Prescriptions may be written, sent as electronic orders, or verbally communicated directly to the pharmacist (at which point they must be written in a proper format, immediately). Prescriptions must come from a practitioner or their authorized agent. A prescription, or Rx, may also be given directly to the patient's health care professional if not the patient themselves, who may then present it to the pharmacy. Electronic prescriptions sent by fax or from the practitioner's computer to the pharmacy's computer, must be sent directly to the pharmacist via a secure system. Prescriptions can be for drugs as well as drug devices. Prescriptions are legal documents and may not be altered without the express permission of all parties involved. In an institutional setting, prescriptions are known as medication orders and nursing staff generally administer medications to patients. Prescriptions must be complete. Incomplete prescriptions will cause additional wait time for customers in a retail pharmacy setting as the pharmacy must contact the doctor. In an institutional setting a pharmacy can not dispense an incomplete medication order to a nurse for a patient.
A written prescription has several parts:
- Prescriber's name, title, office address & telephone number
- Prescriber's DEA registration number
- Prescriber's NPI (National Provider Identifier) number
- Prescriber's signature
- Date prescription was written
- Patient's name & address
- The signature (written as Signa, Sig, S, or blank) with directions for use and route of administration
- Refill instructions
- Inscription, (body of the prescription), will have for each drug:
- Drug name (brand and/or generic)
- Medication strength
- Quantity to dispense (may be in subscription below inscription)
- Dosage form
- If a compound is prescribed:
- List of directions
- Directions for mixing
A dispensed prescription drug label will have the following information (depending on the drug or state, certain drugs may have greater requirements):
- Dispenser's name, address & telephone number
- Prescription's serial/transaction number
- Date of prescription/filling
- Expiration date
- Prescriber's name
- Initials of dispensing pharmacist
- Drug/medication information:
- Drug name
- Manufacturer (name or NDC number)
- Dosage form
- Refill information
- If stated in the prescription:
- Patient's name
- Clear and accurate directions for use including route of administration, dose, and frequency/schedule of administration
- Auxiliary labels & cautionary statements
A dispensed institutional unit dosed drug label will have the following information:
- Drug name
- Manufacturer & NDC number
- Lot number
- Expiration date
- Dosage form
The DEA issues registration #'s to practitioners that begin with different series of letters. DOD personal service contractors = G. Hospitals, Clinics, Practitioners, Teaching Institutions, Pharmacies = A, B, F, or G. Mid-Level Practitioners (NP/PA/OD/ET,etc.) = M. Manufacturers, Distributors, Researchers, Analytical Labs, Importers, Exporters, Reverse Distributors, Narcotic Treatment Programs = P.
These registration numbers follow a specific pattern. Take the sum of the 1st, 3, and 5th digits of the DEA #. Add that value to: 2 multiplied by (the combined sum of the 2nd, 4th & 6th digits of the DEA #). Then take the last digit of that sum, known as the checksum or check digit, and see if it matches the last digit of the DEA #.
For example, a possible DEA # for Kamara's Pharmacy may be BK1375597 since 1+7+5+2*(3+5+9)=47
See the following links for more information:
The process a prescription follows:
- A prescriber (physician, practitioner, MD, DO, DDS, DVM, etc.) determines a prescription is necessary and writes one for the patient.
- The patient (or health care professional/other representative) presents the prescription to the pharmacy
- The pharmacy technician, such as yourself 🙂 , checks the prescription for completeness, authenticity and if the drug(s) is(are) in stock
- The pharmacy technician then confirms or collects relevant patient information (name, address, insurance & allergy information) & then scans the prescription into the computer system and enters the prescription information
- The pharmacy technician processes any 3rd party billing online, known as adjudication, and the prescription data into the computer system. DUR (drug utilization review) messages will also be returned if applicable
- After the prescription and any 3rd party billing are confirmed, the label is generated. It will include member co-payment or insurance information. The pharmacy technician checks that the label matches the initial prescription exactly.
- The pharmacy technician matches the NDC code on the stock bottle to the drug(s) and after measuring, weighing, compounding, etc. of the drug(s), will place them in proper containers and affix the label(s) and other necessary information. Child proof containers will be used unless a request for easy open containers is on file.
- The pharmacist does a final verification & check for any clinical issues. Upon approval, the completed prescription is properly stored along with any pertinent information sheets in bins, refrigerators, etc.
- At the time of pick up, the pharmacy technician will present the insurance log to be signed by the patient or representative, along with the pharmacy's notice of HIPPA compliance if not already signed. The pharmacy technician then rings up the sale and the pharmacist must offer counseling/consultation.
It's important to note that the computer system may warn of different drug interactions which should not be overridden or ignored. Possible adverse reactions should be reported to the pharmacist. Some of them may include:
- Drug-drug interaction
- Drug-food interaction
- Drug-disease interaction
- Drug-lab interaction
- Therapeutic duplication
- IV incompatability
Patient profiles are confidential legal records that the pharmacy technician is responsible for setting up and maintaining for the pharmacist. They contain:
- The patient's demographic composition including complete name, address, phone #, DOB, sex, ID#, as well as name of parent or guardian
- The patient's insurance information including the insurance company's name, phone #, patient code, group code and any other necessary information
- The patient's medical history such as allergies (along with severity of last known reaction and it's rating of 1 - nausea, 2 - rash/hives, 3 - trouble breathing or requiring immediate medical intervention) as well as any past/present medical conditions. This is an especially critical section for the pharmacist
- The patient's prescription history at that particular pharmacy as well as over the counter and herbal medicines
- The patients preferences such as brand/generic drugs and if they don't want child proof containers for their medications
- Refusals to sign pharmacy documents such as insurance forms, HIPPA forms, etc.
Pharmacy technicians must ensure that all of this information is kept up to date with accurate information. Ask the patient if there have been any changes to their profile ESPECIALLY name changes and changes of address, phone number, insurance carrier, etc. In an institutional setting such as a hospital, pharmacy technicians should pay special attention not add multiple incomplete profiles to the computer otherwise prescriptions can be dispensed to the wrong person or produce other unfavorable results. This can be avoided by comparing the patient's name against the date of birth coupled with their address, phone number, etc. A hospital profile may also include the patient's account #, room #, diagnosis, name of practitioners, allergies, disabilities, languages, dietary restrictions and more. This data becomes part of the patient's permanent hospital record.
Prescription information checklist:
- Confirm that name is full name, not a nickname to avoid multiple files for the same patient
- Confirm that DOB, address, telephone #, insurance info, brand/generic preference, allergy information, etc. is already on file. Record patient's DOB on prescription to double check when filing prescription
- Check with the pharmacist as to whether the prescription isn't already available over the counter
- If the prescription is for a C-II (schedule II) drug, make sure all special requirements are fulfilled, including completing the perpetual schedule II inventory log, short expiration dates, etc.
- If the prescription is more than a few days old, check with the pharmacist if it may still be filled. Furthermore, if there appears to be any tampering of the prescription such as changes in handwriting, ink, prescription quantity/strength/drug name/etc or anomalies then inform the patient or representative that there may be a delay and calmly alert the pharmacist.
- Make sure the drug is available