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Receive a Prescription Order(Dari)
EO 003.02
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Purpose of Lesson(Dari)
The pharmacy technician student will learn how to:
(1)Screen prescriptions for completeness and authenticity.
(2) Complete the proper patient prescription intake procedure.
This topic will be taught using a lecture format and students will be given a chance to practice these skills during an in-class assignment as well as during a skills lab.
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Overview of Lesson(Dari)
(1) Outpatient vs. Inpatient
(2) Essential components of an outpatient prescription.
(3) Essential components of an inpatient medication order (MoD form 58).
(4) Stepwise approach to outpatient prescription intake.
(6) In-class assignment
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Outpatient vs. Inpatient(Insert Dari)
An outpatient is a patient who is hospitalized for 24 hours or less. It is a patient who visits a hospital, clinic, or facility for diagnosis or treatment.
An inpatient is admitted to the hospital and stays overnight or for a longer amount of time, usually several days or weeks.
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Outpatient vs. Inpatient Prescriptions(Insert Dari)
Hospital pharmacies provide services for both outpatients and inpatients.
Outpatient prescriptions are usually brought to the pharmacy to by the patient or a family member of the patient.
Inpatient prescriptions will be brought to the pharmacy by a nurse from the ward on which the patient is staying.
Outpatient and inpatient prescriptions look different and also have different information requirements.
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Outpatient Prescriptions(Insert Dari)
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Outpatient Prescriptions(Insert Dari)
Information required on the prescription:
(1)Hospital/facility name(2)Patient’s name(3)Patient’s gender and date of birth(4)Patient’s father’s name(5)Patient medical condition (if known)(6)Date the prescription was written(7)Drug name (8) Drug strength and dose to be administered(9) Instructions for use, including route of administration, frequency and duration of use. (10) Quantity to be dispensed
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Outpatient Prescriptions(Insert Dari)
(11) Doctor’s signature(12) Doctor’s name(13) Doctor’s address and contact
information. (14) Doctor’s license/registration
number
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Instructor lead discussion(Insert Dari)
The instructor will take 10 minutes to discuss the question on the following slide with the class.
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Discussion Topic(Insert Dari)
Why are the following pieces of information important to have on the prescription?
• Doctor’s contact information• Date the prescription was written• Medical condition• Patient’s gender and date of birth.
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Possible Responses(Insert Dari)
Doctor’s contact information:
• If there is a problem with the prescription (i.e. the prescription is incomplete, drug not on the formulary etc) the pharmacist may need to contact the doctor.
Date the prescription was written:
• It is important to know when the prescription was written. Do you think it would be appropriate to fill a prescription that was written 10 months ago? Likely not, the patient should be re-evaluated by a physician.
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Possible Responses(Insert Dari)
Patient’s medical condition: • Allows the pharmacist to evaluate if the
choice of medication is appropriate and if it is being dosed appropriately.
Patient’s gender and date of birth:• Gender is important to know for the
pharmacist to evaluated if the medication is appropriate and if there is specific information the patient should know (i.e. issues with pregnancy, side effects etc).
• Date of birth is important to know if you are dealing with a child or an adult, which affects how medication is dosed.
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Inpatient Prescriptions: Medication Orders and MoD Form 58
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What is a medication order? (Insert Dari)
Medication order refers to a written request on a physician’s order form (in the patient’s chart) or a transcribed verbal or telephone order in an inpatient setting (ward).
Medication orders are then transcribed onto the MoD Form 58 for all the patients on the ward.
This is usually done by the nurse and is approved by the physician prior to the MoD Form 58 being brought to the pharmacy for filling.
In the pharmacy the pharmacist on duty will review the MoD Form 58 and sign off prior to the medications being filled.
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Role of the clinical pharmacist on the ward(Insert Dari)
One of the major roles for a clinical pharmacist working on a ward is to review medication orders for completeness, accuracy and therapeutic use (i.e. dose, route of administration, indication etc.)
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Form 58
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Form 58
Patient
Total of Each Drug Required
Drug
Strength
Amount of Drug Required for Each Patient
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Differences between inpatient and outpatient prescriptions(Insert Dari)
Each outpatient prescription is for a single patient. It can have multiple medications on one form but the medications are all for the same patient.
MoD form 58 (an inpatient prescription) can have orders for multiple patients and multiple medications on the same form.
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Stepwise procedure for outpatient prescription intake
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Step #1(Insert Dari)
Greet the patient and introduce yourself:
• This makes the patient feel more comfortable and welcome.• Be sure to identify yourself as a pharmacy technician.
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Step #2(Insert Dari)
Verify patient identity including:
(1)Name (2)Date of birth(3)Gender
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Step #3(Insert Dari)
Ask the patient if they have any medication allergies that they are aware of.
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What is an allergy? (Insert Dari)
Review from anatomy and physiology:
• Undesirable over-reaction of the
immune system to normally harmless substances such as medications.
• The immune system ‘thinks’ the medication is a ‘foreign invader’.
• Reactions can be damaging and uncomfortable.
• Symptoms can include:
- itchy rash
- difficulty breathing
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Medication intolerance vs. Medication allergy(Insert Dari)
Often patients will confuse an intolerance with an allergy.
An intolerance refers to a normal side effect experienced when taking a medication (i.e. stomach irritation with an antibiotic).
A true medication allergy is characterized by breathing problems or a full body rash.
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Step #3 Continued(Insert Dari)
Ask the patient if they have any medication allergies that they are aware of.
• Regardless, if a patient identifies themselves as having an allergy you must get a pharmacist to speak with the patient before proceeding.
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Step #4(Insert Dari)
Verify the medical condition/diagnosis for which the patient is taking the medication.
• If there is an inconsistency between what is written on the prescription and what the patient says, do not proceed and refer the issue to the pharmacist on duty.
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Step #5(Insert Dari)
Confirm the name of the medication with the patient.
Note: not all patients will remember the name of the medication that has been prescribed for them and that’s okay.
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Step #6(Insert Dari)
Ask the patient if they have taken this medication before.
• If they have not taken this medication before, the patient may wish to speak with the on duty pharmacist regarding side effects and any concerns or questions they may have.
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Step #7(Insert Dari)
Now that you have verified all the appropriate information with the patient you should screen the prescription for completeness and authenticity.
• Ensure all 14 components of the outpatient prescription are complete
• Check for signs of counterfeit prescriptions (see next slide).
• If any information is missing or the prescription appears to be counterfeit refer to the pharmacist on duty.
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Counterfeit Prescriptions(Insert Dari)
• Look for:– Use of two colours of ink. This
may indicate changes made after it was written.
– Unknown prescriber.
– Incorrect registration number
– Drug names misspelled
– Quantity does not match direction requirements
– Not written on an official prescription form.
– No Sig Code
– Quantities changed by crossing out
• In all these instances the Pharmacist will have to investigate.
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IMPORTANT: Be sure to keep the patient informed of any issues encountered throughout
the intake process.
This will help ensure they understand any time delays in receiving their medication.
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Step #8(Insert Dari)
Inform the patient of the approximate wait time until their prescription will be ready. Be sure to tell them:
• Where they can wait in the meantime. • If you will get them when their medication is ready or if they should check back at the pharmacy.
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Step #10(Insert Dari)
Fill the prescription (will be covered in EO 003.03)
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1. Greet the patient/ introduce yourself
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2. Verify patient identity -Age, gender, date of birth.
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3. Ask if the patient has any allergies
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4. Confirm the medical condition/diagnosis
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5. Confirm the name of the medication
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6. Ask if they have taken the medication before
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7. Ensure the prescription is complete/authentic
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8. Inform the patient of the wait time.
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Continue to the next step in the process(Insert Dari)
Refer to the on duty pharmacist
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None(Dari)
Yes(dari)
Matches with the prescription (Insert Dari)
Doesn’t match with the prescription (Insert Dari)
Yes(Dari)
No(Dari)
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In-class Assignment(Insert Dari)
Identify the missing piece(s) of information with the following prescriptions and determine whether you need to refer the issue to a pharmacist or if it is something you can just ask the patient.
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1.
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Answers(Insert Dari)
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1.
The doctor’s signature is missing(Insert Dari)
This is an issue that you should refer to the on duty pharmacist. They can contact the physician to obtain the signature.
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The name of the drug is missing(Insert Dari)
This is an issue that you should refer to the on duty pharmacist. They can contact the physician to obtain the correct information.
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3.
The date the prescription was written is missing(Insert Dari)
This is an issue that you should refer to the on duty pharmacist. They can contact the physician to obtain the correct information.
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4.
The diagnosis is missing(Insert Dari)
You can ask the patient what condition they are being treated for. Once you obtain that information you can then discuss it with the on duty pharmacist.
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5.
The gender and date of birth is missing(Insert Dari)
You can ask the patient for the date of birth and fill it in along with gender, then take the prescription to the on duty pharmacist.
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