Chapter 6 Medication Order Entry and Fill Process

Storage of Unit-Dose Medications

-Should be rotated to ensure first-in, first-out processes. -Do not exceed 25 C. -Final product should be examined for instability caused by changes in color or odor.

3. Entering Information into Computer System

1. Information required is prompted. 2. Quantities in metric units. 3. Input correct *Dispense as Written (DAW)* code. (DAW 1 = Brand name drug dispensed) 4. Calculate day's supply of medication. 5. Third-Party Adjudication: Insurance 6. Drug Utilization Evaluation -No adverse interactions

ac

Before meals

Inscription

Contains the name of the medication and its quantity.

Hermetic Container

Impervious to air or gas.

Multiple-Dose Container

Multiple unit container for parenteral administration.

pc

after meals

IM

intramuscular

tid

three times a day

Mission Statement; Policy; Procedure

*Mission Statement*: States the purpose and goals of an organization. *Policy*: A definite course or method of action; a plan establishing goals and objectives. *Procedure*: Process of accomplishing a task to ensure efficiency and consistency; a step-by-step method to accomplish a policy. -Required by ASHP, APhA, and TJC.

Types of Prescription Orders

*STAT*: A medication order that should be filled within 15 minutes of receiving it in a hospital. *ASAP*: A medication order that does not have the priority of a STAT order but needs to be processed as soon as possible. *PRN (As needed)*: An order that may be filled or administered when a patient requests it, but there may be limitations associated with it.

Types of Unit Dose Packages

*Unit-Dose System*: Provides a medication in its final "unit of use". *Modified Unit-Dose System*: Combines unit-dose medications, which are blister packaged onto a multiple-dose card. *Blended Unit-Dose System*: Combines a unit-dose system with a non-unit dose system.

Data Entry in Prescription Processing

-Prompted by computer. -Name searched last name, then first. Birth date distinguishes between same named patients. -Insurance Card: Bank Identification Number (BIN), Plan group number, and patient's ID number. -Relationship: 01 - Cardholder, 02 - Spouse, 03 - Dependent. -Physician's name searched by last name, first name. Then DEA number distinguishes. -Drug name entered, NDC number selected. -Quantity dispensed in metric units. -DAW code entered based on how written.

Auxiliary (Ancillary) Labels

-Provide additional information as special instructions, warnings, or storage conditions. Examples: -Do not drink alcohol -May cause drowsiness -Take with food or milk -Avoid sunshine -Take on empty stomach -Shake well -Refrigerate.

Pharmacy Technician Tasks

1. Accepting new prescriptions 2. Receiving prescription refills 3. Requesting refill authorization from prescriber. 4. Collecting patient information 5. Maintaining patient profiles 6. Entering information into system 7. Billing prescription to third-party provider. 8. Counting and pouring correct medication 9. Labeling prescription bottles 10. Returning bottles to shelves 11. Repackaging medication 12. Preparing unit-dose medications

5. Patient Consultation

1. Ask patient if they have any questions for the pharmacist. -If yes, pharmacist will counsel patient. 2. Pharmacy technicians are not permitted to counsel patients.

Required Prescription Label Information

1. Date filled 2. Prescription number 3. Name and address of pharmacy 4. Name of patient 5. Name of physician 6. All directions for use 7. Generic or brand name 8. Strength 9. Name of drug manufacturer 10. Quantity 11. Expiration date 12. Initials of pharmacist 13. Number of refills allowed *DEA number only needed for controlled substances!*

Repackaging Log

1. Date of repackaging 2. Name of drug 3. Strength 4. Dosage form 5. Drug manufacturer 6. Lot number 7. Drug manufacturer's expiration date 8. Beyond-Use date assigned by pharmacy 9. Quantity repackaged 10. Pharmacy Technician's Initials 11. Pharmacist's initials

Required Prescription Information

1. Date prescription was written 2. Patient Information: Name and address. 3. Inscription -Name of medication -Strength -Dosage form -Quantity of medication dispensed. 4. Subscription -Instructions to the pharmacist 5. Physician's Signature: In ink, NOT stamped.

Unit-Dose Log Record

1. Date unit dose prepared 2. Drug 3. Strength 4. Quantity 5. Dosage Form 6. Drug Manufacturer 7. Manufacturer's Lot Number 8. Manufacturer's Expiration Date 9. Pharmacy Assigned Beyond-Use Date 10. Pharmacy Lot Number 11. Pharmacy Technician Initials 12. Pharmacist's Initials

Patient Package Insert Requirements

1. Description 2. Clinical Pharmacology 3. Indications and Usage 4. Contraindications 5. Warnings 6. Precautions 7. Adverse Reactions 8. Drug Abuse and Dependence 9. Overdosage 10. Dosage and Administration 11. How supplied 12. Date of most recent revision of the labeling. Required for metered-dose inhalers, oral contraceptives, estrogen, progesterone, and isotretinoin.

Prescription Refill Information

1. Name 2. Contact information 3. Date of birth 4. Phone number 5. Prescription Number 6. Name of medication, strength, dosage form, and quantity.

Required Medication Order Label Information

1. Name and location of patient. 2. Trade or generic name of drug 3. Strength 4. Quantity for outpatient prescription labels 5. Expiration date 6. Lot number of medication

Unit-Dose Labeling

1. Name of drug 2. Drug Manufacturer 3. Strength 4. Beyond-Use date 5. Lot number Unit dose log must be maintained.

Repackaged Medications

1. Name of medication 2. Drug manufacturers name 3. Dosage form 4. Strength 5. Beyond-Use Date 6. Lot Number of medication

Required Prescriber Information

1. Name of physician 2. Office address 3. DEA number for controlled substances 4. NPI number 5. State license

2. Interpreting the Prescription

1. Name, strength, dosage form, and quantity of medication. 2. Route of administration. 3. Frequency of administration. 4. Determine if generic drug may be dispensed. 5. Number of refills permitted. 6. When in doubt, ask pharmacist.

Required Patient Information

1. Patient Information: Name, sex, address, age, phone number. 2. Billing Information: Third Party Provider, includes group number and subscriber identifier, and relationship to cardholder. 3. Disease States or Health Conditions. 4. Medications Patient is Taking: Prescription, OTC. 5. Drug Allergies

Sterile Product Prescription Labeling

1. Pharmacy name 2. Patient name 3. Date of filling 4. Ingredients (Strength and quantity of each) 5. Total volume 6. Directions for use 7. Infusion rate 8. Beyond-Use Date

Required Medication Order Information

1. Prescriber's Information: Name, DEA Number, and Hospital Assigned ID. 2. Date of Order 3. Patient Information: Room number, bed number, and ID number. 4. Name, strength, and dosage form of medication. 5. When to be administered. 6. Duration of therapy 7. Prescribers signature

4. Filling the Prescription

1. Verify prescription information entered properly. 2. Pull medication from shelf, check prescription label against NDC number; scan UPC code to verify. 3. Count medication. -Manually: Multiples of 5. -Wipe down tray with isopropyl alcohol if sulfa or penicillin drug dispensed. 4. Select appropriate container, and add medication. 5. Place child-resistant top. -If patient requests EX open top, have them sign back of original prescription. 6. Place labels on container and upper backhand corner of original prescription. 7. Add printed auxiliary labels to the prescription container. 8. Place prescription on top of original prescription with container pulled from shelf. 9. Pharmacist checks and bags. 10. Prescription placed in appropriate bin. 11. Bottle returned to shelf.

Tamper-Evident Packaging

A container or individual carton of a sterile article intended for ophthalmic or otic use must be so sealed that the contents cannot be used without obvious destruction of the seal.

Single-Dose Container

A single-unit container for parenteral administration.

1. Receiving the Prescription

A. *Method of Receipt* 1. Walk in 2. Call in 3. E-prescribing 4. Fax B. *Patient Profile*: Completed first time prescription is filled. 1. Name, age, sex, race, occupation, address, weight. 2. Medical history 3. Medication history and current. 4. Drug food allergies 5. Drug effects C. *Prescribing Information* 1. Patient Information: Name, address, phone number, and birth date. 2. Prescriber Information: Name, address, phone number, NPI number, and DEA number. 3. Prescribing Information

Subscription

Any special instructions or directions to the pharmacist.

Blister Pack Components

Blister: Holds the medication. Lidding Stock: Material that seals the blister.

po

By mouth

Medical Terminology

Card- Heart Derm- Skin Gastro- Stomach Lipo- Fat Pulmo- Lung Pyr- Fever Ren- Kidney Brady- Slow Hyper- Above Hypo- Below Intra- Across Peri- Around Tachy- Fast Tri- Three -Algia: Pain -Emia: Blood -Itis: Inflammation -Ology: Study of -Pathy: Disease -Phagia: Eat -Uria: Urine

Automated Dispensing Systems

Centralized Pharmacy: Found in the central pharmacy that is used to improve manual unit dose cart fill process. -Inability to handle all dosage forms. Decentralized Pharmacy: Found in the patient care areas of a hospital to eliminate or reduce management issues that include narcotic diversion and poor record keeping. -Advantage: Ability to dispense and return medications, document medication waste, and produce reports. -Examples: 1. Pyxis MedStation System: Bar code scanning. 2. Cubie System: One medication at a time. 3. Pyxis CII Safe: Tracks replenishment of controlled substances within a hospital. 4. Pyxis Anesthesia System

Child-Resistant Containers

Consumer Product Safety Commission requires if the original package is intended to go directly from the pharmacist to the patient. -Drugs dispensed in inpatient institutions are not required.

Single-Unit Container

Designed to hold a quantity of drug product intended for administration as a single dose.

Signa

Directions for taking the medication.

Dispense as Written Codes

Ensure pharmacy is properly reimbursed by a third party. 0 = No product selection indicated. 1 = Substitution not allowed by provider 2 = Substitution allowed; patient requested product dispensed. 3 = Substitution allowed; pharmacist-selected product dispensed. 4 = Substitution allowed; Generic drug not in stock. 5 = Substitution allowed; Brand drug dispensed as generic. 6 = Override 7 = Substitution not allowed; Brand drug mandated by law 8 = Substitution allowed; Generic drug not available by marketplace 9 = Other

Oral Syringes

For Liquids

Foil Cups

For Liquids and suspensions

Amber Blister Packs

For Tablets and Capsules

Plastic Cups

For liquids and suspensions

Amber Glass

For liquids.

Syringes

For parenterals, oral liquids, and transdermal gels.

Plastic Suppository Shells

For suppositories

Applicators

For suppositories, creams, and ointments

Heat-Sealed Strip Packs

For tablets, capsules, and troches.

NS

Normal Saline

Unit-of-use Container

One that contains a specific quantity of a drug product that is intended to be dispensed as such without further modification except for appropriate labeling.

Multiple-Use Container

Permits withdrawal of successive portions of the contents without changing the strength, quality, or purity of the remaining portion.

Tight Container

Protects the contents from contamination by liquids, solids, or vapors.

Well-Closed Container

Protects the contents from other solids and from loss of the article under normal conditions.

Light-Resistant Container

Protects the contents from the effects of light caused by the contents of the container.

Superscription

The Rx symbol.

prn Refills

The patient may refill the prescription for 1 year from the date the prescription was written.

Unit-Dose Container

Unit-dose container is a single-unit container intended for administration other than parenteral.

Applicator Bottles

Used for applying liquid medications to a wound or skin surface.

Wide-Mouth Bottles

Used for bulk powders or large quantities of tablets, capsules, and viscous liquids that cannot be poured readily from narrow-necked containers.

Hinged-Lid or Slide Boxes

Used for dispensing suppositories and powders.

Prescription Bottles

Used for liquids of low viscosity.

Dropper Bottles

Used for ophthalmic, nasal, otic, or oral liquids to be administered by drop.

Round Vials

Used for solid dosage forms. -Tablets -Capsules

Ointment Jars and Collapsible Tubes

Used to dispense semisolid dosage forms.

hs

bedtime or hour of sleep

qid

four times a day

dtd

give of such doses

bid

twice a day