Chapter 6 Dispensing Medications in the Community Pharmacy Created by Jennifer Majeske, Mineral Area College

Created by Jennifer Majeske, Mineral Area College

Chapter 6Dispensing Medications in the Community

Pharmacy


Discuss overall community pharmacy operations and general responsibilities of the pharmacy technician with regard to the dispensing of prescription drugs.

Identify the parts of a prescription and recognize the most commonly used abbreviations for amounts, dosage forms, times of administration, and sites of administration.

Discuss the various types of prescriptions that are processed in a community pharmacy.

List the advantages of electronic prescribing in modern-day community pharmacy practice.

Learning Objectives


Know the federal laws on the filling, refilling, and transferring of controlled substances.

Describe controls necessary for reviewing prescriptions of scheduled drugs, including the identification of possible forgeries.

Identify the parts of a patient profile, detail the steps required to select a patient from the data-base, and discuss the importance of including up-to-date insurance, allergy, and adverse drug reaction information.

Identify the parts of a stock drug label and know the importance of comparing National Drug Code numbers in medication selection and filling.

Learning Objectives


Describe the parts of a medication container label.

Explain the step-by-step procedures for processing both new and refill prescription orders.

Discuss how automation is utilized in community pharmacy to minimize medication errors.

Discuss the importance of a final check and verification by the pharmacist prior to dispensing prescription drugs to the patient.

Identify the OBRA-90 mandated regulation that must be executed by pharmacy technicians prior to dispensing medications to patients.

Learning Objectives


The primary role of the pharmacist is to dispense medications safely…upon receipt of a valid medication order.

Prescribers are: physicians, dentists, vets, nurse practitioners, physician assistants.

Technicians play a crucial role in customer service, updating patient demographics/insurance, and accurately filling prescriptions.

Introduction


Almost 4 billion prescriptions are dispensed annually in the pharmacies of the U.S.

Community pharmacy is divided into two areas: Front area Restricted pharmacy area

Automation: Parata® Hours of operation can vary from 40 to 168 hours weekly. Convenience and customer service are important in a community pharmacy. Why?

Community Pharmacy Operations


Pharmacists: what are some responsibilities of a community pharmacist?

Pharmacy Technicians in a community pharmacy are involved in selling medications and health-care related products.

A technician’s role changes throughout the day, they are often responsible for juggling many different tasks at the same time.

Table 6.1 Key Pharmacy Technician Duties in the Community Pharmacy

Community Pharmacy Personnel


Prescription – is an order of medication for a patient, issued by a physician or qualified licensed practitioner for a valid medical condition and then filled by a pharmacist.

Patients may hand you a hard copy, or prescribers may deliver the prescription via phone, fax or electronic transmission – e-prescribing.

Table 6.2 Parts of a Prescription pg. 204

Reviewing a Prescription


Pharmacy technicians are responsible for checking each prescription for completeness and accuracy.

DEA number – issued by the Drug Enforcement Administration (DEA) to authorize a prescriber to prescribe controlled substances.

NPI number – National Provider Identifier is required to file a third-party insurance claim on all non-controlled prescriptions.

Patient’s name – given in full, first and last names. Technicians should rewrite the patient’s name if written illegible and verify spelling.

Basic Components of a Prescription


Patient’s address and telephone are needed for patient records. Asking for a telephone number, both primary and secondary, aids patient identification, minimizes dispensing errors and is helpful if additional information is needed.

Patient’s date of birth is necessary for third-party billing and correct identification.

The date written of the prescription should be provided, if not the prescription should be verified.

Inscription – the part of the prescription that lists the medication prescribed, including strength and amount.



Subscription – the part of the prescription that lists the instructions to the pharmacist about the dispensing of the medication.

Refill – an approval by the prescriber to dispense the medication again without requiring a new order; No refill – NR; prn – as needed

Dispense as written (DAW) – the substitution of a generic equivalent is not permitted. Brand name medically necessary – brand

necessary; must be designated on the prescription if a prescriber wishes that only the brand name product be dispensed.

Signa – sig – the part of the prescription that communicates the directions for use.

Physicians signature should be recognizable; an electronic signature may be used on a faxed prescriptions except for controlled substances.



Any doubts about authenticity of a prescription should be brought to the attention of the pharmacist.

A phone call to the prescriber either by the pharmacist or technician may be necessary to clarify an order.

In some states, the technician is allowed to clarify a prescription.

All changes should be documented on the prescription (and/or patient profile), including the name of the individual who clarified the prescription and initials of the technician or pharmacist.

Authenticity of a Prescription


A new prescription can be written as a hard copy, a verbal order, an e-prescription, a telephone or faxed order, a prescription not yet due, or a transfer from another pharmacy.

Refill requests can come from the patient. Partial fills. Emergency fills. Transfer prescriptions to another pharmacy.

Types of Prescriptions


A written prescription contains: name, address, and telephone number of the prescriber; information about the patient; date; and medication(s) prescribed.

Pharmacy technicians need to be familiar with common prescription abbreviations. Table 6.3 pg. 208

Misinterpretation of abbreviations could result in a serious medication error from the wrong dose, wrong drug or wrong directions.

If any part of the prescription is unclear the technician must check with the pharmacist and/or the prescriber for clarification.

Written Rx


All prescriptions for Medicaid patients must be written on a tamper-resistant prescription pad.

Tamper-resistant prescription pad (TRPP) – a paper pad that is specifically designed to prevent copying, erasure, or alteration.

If a prescription for a Medicaid patient is not written on a TRPP, then the pharmacy must contact the prescriber’s office to authenticate the order.

Medicaid Prescriptions and TRPPs


Technicians must exercise diligent care and effort while transcribing a prescription as it is entered into the computerized patient profile.

Technicians should verify with patients their date of birth and/or address to avoid any confusion.

Subscription comments written on the prescription by the prescriber must be included on the medication label.

Computer Entry of Written Prescriptions


e-prescriptions are increasingly being embraced by medial practitioners.

E-prescriptions – or electronic prescriptions, are prescriptions that are transmitted electronically from prescribers to pharmacies.

Approved by all state boards, this form of prescribing has financial incentives from the federal government and provides advantages in ensuring safe and effective patient care.

2011, more than 570 million prescriptions were written; 1/3 of these were e-prescriptions; 75% increase in e-prescribing from the previous year.

e-Prescriptions


Advantages include: speed, accuracy, improved billing, and decreased potential for prescription forgeries and medication errors.

Optional applications that benefit healthcare personnel include: (1) e-refills automatically sent from the pharmacy to the provider; (2) prescriber access to patient pharmacy data-bases; (3) access to insurance eligibility and preferred drug lists.

Patient advantages to e-prescriptions include: increased accuracy and decreased wait times; improved patient compliance; 10% improvement in first-fill adherence with e-prescriptions over written, verbal, and faxed prescriptions.

Advantages of e-Prescriptions


Schedule II prescriptions must come in a hard copy form, with a signature from a prescriber licensed with the DEA.

Electronic prescribing of controlled substances (EPCS) must be approved by each state board of pharmacy prior to implementation.

http://www.nabp.net/news/missouri-news-electronic-transmission-of-controlled-substance-prescriptions

http://www.deadiversion.usdoj.gov/fed_regs/notices/2012/fr0801_4.htm

e-Prescribing and Controlled Substances








Some technicians can receive and enter telephone and faxed orders otherwise it must be referred to a pharmacist for processing.

Once the prescription has been verified by the pharmacist, the technician can enter the information into the computerized patient profile as a new prescription.

Faxed orders must contain all the necessary patient demographics, prescriber and medication information.

Schedule II prescriptions cannot be faxed and require a hard copy and signature from an authorized prescriber.

Telephone/Fax Orders


When a patient presents a new written prescription, or receipt of a verbal, faxed or e-prescription that cannot be filled until a future date.

These types of prescriptions can be placed on hold. http://

www.deadiversion.usdoj.gov/pubs/manuals/pract/pract_manual012508.pdf

State of Missouri: Multiple Schedule II Prescriptions A practitioner may issue multiple prescriptions for

Schedule II drugs on the same date. All prescriptions should be dated at the top on the date they were signed and issued. Each prescription should have “Do not fill until “ across the bottom. Although multiple prescriptions can be issued at once, the prescriber cannot exceed a 90-day supply of Scheduled II drugs.

Prescriptions Not Yet Due

http://www.deadiversion.usdoj.gov/pubs/manuals/pract/pract_manual012508.pdf




Prescriptions, at the patient’s request, may be legally transferred between pharmacies.

“Transfer in” involves the “transfer” pharmacy contacting the “originating” pharmacy on an original prescription.

What can make a transfer easier? Processing of Transfers In:

Why might a patient choose to transfer a prescription?

Most states only allow pharmacists to transfer a prescription.

Additional time is required when processing a transfer prescription.

Transfers In


Technicians will often receive requests for the pharmacy to refill a patients medication.

Refills are relatively easy when the patient has the prescription number.

Pharmacy software often has the capability to record automatic refills when a medication is due.

Technicians must be able to handle a refill request and verify that a refill does exist, or if one doesn’t know how to further a request for a refill.

Most pharmacies and insurances will allow a refill approximately 5 days prior to the next refill date.

Refill Requests


If a refill request is made to early, most likely the claim will be rejected by the third-party insurance.

Each pharmacy and insurance has their own policy for handling early refills, especially for controlled substances.

Special requests for early refills may or may not be granted by the insurance company.

Prior approval may need to be granted by the insurance provider before obtaining an early refill.

A patient may be required to pay for the prescription and send for reimbursement at a later date.

Early Refills


Under certain circumstances, no refills of medications are permitted, this includes: A prescription that is more than 12 months old A prescription for a controlled substance that

was written more than 6 months ago or refilled 5 times

A prescription for a controlled substance that has been previously transferred to another pharmacy

Prescriptions written in the ER are commonly prescribed for short-term use with no refills.

ER prescribers will not authorize refills.

No Refills


The pharmacy may have an insufficient quantity of a drug in stock, for either a refill or an original fill.

Partial fill – a 2-5 day supply of medication can be dispensed to the patient until the pharmacy is able to fill the balance of the prescription.

The hope is with the limited supply given to the patient that the patient will not be terribly inconvenienced.

Billing procedures for partial fills will vary depending on the pharmacies policies.

Technicians will need to inform the patient when they will be able to pick up the remainder of their prescription.

Partial Fills


An emergency fill is a short-term supply of needed medication for a chronic condition.

Emergency fills often bridge the gap when a refill is not feasible.

Most states allow pharmacists to make a professional judgment in providing an emergency fill of a medication.

There is not usually a charge for these “loaned” medications, but when the prescription is renewed the “loaned” amount will be taken off the number of medication to be dispensed.

Emergency Fills


A “transfer out” is a prescription refill, at the request of the patient, is transferred to another pharmacy. Why might a patient transfer a prescription out?

When the technician receives this type of request, the pharmacist must be notified so the appropriate medication information and refills are communicated to the “transfer” pharmacy.

Many chain pharmacies have a shared database, which allows for a transfer to occur without the need of a telephone call and verification of patient and medication information.

Transfers Out


Controlled substance prescriptions require additional care because of the potential for patient abuse.

Careful review, assessment, and monitoring of controlled substance prescriptions helps provide a safeguard to public health.

Controls can only be dispensed upon receipt of a valid prescription.

The date the prescription was written must be entered into the profile, rather than the date filled.

Federal law requires a name and physical address, no P.O. Box, on all controlled prescriptions.

Controlled Substances


Schedule II prescriptions should be handwritten or typed; they cannot be e-scripts, faxed, or phoned into the pharmacy.

Schedule II prescriptions must be signed (handwritten) by a physician; stamped or electronic signature is not acceptable.

State laws and regulations vary for the initial filling of a Schedule II prescription; quantity may be limited as well.

Schedule II Prescription Requirements


Refills for controlled substances varies depending on the drugs schedule.

Schedule II Refills: no refills; “partial fills” may or may not be possible; permitted to write future-date prescriptions.

Schedule III and IV Refills: refilled up to five times within a six-month period; early refills must be carefully monitored; transfers are closely monitored.

Schedule V Refills: refills allowed only by a prescribing physician; some states allow purchasing of a limited supply of Schedule V medications without a prescription.

Refills for Controlled Substances


Prescription Characteristic

Limitation Schedule II

Limitation Schedule III & IV

Limitation Schedule V

Mode of issuing prescription

• Mostly written• Verbal in an

emergency by doctor only

• Faxed if injectable, to LTCF or hospice

• Electronic as authorized by DEA

• May be written• Orally phoned in• Faxed• Electronic as

authorized by DEA

• May be written• Orally phoned in• Faxed• Electronic as

authorized by DEA

Refills • No refills allowed• Partial filling

allowed for patients in LTCF or hospice

• Maximum of five within six months of issuing prescription

• As authorized by the physician. Can be refilled PRN as prescriber allows for one year

Length of prescription validity

Six months Six months One year

Quantity limitations • 30 days for most• Rx for over 30

days requires medical reason

• Maximum is 90 day supply

• Can write multiple & separate Rx with “Do Not fill until date” written on bottom. Can’t exceed 90 day supply

• 90 days • 90 days


Schedule II medications are rarely dispensed without a prescription.

An emergency dispensing – pursuant to a valid medical reason – can be provided to a patient (state by state).

Certain procedures must be followed for an emergency dispensing.

Most state boards have made provisions for emergency dispensing of pain-relieving narcotics in connection with terminally ill hospice patients.

Emergency Dispensing


Controlled substance prescriptions must be carefully reviewed by both the technician and pharmacist.

This type of prescription is more likely to be forged or altered.

Forgeries may be written on stolen or preprinted facsimiles of prescriptions and can be difficult to recognize.

Telltale signs of possible forgeries in listed in Table 6.4 pg. 218

Pharmacy personnel must be aware of drug-seeking behaviors of patients.

Authentication


Technicians should learn to recognize signatures of local physicians.

Table 6.5 Steps for Checking a DEA Number Caution should be exercised when another person

besides the patient request a refill or picks up a controlled prescription.

Photo ID may be required to pick up a controlled substance prescription.

Drug seekers – patients who may receive prescriptions for the same or similar controlled drugs from several physicians or who constantly request “early refills.”

What other preventive measures might be used in a pharmacy?

Preventive Measures in the Pharmacy Workplace


Prescribers should carry their prescription pads on them or keep them locked in a drawer.

Quantities should be written out so that prescriptions can not be altered.

Individual states have set up preventive measures to eliminate forgeries, example Georgia.

Preventive Measures Taken by State Boards of Pharmacy: Multi-state databases Each state has its own requirements and

definitions for a “tamper-resistant” prescription

Preventive Measures in the Medical Office


A pharmacist has the right to refuse to fill any controlled-substance prescription.

If legitimate concern exists, it is the pharmacist’s duty to refuse to fill a prescription and return the prescription to the patient.

Even with physician approval the pharmacist still maintains the right to not fill the prescription.

It is illegal for a physician to write a prescription for a Schedule II medication for a family member. It is unethical for a prescriber to write a Schedule III or IV prescription for a family member.

Professional judgment lies with the pharmacist in deciding whether to fill or refuse such prescriptions.

The Right of Refusal


Processing of prescriptions is a complex procedure.

The process must be efficient but accurate, requires teamwork and communication from the pharmacist and the technician.

Patients need to understand how to take their medication from the labeled information and/or additional counseling from the pharmacist.

Table 6.6 The Critical Path of a New Prescription

Technicians should ask if the patient prefers to wait for their prescription or if they’ll return at another time.

Processing a Prescription


The state board of pharmacy defines what practices are allowable in their state.

State regulations define dispensing policies. Technicians should be aware of federal laws

regarding patient counseling and confidentiality on prescriptions.

Special Processing of Certain Drugs: Certain drugs must be processed differently

because of their potential for abuse or toxicity. These drugs include: Accutane, Suboxone, and

Tikosyn

Pharmacy Laws and Protocol


Patient profile – a confidential database that contains demographic information to track all prescriptions that have been dispensed at that pharmacy for that individual patient.

Some chain pharmacies have common databases allowing prescriptions to be shared among all affiliated pharmacies nationwide.

This allows for prescriptions to be picked up by patients at the receiving pharmacy rather than the originating pharmacy.

This is helpful for patients with medical needs that cause them to travel or who have residences in more than one state.

The Patient Profile


Patients when they present a prescription to the pharmacy must have a current updated profile.

What is included in a patient profile? Table 6.7 Components of the Patient Profile

pg. 224 A major part of the technician’s job is to

maintain a profile for each patient receiving prescription medications from the pharmacy and updating this profile as necessary.

Managing a patient profile can vary whether or not the patient is a current or new customer.

Components of a Patient Profile


If a patient profile already exists, it is important then for the technician to verify that the correct profile has been selected.

This involves matching the correct patient name with the correct address.

Another patient identifier is commonly the date of birth.

Failure to verify an identifier could result in a serious medication error.

Patient Profile for Current Customer


For a new customer to the pharmacy, a profile must be created.

Some pharmacies require patients to fill out a new patient profile form like Figure 6.10 on pg. 226.

New customers should be encouraged to ask questions.

At an initial visit the patient will likely be given a copy of the store’s confidentiality policy.

Documentation of patient receipt and sign-off is generally kept in the patient profile.

Confidentiality of patients medical information must be maintained at all times.

Patient Profile for a New Customer


It is very important for the pharmacy technician to ask the patient about allergies to medications and past history of adverse drug reactions.

Allergy – a hypersensitivity to a specific substance that may be manifested as a rash, shortness of breath, runny nose, watery eyes or swelling.

Adverse drug reaction (ADR) – any unexpected negative consequence from taking a particular drug.

Antibiotics, especially penicillin and sulfa drugs, are the most common types of medication allergies.

The pharmacist will be altered of any potential allergy or hypersensitivities that may occur, via the pharmacy computer software.

Documenting Medication Allergies and Adverse Drug Reactions


Prescription insurance eligibility must be verified.

Pharmacy technicians must often call insurance providers to resolve problems with rejected claims.

The NPI number is a unique identifier for any health care provider involved in writing prescriptions.

Insurance does not want to pay for expensive drugs or those that may be overused.

If a drug is not covered by an insurance company often times it requires a prior authorization (PA) – the justification for the use of the drug with the patient’s insurer.

Documenting Insurance Information


After the information has been entered in the patient profile it must be verified by the pharmacist.

Drug utilization review (DUR) – requires a closer review of the patient profile for potential medication problems with other drugs in the profile.

Pharmacy software is specifically designed for pharmacies and insurance companies to provide an additional level of protection.

What can trigger a DUR? What are some ways to deal with a DUR?

Pharmacist Review and Verification


A DUR is a good example of medication therapy management (MTM) services.

MTM services would not be possible without the assistance of pharmacy technicians in other steps of the prescription process.

Pharmacist Verification – Once verified the prescription is safe to fill. Patient-specific medication information sheet

Bar code for prescription; co-payments; drug identifier

Patient demographics; detailed information on the drug being dispensed; remaining refills

Insurance billing information; NDC

Pharmacist Review and Verification


The medication information sheet serves as the prescription order.

The pharmacy technician must retrieve the stock bottle, match the NDC number and then fill the prescription from the inventory.

Bottles are commonly marked with an “X” to indicate that they have been opened.

Medication Selection and Preparation


Technicians need to become familiar with drug inventory and its precise location.

Drug name, strength, package size, and NDC number should be checked prior to the technician counting out the medication.

Storage Locations – drugs are usually stock by brand or generic name; pharmacies may have separate shelving sections for birth control pills, topicals, and antibiotic powders.

Schedule II drugs are most commonly kept in a locked cabinet; access is limited to the pharmacist.

Pharmacy technicians need to be aware of the policy and procedure for filling controlled substance prescriptions.

Drug Inventory


Drug inventory must be highly organized. Precautionary measures to prevent drug mix-ups

should be put into place. What are some examples of these precautionary measures?

Special procedures – for when a drug dose or quantity prescribed is not available.

1) “Out of stock” – order the product2) Change the order with pharmacist approval

Technicians may encounter discrepancies between the ordered quantity and the package size available.

Drug products that have more than one generic manufacturer. Right drug, wrong NDC number

Organization of Inventory


The NDC number is used to aid in identifying the exact drug, dose and package size.

The label is affixed to the appropriate container holding the medication.

It is important that the patient be notified that the appearance of the medication may have changed but that the drug and dose are identical to the medication previously dispensed.

Letting the patient know about this change will alleviate any concerns the patient might have about receiving the wrong medication.

Filling a Prescription


Careful attention needs to be paid to product selection.

A common error is selecting the wrong stock drug bottle, dose or package size.

Selecting the wrong insulin from the refrigerator is one of the most common medication errors.

To avoid medication errors technicians need to develop good work habits.

100% accuracy is paramount; even two incorrectly filled medication is two to many.

Accuracy Checks


Oral drug products have many different dosing forms, with its own dispensing requirements.

Tablets and Capsules – are counted and placed in appropriately sized vials or containers.

A counting tray has a trough on one side to hold counted tablets or capsules and a spout on the other side to pour unused medication back into the stock bottle.

Minimize direct finger contact. Spatulas and trays should be cleaned with 70%

isopropyl alcohol. Equipment should be cleaned immediately after

counting sulfa, penicillin or aspirin products.

Preparing Oral Dosage Forms


Most pharmacies allow technicians to fill Schedule III, IV, and V medications.

A double-count may be required of all controlled substances (II-V) by both the pharmacist and technician.

Liquid Formulations – liquid products are often dispensed in their original packaging, they can also be poured from a stock bottle directly into a dispensing bottle.

Handling Prepackaged Drugs – unit-dose or unit-of-use packaging simplify the filling process.

The quality of the technicians work is still verified even with prepackaged drugs.

Controlled Substances


Unit dose – is individually packaged in sealed foil and considered tamper-proof; labeled with the manufacturer’s name, lot number, and expiration date in addition to the drug’s name and strength.

Unit-of-use – a fixed number of dosage units in a stock drug container.

Examples of unit-of-use include: birth control pills, ointments and creams, eye drops and eardrops.

An antibiotic powder is another example of a unit-of-use package; the medication must be reconstituted with a given amount of distilled water.

Due to a short expiration date, antibiotic suspensions are not prepared until the patient picks up the medication.

Unit-Dose PackagingUnit-of-Use Packaging


Children as well as pets may benefit from flavoring of prescribed medications.

Most pediatric suspensions come with some flavor from the manufacturer; the taste however may still not be acceptable to the child.

Flavorings can be added upon request at a minimal additional charge.

Some flavors are incompatible with the prescribed medications.

Flavoring agents have sweetening enhancers as well as bitterness suppressors.

The service of flavoring improves patient compliance with prescribed medication regimen.

Flavoring Drugs


Plastic vial sizes range from 10 to 60 drams. Most containers are amber-colored to

prevent ultraviolet (UV) light exposure and subsequent degradation of the medication.

Other containers: liquid containers (2 – 16 oz) and solid white ointment jars.

Many products are available in manufacturer-provided containers.

Medications should be dispensed in child-resistant containers.

Choosing Medication Containers


Providing patients with sufficient information to correctly take their medication is very important.

Written information is delivered in the form of: Container label Auxiliary labels Patient medication information sheets FDA-mandated MedGuide

Legally, a medication should be accompanied by information to help a patient understand the appropriate use and common side effects.

Medication Information for the Patient


Medication container label – is a label stating the dosage directions from the prescriber and is affixed to the container of the dispensed medication.

What other things might you see on a label? See Table 6.8 pg. 237

Labels can be generated after verification by the pharmacist or by scanning a stock bottle.

Medication labels for C-II – C-V must contain the transfer warning “Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.”

Medication Container Label


Auxiliary label – small, colorful label that is added to a dispensed medication to supplement the directions on the medication container label.

Application of these labels requires professional judgment and is thus usually restricted to the pharmacist.

What auxiliary label might you see on a prescription for a suspension?

Technicians, with experience, may be allowed by the pharmacist to add auxiliary labels to medication containers.

When in doubt ask the pharmacist.

Auxiliary Label


Medication information sheet – a computerized printout that provides details on how to safely take the prescribed medication.

What is contained on the medication information sheet?

Medication Guide: Must be provided to patients receiving a select

number of high-risk drugs. This information was in the past called the

patient package insert or PPI. Some medications, have their own MedGuide

that is automatically dispensed with the product.

Medication Information Sheet


The pharmacist must check every prescription before it is dispensed to the patient to verify its accuracy.

The pharmacist reviews the original prescription, compares it with the patient profile, verifies the drug selected, and checks the accuracy of the medication container label.

A duplicate of the medication label is often affixed to the back of the original prescription.

Prescription records must be stored and readily retrievable for potential review and audit.

Final Check of the Prescription


After final verification and filing of the prescription the medication is available for distribution to the patient.

Prescriptions can be stored alphabetically or numerically; patients generally have 7 days to pick up their prescription.

“Partial fill” or “change of manufacturer” should be relayed to the patient upon receipt of the prescription.

Tablet splitter – can be purchased to more easily divide tablets.

Dispensing to the Patient


This workforce solution was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes not guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or tis completeness, timeliness, usefulness, adequacy, continued availability, or ownership.

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Chapter 6 Dispensing Medications in the Community Pharmacy Created by Jennifer Majeske, Mineral Area College