Winter

INTRODUCTION

• Presentation by: Gretchen K. Garofoli, PharmD, BCACP, CTTS, FAPHA

Learning Objectives

• Describe the process for dispensing a prescription.

• List the necessary components of a prescription for legal consideration.

• Compare and contrast the prescribing authorities of various practitioners.

• Confirm an appropriate Prescriber DEA number.

Prescription Dispensing Process

• Steps Involved:

  • Prescription received by pharmacy.

  • Prescription entered into computer system.

  • Drug interaction check completed.

  • Prescription Drug Monitoring Program checked (specifically for controlled substances).

  • Claim processed through insurance or billed as cash.

  • Prescription filled.

  • Prescription checked by pharmacist.

  • Patient counseled on prescription and payment rendered.

Definition of Prescriptions

• A prescription is an order issued by a licensed prescriber to be dispensed by a pharmacist for a patient outside a hospital or long-term care facility.

• Information on the prescription specifies the drug, strength, dose, and usage instructions for the patient.

Sources of Prescriptions

• Patients or caregivers can submit prescriptions via various methods:

  • Hard copy (paper) at pharmacy.

  • Drive-through.

  • Phone.

  • Electronic formats.

  • Fax.

  • Transfers from another pharmacy.

Legal Components of Prescriptions

• Must include:

  • Prescriber information.

  • Patient information.

  • Date written.

  • Superscription, inscription, subscription, signa, and special instructions.

Detailed Prescription Components

• Necessary Information:

  • Date Written

  • Patient Information:

    • Name.

    • Address.

    • Age/Date of Birth (DOB).

    • Sex.

  • Drug Information:

    • Name/Strength.

    • Quantity.

    • Directions for use.

  • Prescriber Information:

    • Name.

    • Address.

    • License Number or DEA Number for controlled substances.

    • NPI Number.

    • Signature.

  • Diagnosis Codes for Medicare Part B Billing.

West Virginia Law Requirements

• A valid prescription must contain:

  • Patient name and address.

  • Date written.

  • Drug name, strength, and form.

  • Directions for use.

  • Quantity (written out with numerals and words or check boxes for CII prescriptions).

  • of refills authorized (up to 1 year with exceptions).

Additional Requirements for Practitioners

• If written on practitioner’s blank:

  • Practitioner’s printed name.

  • Address of practice.

  • Professional designation.

  • Practitioner ID number (DEA, NPI, State license #).

  • Practitioner SIGNATURE.

• If written on institutional blank:

  • Practitioner’s printed name.

  • Professional designation.

  • DEA # with suffix.

  • Practitioner’s SIGNATURE.

Common Prescription Medication Errors

• Written:

  • Illegible handwriting, wrong symbol/abbreviation use.

• Electronic:

  • Incorrect medication, strength, dosage form, etc.

Abbreviations to Use Cautiously

• Prescribers commonly use abbreviations; awareness is essential due to potential mistakes.

• Refer to list posted on SOLE for problematic abbreviations.

Common Mistakes & Corrections

• Example Mistakes:

  • o.d. or OD: Mistaken as "mg"; use "mcg."

  • AD, AS, AU: Mistaken meanings; use specified terms (right/left ear).

  • D/C: Misread as "discontinued" instead of "discharge"; use "discharge."

• It is essential to spell out terms to prevent misinterpretation.

Specific Avoidances in Prescription Writing

• Do not use:

  • Trailing zeros.

  • Naked decimal points.

  • Abbreviations for units.

Prescriptive Authority Overview

• Various practitioners include:

  • MD (Medical Doctor).

  • DO (Doctor of Osteopathic Medicine).

  • ANP (Advanced Nurse Practitioner).

  • PA-C (Physician Assistant).

  • DDS (Doctor of Dental Surgery).

  • OD (Doctor of Optometry).

  • DPM (Doctor of Podiatric Medicine).

  • DVM (Doctor of Veterinary Medicine).

  • DC (Doctor of Chiropractic).

  • OMD (Oriental Medical Doctor).

  • ND (Doctor of Naturopathic Medicine).

Specific Practitioner Regulations

Medical Doctor (MD)

• Can prescribe both prescription and control medications; regulated by the Board of Medicine.

Doctor of Osteopathic Medicine (DO)

• Similar to MD in prescribing authority and regulated by the Board of Osteopathic Medicine.

Advanced Nurse Practitioner (ANP/CRNP)

• Can prescribe medications after collaboration with a physician for three years; specific limits for controlled substances apply.

Physician Assistant (PA-C)

• Similar authority to the ANP; regulated by the respective boards.

Doctor of Dental Surgery (DDS)

• Can prescribe medications and controlled substances; regulated by the Board of Dentistry.

Doctor of Optometry (OD)

• Can prescribe topical and certain oral medications; limited authority regarding controlled substances.

Doctor of Podiatric Medicine (DPM)

• Prescribing authority regulated similarly to MD and DO.

Doctor of Veterinary Medicine (DVM)

• Can prescribe medications for animals; documentation requirements differ.

Doctor of Chiropractic (DC)

• Generally cannot prescribe medications or controlled substances.

Oriental Medical Doctor (OMD) and Doctor of Naturopathic Medicine (ND)

• Both have no prescriptive authority in West Virginia.

Expedited Partner Therapy

• Prescribing is allowed when a clinical diagnosis of a sexually transmitted disease is made; limited to partners exposed within the previous 60 days.

DEA Number Verification

• Verify using specific criteria regarding letters and digits.

Handling Verbal Orders in West Virginia

• Must be accurately documented with all required elements (e.g., patient’s name, medication, physician details, etc.).

Transferring Prescriptions Between Pharmacies

Responsibilities of Transferring Pharmacist

• Mark original as "VOID" and document transfer details (receiving pharmacy information).

Responsibilities of Receiving Pharmacist

• Document the transfer and original prescription details accurately on the new prescription.

Handling Controlled Substance Prescriptions

• Must have filled at original location; different rules apply for CII versus CIII-CV categories.

Prescription Entry into Computer System

• Performed by technicians or pharmacists; software checks for errors and interactions.

Filling a Prescription

• Staff processes stock, verifies NDC, and labels the prescription container correctly.

Prescription Checking

• Pharmacist checks against the original prescription and verifies patient details.

Importance of Focus During Prescription Checking

• Distractions can increase error rates significantly; ensure a focused environment.

Patient Counseling Responsibilities

• Educate patients on medication use, benefits, side effects, and proper device usage.

Common Community Pharmacy Problems

• Potential issues include incorrect choice of medication, stock discrepancies, prior authorizations, etc.

Conclusion & Questions

• Open the floor for any questions from the audience.