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Qualified Prescriber

A healthcare provider who is legally authorized to grant a medication prescription to a patient

The Joint Commission

A not-for-profit organization that accredits and certifies healthcare organizations and programs in the United States

Medical Record Number (MRN)

A number that's specific to the patient and remains the same during multiple admissions to the same hospital

Formulary Management

A patient care process that enables healthcare professionals to work together to promote clinically sound and cost-effective medication therapy and positive therapeutic outcomes

Prescription Label

A pharmacy-generated label that contains a brief description of the medication dispensed and provides important medication information and instructions for the patient. It also includes the auxiliary label details.

Think of your experience at the local community pharmacy that you visited to get your or a family member's prescription filled. How was the experience? How helpful was the pharmacy technician during your visit? What problems have you faced at the pharmacy?

A sample answer might include: Community pharmacies are very busy places, especially during normal business hours. Pharmacies are also extremely busy during the flu season and the winter months. Pharmacy technicians are an important part of the pharmacy team. They help make sure that the pharmacy workflow runs smoothly and the patients are able to get their medication orders filled within a reasonable amount of time. Pharmacy technicians with great customer service skills and excellent computer knowledge play a major role in providing fast and efficient services to their patients. Two main barriers to smooth processing when filling medications at a community pharmacy are medications being out of stock or facing rejected insurance claims.

Where in hospitals are all the IV bags, IV drips, chemotherapy medications, and emergency crash carts prepared and who prepares them?

A sample answer might include: In a hospital, the pharmacy is the center from where all medications are dispensed to the patients. In general, hospital pharmacy staff includes pharmacists, pharmacy technicians, pharmacy buyers, controlled substance technicians, and management. Pharmacies are responsible for supplying medications for medical nursing floors, emergency rooms, operation rooms, endoscopy areas, and any other part of the hospital where patients need medication. Pharmacies have an enormous responsibility to make sure that all the needed medications are available for the nurses and physicians at patients' bedside as ordered and for immediate use. Emergency medications are stored on the nursing floors utilizing methods such as ADMS, emergency crash carts, and emergency boxes. The IV drips are prepared by pharmacy technicians under the supervision of pharmacists and are delivered to the nursing floors. Pharmacy technicians assist in refilling used crash carts and emergency boxes to make sure that they're available for use for the next patient requiring treatment with emergency medications.

Financial Identification Number (FIN)

A unique number used to identify each patient in a hospital; is specific for each hospital admission

Computerized Physician Order Entry (CPOE)

An electronic system used in hospital pharmacies to transmit medication orders generated by prescribers to the pharmacists

Cart-Fill

An important task in hospital pharmacies is to fill a 24-hour supply of patient medications in the patient cassette drawers. Patient cassette drawers are usually filled during the midnight shift by pharmacy technicians and are delivered to the nursing floor during the early morning hours.

Clinical Trial

Clinical studies in human volunteers that test potential new treatments for the purpose of determining if these treatments should be approved for general use

Pharmacy Technicians' Role in Community Pharmacies

Common duties of pharmacy technicians working in a community pharmacy are as follows: • Provide customer service. • Gather all pertinent information from patients. • Interpret medication prescriptions. • Enter patient and prescription data in the pharmacy's database. • Successfully perform third-party billings or online adjudication to bill prescription medications to the patients' insurance companies. • Assess all rejected insurance claims and take appropriate actions to resolve them. • Count, measure, weigh, mix, and compound medications.

Community, Institutional, and Additional Practice Settings

Community, Institutional, and Additional Practice Settings

Dispensing Controlled Substances

Controlled substances are mainly stored in automated storage units or automated dispensing machines to comply with strict rules and regulations. These and

Stat Orders

Emergency medication orders that must be filled within minutes

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Generic substitution is allowed by the prescriber but the patient requests the brand name medication. The insurance company charges the cost difference between the brand name and generic name medication; or, it may not cover the brand name medication at all.

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Generic substitution isn't allowed by the prescriber. Note: The insurance company will charge a higher copay as compared to the generic drug.

• Prescriptions can arrive at the pharmacy via telephone, in writing, by fax, or electronically.

However, in most states, pharmacy technicians can't accept telephoned prescriptions.

Additional Pharmacy Technician Duties

In addition to filling a prescription for the first time, pharmacy technicians are also involved in additional duties such as refilling prescriptions and contacting prescribers for refill authorization.

Unit-Dose

Individual single-dose medication packages prepared for hospitalized patients

Auxiliary Labels

Labels affixed to prescription medication containers to provide additional important information and list any precautions to use while taking the medication

Hospital Pharmacy Settings

Larger hospitals, which usually have a wider scope of services, may have satellite pharmacies in various sections of the hospital in addition to the central pharmacy.

Pharmacotherapy

Medical treatment via the use of drugs

Controlled Substances

Medications with the potential for abuse and addiction; these require stricter regulations to monitor prescribing and dispensing.

Days Supply Calculation

Most insurance companies allow dispensing only a 30-day supply of medication at a time. Pharmacy

Ambulatory

Patients not admitted to or occupying beds in hospitals or other inpatient settings

institutional pharmacies.

Pharmacies that dispense medications for the patients being treated in these acute healthcare settings are called institutional pharmacies.

Institutional Pharmacies

Pharmacies that dispense medications to patients treated in acute healthcare settings for acute or chronic treatments

Community Pharmacies

Pharmacies that dispense outpatient prescription medications to patients; also known as retail or ambulatory care pharmacies

Prescription Dispensing Process in Hospital Pharmacies

Prescription Dispensing Process in Hospital Pharmacies

Outpatient Prescription

Prescription written for a patient who doesn't require admission to a hospital or other acute healthcare institution

Bar Coded Medication Administration (BCMA)

Process where patient demographics, medical records, clinical notes, medications, and other medical records are all electronically connected

Three of the most common type of ADMS used in hospital pharmacies are made by

Pyxis, AcuDose, and Omnicell.

Poison Prevention Packaging Act of 1970

Requires the use of child-resistant packaging for all prescription drugs, household chemicals, and other hazardous materials that can be dangerous for children

The Five Rights of Drug Administration

Right person, right dose, right time, right drug, right route

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Substitution of the approved generic name medication is allowed.

Labeling in Hospital Pharmacy

The following information must appear on the medication label: • Patient's name and room number • Patient's FIN and/or MRN • Name, strength, dosage form, and quantity of medication • Date on which the medication is dispensed • Frequency of medication administration • Name of the solution and infusion rate for IV medications • Expiration date/before use date (BUD) • Initials of pharmacists and technicians involved in the dispensing process • Auxiliary labels

Prescription Components in a Community Pharmacy

The following is a list of the required components of a valid prescription: • Patient name and date of birth • Date of the prescription • Physician name, address, and contact information • A Drug Enforcement Administration (DEA) number is required for dispensing controlled substances (CS), These medications are subject to strict regulations to monitor their prescribing and dispensing processes to prevent abuse and addiction. • Medication name, strength, dosage form, quantity, and directions on how to take the medication • Refills, if applicable (If no refills are written, it's assumed that the prescriber didn't order any.) • Prescriber's signature

Medication Reconciliation

The process of collecting all medication-related information from patients at the time of admission and updating inpatient records to reconcile the list of home medications and medications ordered during the hospital stay

Considerations in the Prescription Dispensing Process

These include interpreting pharmacy abbreviations, understanding how to calculate a days supply (how much medication in total is required), using pharmacy refill codes, and properly labeling the medication bottle.

Sterile Compounding

an important job duty of pharmacy technicians working in hospital pharmacies. Sterile compounding is federally regulated by the guidelines and standards published in United States Pharmacopeia chapters 797 (USP 797) and 800 (USP 800).

• The important pharmacy abbreviations

and their meanings are as follows:

community pharmacy, These pharmacies

are also known as retail or ambulatory care pharmacies.

• Here is a comparison of the job duties of inpatient hospital pharmacy technicians vs. outpatient

community pharmacy technicians:

Medication reconciliation

compares a patient's medication orders to all medications and products that the patient has taken while in an inpatient setting. This is crucial to prevent medication errors that affect patient outcomes. Examples of the types of errors that can occur include the following: • Duplication of therapy • Incorrect dosing levels • Undesired drug interactions

Bulk containers

contain large amounts of medications in various forms such as tablets, capsules, solutions, suspensions, creams, and ointments.

• Ten specific steps of drug-order

filling are crucial to avoid drug filling mistakes.

• Patient counseling by the pharmacist includes instructions for proper medication use and

information regarding possible drug side effects.

Bar-Coded Medication Administration (BCMA)

is another popular technology utilized in hospitals. BCMA is a process where patient demographics, clinical notes, medications, and other medical records are all connected electronically.

• All pharmacy personnel should

keep abreast of the Joint Commission standards of care.

• Medication reconciliation is crucial to prevent

medication errors that affect patient outcomes.

STAT orders are

medication orders that must be filled within minutes because of an emergency situation.

ADMS

offer the advantages of accurate inventory control, ease of medication access, and accuracy in the dispensing process. Controlled substance storage and dispensing are done exclusively by using ADMS to assure accuracy in the dispensing, inventory tracking, and record-keeping process.

Automated Dispensing Machines (ADMS)

or automated dispensing cabinets (ADCS) are computerized devices that facilitate dispensing of medications directly by the nurse to the patient.

• Inpatient pharmacies prepare and dispense drugs for administration to admitted hospital

patients.

• One of the most common challenges for pharmacy technicians and pharmacists is the legibility

pharmacy of handwritten prescriptions. • Prescriptions

• Inpatient pharmacists dispense patient-specific unit dose packages to nursing units because this decreases

risk of medication errors.

computerized physician order entry (CPOE)

transmit the medication orders generated by prescribers to the pharmacists. CPOE plays a huge role in reducing the number of medication errors made due to wrong interpretation of prescribers' writing during the data entry process. medication

community pharmacy,

which is a pharmacy that dispenses outpatient prescription medications to patients. Outpatient

The common duties of pharmacy technicians working in hospital pharmacies are as follows:

• Compound sterile medications, such as intravenous (IV) drips, IV syringes, and continuous infusions or drips. • Compound nonsterile medications, such as oral suspensions, topical creams, and ointments. • Prepare chemotherapy medication, • Prepare total parenteral nutrition (TPN). Many hospital pharmacies outsource the preparation of TPNS to compounding pharmacies. • Repackage bulk products. Pharmacies purchase large containers of tablets and capsules that must be repackaged to prepare individual doses for patients. Unlike community pharmacies, where a monthly supply of medications is dispensed, hospital pharmacies dispense only a 24- hour supply of medications to the nursing floor. Unit-dose medications are individual single- dose medication packages. These packages must also adhere to proper labeling requirements (drug name, lot number, expiration date, and so on). • Deliver the prepared medications to all the nursing floors. • Maintain automated technologies that are used to dispense, compound, store, and package medications.

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• Label all medications with the required auxiliary labels, which provide additional important information about the medication and precautions that are to followed while taking the medication. • Ensure compliance with pharmacy laws and regulations to dispense controlled substances, which are medications with the potential for abuse and addiction. • Make sure medications are stored appropriately. • Maintain accurate inventory. • Maintain a well-documented log book. • Perform clerical functions. • Deliver medications when needed. • Package certain medications manually. • Help patients find over-the-counter (OTC) medications when applicable.

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• Maintain the processes of inventory, ordering, receiving, and safe storage of medications. • Perform medication reconciliation at the time of admission and update inpatient records to harmonize all home medications and medications prescribed for the patient during the hospital stay. Medication reconciliation is also done at the time of patient discharge. This helps ensure that all the medication changes are reflected, documented, and communicated to the patient at the time of discharge. • Assist pharmacists in maintaining investigational drug records. • Play a major role in storage, dispensing, and record-keeping of controlled substances. • Interact with the nursing staff to coordinate timely delivery of medications. • Take part in various committees to ensure that medication compliance standards and guidelines are met. These compliance standards and guidelines are determined by various regulatory agencies such as the Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS). • Assist pharmacists in formulary management, which is a patient care process that enables healthcare professionals to work together to promote clinically sound and cost-effective medication therapy and positive therapeutic outcomes.

Pharmacy technicians in this role are solely responsible for the following:

• Maintaining accurate stock levels of the controlled substances • Replenishing controlled substances in the ADMS • Overseeing usage of the controlled substances dispensed from ADMS • Maintaining all records as per state and federal regulations • Performing all inventory-related functions

The essential components of a paper order include the following:

• Patient's name and date of birth • Patient's financial identification number (FIN), a unique number used for each patient admitted to the hospital, or medical record number (MRN), a number specific for each patient that remains the same during multiple admissions to the same hospital • Date on which the medication order is written • Allergy information • Medication name, strength, dosage form, quantity, and directions on how to give the medication • Prescriber's name and signature