Lecture 4 - Processing an outpatient rx Flashcards
What are the pharmacy positions in an outpatient setting?
ancillary help
technicians
interns
pharmacists
Who are ancillary help and what is their purpose
unlicensed personnel
their job is to maintain stock and medical records, type labels, count and prepare dosage untits, and hand deliver completed prescriptions to patients
the pharmacist can supervise a maximum of ___ individuals at one time
4
can unlicensed personnel interpret or evaluate a prescription (ie: give instructions)
NO
What is the job of pharmacy interns?
they can perform ALL the duties of a pharmacist but must be supervised by a pharmacist at all times
what does HIPAA stand for
the health insurance portability and accountability act of 1996
what are some examples of “individually identifiable health information”
-the person’s past, present or future physical or mental health condition
-the provision of health care to the individual
-the past present or future PAYMENT for the provision of health care
what are some common ways to identify a person’s identity
name, address, DOB, SS#
what is the HIPAA term for places that provide treatment, payment, and operations in healthcare
a covered entity (pharmacy is one)
What is the FIRST STEP of the pharmacist patient care process
collect
what exactly are we collecting in this first step?
patient information (patient profile)
medication information (prescription order, evidemce based medicine_
when collecting information and pulling up a patient’s profile, what information should we be looking to update?
allergies, health, address, insurance
what are the 9 important things on a patient’s profile
name
address
DOB
phone number/email
gender
allergies
medications
chronic diseases/conditions
other relevant counseling information
does NKA mean that no allergies exist?
NO — IT MEANS WE DONT KNOW IF ANY ALLERGIES EXIST
patient profiles must be maintained for _____ years from the most recent entry
5
patient profiles must be reviewed for which 5 things
-DTP due to therapeutic duplication
-drug-drug interactions (includes OTC)
-incorrect drug dosage or duration
-drug-allergy interactions
-clinical abuse or misuse
what is some ADDITIONAL information that is good to collect from the patient
safety cap preference
delivery services
contact preference
any pharmacy in a group larger than ____ in NYS or ____ in NYC is required to have free written and oral translation services
8 in NYS
4 in NYC
What does LEP stand for
limited english proficiency
what are 4 ways to receive a prescription
in person on paper
verbal from prescriber
fax from prescriber’s office
electronically
name the 8 work stations/work flow in a community pharmacy
pickup/drop off counter
prescription entry
order evaluation
assemble/fill station
final verification
consultation counter
storage (bins)
immunization room
what do standing orders do?
they allow non-prescribing healthcare providers to prescribe under a set protocol for a set group or population
ex:
vaccinations
naloxone
pre and post exposure prophylaxis
COVID testing
paxlovid
public readiness and emergency preparedness act
what documentation is REQUIRED on a verbal prescription order
the date received
initials of who is receiving the call
FULL SIGNATURE (required for controlled substances)
though not required, what are some good habits to include on a verbal prescription order
-identify who you are speaking with to ensure it is authorized
-always verify and repeat back
-check patient profile and stock
what is the controlled substances act
federal law.
divided into 5 schedules based on
accepted medical use
abuse potential
likelihood of causing dependence when abused
STATE LAWS ON CONTROLLED SUBSTANCES CAN BE STRICTER THAN FEDERAL LAW
from CV to C1, which is the one that has NO ACCEPTABLE MEDICAL USE and has a high potential for abuse
C1
what must be on a controlled substance order to fill it
patient address and age
the # of refills allowed for a controlled substance is dependent on…..
schedule
If refills ARE allowed for that schedule of controls, what is the maximum amount of refills?
5 (less than a 6 month supply)
what are the ONLY things that a RPH can add or change to a controlled substance prescription without authorization?
patient address
patient sex
patient age
what are the 5 things that can NEVER be added to a controlled substance prescription
patient name
practicioner signature
date written
drug name
quantity
collect + assess =
implement
a pharmacist’s responsibility is to ensure….
the safe and efficacious use of every medication
can we ever assume things in the pharmacy?
NOOO
What is used to minimize medication errors when it comes to pulling stock bottles?
“tall letters”
NDC
bar codes
what 4 things on a prescription label should be the BIGGEST FONT and a minimum of 12 pt
patient name
drug name
drug strength
directions for use
NAME THE 9 REQUIREMENTS ON A LABEL
- name and address of the owner of the pharmacy in which it was dispensed
- name of the prescriber
- name of the patient
- patient’s address
- directions for use
- date compounded
- rx number
- name and strength of the drug
- if generic, the name of the manufacturer
is refill and quantity required to be on a prescription label by NY law?
NO
which is better….
morning and evening or
two times a day
morning and evening
which is better….
with breakfast or….
30 minutes before breakfast
30 minutes before breakfast
which is better
2 times a day or…
two times a day
2 times a day
which is better…
mL or teaspoon
mL
what are auxiliary labels?
provide additional information to the patient such as….
if the product is a new generic drug for the same med dispensed previously
storage
what to avoid taking
possible side effects
expiration
where should auxiliary labels be placed?
DIRECTLY ONTO THE RX CONTAINER
are auxiliary labels required by law
no
What is the purpose of DUR
to identify DTP’s
can we rely on the system to tell us about DUR
NO – THEY MUST BE EVALUATED BASED ON CLINICAL AND LEGAL JUDGMENT
documentation is vital
what does TPR stand for
third party claims
what does the NYS PMP require dr’s to do
dr’s have to check the PMP registry before writing a prescription for a controlled substance, schedules 2-4 for a pt
the PMP includes all controlled substances that were dispensed and reported by the pharmacy for the past ________
6 months
all NYS pharmacies are required to submit their controlled substance dispesing data to…..
the Bureau of Narcotic Enformcement
the PMP registry displays the ____ and ____ but does not specify the ____
displays the drug and strength but does not specify the dosage form
FDA requires med guides when….
-its necessary to prevent serious adverse effects
-pt should be informed of a known serious side effect
-pt adherence to directions for usage of a product are essential to its effectiveness
what are CvI’s
NON CONTROLLED
If a pharmacist must cancel an RX, what must they include?
RPH initials, date, RX#, and manufacture if generic
for non controls (CVI) ^^^^
for controls…..
RPH SIGNATURE, date, rx#, manufacture if generic
when a prescription is cancelled and filed away, how long is it stored for?
FIVE YEARS
under ORBA, what must pharmacist or pharmacy intern do?
the pharmacist/pharmacy intern MUST PROVIDE COUNSELING
-before dispensing a new med to a new pt of the pharmacy
-before filling a new script for an exisiing pt of the pharmacy
-if the dose, strength, route of administration, or directions for use has changed for an exisitng presciption previouslt dispensed to an exisiing patient
any time a patient has a prescription refilled, what must be done?
an OFFER to provide counseling
a daily log is printed every day which reports all new and refilled prescriptions dispensed. What must the pharmacist do with this?
sign it, and it must be kept for 5 years
are we required to fill every prescription?
NO
PC
after meals
