PROCESSING THE
PRESCRIPTION
ORDER
Dispensing refers to the
pharmacists function of taking an
order or prescription, preparing the
drug/s according to the instructions
of a physician/dentist/veterinarian
and delivering it to the patient or
client with proper instructions.
10 Strategies for minimizing
Dispensing Errors
1. Ensure correct entry
of Rx
Transcription error
Omission
Inaccuracies
10 Strategies for minimizing
Dispensing Errors
2. Confirm that Rx is correct
and complete
Illegible/ambiguous
Nonstandard abbreviations
Acronyms
Decimals
10 Strategies for minimizing
Dispensing Errors
3. Beware of
LASA/SALAD
Similar drug names
Aldactone Aldazide
Gliclazide - Glipizide
10 Strategies for minimizing
Dispensing Errors
4. Be careful with zeros
& abbreviations
Misplaced zeros
Decimal points
Faulty units
10 Strategies for minimizing
Dispensing Errors
5. Organize work place
Organize work space
Work environment
Workflow
10 Strategies for minimizing
Dispensing Errors
6. Reduce distraction
when possible
Multitasking
Distraction during work
10 Strategies for minimizing
Dispensing Errors
7. Focus on reducing
stress and balance
heavy workload
Workload increase
10 Strategies for minimizing
Dispensing Errors
8. Take time store drug
properly
Avoid mix - ups
10 Strategies for minimizing
Dispensing Errors
9. Thoroughly check all Rx
Repeat checking
Counterchecking
Compare written Rx &
the product
10 Strategies for minimizing
Dispensing Errors
10. Always provide
through patient
counseling
PROCESSING
PRESCRIPTION
R
Prescription written
by authorized
prescriber
Patient presents
prescription to the
pharmacy
Prescription is checked for
completeness; prescriber
info, drug name, strength,
dose, and directions
Correct patient info is
entered into computer
system
LABEL
Prescription is prepared.
Correct amount of med
prescribed is measured and
placed into container
Prescription is prepared by
pharmacy technician, and
final check done by
pharmacist
Pharmacy label is generated.
Make sure all the legal items
are identified
Patient receives script, pharmacy
assistant must offer counseling to the
patient. Then script is rung on cash
register, and insurance log signed
Prescription is interpreted and
confirmed by pharmacy system.
Third party is billed online (optional)
Pharmacist provides counseling
on the medication prescribed and
all medically related questions
How is a prescription processed?
receiving the
prescription
packaging
rechecking
reading and checking
delivering and
the prescription
patient counseling
numbering and
dating
Labeling
preparing the
prescription
recording and
filling
pricing the
prescription
What is the purpose of
numbering and dating the
prescription?
The
same number of the original
prescription should appear at the label
of the filled prescription to avoid error
in dispensing
The date of the prescription is not the
same date that should be placed on the
filled prescription for identification
purposes
Information to be recorded in the
Prescription Book
1.name
of physician
2.name of the drug
3.quantity
4.date when dispensed
5.balance (quantity if any)
6.pharmacist signature, etc
1. RECEIVING THE
PRESCRIPTION
Enhance
the
pharmacist
patient relationship
PHARMACIST should:
Estimate
length
of
time
required to fill the Rx
To price the Rx if requested by
the patient.
Receiving the Rx
The appropriateness of the Rx for that patient can
be assessed
Any required records can be completed correctly
The product can be labelled for that patient
If, necessary, the Rx can be delivered to the
correct patient at the correct address
The patient can be contacted, if necessary, even
after the medicine has been dispensed and
supplied to the patient
2. READING AND
CHECKING THE Rx
Read the Rx in the privacy of
the prescription department
There should be no doubt as
to
the
ingredient
or
quantities prescribed
2. READING AND
CHECKING THE Rx
If something is illegible or if it
appears that an error has been
made. Pharmacist should consult
another pharmacist or the prescriber.
Should verify omission or failure to
specify
desired
strength
of
medication
2. READING AND
CHECKING THE Rx
The size and frequency of dose be
carefully noted and checked:
1. Age
2. Weight and condition of patient
3. Possible influence of other drugs
being
taken
4. Frequency of administration
Clinical and Legal
Checking of Rx
Suggested Way to do this REVIEW
is
IDEAL CASE
Checking of Rx
Interaction
Dose
Evidence of harm/benefit
Appropriate
Legal and complete ( and here is where
we make a CASE for the medication)
CASE
Cost effective
Acceptable to the patient
Safe
Effective
INTERACTION
Does the drug interact
with any other items the
patient is taking or with
the patients condition?
DOSE
Specific dose per day
A specific dose per day for a specific time
A specific dose for a specific number of times per day
A combination of the above
Example: 200mg/day/individual doses, for 15 days
An initial dose
A dose per kg of body weight
A maximum dose
Reading and
Checking
Aldactone Aldactide
CARBOplatin CISplatin
Betnesol Betnetan
cefiXIME cefuROXIME
Co-amifruse Co-amilazide
DOBUtamin DOPamine
Cordene Codeine
ephEDRINE epINEPHRINE
Daonil Danol
FOLIC acid FOLINIC acid
Gliclazide Glipizide
hydrOXYZINE hydraALAZINE
Nicardipine Nifedipine
Promazine Promethazine
INFLIXimab RITUXimab
Zocor - Zoton
metFORMIN metRONIDAZOLE
vinCRISTINE - vinBLASTINE
3.
NUMBERING AND
DATING THE Rx
It is a universal practice to
number the Rx order and to
place the same number on the
label.
To connect the bottle or package
with the original medication
order.
4.
LABELING THE Rx
Prescription label prepared
by pharmacist, an assistant may
be employed for this purpose.
Rx
labels
should
be
computerized or typewritten to
make them neat, attractive and
legible
4. LABELING THE Rx
(cont.)
A prescription should have an
aesthetic
and
professional
appearing label.
The size of the label should be in
conformance with the size of the
prescription container.
4. LABELING THE Rx
(cont.)
Name,
address
and
telephone number of the
pharmacy are generally
imprinted in the label
The pharmacist should
give clear directions
4. LABELING THE Rx
(cont.)
Label of Compounded Rx should
include:
1.Number of Rx
2.Date of filling
3.Name of Patient
4.Quality and quantity of ingredients
4. LABELING THE Rx
(cont.)
Label of Compounded Rx
should include:
5. Directions for administration
6. Name of Physician
4. LABELING THE Rx
(cont.)
Label of Unit Dose Rx should
include:
1.Name of Patient
2.Generic name of drug
3.Brand Name
4.Manufacturer
4. LABELING THE Rx
(cont.)
Label of Unit Dose Rx should
include:
5. Dosage strength
6. Expiry date
7. Directions for use
8. Name of Pharmacist
4. LABELING THE Rx
(cont.)
AUXILIARY LABELS emphasize a
number of important aspects of the
dispensing medication including:
1. proper use
2. handling
3. storage
4. LABELING THE Rx
(cont.)
AUXILIARY LABELS
4. Refill status
5. Necessary warnings and precautions
Example: Shake well
POISON
Should Not Be Swallowed
Keep Out of Reach of Children
Standard Requirements for
Labeling Dispensed Medicines
1. Name of the preparation,
strength and form
The name which appears on
the label must be the same as
the one which appears on the
prescription
Standard Requirements for
Labeling Dispensed Medicines
2. Quantity
The quantity which appears
on the label will be the
quantity which has been
prescribed
Standard Requirements for
Labeling Dispensed Medicines
3. Instruction for use
No patient should leave a
pharmacy without knowing
How much
How often
How to use
Recommended wording for
directions
Recommending wording
Wording to be replaced
Do not swallow
Put two drops in the
affected eye
For creams,
ointments: spread
thinly
For Pessaries or
suppositories: gently
put one into the
vagina/rectum
Not to be taken
Instill 2 drops into
the affected eye
Use sparingly
Insert one into the
vagina or rectum
Auxiliary labels
Shake well
Keep in the refrigerator, Do not Freeze
Do not use after
Refrigerate, Shake well, Discard After
External Use Only
May cause drowsiness; Alcohol and Operating Car or Machine Warning
Do not Drink Alcohol
Avoid Sun Exposure
Take with food
Take on an Empty Stomach
Finish all this medication
Do not take Aspirin
5. PREPARING THE
Rx
Information Necessary:
1.Adjuvant used
2.Order of mixing
3.Amount of each ingredients
4.Capsule size
5. PREPARING THE Rx
(cont.)
Information Needed:
5. Type and size of container
6.Name and product identification
number of manufacturer.
5. PREPARING THE
Rx (cont)
Partially filled Rx should be
returned to the buyer after
recording the partial filling in the
Rx book
Partial filling of prohibited or
List A drugs shall not be
allowed.
6. PACKAGING
Pharmacist should
consider the size,
shape, mouth opening,
color and composition
in packaging
6. PACKAGING
TYPES
OF
CONTAINERS
GENERALLY USED:
1. Round Vials for solid dosage
forms as capsules and tablets.
2. Prescription
Bottles
for
dispensing liquids of low viscosity
6. PACKAGING
Pharmacist should CHECK for:
1.Permeability of containers
atmospheric
gases
and
moisture vapor.
to
to
2. Leaching of constituents of the
container to internal content
6. PACKAGING
Pharmacist should CHECK for:
3. Absorption of drugs from content
container
4. Transmission of light through the
container
5. Alteration of the container on storage,
particularly at extremes in temperature.
6. PACKAGING
Child-Resistant Containers
- To prevent accidental poisoning
resulted
from
ingestion
of
medication and other household
chemicals by children.
- With safety closures
7. RECHECKING
The importance of this step
should not be overemphasized
Every Rx should be rechecked by
the Pharmacist
All details of the label should be
rechecked against the Rx order
to verify directions, patients
name, Rx number, date and
prescribers name
8. DELIVERING THE
PRESCRIPTION
Every prescription leaving the store
should not only be correctly and
skillfully compounded but the
physical appearance of the finished
preparation should indicate the
pride
and
care
which
the
pharmacist has taken in his
professional work.
9. RECORDING
A record of the prescriptions
dispensed should be maintained
in addition to the prescription
files.
This would permit rapid location
of prescription orders.
9. RECORDING
(cont.)
Different RECORDS used:
1. Prescription Book
2. Poison Book
3. Dangerous Drug Record Book
10. PRICING
MOST COMMONLY USED:
1.% Mark-up
Dispensing Price =
Cost of Ingr. + (Cost of Ingr. X %
Mark-up)
10. PRICING (cont.)
2. % Mark-up + Minimum Fee
DP = Cost of Ingr. + (Cost of Ingr. X
% mark-up) + Minimum Fee
*DP = dispensing price
Minimum Fee recover the
combined cost of container, label,
overhead & professional service
10. PRICING (cont.)
3. Professional Fee
DP = Cost of Ingr. + Professional Fee
The greater the cost of the Rx
ingredients the greater is the fee
Professional fee - represents the
payment for professional service
10. PRICING (cont.)
Code in Pricing letters selected
should have 10 letters with no
duplicate letters.
Example:
B
11. FILING
Too be kept for 2 years
Prescription File Types:
1. metal or cardboard unit
2. partitioned drawers
11. FILING (cont.)
Methods of Preserving
Prescriptions:
1. Filing on string or wire
2. Pasting on scrap book (old method)
3. Writing a copy in a blank book and
returning the original
11. FILING (cont.)
Methods of Preserving
Prescriptions:
4. Wrapping the Rx in packages of
100 and packing ten consecutive
hundreds in wooden box (old method)
5. Pasting the Rx to a card which is
then filed in a cabinet
11. FILING (cont.)
Computer filing of prescription
is most recommended.
Exercises:
Rx
Salbutamol tablet.2mg
Theophylline tablet ..125mg
Lactose q.s. .300mg
In one cap # 20
Sig. One cap b.i.d. p.c. and H.S.
Data
Nuelin tablet .. P 3.75
Ventolin tablet .. P 4.50
Lactose . P 40.00 / half Kg
Capsule . P 0.75/piece
Minimum fee P30.00
% mark up 15 % and Professional Fee P 50.00
QUESTIONS:
1. What is the dispensing price using the
% mark up plus minimum fee method?
2. Cost of the above Rx per capsule
3. What is the dispensing price using
professional fee method?
4. What is the daily dose of Salbutamol?
