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CORE ASSIGNMENT 4 PRESCRIPTION/PHYSICIAN ORDER (RX) PROCESSING

The foreign graduate registered intern should follow the processing of a prescription from the time of receipt:
1.) What information should this prescription contain?
a. Prescribers address is required on all prescriptions. The DEA number is required only for
the controlled substances.
b. Patients name is required. Patients address is required on prescriptions for controlled
substances. Telephone number is not required by law. Age is not required but is very useful
in verifying prescription dosage.
c.

Date of issuance of the prescription.

d. Exact interpretation of the medication is mandatory


e. The total quantity of medication to be dispensed.
f.

Sig is a Latin abbreviation for you write, which is the prescribers instructions to put the
indicated directions on the label. Directions may be written in a combination of English and
Latin abbreviations.

g. Indicates the number of refills in addition to the original prescription fill. When no refill
information is provided, the prescription cannot be refilled unless the pharmacist receives
authorization from the prescriber.
h. The prescribers signature, or a signature by an authorized representative, must be hand
written.
i.

Non-Safety Cap requested for controlled substances

j.

The red C for controlled substances prescriptions is stamped in the lower right-hand
corner of the prescription form when Schedule III-IV prescriptions are filed with noncontrolled prescriptions.

2.) How is the medication labeled and handled?


Once the prescription is received, it will be check for completeness such as the prescriber
information, drug name, strength, dose and directions. Correct patient information and prescription

information is entered into the computer system. It will be interpreted and confirmed by the pharmacy
system. Third party is billed and pharmacy label is generated. The information commonly printed on the
prescription container label:
a. Pharmacy name, address and telephone number
b. Serial number of prescription
c.

Quantity dispensed

d. Refills available
e. Original date when prescription was written
f.

If this statement does not appear on your pharmacys label (Federal law prohibits the transfer
of this drug to any person other than the patient for whom it was prescribed), affix an auxiliary
label to all controlled substances prescriptions

g. Prescribers name
h. Dispensing date
i.

Patient information

j.

Directions for use

k.

Name, strength and dosage form of the medication dispensed

l.

Manufacturer of medication dispensed

m. Expiration date
n. Dispensing pharmacist/technician initials

3.) What safety checks are utilized to assure accuracy in filling the prescription?

Records of history of patients

Dangerous abbreviations and confusing symbols Institute for Safe Medications Practices
(ISMP) and the Joint Commission on Accreditation of Healthcare Organization (JCAHO)
have a detailed lists of DO NOT USE list such as U and IU, QD, Q.D,

Sound-a-like or look-a-like drug names are have a separate locations

Application of tall man letters during prepacking of medications

Several safety techniques observed in pharmacies:

a. Keep work procedures organized and simplified


b. Dont work on several prescriptions at once, just one at a time
c.

Manage interruptions, dont be pressured to rush

d. Smell check
e. Bar code check
f.

Use a magnifying glass when needed

g. Enhance the design of the facility

4.) What is done about drug interaction information, possible side effects of an auxiliary
labeling?
Pharmacists assess the medication profiles to confirm the correctness of prescriptions. They should
not fill or process prescription if they have concerns with the appropriateness such as drug
interaction. Pharmacist should call or contact the Prescriber and discuss the situation.
Auxiliary labels convey additional instructions to patients:
a. How and when to take medication (Shake well before using)
b. What food or medications to avoid while taking the medication (Take with food or milk)
c.

How to store the medication (Keep in refrigerator; Do not freeze)

d. How to administer the medication (External use)


e. What side effects can occur (May cause drowsiness or dizziness)
f.

Number of refills remaining

g. When the medicines expires (Refrigerate; Shake well; Discard after ____)
Auxiliary labels are usually colorful to attract patients attention and to make it easier for you to
distinguish between the labels as you select them. If your computer system cannot indicate which
auxiliary labels to use, ask a pharmacist to identify labels to accompany specific medications.
Auxiliary labels should be placed neatly on the prescription bottle. They should not cover any
information on patient labels.

5.) How are prescription inaccuracies handled?


Pharmacists are required to review medication profiles to ensure the appropriateness of
prescriptions or medication orders. This is commonly called drug utilization review (DUR).
Pharmacists should not fill or process prescriptions or medication orders that they have concerns
with or that are considered inappropriate but, rather, should contact the prescriber. The process of
calling a prescriber to discuss concerns identified during a DUR is commonly called therapeutic
intervention.

6.) What is the procedure for refilling a prescription, and what are the refill limitations?
If refill information is not supplied, it is generally assumed that no refills are authorized. As needed
(pro re nata [prn]) refills usually interpreted as allowing for refills for 1 year unless laws or
regulations restrict the amount and time period in which a prescription is valid.

7.) Is a computer utilized? If so, how?


Tampa General Hospital Pharmacy utilized the computer to access the following:
a. Epic System is an electronic healthcare record. EPIC is fully integrated system which
encompasses not only clinical information, but also registration, patient scheduling and
billing. With Epic System, doctors can do the electronic prescribing when patients are
discharged.

b. Script Pro System maintains a comprehensive database for all items in the pharmacy. It
has a Pharmacy Dispensing Management System which capable of doing different
functions such as checking prescription status and order location on the pharmacy, it
automatically prints auxiliary labels on the prescription label eliminating the need to
manually apply them. Barcode driven systems prevents medication dispensing errors. This
software platform links all together to ScriptPro robotic systems.

c.

Emdeon System and Florida Medicaid to look up for patients prescription insurance plan

8.) Hospital foreign graduate registered interns, explain the stop-order policy and its purpose.
Automatic stop orders are a type of medication order that originates not with the physician but with
the hospital pharmacy. Automatic stop orders on medications are intended to safeguard patients
against unnecessary or prolonged drug therapy.

Medication orders for certain types of drugs (e.g., controlled substances) are only valid for a certain
number of days while the patient is in the hospital. (The exact number of days is determined by the
hospitals Pharmacy Committee.) After that time, the pharmacy automatically stops sending the
drug to the patients nursing unit, and the attending physician must write an entirely new order if
the patient is to continue to receive that drug.

All drug orders carry an automatic stop order that is activated whenever a patients situation
changes in the hospital (e.g., the patient goes to surgery, is transferred to another nursing unit
within the hospital, is discharged to another healthcare facility, or is discharged to home). If the
patient is discharged to another healthcare facility, the physician lists all of the patients drugs in
the discharge summary. The discharge summary is faxed to the other healthcare facility, and the
attending physician there must reorder the patients drugs. If the patient is discharged to home, the
attending physician at the hospital provides individual prescriptions that the patient can take to a
local pharmacy to be filled.

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