Tuesday, June 14, 2011

The Dispensing Process: Intake to Ringing Up

A lot of work goes into getting a prescription in and out in a reasonable amount of time, and more importantly, right. All while Mrs. Jones is telling your her tablets look different than last time, Mr. Smith is asking where the hemorrhoid cream is and Mrs. Brown's child is ripping up the magazines in the waiting room... again. The phone's ringing and the fax machine is out of paper and the pharmacist is on the phone with a doctor's office taking another call in. Many pharmacies are fast-paced environments with spacial limitations and it's vital for you to know how to streamline the work and prepare it to ensure that no errors happen.

It is important to note that federal and state laws may differ and I will always default to federal law. When in doubt, always err on the side of caution. When federal and state law differ, follow whichever is more strict.

Prescription Intake

When accepting a prescription from a patient, you should always check that the doctor has written the patient's name and the date the prescription was written on the paper. Less frequently written, but equally important are a patient's date of birth and address. The patient's address is required to be written on any prescription for controlled substances that a pharmacy processes. The date of birth is a safety mechanism. If a patient named John Smith brings in a prescription for his son, John Smith, Jr., you need to know which patient to fill the prescription under. This prevents accidental insurance fraud (yes, even accidental counts), and helps ensure that relevant allergies, drug-to-drug and drug-disease interactions are caught. When taking in a prescription you should add both items to the prescription if they are not already written on it. Finally, every time a patient brings in a new prescription (especially important with children and infrequent customers) you should double check that allergy and insurance information have not changed. If it is a new patient, there is often additional paperwork required. After all of this, you are ready to begin typing and labeling the prescription.

Typing a Prescription Label


The first thing to do when preparing a prescription label is to pull up the patient by name and confirm that you have the right patient using the date of birth. If you can't find the patient in the computer system through any of the common look-up methods, you should confirm again with the patient whether they've been to the pharmacy or not. Yes, I know they always think they have been. Simply explain to them that you can't seem to find them in your system and kindly ask them to fill out the necessary paperwork. If they give you too much hassle, refer them to the pharmacist.

Once you have their profile open, or you've added them to the computer, it's time to begin typing the prescription. Always be certain to enter the order under the correct doctor. If the prescription is for a controlled substance, remember that the DEA number must appear on the prescription. It is during this time that you should screen the prescription for evidence of fraud or tampering and alert the pharmacist to any potential issues. Double check to make sure that the NDC you're billing and the NDC you're dispensing match. This is of particular importance for schedule II medications where using different NDCs will affect the inventories of the medications and needlessly complicate proceedings in the event of a DEA audit. While many software programs have equations imbedded to calculate how many days supply based on the codes you enter, these equations are not fool-proof and are often maintained by people. You should always double check the computer-generated days supply.

A doctor's handwriting can often leave a lot to be desired, and with all of the abbreviations in the pharmacy, a prescription can get messy fast. If you ever have a question, ask the pharmacist. If neither of you can figure it out, the pharmacist should call the doctor to confirm the issue. The specifics of labeling medications have already been covered in a previous post, so I won't cover that again here.

As you enter the prescription into the computer, you should check the patient's profile for drug-to-drug or drug-to-disease interactions as well as allergies and cross-sensitivities. The prescription-filling software and occasionally even responses from the insurance company should help you with this, but you should always double check, especially for interactions that you know the system misses. Never assume that the computer is perfect. There's never a replacement for a human touch.

Counting the Medication

Obviously "counting" a prescription doesn't always involve counting it. Sometimes it is as simple as putting the label on a unit of use bottle and then attaching the appropriate auxiliary labels. When you actually have to count the tablets or capsules, be sure to double check the quantity. Some people get 90 day supplies of medications and it is inconvenient for the patient and the pharmacy to have to correct the error when a patient only receives 30 of their 90 days. Always be aware of certain risks of certain medications; for example, female technicians of child-bearing ages should not count count Avodart (dutasteride) capsules because of the risk of absorption and fetal harm simply from handling the capsules. Certain medications have special strorage requirements, like nitroglycerin, which should not be removed from its original stock bottle when being dispensed due to its sensitivity to light and moisture. Where required by law, pharmacists should count all narcotic and/or controlled prescriptions. After counting, the medication should be placed in the smallest dispensing vial that adequately accommodates the volume of the tablets or capsules and the vial should be labeled. Safety caps should be used unless the patient has specifically asked otherwise, in accordance with the Poison Prevention Act (except in the case of nitroglycerin). It is during this stage of the process that the technician should take the opportunity to double check themselves on all aspects of the dispensed medication.  Double check the following:

  • Medication name and strength
  • Dosage form
  • Quantity
  • Directions
  • Prescriber
  • Patient
If any of those don't match, take the opportunity to correct yourself and save the pharmacist the work. If all is well, follow your pharmacy's procedure for flagging the prescription for pharmacist approval. Some pharmacies move the prescription to a particular area of the pharmacy, others use different colored baskets or even just a note of some sort to indicate that the prescription is ready to be checked. 

Ringing up the Patient

While some pharmacies have dedicated cash register personnel, many pharmacy technicians are still expected to participate in the process when the register personnel are performing other tasks, or during off-peak hours, when it is more likely just to be a technician and a pharmacist. A patient is required to sign for each prescription for several reasons: in the event of a third-party audit, this will serve as evidence that the patient picked up the prescription and this serves as proof for in-house requirements as to whether the prescription was picked up or not, and a signature is required if safety caps are not used. The patient should always be asked if they need to ask the pharmacist any questions. This step is often skipped due to time constraints in a pharmacy, but is actually required. Remember that a technician can offer counseling (by asking if the patient would like to ask the pharmacist anything about their medicine) but the technician cannot actually perform the counseling.

See? There's not too much to the process. And if you make sure that the prescription is checked in properly at the beginning and double check yourself before forwarding the prescription to the pharmacist, you can help ensure that medication errors and preventable adverse reactions are kept to a minimum.

Until next time,
C. Samuels

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