prescriptions

Prescriptions Key Terms and Concepts

prescription - an order for the preparation and administration of medication or a medical treatment. Authorized prescribers are MD, DDS, DVM, or DO. In Texas, RN and PA may also prescribe. In other states, RPh may prescribe,depending on state law. Prescriptions may be phoned in, faxed, or written. In some states, prescriptions may even be sent by computer. Prescriptions are usually outpatient orders. Prescriptions and medication orders are always written in black ink, never pencil.
medication order - just like prescriptions, except it is for an institiutional setting
brand name - trade or proprietary drug names protected by trademark
generic name - chemical or nonproprietary drug names not protected by trademark
compound Rx - a prescription that must be prepared according to the directions and ingredients outlined on the prescription.

Components of a Prescription

A. Dr. A. B. Normal
229 El Camino Dr
Beverly Hills, CA 90210
Ph: 210-552-0136
D. DEA# AN1218088

E. Date: 7/4/2000

B. Name: Eddie Manimal
     Address: 18 Scream St, Bevery Hills, CA 90210
     Rx C. Amoxicillin 500mg #30
F. Sig: ipotid G. Refill: 0
     _______________________         _A.B. Normal_I._____
     H. Product Selection Permitted         H. Dispense as Written

Use separate form for each controlled substance prescription.
Theft, unauthorized possession and/or use of this form including alterations or forgery, are crimes punishable by law.

A. Prescriber information - name, title, address, and telephone number
B. Name and address of patient - other information such as birthday or weight is optional but sometimes important
C. Inscription - name, strength, and quantity. Strength may be omitted if there is only one strength commercially available or if the prescription is for a medical device. The quantity may be omitted if it can be implied from the sig.
D. DEA registration number of prescriber - mandatory on all controlled substance prescriptions
E. Date the prescription was written
F. Sig - instructions on how to use the medication to be printed on the Rx label
G. Refills authorized
H. Brand or Generic Designation - A doctor's signature on top of "Dispense as written" means to only give the brand name medication. However, a signature on top of "Product selection permitted" means that it is O.K. to dispense either the brand or generic medication as indicated by the patient's preference.
I. Signature of Prescriber - not necessary on oral prescriptions

Medication Orders

medication orders are instructions to the nursing staff for medical care that may include drug therapy. They are the same as prescriptions exept for the following points;

Patient Information - medication orders typically include the patient's birthday, room #, I.D. #, indication for medication use, and allergies
Date and time the medication order was written. Actual administration times are noted and signed by nurses.
If it is an oral medication order, then the name or initial of the recipient (RN or RPh) should be on the medication order.
Orders may be revised to reflect therapy changes.
Instructions for administering the medication should include route of administration, dosage and dosing schedule, duration of therapy, and any other information that a caregiver would need to administer the medication.

Community Pharmacy Prescription Labels
The above prescription should result in the prescription label below;

A. Bob's Guns & Drugs                              972-123-4208
     18 Danger St
     Bobstown, TX 75287                        B. RPh: TK
C. Rx #888                                               D. Date filled: 7/4/2000
E. Eddie Manimal
     18 Scream St
     Bevery Hills, CA 90210
F. Take 1 capsule by mouth three times a day.
G. 30 Amoxicillin 500mg capsules PFIZER
I. Dr. A. B. Normal
J. Refill 2 times by 7/24/02
H. Caution: State and federal law prohibits transfer of this drug to any person other than patient for whom prescribed.

A. Name, address, and phone number of the pharmacy
B. Pharmacist's initials
C. Prescription and/or transaction number
D. Date the prescription was filled
E. Patient's name and address
F. Sig or instructions on how to use the medication
G. The quantity, drug name, strength, dosage form, and manufacturer of the medication
H. Legally mandated statement for all prescriptions
I. Doctor's name
J. Number of refills remaining and the last date that you can get the refills

Institutional Pharmacy Prescription Labels

Unit dose medications should have the following information on the labelling; drug name & strength, lot number, expiration date, directions for administration (if needed), and auxiliary labels (if needed). This is often already put on the packaging by the manufacturer.
Multi-dose medications should have the same information as unit dose medications plus the following information; patient's name & room number, drug quantity, and directions for administration.
Sterile products have the same labelling requirements as multi-dose medications.

Auxiliary Labels

Auxiliary labels provide additional information on the prescription bottle. CII-V prescriptions must state on the bottle, "Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed." This is often added on the bottle as an auxilliary label. Also, if generics are dispensed, the bottle has to say that the generic was substituted for the brand prescribed. This statement is also often added on the bottle as an auxiliary label. Other auxiliary labels include; "Take with food", "May cause drowsiness", "Do not drink alcohol", and "Do not take with aspirin", etc. Receiving Prescriptions

Prescriptions or medication orders are received by written means or by fax. In an institutional setting, medication orders may also be transmitted via an in-house computer system or a pneumatic tube system. Verbal prescriptions, medication orders, and changes to them may only be received by a pharmacist or supervised intern. In an institutional setting, a nurse can also receive a medication order.

Receiving Prescription Refill and Transfer Requests

Accepting Refill Requests - The technician should try to acquire the following information from the person requesting the refill. At the very least, try to get items 1 to 3. That way, if the patient gives you an invalid prescription number, you can still look up the proper prescription number in the computer. Also, if there are any other problems, you can contact the patient.

Patient name, birthday and phone number
Prescription number
Drug nume, strength, and quantity
Prescriber information
Reimbursement mechanisms/third-party-payer information

Contacting Prescribers For Medication Order/Prescription Clarifications or Refills - The following information should be given to the prescriber or representative thereof when requesting authorization for prescriptions & medication orders that have expired.

Pharmacy's name, phone number, and fax number
Patient's name, birthday
Drug name, strengh, quantity
Last fill date
Sig or instructions for medication administration
Statement that this is a refill authorization request or the question regarding the prescription if it is a clarification

Assessing Prescriptions & Medication Orders

Clarity - Make sure that the prescription or medication order is clearly written and complete.
Authenticity - Make sure that the prescription is not a forgery.
Legality - Be certain that everything is in compliance with the law.
Reimbursement Eligibility - Check to see if the drug is covered by the insurance plan. Is the patient covered by the presented insurance plan? Is the patient's insurance plan honored by your pharmacy?

Work Flow

In community pharmacies, the technician usually receives the patient's prescription, collects all pertinent patient information (everything outlined in "components of a prescription", patient's phone number, sex, allergies, other drugs the paient is taking, birthday, insurance information, and whether or not they want child safety caps), and types the prescription in the computer. Check with the patient if generics are O.K. Check to see if a CII is in stock before typing it in the computer. Consult with a pharmacist if any judgement or counseling is needed. This includes the recommendation of OTC medicines. Although OTC prescriptions do not have to be typed in the computer (except for insurance purposes), the pharmacist should still counsel the patient. Alert the pharmacist if there are any potential forgeries. Alert the pharmacist if the prescription is more than a week old. In Texas, CII Rx's are valid for 7 days counting from the day after the prescription was written. CIII-V are valid for 6 months for 5 refills. However, special conditions may apply, so consult with your pharmacist.
The computer then processes the prescription and simultaneously bills the insurance company online. Then, the computer prints a prescription label. Alert the pharmacist if there is a possible drug interaction pointed out by the computer.
The prescription may then be prepared by a technician. Some computer systems may print out the proper auxilliary labels automatically. At the pharmacist's discretion, a technician may label the bottle. FDA regulations require patient package inserts (PPI) to be provided to all patients of the following medications; oral contraceptives, estrogenic drugs, progesteronal drugs, isotretinoin, intrauterine devices (IUD), and isoproterenol inhalation drugs. PPI are often provided by the manufacturer of the drug. Also, the computer may print out patient drug information on all new prescriptions.
The pharmacist checks the prescription.
The technician hands the patient his/her medication, rings up the sale, and has the patient sign the insurance log.
The pharmacist then counsels the patient. All patients receiving new prescriptions have to be counselled.