Appendix 1.

Prescription Dispensing and Consultation Rubric

Authenticity of written prescription

Prescription contains all items required by North Dakota Pharmacy Statutes 61-04-06-02 and 61-04-06-03
1. Name and address of patient
2. Date of issuance
3. Name of drug
4. Quantity
5. Strength
6. Adequate directions for use
7. Prescriber’s name, either printed or stamped
8. Prescriber’s indication of refill authorization
9. Reminder legend
10. Signature of prescriber, unless an oral or telephoned order
11. Written prescription for controlled drugs, in addition to above, must include the DEA number of prescriber
Documentation: Changes to the prescription authorized by the prescriber
Date of the change, name of the person contacted, changes made, pharmacists initials
Patient
Dispensed to the correct patient
Allergy screening performed and presence or absence of allergies is noted on prescription
Easy open caps used if requested by patient or as required by law
Prescription label and auxiliary labels
Instructions are correct
Directions use correct verb
Directions specify correct route of administration
Directions are spelled correctly
Correct number of refills
Correct quantity
Correct expiration date
Correct prescriber
Auxiliary labels are appropriate
Auxiliary labels do not cover up required information on label
Medication
Correct medication dispensed
Correct day supply documented
Prescription Verification
Initials of filling student pharmacist
Initials of checking student pharmacist
Consultation
Introduction of pharmacist to patient
Verification of two patient identifiers (including first and last name + one other)
Name and strength of medication
Indication for use
Dosage form
Route of administration
Duration of therapy (Short-term or long-term treatment?)
Special instructions for preparation, administration, or use by the patient
Common adverse effects including instructions on how to avoid or manage
Techniques for self-monitoring (How will the patient know if it is working?)
Proper storage instructions
Refill information
Missed dose information
Introduction of pharmacist to patient
Verbal Communication
Appropriate nonverbal communication (eye contact, distracting gestures, etc)
Spoke clearly and avoided long pauses
Used terminology appropriate for patient to understand
Used filer words minimally (um, uh, like, gonna wanna)