Medication order entry and fill process

Question 1

Medication order

Answer 1

An order written by a prescriber for a patient in a hospital or other inpatient setting.

Question 2

AdMiSSion order

Answer 2

A type of medication order written by a physician if a patient should be admitted into the hospital; this order is sometimes written when a patient has visited the emergency room and, after a physician’s assessment, it is decided he or she should be admitted into the facility.
Will contain:
• drugs the patient is currently taking
• drugs the patient should continue taking
• new medications the physician has ordered for the patient
• lab tests ordered, and any results obtained while in the ER
• suspected diagnosis
• any allergies
• weight and height of patient (for dosing)
• medical record number
• room number

Question 3

StAt order

Answer 3

A type of medication order sent to the pharmacy that must be filled immediately.

Question 4

discharge order

Answer 4

A medication order that gives instructions for a patient who is being dis- charged from the hospital; it should include all at-home information and prescription instructions for the patient until follow-up with a primary care physician can occur.

Question 5

PRN order

Answer 5

A medication order given on an “as needed” basis for specific signs and symptoms exhibited by a patient; some examples of symptoms requiring a PRN medication could be:
• fever
• pain
• anxiety or restlessness
• itching
• coughing
• sneezing

Question 6

unit dose

Answer 6

A drug used in a hospital or other inpatient setting that is prepackaged from bulk for a single administration for one patient.
Benefits of unit dose are:
• easy for nurse dispensing to patients
• cuts down on medication errors (each unit dose may be bar-coded)
• less waste of medication

Question 7

unit dose labels

Answer 7

To be repackaged from bulk, the labeling of unit doses must contain specific information:
• drug name (generic or brand)
• strength of medication
• name of original manufacturer
• original lot number and expiration date of manufacturer (for tracking in the event of a recall)
• bar code
• facility expiration date—cannot exceed date given by manufacturer

Question 8

Floor Stock

Answer 8

Drugs that are stored on each unit of the hospital that are frequently pre- scribed for that unit; most floor stocks are stored in automated dispensing cabinets.

Question 9

automated dispensing cabinets

Answer 9

A secure storage device that contains medications used by specific patient care units; access is limited to authorized individuals who have patient orders that need to be filled.
Examples of ADCs:
• Pyxis® (Cardinal Health)
• AcuDose-Rx® (McKesson)
• Omnicell®
• Rx-Station® (Cerner)
• Med Select® (Amerisource Bergen)

Question 10

Prescription

Answer 10

An order written for a patient by a licensed practitioner to be filled by a pharmacist.
Parts of the prescription: • inscription
• signa
• subscription
• superscription

Question 11

Inscription

Answer 11

art of the prescription that includes the name and strength of the medica- tion prescribed and the amount to be dispensed.
Example: Lipitor (atorvastatin) 10 mg #30

Question 12

Signa

Answer 12

Also known as the sig; directions to the patient. Example: Take 1 tablet by mouth daily

Question 13

Subscription

Answer 13

Part of the prescription that includes directions to the pharmacist for dis- pensing the medication.
Example: Number of refills permitted

Question 14

Superscription

Answer 14

Part of the prescription that includes the information at the top: the pa- tient’s name and address, date of birth, date the prescription was written, and Rx symbol.

Question 15

Dispense as written (daw)

Answer 15

A part of a prescription that when checked indicates that the generic of a drug must not be dispensed; brand name is required.

Question 16

DAW codes

Answer 16

0
No Product Selection Indicated (may also have missing values)
1
Substitution Not Allowed by Prescriber
2
Substitution Allowed - Patient Requested That Brand Product Be Dispensed
3
Substitution Allowed - Pharmacist Selected Product Dispensed
4
Substitution Allowed - Generic Drug Not in Stock
5
Substitution Allowed - Brand Drug Dispensed as Generic
6
Override
7
Substitution Not Allowed - Brand Drug Mandated by Law
8
Substitution Allowed - Generic Drug Not Available in Marketplace
9
Other

Question 17

Patient Profile

Answer 17

A database of information stored in a pharmacy system for each patient; should be continually updated by the pharmacy technician.
Contains the following information:
• name
• address
• phone number
• birth date
• gender
• allergy information
• medical information (preexisting conditions or diagnoses)
• insurance information
• prescriptions filled
• preference for child-resistant containers
• may contain other preferences, such as generic substitution or large- print labels

Question 18

Allergies

Answer 18

Hypersensitivity of the immune system that may begin immediately after taking a medication or take weeks to show symptoms.
Examples of allergy indicators:
• rash
• watery eyes
• swelling
• itching
• wheezing
More severe allergic reactions can result in anaphylaxis, which leads to swelling of the airways and difficulty breathing; can lead to death if not immediately treated.

Question 19

Prescription container label

Answer 19

Label should be affixed to the medication container and match the pre- scription exactly. Specific information is required to be printed on the label, including:
• pharmacy name, address, and telephone number
• patient’s name
• date prescription was filled
• prescriber’s name
• prescription Rx number (unique to pharmacy)
• medication name and strength
• directions for use
• quantity of medication (if controlled, should be spelled out)
• expiration date
• refills allowed (if any)
• initials of pharmacist dispensing prescription

Question 20

Fill Process

Answer 20

Process of filling prescriptions for patients in an outpatient setting:
1. Obtain prescription from the patient.
a. if new patient, add her or him into the system
b. if current patient, update profile with current information
2. Enter prescription information into the computer.
3. Obtain a prescription label and compare it to the original prescription to check accuracy.
4. Pull the appropriate medication from the shelf using the NDC number to confirm the correct medication was selected.
5. If medication is capsules or tablets, a counting tray will be used, and then they will be poured into an amber vial.
6. If medication is a liquid, an appropriately sized bottle should be used to pour the liquid to the proper level.
7. After proper filling, the prescription label is then affixed to the medica- tion container.
8. The prescription must then be checked by a pharmacist for final verification or the final check before being dispensed to the patient
9. If the patient is coming back to pick up the prescription later, the medication will be filed alphabetically in a specific area of the phar- macy.
10. If the patient is waiting, the pharmacy technician can ask the patient whether he or she has any questions for the pharmacist and whether counseling is required.
Remember: A pharmacy technician must never counsel patients.

Question 21

Refills

Answer 21

Refills can be easily handled by a technician when a patient calls in and refills remain on the patient profile for that medication.
Some situations require more attention:
• Early refill
- Dosage may have changed or patient may be requiring a vacation
fill—insurance company may need to be contacted

• No refills
- A patient may be out of refills and the physician must be called
for a refill authorization request
- The prescription may be older than 12 months

• Controlled substance
- C-II cannot be refilled
- C-III and C-IV can only be refilled five times within a 6-month
period

Question 22

Patient package insert

Answer 22

Required by the FDA for all medications dispensed; provides information about the drug for the patient, including:
• how the drug works
• what to do if a dose is missed
• contraindications
• warnings
• side effects
• overdose information
• dosages and packing information
• indications and use

Question 23

Medication guide

Answer 23

Supplemental information required by the FDA to be included in addition to the patient package insert for specific drugs.
Examples of some medications requiring a MedGuide are:
• Accutane
• antidepressants
• birth control
• NSAIDs
• medications for ADD including Adderall®, Concerta®, Ritalin®, and
Strattera®