IPC - exam 1 - Rx verification - not on exam :) Flashcards
A 65-year-old woman with a history of acute myeloid lymphomacalled her oncology physician’s office with symptoms of chemotherapy-induced nausea.
After a prescription was called into her local pharmacy, the patientpresented to the pharmacy to pick up her prescription for ondansetron. She was asked to provide her last name, but no other identifying information. After several unsuccessful calls from the oncology office to check on the patient over the next few days, the physician’s staff called 911.
Paramedics found that the patient had collapsed at home. Upon arrival at the hospital, she was diagnosed with severe dehydration, hypotension, and acute kidney injury requiring aggressive fluid resuscitation.
Upon further investigation, it was discovered that the patient was inadvertently dispensed spironolactone which was meant for a different patient with the same last name.
AHRQ 2021
wow very close to dying due to wrong med, it was not verified well :(
goal
prevent medication errors
Rx Verification: Why?
Every year, 7,000 to 9,000 patients die as a result of medication errors in the United States.
The most common medication dispensing error types are:
- incorrect medication
- incorrect doses
- incorrect directions - maybe take too much
There are an average of four errors per day in a typical pharmacy filling 250 prescriptions daily.
A more recent meta-analysis of this study and eight others estimated a similar error rate of 1.5% in community pharmacies.
goal: keep rate as low as possible
Rx Verification: Who, what and why?
__pharmacist____________ is ultimately responsible for prescription verification
Part of the process of filling prescriptions
To verify:
ACCURACY of
- Prescription/order entry and vial label
- Product selection
APPROPRIATENESS of prescription for a patient - is it appropriate for patients
- Drug Utilization Review (DUR) - allergies, drug-drug interaction
Requires attention to detail and focus
Rx Verification: When is it done?
Rx/Order Entry
- Enter (type) Rx/Order into the system
Filling
- Label/Leaflet prints
- Drug pulled, scanned, counted and labeled
Rx/Order Verification
- Confirm accuracy/ appropriateness of Rx/order entry, vial label, and product selection
Dispensing
(to pt/caregiver)
Rx Verification: How is it done?
Checking for accuracy:
Use prescription/order to verify the accuracy of:
1. Order entry/vial label (info related to Rx/order)
2. Product
After the product is verified as correct then confirm:
3. Order entry/vial label (info related to product)
Rx Verification: How is it done?
Checking for accuracy:
- Rx/Order to order entry/label
- Rx/Order to product
- product to Order entry/label
Never reverse the arrows - Why?
to prevent med. error
When checking for ACCURACY what are we verifying:
Rx/Order Entry/Vial Label
Product
Everything
When checking for ACCURACY what are we verifying:
Patient
- Name, DOB, address
- Med Rec #
Product
- Name, strength, dosage form
- Mfr, NDC, expiration date
- Substitution correct, if allowed
Directions
- Verb, dose, dosage form, route of administration, frequency
- Duration if applicable
- Proper grammar/spelling
Prescriber
- Name, address/phone, DEA #
Law
- Qty, refills, fill date
- Interchange/DAW (dispense as written)
- CS laws
- Days supply
Product
- Name, strength, dosage form
On-stock bottle label OR per UPC scan info
- Expiration date
- Actual pill/product inside the prescription vial
Products taken from one container and put into another
Use pill markings to ID
Pour into the cap, not hand
Rx Verification: Need to know
Know the brand and generic for all of the Top 200
Review pharmacy abbreviations list (on BB) and notes from IPC I about interpreting Rx’s
Interchange Laws
You are responsible for interchange when applicable
Understand what “No Substitution” on the bottom of the Rx means
If a prescription is written for a brand name product and the prescription allows for substitution and there IS a generically equivalent product available on the market
You must then make sure that both the Rx vial label and product stock bottles are the correct generic product
Ex: Fosamax = __alendronate_______ NOT risedronate
Use of “IC” on Rx vial label (as required per law)
Review your law notes
May find other types of law violations/errors
see the rubric for examples
DAW
dispense as written
can be zero: substitution allowed
can be one: no substitution
product expiration
NDC
a year from the date of filled or the expiration date on the product
choose whichever one is sooner
NDC: 5-4-2
Did we verify everything?
Let’s check….
Here’s the rubric which tells you what you are responsible for verifying…
Misspelling / Grammar?
What is embellishing?- add details that may or may not be true
Major embellishment- adding to the sig that is false or causes confusion or harm to the patient, like adding duration when not stated on Rx or wrong indication
Minor embellishment - if adding something not on the Rx
looks like this for PPP lab in the summer
Did we verify everything?
Let’s check….
Here’s the rubric which tells you what you are responsible for verifying…
Misspelling / Grammar?
What is embellishing?
Major embellishment
Minor embellishment
