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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?