Prescriptions and dispensing labels Flashcards
VCPR and prescriptions
A vet cannot prescribe drugs requiring a prescription unless a valid VCPR exists.
However, a prescription may be filled/dispensed without a VCPR to clients of another clinic in which case your clinic is acting as a veterinary pharmacy.
Clients also have the option of taking their prescription elsewhere e.g. a human pharmacy or another vet clinic to be filled.
SVMA Bylaw 13: VCPR Definition
i. the veterinarian has assumed responsibility for making medical judgments regarding the health of the animal and the need for medical treatment, and the client, owner or other caretaker has agreed to follow the instructions of the veterinarian;
ii. the veterinarian has sufficient knowledge of the health, environment and need for care of the animal (s), acquired by virtue of:
A. personally examining the animal(s); or
B. making medically appropriate examinations and timely visits to the premises where the anima is kept, thereby obtaining sufficient knowledge to initiate a general or preliminary diagnosis of the medical condition of the animal; or
C. where medically appropriate, through history taking, including details of any presenting complaint and a review of previous medical records obtained as soon as possible after the first encounter; and
iii. the veterinarian is readily available or has arranged for emergency coverage for follow-up care in case of adverse reactions or failure of the treatment regimen
grey areas with animals and VCPRs
In the case of herd animals/litters it is not always required to examine each animal in the herd/litter to prescribe medication. Visiting the premises sufficiently to have enough knowledge to be able to make a confident diagnosis is acceptable to prescribe to others in the herd/litter.
Refills may also be prescribed for a current condition without the need to see the patient again.
It is ultimately the veterinarian who must use their judgement in some of the more “grey” situations.
A VCPR is terminated when
a. the condition is reasonably resolved;
b. care is transferred to the client;
c. care is transferred to another veterinarian;
d. care is transferred to another competent person or body;
e. the requirements of Section 13.1.b have not been met; or
f. the client has been informed in writing, delivered either in person or by registered mail, that the veterinarian and/or veterinary practice will no longer provide service to the client
Options for the veterinarian for the filling of prescriptions:
Human Drug- Phone, Fax, or Write Prescription to a Human Pharmacy or fill at a clinic.
Veterinary Drug- Phone, Fax, or Write Prescription to a Veterinary Pharmacy or fill at your clinic if have a valid VCPR. (Veterinary drugs in Canada are not usually available to human pharmacies due to the marketing policies of veterinary drug manufacturers.)
Blanket prescription is
When a veterinarian authorizes a specific list of prescription medications, to be given at any time and any quantity for a period of ONE year to a specific list of clients with a valid VCPR. An example of this would be Herd Health. Once the list is made, it must be reviewed every year and signed by the veterinarian and acts as a prescription authorization. When the client requests a drug from the list, a prescription order is written and kept on file.
How do animals prescriptions get refilled
Prescriptions can only be refilled if the veterinarian has authorized refills.
It cannot be refilled more times than the number of refills the veterinarian has authorized.
The refill must be exactly as the original prescription. Any changes (dose, frequency, dose form, duration) requires a new prescription.
Refills & Rxs are only good for 1 year from the date the script was written. I.e. if the client hasn’t filled the Rx within 1 year of receiving it, it should not be filled.
Frequency of refills must be checked to ensure intervals are consistent with the prescription.
Part-fills are not the same as refills. A part-fill is where the client requests only a portion of the drug ordered to be dispensed at any one time.
Prescriptions are
A prescription is a legal order for a specific patient, with a specific condition, for a specific drug with specific instructions as to dosage and use.
It is prescribed by a veterinarian.
It can be provided in written or verbal form. If provided verbally, it must be transcribed into the written record.
It must be documented by the prescribing veterinarian and the veterinarian responsible for filling it.
Dispensing label is and what does the RVT do
The label and information placed on the package of medication to go home with the patient.
RVTs can perform the task of dispensing medication as per the Rx order which includes creating a dispensing label.
What are the legal requirement’s for prescription labels
Name of Client (Address if narcotic)
Name of Patient and Species (weight optional)
Drug (Brand or generic name or both acceptable, if Brand name given, cannot be substituted without DVM permission)
What may be on a prescription label
Strength/Concentration (100mg capsule or 25mg/ml)
Dosage Form (Suspension, tablet, ointment)
Quantity (If not conveyed through the directions e.g. 40 tabs)
Directions on prescription labels must include
Route (po, IM, od, au)
Dose (ml, ii, TWO, ¼ inch)
Frequency (tid, q8h)
Duration (for 10 days, until recheck, 1/12)
What is on the prescription label
Legal requirements
May have strength/concentration, quantity or dosage form
Directions
Refills if requested (None if narcotic; Interval if controlled drug or Pr)
Clinicians Signature (Printed name & phone number also)
Date
Must be legible!!
Verbal orders for Rx
Verbal orders are common in clinic between the DVM and RVT.
RVT then writes the Rx in the patient’s medical record
Then dispenses the drug.
Verbal orders may be called to a human pharmacy to be filled or another veterinary hospital
The DVM needs to make this call.
How to record verbal Rx
Verbal orders must be recorded into the permanent record. When making a record of a verbal order, the same information must be present as on a written prescription.
If from outside veterinarian, recommended to re-write it on a clinic prescription pad, under “signature” enter veterinarian’s name, time of call, (all clinic contact into) and indicate “by phone”. Scan into file.
How to take a verbal drug order when it is controlled drugs
For controlled drugs, it is recommended that prescription transfers are received directly from the prescribing clinic (fax or signed e-script or veterinarian phone call). ALWAYS verify validity with the prescribing clinic.
What to do if you are getting verbal drug orders from someone on the phone
If receiving a verbal prescription from another clinic, the verbal drug order must come directly from the prescribing veterinarian.
If from outside veterinarian, recommended to re-write it on a clinic prescription pad, under “signature” enter veterinarian’s name, time of call, (all clinic contact into) and indicate “by phone”. Scan into file.
CAN RVT TAKE VERBAL ORDER (VO) FROM YOUR OWN VETERINARIAN?
yes
CAN VT TAKE VO FROM AN OUTSIDE VETERINARIAN FOR A CLIENT?
YES (This is new)
CAN RVT TAKE VO FROM AN OUTSIDE RVT FOR A CLIENT?
NO
CAN RVT TAKE VO FROM AN OUTSIDE VETERINARIAN FOR EMERGENCY CLINIC USE?
YES
For example, if a neighboring clinic needs to purchase some emergency medication for in clinic use such as TRAMADOL than verbal Rx can be taken by the RVT
THE RVT & GIVING PHONE ORDERS
ONLY THE VETERINARIAN CAN GIVE THE VERBAL ORDER FOR A PRESCRIPTION FOR A CLIENT OVER THE PHONE. This is federal law.
THE VETERINARIAN CAN ONLY GIVE THE VERBAL ORDER FOR THE PRESCRIPTION FOR THE CLIENT TO A PHARMACIST (DVM) OR RVT (who is acting under the direct supervision of their veterinarian).
The RVT cannot phone in prescriptions on behalf of the veterinarian for their patients. (Scope of the veterinarian) unless ordering stock for clinic.
An easier away around this is FAX in the prescription for client to the pharmacy of client’s choice if vet does not have time to phone the order in.
How does a clinic act as a pharmacy
fill Rxs for clients from another clinic.
Your clinic does not have a VCPR with this client/patient.
Must still assess validity of the Rx written or verbal.
Does the Rx make sense i.e. drug for the condition, dose for the size of patient
Call to confirm with other clinic.
Make sure prescribing DVM’s name is on dispensing label.
Maintain records: Place physical Rx in a file with any additional pertinent information e.g how was validity verified? Record of your dispensing e.g. label etc.
When may Rxs be transfered
Veterinarians can transfer a prescription to another veterinarian or a pharmacist
Transfers involve prescriptions that were originally given to one clinic/pharmacy to fill. In other words, one prescription is dispensed by more than one clinic and/or pharmacy.
When does Rx transfer happen
a client moves and requests records be transferred (which would include Rxs) to a new hospital and there is an ongoing Rx
a refill/part fill occurs at another location
How to do a prescription transfer
The clinic/pharmacy with the original prescription writes an “order” with the original prescription and a set number of valid refills for the recipient clinic/pharmacy to fill.
Must record each transfer of a prescription, including number of refills transferred. Number of refills transferred must be adjusted (subtracted) from remaining refills.
What to do to the new prescription when its transfered
Must adjust in-clinic record to reflect that refills are reduced OR may be “0” if the entire remainder of the prescription was transferred
The total amount of drug accessible to the client must be the same as indicated on the original prescription.
Expiry date on the prescription must be consistent with the expiry date on the original prescription.
Narcotics as a pescription
Written prescriptions required. (TPP program in AB)
Must have DVM signature.
Verbal prescriptions not permitted.
No refills (part-fills OK).
Can you transfer narcotic prescriptions
Transfers of prescriptions not permitted.
Clients with VCPRs cannot get “refills”. 1 script per fill.
A client must provide a new written prescription with DVM signature each time they take a narcotics prescription to be filled at another clinic or pharmacy.
How long do you need to keep a narcotics Rx and where
Original prescriptions must be kept on file for 5 years* (*SVMA bylaws say 5 years; federal law is 2 years).
Recommended that all original narcotics prescriptions be kept in the same place for tracking and audit purposes. (Can be with the dispensing log must be separate from regular prescriptions).
What is unique about the narcotics dispensing record
Dispensing records must have clients name and address – Check address!
Controlled drugs Rx
Written and verbal prescriptions permitted
Refills are permitted for verbal prescriptions in Part II & III of regulations, but NOT for those drugs in Part I of the regulations
Refills are permitted for written prescriptions in all 3 parts of the “C” drug regulations
Refills must state either verbally or written the number of refills and the time interval between refills
Transfers of prescriptions NOT permitted
Control drug Rx need to be kept how long
All Documents are required for the receipt and issue of controlled drugs and must be kept for a minimum of 5 years*
Must report any loss or theft (same regulations as narcotics)
BENZODIAZEPINES and TARGETED CONTROLLED DRUGS T/C Rx requiremnets
Less tightly controlled than narcotics and controlled drugs but more tightly controlled than prescription drugs.
Written and Verbal prescriptions permitted
Refills permitted on both Verbal and Written prescriptions (interval not required)
Transfer of prescriptions permitted but only ONCE
All Documents are required for the receipt and issue of BZD and T/C and must be kept for a minimum of 5 years*
Loss or theft also must be recorded (same regulations as narcotics and controlled drugs)
Prescription class drugs can be prescribed by
Written and Verbal prescriptions permitted
Refills permitted on both Verbal and Written prescriptions (interval not required)
Transfer of prescriptions permitted must track number of transfers
Drugs prescribed for ON-LABEL use and in the manufacturer’s original container with all labels intact and that has not been disturbed do not require a complete dispensing label YET in Sk
Prescription drug classes need what documentation
All Documents (prescription and dispensing) must be kept for a minimum of 5 years*
All human-labelled drugs and any ELDU are treated the same as prescription class drugs
Prescription Drug List medications can be sold without prescription to:
Manufacturer
Practitioner
Wholesale druggist
Pharmacist
Hospital
E.g. WDDC sells to the vet clinic
Chemical company sells products to manufacturer
Restricted or OTC can be sold how
May be sold without a prescription and without a dispensing label, if they are in the original container with the manufacturer’s label to comply with the requirements of the labeling regulations and labeled for “Veterinary Use Only” and used on-label.
If “Veterinary Use Only”, but repackaged (not sold in original manufacturer’s container) or used ELDU, they must be sold pursuant to a prescription, and MUST have a dispensing label.
What do you do for human restricted drugs for animals
Human restricted class drugs used in an animal require a prescription AND MUST BE LABELED even if in the manufacturer’s original packaging.
Part I schedule F PR needs
Human Labeled Drug
-Rx required
Veterinary Labeled Drug
-Rx required
PART II SCHEDULE F “R” needs what
Human Labeled Drug
-Rx required
Veterinary Labeled Drug
-Rx NOT required
DOCUMENTATION OF SALE OF PRESCRIPTION DRUGS “RECORD KEEPING”
When the prescription/order for prescription drugs is in writing, the document must be kept for at least 5 years from the date it is filled.
If the prescription is verbal, the person who receives the order must record the order on paper and keep the document for at least 5 years from the date it was filled.
Re-write on clinic prescription pad. Enter signature as: name of prescribing veterinarian and “by phone”.
What does the VT do for record keeping on Rx drugs
A Veterinarian Technician filling a prescription, upon a veterinarian’s order, usually would enter it into the patients medical records or chart.
Regular Pharmaceutical Waste should go where
DO NOT DUMP DOWN DRAIN !!!!
Includes empty vials, expired product, contaminated product, etc.
Does not require documentation
Should be incinerated – contact local bio-waste management company.
Bio-waste pails can be obtained for this use
Cytotoxic waste (such as Chemotherapy) should be disposed how
All drugs, administration equipment, PPE should be discarded in biohazard waste pails & incinerated through bio-waste management company.
Does not require documentation
How to dispose of drugs
DO NOT THROW OUT NARCOTIC OR CONTROLLED DRUGS!!
Keep all expired or unusable Narc/Contr. drugs in safe until able to destroy properly
Can return to original distributor for destruction (must arrange secure transfer)
For large volumes, the VETERINARIAN can destroy drugs (place in container with cat litter & send for incineration). The purpose is to alter the drug so it cannot be consumed. This act must be witnessed by a DVM, an RVT or other health professional. Must record date, name, strength per unit, quantity. (federal law).
Remainder of drug from single use ampoules or broken or spilled vials or unnecessary doses - The RVT can discard into pharmaceutical waste (should contain kitty litter) . Must be witnessed & recorded in controlled drug logs as per regular dispensing entry.
Dispensing is and doen when
the act of filling a prescription
Does not require a VCPR
Within the scope of practice of the RVT (under veterinary direction)
What should the despising label include
Name of client
Identification of animal(s)
Date dispensed
Name of drug
Strength of drug
Quantity Dispensed
Name of veterinarian prescribing and/or dispensing the drug
Directions for use
Veterinary Use Only (printed advisory)
Practice phone number
Practice Name
DIN
WT if food producing animal
