Medication order entry and fill process - PowerPoint Presentation

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Medication order entry and fill processSlide2

Policies and Procedures

Each pharmacy must have a policies and procedures manual:

Mission statement: States the purpose and goals of an organizationPolicy: A definite course or method of action; a plan establishing goals and objectivesProcedure: Process of accomplishing a task to ensure efficiency and consistency; a step-by-step method to accomplish a policyProvide standards for the operation of a pharmacy

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Outpatient pharmacySlide4

Filling Process VideoSlide5

Step 1: receiving

a prescription

Walk in

Verbal

Order

E-Prescribing

FaxSlide6

Hardcopy prescriptionSlide7

Required

Prescription

Information Date the prescription was writtenPatient information (patient’s name and address)InscriptionName of medication (may be either brand or generic)Strength of medication (if applicable)Dosage formQuantity of medication to be dispensed

Subscription: Instructions to the pharmacist

Physician’s signature

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Dispense as Written Codes (DAW)

Used to ensure the pharmacy is properly reimbursed by a third-party provider:

0 = No product selection indicated1 = Substitution not allowed by provider2 = Substitution allowed; patient-requested product dispensed3 = Substitution allowed; pharmacist-selected product dispensed

4 = Substitution allowed; generic drug not in stock

5 = Substitution allowed; brand drug dispensed as generic

6 = Override7 = Substitution not allowed; brand drug mandated by law8 = Substitution allowed; generic drug not available in marketplace

9 = Other 8Slide9

Step 2:

Entering the prescriptionSlide10

Step 2A: enter patient information

Patient information

Patient name, DOB, Address, Phone NumberInsurance Information, if applicableTo be discussed in later chaptersDisease states or health conditionsMedication patient is takingDrug allergies

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Step 2B:

enter Prescription information

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Date the prescription was written

Patient name (if not already in patient profile)

Inscription

Name of medication

Strength of medication

Dosage form

Quantity of medication to be dispensed

Subscription: Instructions to the pharmacistDAW code To prevent autosubstitutionPhysician’s signatureSlide12

Step 3:

Filling the prescriptionSlide13

Filling the prescription

Pull medication from the shelf

Check prescription label against the NDC number found on bulk container; Scan the UPC code on the bottle to ensure the correct medication was selectedMeasure or count the medication; if counted manually, count in multiples of fiveSelect an appropriately sized container and pour the medication into the containerPlace an appropriately sized child-resistant top on the container Or, if requested, a non-child resistant top

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Step 4:

labeling the prescription vialSlide15

Labeling Process:

Required Prescription Information

Date when the prescription was filled

Serial (prescription) number of the prescription

Name and address of the pharmacy

Name of the patient

Name of the prescribing physician

All directions for use of the prescription

Generic or brand name of the prescriptionStrength of the medicationName of the drug manufacturerQuantity of the drug

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**Don’t forget to add auxiliary labels after adding the prescription label!**Slide16

Patient Package Insert Requirements

Information found on a package insert includes the following:

DescriptionClinical pharmacologyIndications and usageContraindicationsWarningsPrecautions

Adverse reactions

Drug abuse and dependence

Overdosage

Dosage and administration

How supplied 16Required to all patients receiving metered-dose inhalers, oral contraceptives, estrogen, progesterone, and AccutaneSlide17

Step 5:

Prepare the vial for pharmacist checkSlide18

Preparing the prescription vial for pharmacist check

Place the completed prescription container in a bin/basket, and slide over to pharmacist

Certain pharmacies: place filled RX on top of the original prescription with the bulk container that has been pulled from the shelf (in certain pharmacies)The pharmacist checks the completed prescription and bags the prescriptionThe completed prescription is placed in the appropriate pick-up bin

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Summary: pharmacy technician tasksSlide20

Pharmacy Technician Tasks

Accepting new prescriptions from the patient

Receiving prescription refills from the patientRequesting refill authorization from the patient’s prescriberCollecting patient informationMaintaining patient profilesEntering patient, prescriber, and medication information into the pharmacy’s information system

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Pharmacy Technician Tasks

Interpreting the prescription

Billing prescription to third-party prescription providersCounting and pouring the correct medicationLabeling prescription bottlesReturning medication bottles to the pharmacy shelvesRepackaging medicationPreparing unit-dose medications

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Switching gearsSlide23

Mail order

Outpatient pharmacySlide24
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Switching gearsSlide26

Inpatient pharmacy

(Hospital)Slide27

Step 1: receiving

a prescription

Orders are transmitted through the hospital’s internal computer system directly to the pharmacy

STAT

: Should be filled within 15 minutes of receiving it in a hospital

ASAP (as soon as possible)

: Does not have the priority of a STAT order but needs to be processed as soon as possible

PRN (as needed): May be filled or administered when a patient requests itSlide28

Required Medication Order Information

Prescriber’s information

Date of orderPatient information, including the room number, bed number, and ID number assigned to the patientName, strength, and dosage form of medicationWhen to be administered (frequency)Duration of therapyPrescriber’s signature

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Step 2:

Filling

a prescriptionSlide30

Remember, all medications sent to patients are

“unit doses”Slide31

Unit dose medications

2 options for unit dose packaging:

Ordering unit-dose specific packing directly from warehouseOrdering bulk packaging from warehouse, and unit-dosing the medication using in-house equipmentSlide32

Unit-Dose Packaging Procedures

Unit-dose log:

Date unit dose was prepared

Drug (generic name)

Medication strength

Dosage form

Quantity prepared

Drug manufacturer

Drug manufacturer lot number

Manufacturer’s expiration date

Pharmacy-assigned beyond-use date

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Unit-Dose Labeling Requirements

Trade or generic name of drug

Drug manufacturerStrength of drugBeyond-use dateLot number of medication

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Or…

Sterile compounding is performed! Slide35

Step 3:

delivering the prescription to the patientSlide36

Drug Distribution Systems

Automated dispensing systems:

A storage, dispensing, and charging system that is used to save time, improve inventory control tracking, and reduce medication errorsMost commonly found in hospitals:Centralized pharmacyDecentralized pharmacyOtherwise, medication is manually delivered to each unit via carts

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All hospital pharmacy inventory systemSlide43

Switching gearsSlide44

Misc. information applicable to both inpatient and outpatient pharmaciesSlide45

Auxiliary Labels

Provide additional information (special instructions, warnings, or storage conditions) to the patient

Are printed with the prescription label and should be affixed to the container so that they do not cover any words on the prescription label

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Beyond-Use Date vs. Expiration Date

The expiration date is determined by the drug manufacturer

Beyond-use is used when medications are repackaged from a bulk container 46Slide47

Packaging Requirements

Types of containers used:

Round vials: Used for solid dosage forms such as tablets or capsulesPrescription bottles: Used for liquids of low viscosityWide-mouth bottles: Used for bulk powders or large quantities of tablets, capsules, and viscous liquids that cannot be poured readily from narrow-necked containersDropper bottles: Used for ophthalmic, nasal, otic, or oral liquids to be administered by drop

Applicator bottles

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

Ointment jars and collapsible tubes: Used to dispense semisolid dosage formsHinged-lid or slide boxes: Used for dispensing suppositories and powders

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Storage Temperature Terminology

Freezer- -25°C and -10°C

Cold- 8°CCool- 8°C and 15°CRoom temperature- the temperature prevailing in a working environmentControlled room temperature- 20°C-25°CWarm- 30°C and 40°CExcessive heat- >40°CProtect from freezingDry place- does not exceed 40% relative humidity

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Questions?