Interpreting and Processing Prescriptions; Patient Charts

Question 1

Requirements of a Valid Prescription

Answer 1

• patient name
• date script was written
• name of med
• strength of med
• quantity requested
• directions for use = Signa or Sig for short
• number of refills allowed
• name, address, telephone number, and signature of prescriber
• NPI - now required for all insurance claims
• if generic can be substituted
• if a compounded medication it must include all ingredients and directions for mixing
• If controlled substance, must also include:
  
  • patients address
  • DEA number of prescriber
  • prescriber’s signature, in black ink, if a schedule II drug
• If Medicare Patient must include:
  
  • diagnosis or diagnosis code on the prescription
  • generally required for diabetic testing and incontinence supplies

Question 2

Critical Path of a New Prescription

Answer 2

1. patient drops off script. Pharm Tech check the script to make certain it is:
   
   1. legible
   2. complete
   3. authentic
2. Pharm Tech verifies that the patient information is contained in the pharmacy database. If not, the tech obtains necessary demographics, insurance, allergy and health information from the patient and enters that information into the computer
3. pharm tech enters the script into the computer database from the written prescription, faxed prescription, or e-script, billing the insurance company or calculating the cost to the patient
4. pharmacist then verifies the accuracy of the technician’s computerized entry against the original prescription and generates the medication information sheet and the medication container label
5. pharm tech asks the pharmacist to check the drug tuilization review (DUR) or drug interaction warning screen when required
6. pharm tech selects the appropriate medication and verifies the National Drug Code (NDC) number on the stock drug bottle against the computer-generated medication information sheet.
   
   1. some pharmacies, the bar code on the stock bottle and medication container label are compared for accuracy
7. pharm tech prepares the medication (the prescribed number of tablets or capsules are counted or the the prescribed amount of liquid measured).
   
   1. controlled drugs are often double-counted and initialed
8. pharm tech packages the medication in the appropriate container
9. pharm tech (or pharmacist, depending on state law) affixes the computer-generated medication label to the prescription container
10. the pharm tech prepares the filled prescription (including original prescription, medication information sheet, stock drug bottle, medication container label, and medication container) for the pharmacist to make a final check
11. pharmacist checks the prescription and may initial the label and prescription
12. pharmacist bags the approved prescription for patient sale and attaches the medication information sheet (and MedGuide, if required) about the script, including indications, interactions, and possible side effects
13. pharm tech returns the stock drug bottle to the shelf. If the bottle is opened, then the bottle is so marked or labeled for inventory ordering
14. pharmacist or pharm tech delivers the packaged prescription to the cash register area for patient pickup (or storage) and pharmacist counseling. The pharm tech verifies that the correct patient is receiving the prescription by asking for address or birth date verification. If someone other than the patient is picking up a controlled drug prescription, then a photo ID may be required.
15. Payment is collected if due. Some insurance providers require the patient to sign a form verifying that the prescription was picked up.

Question 3

Category X Drug

Answer 3

drug that is highly likely to cause birth defects

• female patients must undergo monthly pregnancy tests
• those that are sexually active must be on some form of birth control
• males must be educated as the risk of the drug pasing to the female during sexual intercourse could cause birth defects
• strict time limits on dispensing the drug to the patient due to careful monitoring and the need for frequent laboratory testing

Question 4

iPLEDGE

Answer 4

• a program that both the prescriber and the pharmacy must enroll in to dispense category X drugs

Question 5

Patient Profile

Answer 5

• confidential database that contains demographic information to track all prescriptions that have been dispensed at that pharmacy for that individual patient
• each patient who presents a prescription to be filled at a pharmacy must have a current updated profile

Question 6

Patient Profile Components

Answer 6

• identifying information
• insurance and billing information
• medical and allergy history
• medication and prescription history
• prescription preferences
• HIPAA confidentiality

Question 7

Pt. Profile Identifying Information

Answer 7

• patients full name (including middle initial in some states)
• street address
• telephone number
• birth date
• gender
• email addresses
• text preference for mobile numbers

Question 8

Pt. Profile Insurance and Billing Information

Answer 8

• all information necessary for billing

Question 9

Pt. Profile Medical and Allergy History

Answer 9

• existing conditions
  
  • diabetes
  • heart disease
• known allergies
• adverse drug reactions

pharmacy software reviews the medical history for the pharmacist to ensure that the prescription is safe to fill for a given patient.

Question 10

Pt. Profile Medication and Prescription History

Answer 10

• listing of any scripts filled at that location
• some allow listing of OTC medications
• new scripts are compared with previous scripts - the software compares this infomation to ensure there are no adverse drug interactions due to combined effect or interactions between different medications

Question 11

Pt. Profile Prescription Preferences

Answer 11

• pt preferences as the apply to prescriptions
  
  • child-resistant caps
  • non-child-resistant caps
  • generic substitutions
  • large-print labels
  • foreign language preference

Question 12

Pt. Profile HIPAA Confidentiality

Answer 12

• each new patient is required by law to receive a statement on pateint confidentiality of information on the patient profile, which must be documented
• this statement is for the protection of the pharmacy

Question 13

Current Customer Patient Profile

Answer 13

• must ensure the correct patient profile is selected
• must match the patient name with the correct address and also a DOB
  
  • critical to have more than one identifier as many patients share the same name or may have more than one address listed
• must also verify that the address, phone number and name of prescriber are correct or refills will be sent to the wrong provider

Question 14

allergy

Answer 14

• hypersensitivity to a specific substance that may manifest in many physical way and can be life threatening
• allergies should be ascertained every time a prescription is presented to the pharmacy
• also include past adverse reactions (ADR) which is a generally a milder reaction to a medication but which patients may consider an allergy. it is an unexpected negative consequence from taking a medication
• allergies can begin at any age. a patient need not have had a reaction before to experience one.
• missing a drug allergy could trigger a lawsuit for negligence on the pharmacies part

Question 15

prior authroization (PA)

Answer 15

• requires the pharmacy to call or fax the prescribers office to obtain from the prescriber and explaination/justification for the use of the medicatio with the patient’s insurer
• delays processing of the script for 72hrs or longer

Question 16

DUR

Answer 16

• drug utilization review
• requires a closer review of the patient profile for potential medication problems with other drugs in the profile
• extremely important step in script filling - during this step is when a potential allergy, hypersensitivity, adverse reaction, or drug interaction will be recognized
• DUR triggered by:
  
  • prescribed med may interact with existing or past medications on the patient’s profile
  • prescribed med may be contraindicated bc of patient’s allergy or medical history
  • prescribed med may be a duplicate of a similar drug prescribed in the past
  • prescribed med may have been prescribed in doses too low (subtherapeutic) or too high (toxic) for the patient
  • prescribed med may not be indicated or may be used with caution in certain patient populations
• DUR categorized by potential severity
  
  • mild
  • moderate
  • severe
• in most pharmacies, action taken on Severe DURs are documented
  *

Question 17

MTM

Answer 17

medication therapy management

DUR is an example of this service, and in which cases the pharmacy is reimbursed and additional fee for identifying, resolving and documenting a potentially severe, and costly, adverse drug effect

This reimbursement is available from some insurance and all Medicare Pard D providers

Question 18

medication container label

Answer 18

• date when filled
• prescriptions serial number
• pharmacy name, address, telephone number
• patients name
• prescribers name
• all directions for use given on the script
• all necessary auxiliary labels containing patient precautions
• medication name and whether generic or brand
• medication strength
• drug manufacturer’s name
• drug quantity
• drug expiration date or date after which drug should not be used because of possible loss of potency or efficacy
• initials of the licensed pharmacist
• number of refills allowed or the phrase “No Refills”

Question 19

auxillary label

Answer 19

small colorful label that is added to a dispensed medication to supplement the directions on the container label

ex. shake well before using

take with food

Question 20

Medication Information Sheet

Answer 20

• computerized printout that provides details on how to safely take the prescribed medication
• contains patient demographics
• prescription specific information such as directions, Rx number, and refills remaining
• ingredient name
• common uses
• before using this medication
• how to use this medication
• cautions
• possible side effects
• overuse
• additional information

Question 21

Medication Guide

Answer 21

• MedGuide
• must be provided to patients receiving a select number of high-risk drugs
• commonly printed after the final check of the prescription by the pharmacist
• black box warning advising consumers of a potential adverse reaction or of the proper use of a medication with a special dosage formulation
• some medications have their own medguide that is automatically dispensed with the product

Question 22

Final Prescription Check

Answer 22

• requiered by law that the pharmacist checks every prescription before it is dispensed to the patient to verify its accuracy

Question 23

patient counseling

Answer 23

• cannot be done by tech
• tech must offer it to patient and refer the patient to the pharmacist

Question 24

DAW codes

Answer 24

DAW identifies why a brand name drug was dispensed when a generic was available

• DAW0 - indicates that no product selection was indicated and usually a generic product is dispensed if there’s one available
• DAW1 - substitution is not allowed by prescriber
• DAW2 - substitution is permissable but patient has requested brand name

Question 25

unit of use

Answer 25

fixed number of dosage units in a stock drug container

ex. birth control pills

Question 26

unit dose packaging

Answer 26

each unit dose of tablet or capsule is individually packaged in a sealed foil andconsidered tamper-proof

ex. cold pills