chap 4. prescription and medication order intake and entry

Elements of a prescription

1. Patients name and date of birth

2. Physical address

3. Date

4. Prescribed medication and dosage

5. Sig code

6. Amount

7. Refills

8. DEA number (controls)

9. Prescribers name, address, and phone number

Dispense as Written (DAW)

a request by a prescriber that a pharmacist dispense the brand-name medication prescribed rather than a generic equivalent

Sig Code

Medical abbreviations and acronyms used in healthcare to communicate directions.

DEA number

A registration number assigned to physicians by the Drug Enforcement Administration for prescribing or dispensing controlled drugs

E-script

Electronic prescription sent directly into a computer system

Partial fills

Can dispense 3-5 days if pharmacy is out of stock

Patients profile

1. Full name, address, and phone number

2. Date of birth, weight, and sex

3. Medical conditions

4. Allergies

5. Medication history

6. Current OTC meds

7. Preference for generic substitution

8. Preference for child-resistant lids

9. Insurance information

drug-drug interactions

when the effect of a medication is changed, enhanced, or diminished when taken with another drug, including herbal substances

Contraindications

specific signs or circumstances under which it is not appropriate and may be harmful to administer a drug to a patient

Insurance card numbers

1. BIN

2. PCN

3. ID

4. Person code

5. Group

Prior Authorization (PA)

The process of obtaining certification or authorization from the health plan or pharmacy benefit manager for specified medications or specified quantities of medications. Often involves appropriateness review against preestablished criteria. Failure to obtain prior authorization often results in a financial penalty to the subscriber.

Formulary

a list of medications approved for use

coordination of benefits

a group health insurance provision that specifies how the insurers will share the cost when more than one policy covers a claim

Durable Medical Equipment (DME)

Any medical device, equipment, or instrument used in the care of a patient.

Adjudication

series of steps that determine whether a claim should be paid

Deductible

Amount you must pay before you begin receiving any benefits from your insurance company

Prescription Monitoring Program (PMP)

must report all controlled rxs (CII-CV)

Third-party payer

private or government organization that insures or pays for health care on behalf of beneficiaries

Sig

Let It Be Written, label, instructions

Processor bank identification number (BIN)

a six-digit processor ID issued by NCPDP that health plans can use to process electronic pharmacy claims

Processor Control Number (PCN)

A secondary identifier used in routing of pharmacy transactions

Drug-Drug Interactions (DDIs)

medication affects the activity of another medication when administered together

National Council for Prescription Drug Programs (NCPDP)

not for profit, multi-stakeholder forum for developing and promoting industry standards and business solutions that improve patient safety and health outcomes, while also decreasing costs

Centers for Medicare and Medicaid Services (CMS)

a federal agency within the U.S. Department of Health and Human Services that is responsible for Medicare and Medicaid, among many other responsibilities.

DAW 0 means

No product substitution is indicated, and substitution is allowed

DAW 1 means

Substitution is not allowed by the prescriber

DAW 2 means

Substitution is allowed by the prescriber, but the patient requested the brand-name product to be dispensed

DAW 3 means:

Substitution allowed: Pharmacist selected brand product even though generic is available

DAW 4 means

Substitution allowed: brand dispensed generic not in stock

DAW 5

Substitution allowed - pharmacy uses a brand drug dispensed as generic

DAW 6 means

Override is required

DAW 7 means

Substitution is not allowed since the brand-name drug is mandated by law

DAW 8

Substitution allowed; generic drug not available in marketplace

DAW 9

Other: The other codes do not accurately describe the note required.

Person Code

number identifying which family member the pharmacy is billing for

Rx Group Number

A group number identifies your group, or business, from other groups, or businesses, who are insured by the same insurance company

Member Identification Number

An ID number unique to the primary insurance holder on a plan

Medicare Part B covers

prescribed durable medical equipment

Medicare Part A Coverage

hospital care, skilled nursing facility care, nursing home care, hospice, home health services

Medicare Part C covers

Advantage plans offered through private health insurance

Medicare Part D covers

Prescription drug coverage

Carrier/Insurer

insurance company

processor

a company hired by the insurer to process claims

claim

request for reimbursement for products or services rendered from a health care provider to an insurance provider

Copayment

Portion of the cost of each service a patient pays

Day supply

the number of days the prescription filled will last the patient

each nostril

EN

intravenous

IV

IVPB

intravenous piggyback

locally

LOC

UD, UT

as directed

topically

TOP

vaginally

vag

ample

AMP

capsule

cap

Cream

CR

elixir

ELIX

Expect

expectorant

Fluid

FL

Liquid

liq

lotion

LOT

powder

PULV

Solution

SOL

SUPP

suppository

Suspension

SUSP

syrup

SYR

tablet

tab

tincture

TINC

ung

ointment

ad lib

as often as needed

AM

morning

ASAP

as soon as possible

ATC

around the clock

h, hr

hour

night

NOC

NV

nausea and vomiting

PM

evening

q

every

q4h

every 4 hours

qhs

every night at bedtime

STAT

immediately, at once

w/

with

w/o

without

abbreviations to avoid

U (unit) IU (international unit) Q.D., QD, qd (daily) Q.O.D., QOD, qod (every other day) @ trailing zeros on decimals lack of leading zeros or decimals

Dispensing Process (9steps)

• organized process

• prescription process is similar in retail pharmacy and hospital pharmacy

1. Accept Rx and establish pharmacy-pt. relationship

2. Review Rx and patient info

3. Review patient med profile

4. Review cost coverage

5. Retrieve drug/ingredients

6. Prepare the medication

7. Label

8. Check and dispense

9. Counsel patient

Medication Guides (MedGuides)

A patient handout provided for many prescription medications to help avoid serious adverse events

Auxiliary labels

labels regarding specific warnings, foods or medications to avoid, potential side effects, and other cautionary interactions

National Council for Prescription Drug Programs (NCPDP)

Not for profit, multi skate-holder forum for developing and promoting industry standards and business solutions that improve patient safety and health outcomes, while also decreasing costs

e-script prescription

Community pharmacy: -Increasingly popular method used by physicians and other prescribing health professionals in an effort to focus on error prevention -Prescribing individuals can use computers or other approved handheld devices to enter prescription information -The prescription information is sent electronically through a screed system to the patient's preferred pharmacy, where it can be filled

Partial Fill

a supply dispensed to hold the patient until a new supply is received from the wholesaler; this practice is due to an insufficient inventory in the pharmacy, which prevents completely filling the prescription

Refills

Permission by a prescriber to replenish a prescription

Refills: DEA Schedule II

no refills allowed

Refills: Legend Drugs

as many times in 1 year that the prescriber authorizes

Most insurance companies require a prescription to be what % used before they will pay for a refill?

75%

patient profile

An electronic record, stored in the pharmacy computer system, that details the patient's personal and billing information, prescription records, and medical conditions

Drug Utilization Review (DUR)

process of reviewing a patient's profile with prescribed medications to ensure patient safety

AB rating

adequate evidence supporting the bioequivalence of the generic to the brand name medication

What is the 1st step in the dispensing process?

Create or update the patients profile

What is the 2nd step in the dispensing process?

Selecting the correct patient with the system

What is the 3rd step in the dispensing process?

Verify each patient with 2 identifiers, such as middle initial, date of birth, address, or other patient numbers