54 terms

Pharmacy Practice- Prescriptions and Medication Orders

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Prescription
Order for medications, devices, or services issued for a specific patient by a licensed, authorized medical practitioner

Most commonly refers to drug products for ambulatory patients (outpatients) who obtain their prescribed medications from retail pharmacies, mail order pharmacies
Medication order
Usually used when referring to drug orders for patients in hospitals, nursing homes, or other institutional settings
Prescription Drugs
Known as Legend Drugs
Medications requiring a prescription
"legend" refers to the legend the manufacturer must provide on the product label
Controlled Substances or Scheduled Drugs
Drugs whose potential for abuse justifies special restriction imposed by federal and state governments.
States may have regulations more stringent than federal ones- pharmacists most follow most stringent.
C2, C3, C4 - prescriptions require federal transfer label
C2, C3, C4
Federal transfer label required for these prescriptions? The label says Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.
C1
Highest potential for abuse
No acceptable medical use in US
Cannot be used safely even with medical supervision
heroin, LSD, mescaline
C2
High potential for abuse with possibility for severe psychological or physical dependence.
Currently accepted medical use in U.S
Morphine, meperidine, fentanyl, codeine oxycodone, hydromorphone, cocaine, amphetamine, methamphetamine, methylphenidate, methadone, pentobarbital
Some in combination products may be in C2,3, or 5 depending on amount present
C3
Less potential for abuse than C1 or C2
Currently accepted medical use in U.S
Abuse may lead to low/moderate physical dependence or high psychological dependence
Certain narcotics in combinations with nonnarcotic drugs in specified amounts
Anabolic steroids and some barbiturates
C4
Low potential for abuse and dependence compared to C1-C3
Currently accepted medical used in U.S
Benzodiazpines (Valium, Xanax, Ativan) Ambien, Lunesta, Sonata, phenobarbital, Lyrica
C5
South Dakota does not have this category
Compounded Medications
The preparation of components into a drug product
1.) As the result of a practitioner's prescription drug order or initiative based on the practitioner/ patient/ pharmacist relationship in the course of professional practice
2.) For the purpose of or as an incident to research, teaching or chemical analysis and not for sale or dispensing
Specific record keeping requirements beyond regular prescriptions
OTC (nonprescription medications)
May be purchased or obtained without a prescription
Can be safely and properly self-administered without the supervision of a prescriber
Generally not habit-forming and have low potential for adverse effects
Complementary and Alternative Medications
Does not undergo FDA approval
Not sure of side effects
Herbals and Dietary Supplements
Investigational Drugs
Research position
Drug names
1. Chemical name
2. Code designations or numbers (NDC code)
3. Acronyms, trivial name
4. Generic name (lower cased)
5. Brand name (upper cased)
6. Sound-alike look-alike drug names
drug use process
The process whereby medications move through the distribution chain from the point of manufacture to the point of use by the consumer.
Process of manufacturing, storing, distributing, prescribing, pricing, dispensing, administering, using, controlling, and monitoring drugs and their effects and outcomes
Stakeholders and influential groups in the drug use process
1. Drug users (legitimate users)
2. Drug manufacturers and distributors
3. Drug dispensers
4. Drug prescribers
5. Payers (government, third parties, managed care)
6. Regulators (local, state, federal government)
7. Policymakers (local, state, federal legislative bodies)
Medication use system
process by which individual patients obtain and use medications
Components of medication use system
Writing the prescription or ordering the medication
Routing prescription or order to the pharmacy
Computer entry of the prescription or order
Dispensing medication
Counseling the patient about medication
Administering medication
Monitoring the patient
Collaborative pharmacy practice agreement
A written and signed agreement between a pharmacist and licensed practitioner that allows the pharmacist to initiate or modify a patient's drug regimen within the guidelines of an agreed protocol for the purpose of drug therapy management.
Writing the prescription or ordering the medication
Prescribing authority granted to several different practitioners and collaborative pharmacy practice agreement
Routing prescription or order to the pharmacy
May be written verbal or electronically transmitted
E-prescribing
CPOE/CPOM
Dispensing medication
Retail Pharmacies (independent community pharmacies, chain store pharmacies, mass merchandise pharmacies, grocery store pharmacies, mail-order pharmacies, outpatient pharmacies in hospitals, internet pharmacies)
Institutional Setting (medication distribution and clinical services in a hospital and clinics via drug samples)
Parts of a prescription
Information
Use of Abbreviations and Symbols
Other components
Information of parts of a prescription
Patient information (full name and address of the patient)
Date issued by prescriber
Rx symbol (superscription)
Medication name, strength, dosage form and quantity (inscription)
directions for pharmacist (subscription)
Refill information
Prescriber information
Use abbreviations and symbols
Commonly used medical abbreviations
ISMP's List of error-prone abbreviations, symbols and dose designation
Other components of a prescription
Roman numerals - occasionally used on prescriptions to designate the number of dosage units prescribed or to indicate the quantity of medication to be administered
Military time- often used by healthcare facilities to record time on med orders
Recommendations to improve written prescription and med orders
1. Written prescriptions and medication orders must be legible
2. Minimize use of verbal orders
3. Avoid use of abbreviations
4. Use the metric system
5. Provide patient age and weight when appropriate
6. Include drug name, metric weight or concentration, and dosage form
7. Include leading zero before decimal point in quantities less than one
8, Never use trailing zero after a decimal point
9. Include purpose of medication especially if it has a variety of indications
10. Do not use imprecise instructions such as "take as directed" or "take as needed"
Parts of a prescription label
Information
instructions for patients
auxiliary labels
information of part of a prescription label
1. Name and address of dispensing pharmacy
2. Name of patient
3. Name of prescriber
4. Directions for use, cautionary statements
5.Date dispensed
6. Serial number of prescription
7. Brand name of drug or generic name and manufacturer
8. Strength of drug dispensed
9. Name or initials of dispensing pharmacist
10. Quantity dispensed
11. Number or refills
12. Beyond-use date of product and expiration date of prescription
Instructions for patients
Direction for use
Use clear, concise language understandable to patients with minimal education
Avoid abbreviations or medical terms
Use complete sentences including a verb and punctuation
Avoid outdated terms such as "instill". Use verbs such as take, give, put, insert, place, apply
Route of administration is usually specified
Directions on the label should be as close as possible to those written by the prescriber. However, the pharmacist may clarify instructions as long as this can be done without changing the prescriber's intent.
Clarify vague instructions especially if patient does not understand how medication is to be taken or used
Auxiliary Labels
- placed on drug product containers to give patient, caregiver, or health care provider important information needed for storing or using product
- Clarify directions, provide additional instructions, or reinforce directions given on regular label
- Not to be used as substitute for patient consultation
- Some labels are necessary ("shake well" for suspension)
- The pharmacist should use professional judgment ot decide which, if any , auxiliary labels to use
- More is not always better
- Some prescription dispensing software now prints auxiliary information directly on the prescription label.
Overview of prescription and medication order processing
Receiving the prescription and gathering patient information
Reading, evaluating appropriateness, and clarifying the prescription
Computer order entry and label generation
Preparing the prescribed medication
Packaging and labeling the medication
Performing final pharmacist verification for accuracy
Deliver medication and provide patient counseling
Performing final pharmacist verification for accuracy
1. Search for errors and omissions
2. Ensure the medication meets the following criteria:
- therapeutically appropriate for the patient
-prescribed the correct dose
- dispensed in the correct strength and dosage form
- correctly labeled with complete instructions for the patient or caregiver
- for the patient in a hospital or other health care facility, each medication must then also be administered to the correct patient, at the correct time, at the correct rate, and by the correct route of administration
evolution of pharmacy practice in the US
1. Apothecary
2. Drug Dispensing and Distribution
3. Clinical Pharmacy
4. Pharmaceutical Care
pharmaceutical care
-The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. These outcomes are 1.) cure a disease 2.) elimination or reduction of a patient's symptomatology 3.) Arresting or slowing of a disease process 4.) Preventing a disease or symptomatology
-A practice in which the practitioner takes responsibility for a patient's drug-related needs and is held accountable for this commitment
-Is patient-centered, outcomes oriented pharmacy practice that requires the pharmacist to work in concert with patient and the patient's other healthcare provider, to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective. The goal is to optimize the patient's health-related quality of life and achieve positive clinical outcomes, within realistic economic expenditures
Elements of pharmaceutical care
Responsible provision of care
Direct provision of care
Caring
Achieving positive outcomes (avoiding side effects)
Improving the Patient's Quality of Life
Resolution of Medication or drug-related problems
Caring
Knowledge of Drugs and Drug therapy
Drug Information Skills
Communication Skills
Resolution of Medication or Drug Related Problems (MRP or DRP)
Undersirable events a patient experiences that involve (or are suspected of involving) drug therapy that actually (or potentially) interferes with a desired patient outcome
Identify potential and actual MRPs, resolve actual MRPs, and prevent potential MRPs
Types of MRPs
Needed drug therapy
Unnecessary drug therapy
Use of wrong drug
Dosage to low
Dosage to high
Adverse drug reaction
Not receiving the drug
Drug interaction
Needed drug therapy
New medical condition
Untreated medical condition
Preventative therapy needed
return, exacerbation of old medical condition
Unnecessary drug therapy
No medical indication
Nondrug therapy more appropriate
Duplicative therapy
Treating avoidable adverse reactions
Substance abuse
Use of wrong drug
More effective drug available
Drug not indicate for condition
Contraindication present
Dosage form inappropriate
Condition refractory to drug
Dosage to low
Wrong does
Inappropriate frequency, or duration
Incorrect storage
Incorrect administration
Drug interaction
Dosage to high
Wrong dose
Inappropriate frequency, or duration
Drug interaction
Adverse drug reaction
Allergic reaction
Unsafe drug for patient
Incorrect administration
Side effect or adverse reaction
Not receiving the drug
Forgets to take drug
Cannot afford drug
Side effects
Prefers not to take drug
Administration error
Drug interaction
Dose to high or low too fast
Drug to high or to low effect of second drug
Effects of two drugs are cancelled
Drug-food interaction
Drug-lab test interference
Drug-disease interaction
Standard process of providing pharmaceutical care
1. Establish the patient-pharmacist relationship
2. Collect and organize information about the patient
3. List and rant the patient's MRPs
4. Work with the patient to establish desired outcomes for each MRP
5. Determine feasible solutions for each MRP
6. Choose the best solution for each MRP
7. Discuss and negotiate the plan with the patient and other health care providers as needed
8. Educate the patient about the plan and counsel the patient about any medication that are part of the plan
9. Design and implement an effective monitoring plan
10. Follow up, measure, and document progress
11. Bill for services as appropriate
Billing
Charge patients up front
Bill major medical payers for the patient
Become a provider in a state or federal disease-state management program
Contract with major medical groups to manage specific patient populations
Medication therapy management
A partnership of the pharmacist, the patient or caregiver, and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes form medication therapy.
Services or programs furnished by a qualified pharmacist to an eligible beneficiary, individually or on behalf of pharmacy provider, which are designated to ensure that medications are used appropriately by such individual, enhance the individual's understanding of the appropriate use of medications, increate the individual's adherence with prescription medication regimens, reduce the risk of potential adverse evens associated with medications, and reduce the need for other costly medical services through better management of medication therapy
Core elements of MTM Service Model in Pharmacy Practice
Medication therapy review
Personal medical record
Medication action plan
Intervention and referral
Documentation and follow-up
MTM Services
Perform or obtain necessary assessment of health status
Formulate medication treatment plan
Select, initiate, modify, or administer medication therapy
Monitor and evaluate response to therapy
review medications for medication-related problems
Document care delivered and communicate with other providers if needed
Talk to patient about medication and provide training if necessary
Provide information and resources necessary to enhance patient adherence
Coordinate and integrate MTM services within the broader health care services the patient is recieving
Tools
SOAP note
Pharmaceutical care plan