36 terms

Receiving the Medication Order

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What must be included in the upper portion of prescription?
1. Patient's full name
2. Date of issue of prescription
3. Name and title of prescriber
4. Drug Enforcement Agency (DEA) number assigned to presciber (required for controlled substances only)
How long is a prescription valid for?
One year after being written, with the exception of prescription for controlled substances (valid for 6 months or less)
Prescriber
Doctor of Medicine (MD), osteopathic medicine (DO), optometry (OD), dentistry (DDS), veterinary medicine (DVM), or podiatry
Other individuals licensed to prescribe drugs
Physician's assistant and nurse practitioner
What must be included in the body of the prescription?
1. Name of drug prescribed (generic or brand name)
2. Strength and dosage form of the drug
3. Quantity of drug to be dispensed
4. Instructions for dosage (SIG)
5. Instructions for labeling
6. Signature of prescriber in ink
7. Authorization to dispense generic substitution (DAW/Dispense as Written or Brand Medically Necessary)
8. Refill information
9. Instructions for preparation of drug (rarely seen; if specific written instructions exist, may be prepared by technician)
Numerical designations of number of tablets, teaspoons, etc.
Lowercase Roman numerals (i, ii, iii, iv, v)
DEA number for top-level prescribers
A, B, or F as first letter (MD, DO, DDS, OD)
DEA number for mid-level practitioners
M as first name (physician's assistants, nurse practitioners)
Second letter of DEA letter
First letter of prescriber's last name
How to verify DEA number
Second letter should match prescriber's last name; mathematically, add odd-numbered digits to the sum of the even-numbered digits multiplied by two; last digit of this number should be same as seventh number in prescriber's DEA number
Information to be placed on prescription form at time of acceptance
1. Patient's address and contact information
2. Age or date of birth
3. Allergies and concurrent medications
4. Medical conditions
5. Method of payment/insurance coverage
Information for prescriptions for Schedule II drugs
Must have all information complete on form before acceptance at pharmacy window
Examples of Schedule II drugs
morphine (MSContin), meperidine (Demerol), oxycodone (Roxicet)
If prescription form is illegible or questionable
Ask pharmacist for clarification
Can technician accept refill requests for prescriptions other than Schedule II drugs?
Yes; they may be made by patient either over the telephone, by fax, or in person and can be accepted by the technician, who then deducts the appropriate amount of drug from the number of remaining prescription refills
Refills spacing
Normally spaced out over an appropriate amount of time, but may be given all at one time (at discretion of pharmacist) if patient requests it (except for refills on prescriptions for controlled substances)
Controlled substances
May be filled by technician, but any refills must be dispensed within a specific time frame to prevent misuse (ex. every 30 days for a 3-month prescription); five refills in six months allowed on Schedule III-IV drugs; no refills may be dispensed on Schedule II drug
Refill authorization
Pharmacy may contact physician/prescriber to extend original prescription if patient runs out of needed medication and has not obtained new prescription; may be obtained only by licensed pharmacy practitioner (pharmacist or pharmacy intern)
Prescriptions for Schedule II Drugs
1. A state may require special prescription form (triplicate form, one for DEA, one for prescriber, one for pharmacy)
2. Must be filled exactly as prescribed
3. No errors, corrections, or write-overs are permitted (if there are, bring to attention of pharmacist)
Receiving Prescriptions by Electronic Means
1. Technician may not take prescription orders from electronic devices
2. Some states allow licensed pharmacy interns to take telephone prescriptions
3. Must be transcribed onto a hard copy form before filling by the pharmacist (or pharmacy intern)
Medication order
Found only in hospital or institutional pharmacy; serves as drug order, much more detailed than retail prescription; Medication Administration Record (MAR) is generated
What does medication order include?
1. Drugs to be administered, doses, dose form (solution, suspension, tincture, etc), routes of administration (orally, IV, intramuscularly), and reason for use
2. Date of drug order
3. Date therapy is started and ate that it is to be discontinued
4. Prescriber's name for each drug
5. Designation of drugs for which generic substitutions allowed/disallowed
6. Drug dosages and schedule for administration
7. Dosage instructions
8. Instructions for compounding of medications
Total parenteral nutrition (TPNs)
Medications that contain balanced mixture of sugars, proteins, and fats to be administered via IV; may be ordered by patient who is undernourished, vomiting, or has severe diarrhea; instructions for compounding are also included
Generation and Organization of MAR
1. Generated by pharmacy and serves as record of medication administration by nursing staff
2. Contains list of drugs dispensed, time of dispensing, initials of person dispensing medication, and dosages and times of administration
3. Puts medication order within specific dosage schedule
Dosage schedule
Drug dosages have to be scheduled relative to each other; MAR contains dosage schedule for drug administration; MAR also serves as record that drug was administered, by whom, and actual time of administration
Filling the medication order
Medication order is transmitted to pharmacy, either directly or by computer; it is responsibility of pharmacist to review order and evaluate suitability of drugs prescribed with regard to patient and his or her existing drug and dosage regimen; once reviewed, order is passed to technician for filling; technician or nurse transcribes information onto MAR; unit dose system is used
Unit Dose
The amount of drug needed for a single dose
Unit Dose System
All of the drug doses for an individual patient that will be required for an entire day are prepared at one time and distributed to the patient floors
Technician's responsibility in unit dose system
Responsible for assessing instructions for dosage of drug (one tablet bid, qid, etc) and calculating amount of drug (number of tablets, milliliters, etc.) that will be given to patient in course of one day; prepares proper amount and places it in properly labeled container for insertion into medication cart
Proper labeling of cassette
1. Patient's name
2. Hospital identification number
3. Attending physician's name
4. Location of patient
Medication cart
Located in individual patient floors; free-standing, computerized cabinets containing the daily medications for all patients on a particular floor or wing; technician delivers unit dose cassettes to patient floor and files medications within drawers of medication cart; drugs filed b patient identification number; unused unopened medications may be returned to pharmacy for restocking and patient credit
Comparison of medication orders
Name of patient and other identifying information, prescriber's name and title, drugs prescribed; amount of information included differs (including diagnosis, laboratory tests, height and weight)
Institutional medication order
Gives detailed schedule of administration; more information is present to ensure that medication is administered to right patient
Retail order
Gives only instructions to be followed by patient, because medication is self-administered
Prescription of controlled substances in institutional setting
1. Does not require special form; prescribers may use DEA number assigned to hospital, there are no prescriber DEA numbers on order
2. Delivery of controlled substances may require special documentation (signatures of technician delivering medication and head nurse in patient care area, documenting transfer of drug)
Prescription of controlled substances in retail setting
Specifically Schedule II drugs, requires a triplicate form, which must be filed separately from other prescription forms, with copies sent to prescriber and DEA
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