Policies and Procedures Each pharmacy must have a policies and procedures manual Mission statement States the purpose and goals of an organization Policy A definite course or method of action a plan establishing goals and objectives ID: 737661
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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 pharmacySlide24Slide25
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?