 15 to 20 minutes with typical interruptions • Additional steps are required for certain types of prescriptions: controlled-substances, high-cost drugs that require PAs from the insurance company, and drugs with REMS programs